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

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Presentation on theme: "Dorsal alopecia in a male crossbred dog Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology."— Presentation transcript:

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

2 CLOSE History | Signs | Approach | Tests | Treatment | Notes Dorsal alopecia in a male crossbred dog Weight 25 kg Dorsal alopecia and mild pruritus of 9 months duration Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin normal History and presenting clinical signs - 1 History Dorsal alopecia in a male crossbred dog Weight 25 kg Dorsal alopecia and mild pruritus of 9 months duration Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin normal Click to reveal the text on this screen Click the forward arrow to jump to the next screen

3 CLOSE History | Signs | Approach | Tests | Treatment | Notes 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 and presenting clinical signs - 2 History 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

4 CLOSE History | Signs | Approach | Tests | Treatment | Notes Initial therapy - 1 Ectoparasite control Dog and both cats sprayed fortnightly with dichlorvos + fenitrothion Home environment treated every 2 to 3 months with permethrin + methoprene spray No improvement Ectoparasite control Dog and both cats sprayed fortnightly with dichlorvos + fenitrothion Home environment treated every 2 to 3 months with permethrin + methoprene spray No improvement History

5 CLOSE History | Signs | Approach | Tests | Treatment | Notes Initial therapy - 2 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 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

6 CLOSE History | Signs | Approach | Tests | Treatment | Notes The ventral abdominal skin Clinical findings on referral - 1 A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum Signs A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum

7 CLOSE History | Signs | Approach | Tests | Treatment | Notes Alopecia & hyperpigmentation in dorsal lumbar region Clinical findings on referral - 2 No visual evidence of ectoparasitism Pendulous abdomen & ventral liver lobes palpably enlarged Testes normal on palpation Signs No visual evidence of ectoparasitism Pendulous abdomen & ventral liver lobes palpably enlarged Testes normal on palpation

8 CLOSE History | Signs | Approach | Tests | Treatment | Notes 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 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 Approach

9 CLOSE History | Signs | Approach | Tests | Treatment | Notes Case investigation Principle differential diagnoses Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis Secondary pyoderma, Malassezia dermatitis Samples Coat brushings, deep and superficial skin scrapings, tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts Biochemistry and haematology panels, urinalysis Approach Principle differential diagnoses Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis Secondary pyoderma, Malassezia dermatitis Samples Coat brushings, deep and superficial skin scrapings, tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts Biochemistry and haematology panels, urinalysis

10 CLOSE History | Signs | Approach | Tests | Treatment | Notes Preliminary results Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi Fasted blood sample Biochemistry: Alkaline phosphatase - 1850 iu/l; Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l Haematology: Mild mature neutrophilia & eosinopenia Urianalysis: Specific gravity - 1.005; No glycosuria Tests Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi Fasted blood sample Biochemistry: Alkaline phosphatase - 1850 iu/l; Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l Haematology: Mild mature neutrophilia & eosinopenia Urianalysis: Specific gravity - 1.005; No glycosuria

11 CLOSE History | Signs | Approach | Tests | Treatment | Notes 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 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

12 CLOSE History | Signs | Approach | Tests | Treatment | Notes Further tests Principal differential diagnosis 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 Principal differential diagnosis 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

13 CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 1 What is the significance of this test? Tests What is the significance of this test?

14 CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 2 Tests

15 CLOSE History | Signs | Approach | Tests | Treatment | Notes Results - 3 What do these tests tell us? Tests What do these tests tell us?

16 CLOSE History | Signs | Approach | Tests | Treatment | Notes Further tests Radiography Mass suspected in the left adrenal region Ultrasonography Hypoechoic foci in the liver suggestive of metastases Tests Radiography Mass suspected in the left adrenal region Ultrasonography Hypoechoic foci in the liver suggestive of metastases

17 CLOSE History | Signs | Approach | Tests | Treatment | Notes What is your diagnosis? What is your principle diagnosis? List any additional problems which you think may need treatment Are there any other possibilities which should be considered at this stage? What is your principle diagnosis? List any additional problems which you think may need treatment Are there any other possibilities which should be considered at this stage? Tests

18 CLOSE History | Signs | Approach | Tests | Treatment | Notes Diagnosis Hyperadrenocorticism resulting from adrenal neoplasia Likely metastasis Tests Hyperadrenocorticism resulting from adrenal neoplasia Likely metastasis

19 CLOSE History | Signs | Approach | Tests | Treatment | Notes How would you deal with this case? What is your prognosis? How will you advise the owner? What treatment would you consider? Treatment What is your prognosis? How will you advise the owner? What treatment would you consider?

20 CLOSE History | Signs | Approach | Tests | Treatment | Notes Prognosis Prognosis is guarded Surgery is not indicated in view of likely metastasis Medical management with Lysodren recommended but results not predictable Treatment Prognosis is guarded Surgery is not indicated in view of likely metastasis Medical management with Lysodren recommended but results not predictable

21 CLOSE History | Signs | Approach | Tests | Treatment | Notes 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 sde Treatment The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left sde

22 CLOSE History | Signs | Approach | Tests | Treatment | Notes Review If you would like to review this case, please use the navigation buttons below Click the right mouse button to navigate or press menu return to the main menu Notes If you would like to review this case, please use the navigation buttons below Click the right mouse button to navigate or press menu return to the main menu


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