Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
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 />
Upcoming SlideShare
Loading in …5
×

Sebaceous Adenitis

9,944 views

Published on

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

  • I have a Samoyed with SA. He was diagnosed 6 years ago at the age of 4 years old. Now at 10 1/2 yrs he is still doing fine with supplements daily. He has more trouble in the spring/early summer when it is coat blowing time. He only had issues the first year when he was diagnosed with skin infections, etc. but once I started using emu oil on his skin and coat and in his shampoo (plus the supplements of salmon and flax oil and Vit. E and A) he has been fine. Minor flare ups but easy to treat.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hi Steven,

    It turns out that they (the vet dermatologists - thanks for that, Katie!), were never able to determine conclusively what was wrong with out puppy, skin, blood and many other tests, notwithstanding. The best guess is that there's some sort of keratinizing disorder going on. And while we'll never know exactly what it is that Bella has, it HAS responded to an immune-suppressant therapy with Cyclosporin.

    We tried all sorts of things, including a version of the SA oil baths, high high doses of vitamin A, herbal horse remedies (which actually seemed to work for a while), anti-fungals and anti-biotics. Had our little girl not had such a strong spirit and apparent will to live, I think that we would have given up before we should have. It took a week or two on the cyclosporin (and a cycle of antibiotics to treat a recurrent deep pyoderma) before her mood began to improve, but things moved quickly and positively after that.

    The crusts and pustules and terrible smell that went along with them have completely disappeared. She now eats voraciously. Her hair is growing back well (good thing, with winter and freezing temps here) and she's just a lovely puppy. Her littermate brother is ecstatic - as are we.

    I'm not sure If that is any help at all - other than to say, if you have the time and patience and she doesn't seem to be suffering too badly or in too much pain please don't give up on her until you've tried a few things. And do, if it is within your means take her to a vet dermatologist that is familiar with small dogs. Although the treatment that Katie outlined is a bit of a hassle, and requires maintenance - if it cures your dog, it's worth it. I (clearly) don't view animal life as dispensable when inconvenient.

    Best of luck -
    Colleen
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hi there, our dog recently became ill, I think it was about a year ago, she has rough and oily scaly skin, sparse hair coverage, and her hair is falling out, she also has a very strong odor that will disappear for a few hours after a bath before returning.

    She is a Shih-tzu x Pug female, black and white, and she was 8 when this started, we haven't had her tested for SA yet (though I keep informing my parents she needs it) so I can't say she doesn't have anything else wrong with her, but the standard blood work and visual inspection has resulted in the diagnoses of a staph infection on her skin and a reoccurring yeast infection, the treatments prescribed have had very little benefit for her health or any improvements (the most I can say is that her skin gets less sticky when shampooed) .

    This issue has driven my parents to the ends and they are seriously considering having her put down when we haven't even tried an oil bath (though seriously considering the rampak treatment without my parents consent).

    I would love any feedback you could provide in this case, whether it be on trying to convince my parents that an oil bath isn't the worst thing in the world or any help with a possible diagnosis (I have found only 1 source which claims her breed can have SA so I would love help with that).
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hi Colleen,

    In general, it is very difficult to diagnose any problem without seeing the patient (your poor lab in distress). That being said, I can tell you that sebaceous adenitis is a disease of young to middle aged dogs, however the youngest I found it described in my short research just now was 1 year (www.offa.org).

    There are multiple other more common problems in younger dogs that can present suspiciously similar to sebaceous adenitis, and can be equally difficult in diagnosing - demodex and ringworm to name a few (even negative findings on common in-house diagnostic tests cannot 100% rule out these diseases - so just because the test was negative, doesn't automatically mean your pup doesn't have it, so keep that in mind)

    If you haven't already, I strongly recommend you contact your local veterinarian and have them thoroughly work up the skin. If necessary, you can always find a veterinary dermatology specialist. Although I'm not familiar with your area, your veterinarian should be able to refer to you to the best one!

    Best of luck!
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hi Katie,

    Thanks for this. Could you tell me if this is a condition that has also been found to present in very young (10 week +) old dogs? We have a lab in great distress that we've had difficulty finding a diagnosis for.

    Thanks in advance,
    Colleen
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

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 />

×