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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

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  • 1. Alopecia of the flank in a female Glen of Imaal Terrier Author: Cathy Curtis Editor: David Lloyd © European Society of Veterinary Dermatology
  • 2. History | Signs | Differentials | Tests | Therapy | Notes Click to reveal the text on this screen Click the forward arrow to jump to the next screen History • 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
  • 3. History | Signs | Differentials | Tests | Therapy | Notes General clinical examination was unremarkable Clinical signs Signs • The flanks showed • Bilateral, well-demarcated areas of alopecia • Intense hyperpigmentation of the underlying skin
  • 4. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 5. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 6. History | Signs | Differentials | Tests | Therapy | Notes Case investigation - 2 Tests • Initial tests • Skin scrapings, hair plucks and fungal culture • Haematology and biochemistry profiles • Urinalysis
  • 7. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 8. History | Signs | Differentials | Tests | Therapy | Notes 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?
  • 9. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 10. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 11. History | Signs | Differentials | Tests | Therapy | Notes Results of additional tests Tests • Thyroid testing • Endogenous TSH – within normal range • Total T4 – within normal range
  • 12. History | Signs | Differentials | Tests | Therapy | Notes Results of ACTH stimulation test Tests
  • 13. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 14. History | Signs | Differentials | Tests | Therapy | Notes Additional diagnostic procedures - 3 Tests • Morphological diagnosis • Atrophic dermatosis
  • 15. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 16. History | Signs | Differentials | Tests | Therapy | Notes Diagnosis • Canine idiopathic flank alopecia Tests
  • 17. History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? • What is your prognosis? • How will you advise the owner? • What treatment would you consider? Therapy
  • 18. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 19. History | Signs | Differentials | Tests | Therapy | Notes Action Therapy • Client education and conservative treatment
  • 20. History | Signs | Differentials | Tests | Therapy | Notes 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
  • 21. History | Signs | Differentials | Tests | Therapy | Notes Final diagnosis • Canine idiopathic cyclic flank alopecia Therapy
  • 22. History | Signs | Differentials | Tests | Therapy | Notes Review Notes • If you would like to review this case, please use the navigation buttons below