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Alopecia of the flank in a Glen of Imaal Terrier

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Alopecia of the flank in a Glen of Imaal Terrier Alopecia of the flank in a Glen of Imaal Terrier Presentation Transcript

  • Alopecia of the flank in a female Glen of Imaal Terrier Author: Cathy Curtis Editor: David Lloyd © European Society of Veterinary Dermatology
  • History Click to reveal the text on this screen Click the forward arrow to jump to the next screen
    • 3 year old neutered female Glen of Imal Terrier
    • Presented with flank alopecia of 3 months duration
    • There were no signs of pruritus
    • The dog was in good general health
    History
  • Clinical signs General clinical examination was unremarkable Signs
    • The flanks showed
      • Bilateral, well-demarcated areas of alopecia
      • Intense hyperpigmentation of the underlying skin
  • How would you approach this case? 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 a definitive diagnosis
  • Case investigation - 1 Differentials
    • Principle differential diagnoses
      • Inflammatory causes of alopecia
        • Bacterial - Staphylococcal folliculitis
        • Fungal – Dermatophytosis
        • Parasitic - Demodex canis
      • Non- inflammatory causes of alopecia
        • Hormonal
        • Dystrophic or dysplastic
        • Telogen or anagen effluvium
        • Cicatricial
  • Case investigation - 2 Tests
    • Initial tests
      • Skin scrapings, hair plucks and fungal culture
      • Haematology and biochemistry profiles
      • Urinalysis
  • Results
    • Skin scrapings and fungal culture
      • No ectoparasites or dermatophytes demonstrated
      • Hair pluckings from the edges of the alopecic areas showed all hairs to be in telogen
    • Haematology and biochemistry profiles
      • Routine haematology and biochemistry profiles were unremarkable
    • Urinalysis
      • Unremarkable
    Tests
  • What now? Tests
    • Which differentials can you now eliminate?
    • Are there any other tests you would carry out or samples you would collect?
    • Should you institute therapy at this stage?
  • Additional procedures Tests
    • Skin scapings and fungal culture results suggest that dermatophytosis and demodicosis are unlikely
    • Endocrine tests and biopsy examination are now required
    • No therapy is indicated at this stage
  • Additional diagnostic procedures - 1 Tests
    • Blood tests to investigate possible endocrinopathy
      • Total T4 and endogenous TSH levels to assess thyroid function
      • ACTH stimulation or low dose dexamethasone suppression test for adrenocortical function
      • ACTH stimulation test for adrenocortical reproductive hormone function (basal reproductive hormone assays if the above is unavailable)
      • Xylazine or clonidine stimulation test for growth hormone status (if available)
    • Skin biopsy
  • Results of additional tests Tests
    • Thyroid testing
      • Endogenous TSH – within normal range
      • Total T4 – within normal range
  • Results of ACTH stimulation test Tests
  • Additional diagnostic procedures - 2 Tests
    • Histopathology report (Joan Rest)
      • There is hyperpigmentation of the non-thickened epidermis with markedly dilated follicular ostea filled with keratin
      • Most follicles seen are in telogen
      • Sebaceous glands are not atrophic
      • A few melanophages are present adjacent to the bases of the follicles
      • No current inflammation or micro-organisms were observed
  • Additional diagnostic procedures - 3 Tests
    • Morphological diagnosis
      • Atrophic dermatosis
  • What is your diagnosis?
    • Do the investigations permit a definitive diagnosis?
    • Are there any additional investigations which you think may need to be done?
    Tests
  • Diagnosis
    • Canine idiopathic flank alopecia
    Tests
  • How would you deal with this case?
    • What is your prognosis?
    • How will you advise the owner?
    • What treatment would you consider?
    Therapy
  • Prognosis
    • In many dogs with idiopathic flank alopecia, hair loss is temporary and regrowth may occur spontaneously
    • In some cases, there is a cyclical pattern to the disease and it may be possible to predict the time of hair loss and hair regrowth
    • Affected dogs remain healthy so the prognosis is good
    Therapy
  • Action Therapy
    • Client education and conservative treatment
  • Comment
    • The dog was followed for the next 18 months
    • She regrew her hair 2 months after the referral appointment but again developed flank alopecia at the same time the following year
    • Predictably, the hair regrew 5 months later
    • No treatment has been administered and the dog remains in good general health
    Therapy
  • Final diagnosis
    • Canine idiopathic cyclic flank alopecia
    Therapy
  • Review Notes
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