Seborrhoea and otitisin crossbred dog
Author: Ross Bond
Editor: David Lloyd
  © European Society of Veterinary Dermatology
may94_2
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History - 1
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9-year-old neutered female Collie cross dog
Weight 43 kg
Has had a dull, somewhat greasy coat for 4 yearsor more
Has always been overweight but gaining more inlast 2 years
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 2
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Decreased exercise tolerance attributed by owners toweight gain and arthritis (reluctance to exercise)
Mild, recurrent head tremor noted on severaloccasions in the past year
Chews and licks feet but not a severe problem, hasitchy ears
Dog is bright, appetite good, thirst unchanged (1.8-2.0litres/day)
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 3
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Neomycin + betamethasone drops for otitis - littleimprovement
Etiderm (ethyl lactate shampoo) - resolved pedalpruritus but erythema remained.  Relapse after 6weeks
Prednoleucotropin (PLT), 1-2 twice daily for arthritis.Some improvement
Efavet 660, 1 twice daily.  No effect
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 1
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Bright, alert dog
Heart rate 110 beats per minute
Rectal temperature 38.1oC
Mild generalised seborrhoea
Mild erythema and hyperpigmentation ofinterdigital skin
Moderate ceruminous otitis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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The dog wasoverweight
The coat was long,thick and greasy
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 3
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Anterior and dorsal views of the dog
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would youapproach this case?
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Signs
What are the next steps you would take?
Make a list of your principle differential diagnoses
List any samples you would collect
List any tests you would perform to assist in making adefinitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Case investigation
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Principle differential diagnoses
Ewan - what would you include?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests
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Tests
Skin scrapings from feet ..... Ewan where else?
Tape strips from interdigital spaces ......?
Blood tests
Routine haematology
Biochemistry panel
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results
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Scrapings did not reveal ectoparasites
Tape strips demonstrated substantial numbers ofMalassezia in the interdigital spaces
Haematological and biochemical profiles were withinaccepted limits
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What now?
What treatment, if any, should you now institute?
What are now your principle differential diagnoses?
Are there any other samples you would collect?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Initial therapy
Ectoparasitism was deemed unlikely
Malassezia numbers indicated infection necessitatingtherapy
Owner was instructed to bathe the feet usingMalaseb Shampoo twice weekly. Allowing a 10minute contact time before rinsing.
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
What is your principle diagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you thinkmay need to be done?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Further tests
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Total T4 and endogenous TSH were measured,
Results
Total T4 = 12.7 µmol/l (13-52)
Endogenous TSH = 0.47 µg/ µl (<0.41)
What does this mean?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
Hypothyroidism diagnosis supported by:
Low total T4 and elevated TSH levels
Dog overweight
Poor exercise tolerance
Susceptibility to skin infection
Hypertrichosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
What is your prognosis?
How will you advise the owner?
What treatment would you institute?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Prognosis
Prognosis is good
Hypothyroidism normally responds well to therapywith thyroxine
Hypothyroidism may explain many, if not all of theclinical problems in this case
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Therapy
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Thyroxine administered at 10 ug/kg twice daily for 12weeks then the 4 hour post-T4 basal plasma total T4measured and gave a value of 35 nmol/l
Maintenance therapy was then established at 15ug/kg of thyroxine twice daily
Response.  Loss of all hair apart from a short 2-3 cmcoat, over a 3 month period
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Response to therapy
Coat then grew gradually to form a normal coat
Weight decreased to 32kg over 12 months
Exercise tolerance and mobility improved
Head tremor absent
Coat improved but still some greasiness
Continuing mild otitis externa
No pruritus
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Points to consider - 1
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How do you asses the significance of Malassezia
Tape strips and surface culture methods only identifysuperficial populations.  Some cases withoutelevated surface populations will respond to anti-yeast therapy
Could ketoconazole have been used to deal with theMalassezia?
Signs were mild and did not justify ketoconazole anunlicensed product.
Ketoconazole inhibits steroidogenesis and wouldhave complicated the interpretation of subsequentendocrine assessments
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Points to consider - 2
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Why is hypertrichosis sometimes a feature ofhypothyroidism?
Thought to be caused by slowed hair cycle turnover -telogen hairs not shed and resultant thick coat
It is a common feature of equine hypothyroidism
In dogs it is seen particularly in setters
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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