Alopecia of the flankin a female Glen ofImaal Terrier
Author: Cathy Curtis
Editor: David Lloyd
  © European Society of Veterinary Dermatology
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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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
General clinicalexamination wasunremarkable
Clinical signs
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 The flanks showed
Bilateral, well-demarcated areas of alopecia
Intense hyperpigmentation of the underlying skin
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would youapproach this case?
Signs
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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 adefinitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Case investigation - 1
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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
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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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results
Skin scrapings and fungal culture
No ectoparasites or dermatophytes demonstrated
Hair pluckings from the edges of the alopecic areasshowed all hairs to be in telogen
Haematology and biochemistry profiles
Routine haematology and biochemistry profiles wereunremarkable
Urinalysis
Unremarkable
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What now?
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Which differentials can you now eliminate?
Are there any other tests you would carry out orsamples you would collect?
Should you institute therapy at this stage?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Additional procedures
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Skin scapings and fungal culture results suggest thatdermatophytosis and demodicosis are unlikely
Endocrine tests and biopsy examination are nowrequired
No therapy is indicated at this stage
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Additional diagnosticprocedures - 1
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Blood tests to investigate possible endocrinopathy
Total T4 and endogenous TSH levels to assessthyroid function
ACTH stimulation or low dose dexamethasonesuppression test for adrenocortical function
ACTH stimulation test for adrenocortical reproductivehormone function (basal reproductive hormoneassays if the above is unavailable)
Xylazine or clonidine stimulation test for growthhormone status (if available)
Skin biopsy
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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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results of ACTH stimulationtest
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june94_2 copy
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Additional diagnosticprocedures - 2
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Histopathology report (Joan Rest)
There is hyperpigmentation of the non-thickenedepidermis with markedly dilated follicular ostea filledwith keratin
Most follicles seen are in telogen
Sebaceous glands are not atrophic
A few melanophages are present adjacent to thebases of the follicles
No current inflammation or micro-organisms wereobserved
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Additional diagnosticprocedures - 3
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Morphological diagnosis
Atrophic dermatosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you thinkmay need to be done?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
Canine idiopathic flank alopecia
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Prognosis
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In many dogs with idiopathic flank alopecia,  hairloss is temporary and regrowth may occurspontaneously
In some cases, there is a cyclical pattern to thedisease and it may be possible to predict the time ofhair loss and hair regrowth
Affected dogs remain healthy so the prognosis isgood
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Action
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Client education and conservative treatment
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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 referralappointment but again developed flank alopecia atthe same time the following year
Predictably, the hair regrew 5 months later
No treatment has been administered and the dogremains in good general health
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Final diagnosis
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Canine idiopathic cyclic flank alopecia
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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