Dorsal alopecia in
a male crossbred dog
Author: Ewan Ferguson Editor: David Lloyd
© European Society of Veterinary Dermato...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
• Dorsal alopecia in a male crossbred dog
• Weight 25 kg
• Do...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
• Coat has become longer and finer in texture in
recent month...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Initial therapy - 1
• Ectoparasite control
• Dog and both cat...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Initial therapy - 2
• Pruritus now reported to be controlled ...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
The ventral abdominal skin
Clinical findings
on referral - 1
...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Alopecia & hyperpigmentation in dorsal lumbar region
Clinical...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
How would you
approach this case?
• What are the next steps y...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Case
investigation
• Principle differential diagnoses
• Aller...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Preliminary results
• Skin scrapings, tape strips, hair pluck...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
What now?
• What are the next steps you would take?
• What ar...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Further tests
• Principal differential diagnosis
• Hormonal i...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Results - 1
ACTH response test
0
100
200
300
400
500
Basal 60...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Results - 2
Low dose dexamethasone suppression test
0
50
100
...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Results - 3
High dose dexamethasone suppression test
0
50
100...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Further tests
• Radiography
• Mass suspected in the left adre...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
What is your
diagnosis?
• What is your principle diagnosis?
•...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Diagnosis
• Hyperadrenocorticism resulting from adrenal
neopl...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
How would you deal
with this case?
• What is your prognosis?
...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Prognosis
• Prognosis is guarded
• Surgery is not indicated i...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Conclusion
The owner requested euthanasia. At post-mortem exa...
CLOSE History | Signs | Approach | Tests | Treatment | Notes
Review
• If you would like to review this case, please use
th...
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Dorsal alopecia in a male crossbred dog

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Dorsal alopecia in a male crossbred dog

  1. 1. Dorsal alopecia in a male crossbred dog Author: Ewan Ferguson Editor: David Lloyd © European Society of Veterinary Dermatology
  2. 2. CLOSE History | Signs | Approach | Tests | Treatment | Notes • Dorsal alopecia in a male crossbred dog • Weight 25 kg • Dorsal alopecia and mild pruritus of 9 months duration • Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin “normal” History and presenting clinical signs - 1 History • Dorsal alopecia in a male crossbred dog • Weight 25 kg • Dorsal alopecia and mild pruritus of 9 months duration • Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin “normal” Click to reveal the text on this screen Click the forward arrow to jump to the next screen
  3. 3. CLOSE History | Signs | Approach | Tests | Treatment | Notes • Coat has become longer and finer in texture in recent months • Polyuria and polydipsia (3 litres per day) reported • Good appetite. Poor exercise tolerance • No previous history of dermatological disease • 2 cats in the house, both healthy • Diagnosed by the referring veterinarian as flea allergy dermatitis History and presenting clinical signs - 2 History • Coat has become longer and finer in texture in recent months • Polyuria and polydipsia (3 litres per day) reported • Good appetite. Poor exercise tolerance • No previous history of dermatological disease • 2 cats in the house, both healthy • Diagnosed by the referring veterinarian as flea allergy dermatitis
  4. 4. CLOSE History | Signs | Approach | Tests | Treatment | Notes Initial therapy - 1 • Ectoparasite control • Dog and both cats sprayed fortnightly with dichlorvos + fenitrothion • Home environment treated every 2 to 3 months with permethrin + methoprene spray • No improvement • Ectoparasite control • Dog and both cats sprayed fortnightly with dichlorvos + fenitrothion • Home environment treated every 2 to 3 months with permethrin + methoprene spray • No improvement History
  5. 5. CLOSE History | Signs | Approach | Tests | Treatment | Notes Initial therapy - 2 • Pruritus now reported to be controlled with 10 mg prednisolone orally once daily, over the last 4 months • No hair re-growth seen • All therapy stopped 2 weeks before referral appointment History • Pruritus now reported to be controlled with 10 mg prednisolone orally once daily, over the last 4 months • No hair re-growth seen • All therapy stopped 2 weeks before referral appointment
  6. 6. CLOSE History | Signs | Approach | Tests | Treatment | Notes The ventral abdominal skin Clinical findings on referral - 1 A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum Signs A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum
  7. 7. CLOSE History | Signs | Approach | Tests | Treatment | Notes Alopecia & hyperpigmentation in dorsal lumbar region Clinical findings on referral - 2 • No visual evidence of ectoparasitism • Pendulous abdomen & ventral liver lobes palpably enlarged • Testes normal on palpation Signs • No visual evidence of ectoparasitism • Pendulous abdomen & ventral liver lobes palpably enlarged • Testes normal on palpation
  8. 8. CLOSE History | Signs | Approach | Tests | Treatment | Notes How would you approach this case? • 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 • 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 Approach
  9. 9. CLOSE History | Signs | Approach | Tests | Treatment | Notes Case investigation • Principle differential diagnoses • Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis • Secondary pyoderma, Malassezia dermatitis • Samples • Coat brushings, deep and superficial skin scrapings, tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts • Biochemistry and haematology panels, urinalysis Approach • Principle differential diagnoses • Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis • Secondary pyoderma, Malassezia dermatitis • Samples • Coat brushings, deep and superficial skin scrapings, tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts • Biochemistry and haematology panels, urinalysis
  10. 10. CLOSE History | Signs | Approach | Tests | Treatment | Notes Preliminary results • Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi • Fasted blood sample • Biochemistry: Alkaline phosphatase - 1850 iu/l; Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l • Haematology: Mild mature neutrophilia & eosinopenia • Urianalysis: Specific gravity - 1.005; No glycosuria Tests • Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi • Fasted blood sample • Biochemistry: Alkaline phosphatase - 1850 iu/l; Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l • Haematology: Mild mature neutrophilia & eosinopenia • Urianalysis: Specific gravity - 1.005; No glycosuria
  11. 11. CLOSE History | Signs | Approach | Tests | Treatment | Notes What now? • What are the next steps you would take? • What are now your principle differential diagnoses? • Are there any other samples you would collect? • List any tests you would perform to assist in making a definitive diagnosis Tests • What are the next steps you would take? • What are now your principle differential diagnoses? • Are there any other samples you would collect? • List any tests you would perform to assist in making a definitive diagnosis
  12. 12. CLOSE History | Signs | Approach | Tests | Treatment | Notes Further tests • Principal differential diagnosis • Hormonal imbalance particularly natural and iatrogenic Cushings syndrome • Secondary folliculitis • Tests • ACTH response test to provide evidence of possible Cushings syndrome and to identify iatrogenic disease Tests • Principal differential diagnosis • Hormonal imbalance particularly natural and iatrogenic Cushings syndrome • Secondary folliculitis • Tests • ACTH response test to provide evidence of possible Cushings syndrome and to identify iatrogenic disease
  13. 13. CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 1 ACTH response test 0 100 200 300 400 500 Basal 60 min. Time Cortisol nmol/l What is the significance of this test? Tests What is the significance of this test?
  14. 14. CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 2 Low dose dexamethasone suppression test 0 50 100 150 200 250 Basal 3 hours 8 hours Time Cortisol nmol/l Tests
  15. 15. CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 3 High dose dexamethasone suppression test 0 50 100 150 200 250 300 Basal 3 hour 8 hour Time Cortisol nmol/l What do these tests tell us? Tests What do these tests tell us?
  16. 16. CLOSE History | Signs | Approach | Tests | Treatment | Notes Further tests • Radiography • Mass suspected in the left adrenal region • Ultrasonography • Hypoechoic foci in the liver suggestive of metastases Tests • Radiography • Mass suspected in the left adrenal region • Ultrasonography • Hypoechoic foci in the liver suggestive of metastases
  17. 17. CLOSE History | Signs | Approach | Tests | Treatment | Notes What is your diagnosis? • What is your principle diagnosis? • List any additional problems which you think may need treatment • Are there any other possibilities which should be considered at this stage? • What is your principle diagnosis? • List any additional problems which you think may need treatment • Are there any other possibilities which should be considered at this stage? Tests
  18. 18. CLOSE History | Signs | Approach | Tests | Treatment | Notes Diagnosis • Hyperadrenocorticism resulting from adrenal neoplasia • Likely metastasis Tests • Hyperadrenocorticism resulting from adrenal neoplasia • Likely metastasis
  19. 19. CLOSE History | Signs | Approach | Tests | Treatment | Notes How would you deal with this case? • What is your prognosis? • How will you advise the owner? • What treatment would you consider? Treatment • What is your prognosis? • How will you advise the owner? • What treatment would you consider?
  20. 20. CLOSE History | Signs | Approach | Tests | Treatment | Notes Prognosis • Prognosis is guarded • Surgery is not indicated in view of likely metastasis • Medical management with Lysodren recommended but results not predictable Treatment • Prognosis is guarded • Surgery is not indicated in view of likely metastasis • Medical management with Lysodren recommended but results not predictable
  21. 21. CLOSE History | Signs | Approach | Tests | Treatment | Notes Conclusion The owner requested euthanasia. At post-mortem examination an adrenal neoplasm and multifocal metastases were demonstrated. The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left sde Treatment The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left sde
  22. 22. CLOSE History | Signs | Approach | Tests | Treatment | Notes Review • If you would like to review this case, please use the navigation buttons below • Click the right mouse button to navigate or press “menu” return to the main menu Notes • If you would like to review this case, please use the navigation buttons below • Click the right mouse button to navigate or press “menu” return to the main menu

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