Transcript Case of the Month

Alopecia of the flank
in a female Glen of
Imaal Terrier
Author: Cathy Curtis
Editor: David Lloyd
© European Society of Veterinary Dermatology
History
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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
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History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs
General clinical
examination was
unremarkable
• The flanks showed
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Bilateral, well-demarcated areas of alopecia
Intense hyperpigmentation of the underlying skin
History | Signs | Differentials | Tests | Therapy | Notes
How would you
approach this case?
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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 | Notes
Case investigation - 1
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Principle differential diagnoses
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Inflammatory causes of alopecia
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Bacterial - Staphylococcal folliculitis
Fungal – Dermatophytosis
Parasitic - Demodex canis
Non- inflammatory causes of alopecia
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Hormonal
Dystrophic or dysplastic
Telogen or anagen effluvium
Cicatricial
History | Signs | Differentials | Tests | Therapy | Notes
Case investigation - 2
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Initial tests
• Skin scrapings, hair plucks and fungal culture
• Haematology and biochemistry profiles
• Urinalysis
History | Signs | Differentials | Tests | Therapy | Notes
Results
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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
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Unremarkable
History | Signs | Differentials | Tests | Therapy | Notes
What now?
• 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 | Notes
Additional procedures
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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 | Notes
Additional diagnostic
procedures - 1
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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)
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Skin biopsy
History | Signs | Differentials | Tests | Therapy | Notes
Results of additional tests
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Thyroid testing
• Endogenous TSH – within normal range
• Total T4 – within normal range
History | Signs | Differentials | Tests | Therapy | Notes
Results of ACTH stimulation
test
History | Signs | Differentials | Tests | Therapy | Notes
Additional diagnostic
procedures - 2
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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 | Notes
Additional diagnostic
procedures - 3
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Morphological diagnosis
• Atrophic dermatosis
History | Signs | Differentials | Tests | Therapy | Notes
What is your
diagnosis?
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Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you think
may need to be done?
History | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
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Canine idiopathic flank alopecia
History | Signs | Differentials | Tests | Therapy | Notes
How would you deal
with this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
History | Signs | Differentials | Tests | Therapy | Notes
Prognosis
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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
History | Signs | Differentials | Tests | Therapy | Notes
Action
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Client education and conservative treatment
History | Signs | Differentials | Tests | Therapy | Notes
Comment
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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
History | Signs | Differentials | Tests | Therapy | Notes
Final diagnosis
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Canine idiopathic cyclic flank alopecia
History | Signs | Differentials | Tests | Therapy | Notes
Review
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History | Signs | Differentials | Tests | Therapy | Notes