1. Dorsal alopecia in a male crossbred dog
Author: Ewan Ferguson
Editor: David Lloyd
© European Society of Veterinary Dermatology

2. History - 1
Dorsal alopecia and mild pruritus of 9 months duration in a male crossbred dog
Weight 25 kg
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History

3. History - 2 Mild papular rash on dorsum and ventrum.
Comedones on dorsum and ventrum.
Ventral coat thin but skin “normal”
History

4. History - 3
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

5. History - 4 Ectoparasite control
Dog and both cats treated with fipronil (Frontline Spot-On, Merial) monthly
Home environment treated annually with pyroxyfen and permethrin spray (Indorex, Virbac)
No improvement
History

6. History - 5
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

7. Clinical signs - 1 The ventral abdominal skin
A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum
Signs

8. Clinical signs - 2
Alopecia & hyperpigmentation in dorsal lumbar region
No visual evidence of ectoparasitism
Pendulous abdomen & ventral liver lobes palpably enlarged
Testes normal on palpation
Signs

9. 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
Signs

10. Differential diagnoses
Principle differential diagnoses
Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis
Secondary pyoderma, Malassezia dermatitis
Differentials

11. Tests - 1
Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi
Fasted blood sample
Biochemistry: Alkaline phosphatase iu/l; Alanine aminotransferase iu/l; Glucose mmol/l; Cholesterol mmol/l
Haematology: Mild mature neutrophilia & eosinopenia
Urianalysis: Specific gravity ; No glycosuria
Tests

12. 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

13. Tests - 2 Principal differential diagnosis Tests
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

14. Results - 1
What is the significance of this test?
Tests

15. Results - 2
Tests

16. Results - 3
What do these tests tell us?
Tests

17. What is your diagnosis?
Do the investigations permit a definitive diagnosis?
List any additional investigations which you think may need to be done
Tests

18. Tests - 3 Radiography Ultrasonography
Mass suspected in the left adrenal region
Ultrasonography
Hypoechoic foci in the liver suggestive of metastases
Tests

19. How would you deal with this case?
What is your prognosis?
How will you advise the owner?
What treatment would you consider?
Therapy

20. Diagnosis Hyperadrenocorticism resulting from adrenal neoplasia
Likely metastasis
Therapy

21. Prognosis Prognosis is guarded
Surgery is not indicated in view of likely metastasis
Medical management with trilstane (Vetoryl, Arnolds) recommended
Notes

22. 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 side
Notes

23. Review
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Notes