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Sebaceous Adenitis<br />Katie Krimetz Turner<br />Western University, College of Veterinary Medicine<br />4th Year Dermato...
Presenting Problem…<br />The owner of a dog with scaly and greasy hair coat has been using a pet shop shampoo over the pas...
Sebaceous Adenitis<br />Inflammation of the sebaceous glands<br />Simple/branched alveolar glands<br />Normally: produce o...
(ORS)<br />Image Ref: Caceci<br />
Sebaceous Adenitis<br />Uncommon in dogs<br />Rare in cats, rabbits, and humans<br />Autosomal recessive inheritance propo...
Pathogenesis<br />Hypotheses: (2,6)<br />Heritable and developmental inflammatory destruction of sebaceous gland<br />Cell...
Clinical Signs<br />Cessation of flow due to inflammation and atrophy<br />Scaling<br />Follicular plugging, casts, <br />...
Clinical Signs<br />Poodles<br />Hyperkeratosis then alopecia, dull, brittle hair (w/ casts)<br />Akitas<br />Generalized,...
Clinical Signs<br />Image Ref: Noli<br />
Examination/Diagnostic Findings<br />Skin scrape and culture – negative<br />Hair casts are prominent<br />Yellow-brown ke...
Diagnosis<br />Differentials:<br />Primary seborrhea<br />Ichthyosis<br />Vitamin A and Zinc responsive dermatosis<br />De...
Definitive Diagnosis<br />Biopsy<br />Site selection<br />Ensure sample from subtle <br />	early lesions with scale <br />...
Histopathology<br />Mild/Early  perifollicular inflammatory cells at level of isthmus of hair follicle (3) directed at se...
Histopathology<br />Complete lack of sebaceous glands<br />Nodular mononuclear cell infiltrate at usual site of sebaceous ...
Treatment<br />May see cyclic patterns of spontaneous improvement and worsening, independent of therapy (6)<br />2 Goals :...
Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function <br />Remove casts,...
Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function <br />Topical emoll...
Images’ Ref: Rampak<br />Bushi’s Topical Treatment…<br />Bushi’s Story<br />4 year old Akita<br />Germany<br />Inflammatio...
Image Ref: Rampak<br />Bushi’s Topical Treatment…<br />5 months of topical treatment total<br />Improvement noted in 4-6 w...
Other Treatment OptionsGoal #2: Arrest ongoing inflammation and destruction of glands<br />Initial course of antiinflammat...
Ideal Outcome(with systemic therapy)<br />Before and After 3 months of oral cyclosporin (5mg/kg q24hr)<br />Able to taper ...
References<br />Angus, John C.  “How I Treat Sebaceous Adenitis.”  81st Western Veterinary Conference, 2009.<br />Gross, T...
Image References<br />ABC Online Pharmacy. http://www.abconlinepharmacy.com/ns/customer/home.php?cat=70  Accessed: 3/24/10...
Questions and Discussion…<br />Thank you!<br />-Katie Krimetz<br />
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Sebaceous Adenitis

March, 2010 - An assigned presentation topic for my dermatology rotation; reviews sebaceous adenitis, focusing on topical therapy

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Sebaceous Adenitis

  1. 1. Sebaceous Adenitis<br />Katie Krimetz Turner<br />Western University, College of Veterinary Medicine<br />4th Year Dermatology Rotation<br />Animal Dermatology Clinic, San Diego<br />3/26/10<br />
  2. 2. Presenting Problem…<br />The owner of a dog with scaly and greasy hair coat has been using a pet shop shampoo over the past 6 months. The dog has been diagnosed with sebaceous adenitis by another veterinarian. <br />Outline a more <br />appropriate<br />management plan<br />for topical therapy <br />in this dog.<br />Image Ref: Green<br />
  3. 3. Sebaceous Adenitis<br />Inflammation of the sebaceous glands<br />Simple/branched alveolar glands<br />Normally: produce oily secretion<br />Retain moisture and maintain hydration of skin<br />Acts as physical barrier (7)<br />Sebum enters hair follicle  contaminated with lipase-producing bacteria  free fatty acids (7)<br />
  4. 4. (ORS)<br />Image Ref: Caceci<br />
  5. 5. Sebaceous Adenitis<br />Uncommon in dogs<br />Rare in cats, rabbits, and humans<br />Autosomal recessive inheritance proposed for the Standard Poodle and Akita (2,6,7)<br />Orthopedic Foundation of America Registry<br />Unknown etiology<br />
  6. 6. Pathogenesis<br />Hypotheses: (2,6)<br />Heritable and developmental inflammatory destruction of sebaceous gland<br />Cell-mediated immunologic destruction<br />Cornification abnormality  sebaceous duct and gland inflammation and atrophy<br />Anatomic defect in sebaceous gland  leakage and foreign body response (2)<br />Defect in lipid metabolism  cornification abnormality and sebaceous gland destruction<br />
  7. 7. Clinical Signs<br />Cessation of flow due to inflammation and atrophy<br />Scaling<br />Follicular plugging, casts, <br /> fronds from dilated hair follicles<br />Diminishing coat quality<br />Dull, dry, brittle broken hairs<br />Bilaterally symmetrical distribution<br />Dorsal trunk, temporal region, face, pinnae, rat tail<br />Usually nonpruritic unless 2° infection present<br />Image Ref: Rhodes<br />
  8. 8. Clinical Signs<br />Poodles<br />Hyperkeratosis then alopecia, dull, brittle hair (w/ casts)<br />Akitas<br />Generalized, erythematous and greasy skin<br />Springer Spaniels (8)<br />Alopecia, seborrhea, pyoderma<br />More severe than poodles<br />Vizsla and short-coated breeds<br />Focal coalescing, firm, nodular lesions<br />Annular plaques with alopecia and fine, non-adherent scale (3,7)<br />Cats<br />Multifocal annular areas of alopecia with scaling, crusting, and follicular casting, dark rims of black scales along margins of eyelids (7)<br />Image Ref: Brooks<br />
  9. 9. Clinical Signs<br />Image Ref: Noli<br />
  10. 10. Examination/Diagnostic Findings<br />Skin scrape and culture – negative<br />Hair casts are prominent<br />Yellow-brown keratosebaceous material<br />Trichogram<br />Broken hair shafts (3) <br />Follicular casts (4)<br />Images’ Ref: Boord<br />
  11. 11. Diagnosis<br />Differentials:<br />Primary seborrhea<br />Ichthyosis<br />Vitamin A and Zinc responsive dermatosis<br />Demodecosis<br />Cutaneous leishmaniasis<br />Exfoliative cutaneous lupus erythematosus<br />Dermatophytosis<br />Endocrinopathy<br />Pemphigus foliaceus<br />Nodular forms – deep bacterial folliculitis and furunculosis<br />
  12. 12. Definitive Diagnosis<br />Biopsy<br />Site selection<br />Ensure sample from subtle <br /> early lesions with scale <br /> without alopecia (2)<br />However representing different stages and appearances will be helpful, too. (1)<br />Best to find active sebaceous gland inflammation<br />Chronic, alopecic sites usually show absent glands<br />Multiple sites<br />Confirms widespread inflammation and/or loss of glands<br />Image Ref: Boord<br />
  13. 13. Histopathology<br />Mild/Early  perifollicular inflammatory cells at level of isthmus of hair follicle (3) directed at sebaceous gland<br />Moderate/Chronic  severe hyperkeratosis, follicular plugging, nodular, granulomatouspyogranulomatous inflammation around sebaceous gland (2,3)<br />Short coats – large granulomatous lesions (6)<br />Keratin ensheathed hair follicles<br />Diffuse absence of sebaceous glands is the most common feature of chronic sebaceous adenitis (2,3)<br />
  14. 14. Histopathology<br />Complete lack of sebaceous glands<br />Nodular mononuclear cell infiltrate at usual site of sebaceous glands<br />Image Ref: Noli<br />Haematoxylin and eosin, 10×<br />
  15. 15. Treatment<br />May see cyclic patterns of spontaneous improvement and worsening, independent of therapy (6)<br />2 Goals : (1)<br />Restore normal function of skin<br />Neutralize consequences of sebaceous gland destruction and loss of function<br />Slow/stop ongoing inflammation and destruction<br />
  16. 16. Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function <br />Remove casts, scale, and open plugged follicles<br />Antiseborrheic shampoo therapy 3-4x/wk<br />Phytosphingosine, sulfer, salicyclic acid, benzoyl peroxide, SebaLyt/SeboRx, DermaSeb, Sulf OxyDex (5)<br />Clip long coats<br />Soft brushing to loosen scales and dead hair<br />Antiseptic topical shampoo<br />Chlorhexidine or benzoyl peroxide<br />
  17. 17. Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function <br />Topical emollients and humectants are critical<br />Propylene glycol, glycerin, colloidal oatmeal, urea, lactic acid<br />Apply AFTER antiseborrheic shampoo<br />Restoring and normalize keratinocyte turnover (5)<br />Suggestions:<br />50:50 bath oil and warm water directly to skin<br />Allow 2 hours contact time<br />Remove oil with 3-7 baths<br />Apply a final humectant rinse<br />Repeat every 7 days for 4-6 weeks<br />Between baths: spray-on emollients/humectants<br />50:50 propylene glycol and water<br />0.2% phytosphingosine spray (Duoxo Seborrhea Microemulsion Spray)<br />1% phytosphingosine pipette (Duoxo Seborrhea Spot-on)<br />
  18. 18. Images’ Ref: Rampak<br />Bushi’s Topical Treatment…<br />Bushi’s Story<br />4 year old Akita<br />Germany<br />Inflammation tx w/ calendumed ointment<br />Flea comb to remove crusts<br />Repeat ointment until crusts came off<br />Applied HettralJohanniskraut Oil (2 hr soak)<br />Bathe with Editerm, repeat<br />Condition with Humilac<br />Repeat every 10-14 days<br />
  19. 19. Image Ref: Rampak<br />Bushi’s Topical Treatment…<br />5 months of topical treatment total<br />Improvement noted in 4-6 weeks<br />Continued baths every 14 days<br />Maintained on oil treatments every 3-4 weeks<br />
  20. 20. Other Treatment OptionsGoal #2: Arrest ongoing inflammation and destruction of glands<br />Initial course of antiinflammatory then tapered to lowest effective dose – likely need for life<br />Rarely see spontaneous and/or complete remission (3,6)<br />Atopica is systemic treatment of choice (1)<br />May help with sebaceous gland regeneration (3)<br />Tetracycline and Niacinamide also possible (1)<br />Corticosteroids only if pruritic (1)<br />May respond to oral omega-6 and omega-3<br />Antiinflammatory action of omega-3 may be beneficial<br />Vit A and synthetic retinoids helpful in severe or refractory cases (1,6)<br />“Effective” = >50% reduction in scaling and alopecia (6)<br />Require 4-8 weeks therapy, usually for life<br />Helps with keratinocyte differentiation (3)<br />Image Ref: ABC<br />
  21. 21. Ideal Outcome(with systemic therapy)<br />Before and After 3 months of oral cyclosporin (5mg/kg q24hr)<br />Able to taper to EOD only<br />Images’ Ref: Noli<br />
  22. 22. References<br />Angus, John C. “How I Treat Sebaceous Adenitis.” 81st Western Veterinary Conference, 2009.<br />Gross, Thelma Lee, et al. Skin Diseases of the Dog and Cat Clinical and Histopathologic Diagnosis, 2nd edition. Oxford: Blackwell Science Ltd, 2005.<br />Linek, Monika, et al. “Effects of Cyclosporin A on clinical and histologic abnormalities in dogs with sebaceous adenitis.” JAVMA, Vol 226, No. 1, January 1, 2005.<br />Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.<br />Rosenkrantz, Wayne. “Practical Applications of Topical Therapy for Allergic, Infectious, and Seborrheic Disorders.” Western Veterinary Student Notebook. Circa >2005.<br />Scott, Danny, et al. Muller and Kirk’s Small Animal Dermatology, 6th edition. Philadelphia: W.B. Saunders Company, 2001.<br />Sousa, Candace A. “Sebaceous Adenitis,” Veterinary Clinics Small Animal Practice, Vol 36, 2006, Pg. 243-249.<br />Tevell, Elisabeth H., et al. “Sebaceous adenitis in Swedish Dogs, a retrospective study of 104 cases.” ActaVeterinariaScandinavica, Vol 50, No. 11, May 25, 2008.<br />
  23. 23. Image References<br />ABC Online Pharmacy. http://www.abconlinepharmacy.com/ns/customer/home.php?cat=70 Accessed: 3/24/10. <br />Boord, Mona. Animal Dermatology Clinic, San Diego. Private Photograph Collection. Accessed: 3/25/10.<br />Brooks, Wendy; and Moore, Wendy. Mar Vista Animal Medical Center. http://www.marvistavet.com/html/body_sebaceous_adenitis.html Accessed: 3/24/10.<br />Caceci, Thomas. “Integument System II: Hair” Virginia-Maryland Regional College of Veterinary Medicine Veterinary Histology Course, VM8054 Exercise 15. August, 2008. http://education.vetmed.vt.edu/Curriculum/VM8054/VM8054HP.htm<br />Green, Linda. “Sebaceous Adenitis - Decisions, Responsibilities & Realities.” http://www.astrolyka.com/illness.html Accessed: 3/24/10.<br />Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.<br />Rampak, Michael. “Report about the successful treatment of Sebaceous Adenitisthrough self-invented therapy.” 2000. http://www.akita-friends.com/special/satreat.htm Accessed: 3/24/10.<br />Rhodes, Karen H. The 5-Minute Veterinary Consult, Clinical Companion: Small Animal Dermatology. https://www.vetconnect.com.au/5min/toc/img1055.htm Accessed: 3/24/10.<br />
  24. 24. Questions and Discussion…<br />Thank you!<br />-Katie Krimetz<br />

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