alopecia of the flank in a female glen of imaal terrier author: cathy curtiseditor: david lloyd ©...

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


General clinicalexamination was unremarkable

Clinical signs

SignsSigns

• The flanks showed

• Bilateral, well-demarcated areas of alopecia

• Intense hyperpigmentation of the underlying skin


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


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


Case investigation - 2

TestsTests

• Initial tests• Skin scrapings, hair plucks and fungal culture• Haematology and biochemistry profiles• Urinalysis


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


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?


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


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


Results of additional tests

TestsTests

• Thyroid testing • Endogenous TSH – within normal range• Total T4 – within normal range


Results of ACTH stimulation test

TestsTests



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



TestsTests

• Morphological diagnosis• Atrophic dermatosis


What is yourdiagnosis?

• Do the investigations permit a definitive diagnosis?

• Are there any additional investigations which you think may need to be done?

TestsTests


Diagnosis

• Canine idiopathic flank alopecia

TestsTests


How would you deal with this case?

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?

TherapyTherapy


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


Action

TherapyTherapy

• Client education and conservative treatment


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


Final diagnosis

• Canine idiopathic cyclic flank alopecia

TherapyTherapy


Review

NotesNotes

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alopecia of the flank in a female glen of imaal terrier author: cathy curtiseditor: david lloyd ©...

Documents

tests blood tests

good therapy

unlikely endocrine tests

signs of pruritus

screen history

stage slide

unremarkable clinical

underlying skin slide