alopecia of the flank in a female glen of imaal terrier author: cathy curtiseditor: david lloyd ©...
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Alopecia of the flankin a female Glen of Imaal Terrier
Author: Cathy CurtisAuthor: Cathy Curtis Editor: David LloydEditor: David Lloyd
© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
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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
HistoryHistory
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
General clinicalexamination was unremarkable
Clinical signs
SignsSigns
• The flanks showed
• Bilateral, well-demarcated areas of alopecia
• Intense hyperpigmentation of the underlying skin
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
How would youapproach this case?
SignsSigns
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Case investigation - 1
DifferentialsDifferentials
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Case investigation - 2
TestsTests
• Initial tests• Skin scrapings, hair plucks and fungal culture• Haematology and biochemistry profiles• Urinalysis
History | Signs | Differentials | Tests | Therapy | NotesHistory | 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
TestsTests
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What now?
TestsTests
• 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?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Additional procedures
TestsTests
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Additional diagnostic procedures - 1
TestsTests
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results of additional tests
TestsTests
• Thyroid testing • Endogenous TSH – within normal range• Total T4 – within normal range
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results of ACTH stimulation test
TestsTests
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Additional diagnostic procedures - 2
TestsTests
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Additional diagnostic procedures - 3
TestsTests
• Morphological diagnosis• Atrophic dermatosis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What is yourdiagnosis?
• Do the investigations permit a definitive diagnosis?
• Are there any additional investigations which you think may need to be done?
TestsTests
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
• Canine idiopathic flank alopecia
TestsTests
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How would you deal with this case?
• What is your prognosis?
• How will you advise the owner?
• What treatment would you consider?
TherapyTherapy
History | Signs | Differentials | Tests | Therapy | NotesHistory | 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
TherapyTherapy
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Action
TherapyTherapy
• Client education and conservative treatment
History | Signs | Differentials | Tests | Therapy | NotesHistory | 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
TherapyTherapy
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Final diagnosis
• Canine idiopathic cyclic flank alopecia
TherapyTherapy