Hypothyroidism and cutaneous allergy

Re: Hypothyroidism and cutaneous allergy

Luca Poddighe — Thu, 18 Jun 2015 17:09:49 GMT

Not always but they can be. Here's a picture I've taken looking on google. I have no copyrights on it, so if Arlo prefers to remove the post it is fine.

https://veterinariodomiciliare.files.wordpress.com/2013/02/leish-orecchie-firma.jpg

Just to be clear I wasn't insinuating that there's much in common with the two diseases, and I believe it's very hard to mis-diagnose the two. In both case you have other signs that are supportive to complete the diagnosis.

Re: Hypothyroidism and cutaneous allergy

Simon Tai — Thu, 18 Jun 2015 16:13:47 GMT

Well done Mark! It gets my goat when Pruritus is spelt Pruritis

I'd also look for a pinnal- scratch reflex- pathognomonic in approx 90% dogs with sarcoptes. As for other causes of scaley, pruritic, pinnal tip disease in dogs- I've seen loads of atopic cases with these signs

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 18 Jun 2015 16:01:37 GMT

https://www.google.co.uk/search?q=cutaneous+leishmaniasis&espv=2&biw=1680&bih=925&source=lnms&tbm=isch&sa=X&ei=JdyCVfWNI-SX7QaS-4LYDA&ved=0CAYQ_AUoAQ#tbm=isch&q=cutaneous+leishmaniasis+dogs

Sites I looked at all cite "non-pruritic" lesions on the ears and they seem to be more wide spread from the images above; I've never seen it and i reckon I could have missed it , given some of the images from Google.

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 18 Jun 2015 15:00:39 GMT

[quote user="robloxley"]atopy[/quote]

What, only on the ear tips and no where else at all?

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 18 Jun 2015 14:57:41 GMT

[quote user="Luca Poddighe"]Leish produce erosions on the tip of the pinna. I agree that's not common here but never say never.[/quote]

Are they really itchy [which I should have added in my early sweeping statement].

What do Leish lesions on the tip of the pinna look like? Got a picture?

I suppose we used to rely on the early response to topical treatment with Eurax and look for something else if there was none.

Re: Hypothyroidism and cutaneous allergy

Luca Poddighe — Thu, 18 Jun 2015 11:16:28 GMT

[quote user="Anthony Todd"]

Never ever seen any form of dermatitis on the edges of pinnae that didn't respond to scabies treatment. Can anyone give me an example [not trauma or food residue (bassetts!)] of a lesion on the edge of an ear pinna that wasn't scabies?

[/quote]

Leish produce erosions on the tip of the pinna. I agree that's not common here but never say never.

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 11 Jun 2015 17:44:34 GMT

[quote user="robloxley"]Add atopy and primary malassezia seborrhoea as 2 I've seen[/quote]

Only round the ear tips and really itchy? Fair enough then.

Re: Hypothyroidism and cutaneous allergy

Rob Loxley — Thu, 11 Jun 2015 17:26:23 GMT

[quote user="Anthony Dennison"]

[quote user="Anthony Todd"]Never ever seen any form of dermatitis on the edges of pinnae that didn't respond to scabies treatment. Can anyone give me an example [not trauma or food residue (bassetts!)] of a lesion on the edge of an ear pinna that wasn't scabies?[/quote]

I've seen scabby ear tips on dogs that have been biopsied and turned out to be vasculitis - vessels get blocked and skin goes necrotic and scabby.

[/quote]

Add atopy and primary malassezia seborrhoea as 2 I've seen

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 11 Jun 2015 16:31:34 GMT

[quote user="Anthony Dennison"]In your post you never said anything about the lesion being pruritic...[/quote]

Sorry, confused again [me] scabies is really itchy but difficult to demonstrate with a scrape. someone said you had to do 5, or was it 10? before you found a mite. the total reverse of demodex [unless you scrape without drawing blood].

The clincher of the owner's inner arm lesions is the clincher though.

Re: Hypothyroidism and cutaneous allergy

Mark Hedberg — Thu, 11 Jun 2015 15:37:34 GMT

I'd definitely agree with skin scrape; the pruritus could very well be due to mange!

Re: Hypothyroidism and cutaneous allergy

Anthony Dennison — Thu, 11 Jun 2015 15:25:24 GMT

[quote user="Anthony Todd"]

[quote user="Anthony Dennison"]vasculitis[/quote]

Fair enough but are they really itchy, never recognised that myself [well, he wouldn't would he...]

Love a picture!

[/quote]

In your post you never said anything about the lesion being pruritic...

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 11 Jun 2015 15:06:36 GMT

[quote user="Anthony Dennison"]vasculitis[/quote]

Fair enough but are they really itchy, never recognised that myself [well, he wouldn't would he...]

Love a picture!

Re: Hypothyroidism and cutaneous allergy

Robin Grimmer — Thu, 11 Jun 2015 14:11:55 GMT

[quote user="Martin Atkinson"]

[quote user="Thomas Johnson"]It works very well for sarcoptes, I'm not convinced it does a lot for demodex whatever the manufacturers say.[/quote] Advocate is the endectocide of choice in my practice but Stronghold should also work against sarcoptes and either is often dispensed where there is any doubt as a belt and braces policy.

There is a general consensus on here that moxidectin is ineffective against demodex and we would be reaching for the milbemycin or Aludex. That said I would expect it to be effective in those Staffies that have a few bald spots +ve on scrapes for Demodex but then it may just seem to work because they tend to be self-limiting anyway!

[/quote]

oral ivermectin is very effective against Demodex and is much cheaper than Milbemax. It is of course unlicensed in dogs.

Re: Hypothyroidism and cutaneous allergy

Anthony Dennison — Thu, 11 Jun 2015 11:23:08 GMT

I've seen scabby ear tips on dogs that have been biopsied and turned out to be vasculitis - vessels get blocked and skin goes necrotic and scabby.

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Thu, 11 Jun 2015 11:17:25 GMT

[quote user="Niall Taylor"]How do you know all these itchy pinna cases are scabies if your skin scrapes are so often negative? It could just as easily be a self limiting dermatitis or something else that also happens to respond to your treatment of choice.[/quote]

Mind you usually there are other lesions elsewhere of scabies at the same time and owners can have pin -prick lesions on the inside of forearms or upper chest concurrently which clinches it.

As I said Crotamiton [Eurax] works brilliantly on people and dogs and is diagnostic too. [also for pubic lice if anyone needs to know]

Re: Hypothyroidism and cutaneous allergy

Martin Atkinson — Thu, 11 Jun 2015 10:58:13 GMT

Re: Hypothyroidism and cutaneous allergy

Thomas Johnson — Thu, 11 Jun 2015 08:36:54 GMT

[quote user="Anthony Todd"]

Does Advocate kill mites?

[/quote]

It works very well for sarcoptes, I'm not convinced it does a lot for demodex whatever the manufacturers say.

Re: Hypothyroidism and cutaneous allergy

Niall Taylor — Wed, 10 Jun 2015 22:47:26 GMT

[quote user="Anthony Todd"]

Got to be scabies...

Scrapes with scabies so often negative,and the client gives you that "wrong again" look...[/quote]

How do you know all these itchy pinna cases are scabies if your skin scrapes are so often negative? It could just as easily be a self limiting dermatitis or something else that also happens to respond to your treatment of choice.

Niall

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Wed, 10 Jun 2015 20:28:51 GMT

[quote user="Bob Russell"]I have given up diagnosing skin conditions on appearance. [/quote]

Don't give up; do your tests, if you want, as well, but derm. is largely a visual skill,

Most classical derm presentations can be diagnosed, [and confirmed later if you need,] when they walk through the door.

Something round the eyes of a young staffy: demodex until disproved. Bald rump on a cat; flea allergy until disproved. Ear tip scaly and itchy, scabies for sure.

My hypothyroid dogs never seemed to get secondary infections"schnauzer bumps" was the classic presentation,just shiny black skin along the dorsum with comedomes at intervals.

Mind you, with 10 spays , 2 bitch spays and a cruciate to do before lunch there wasn't much time to do much in depth.......[not me, and I 'm jesting]

[quote user="Bob Russell"]Every skin case is likely to be multifactorial[/quote]

I'm really not sure this is true. Fix the main problem and everything secondary goes away.

[quote user="Bob Russell"]but I struggle to find sarcoptes. I just treat them in case![/quote]

Don't we all, and we did, but the appearance and the itch gives it to you. I f you scrape and find nothing the client gives you that look and you're against the credibility tide...

Re: Hypothyroidism and cutaneous allergy

Anthony Todd — Wed, 10 Jun 2015 20:04:35 GMT

[quote user="Martin Atkinson"] crusting edges of pinnas. [/quote]

Got to be scabies [sacroptes to the newbies] bet ya! Eurax, available without prescription is anti-pruritic, kills mites and is good to give clients something to do as well as therapeutic, cheap and effective, very soothing on the pinnae.

[Also drug of choice for abdominal itching in pregnant ladies, by the way....]

Scrapes with scabies so often negative,and the client gives you that "wrong again" look,,,,

Is there anything else that [classically] affects the tips of the pinnae, giving a whitish scaly flaky appearance, intensely itching that isn't scabies?

Or anything else that affects the edges of pinnae full stop?

I don't know of anything so pathognomonic.

Does Advocate kill mites?

Re: Hypothyroidism and cutaneous allergy

Martin Atkinson — Wed, 10 Jun 2015 18:50:08 GMT

Had a 7 month old Bull Mastiff in yesterday with generalised pruritis, seborrhaic dermatitis and focal patches of allopecia and crusting edges of pinnas. Typical breed and age for Demodex you might think but skin scrapes were negative and distribution more suggesting sarcoptes but no mites on scrape. Offered Sarcoptes Ab test but declined on cost so has gone off with Advocate and Malaseb. Review in a month.

Re: Hypothyroidism and cutaneous allergy

Robin Grimmer — Wed, 10 Jun 2015 16:05:42 GMT

You could also do a blood sample for Sarcoptes serology as can be hard to find on scrapings.

Re: Hypothyroidism and cutaneous allergy

Bob Russell — Wed, 10 Jun 2015 15:54:46 GMT

I have given up diagnosing skin conditions on appearance. The typical, classic hypothyroid dog has normal T4 and demodex. Almost any complication of hypothyroidism can lead to itchiness and all the dogs I find with demodex have secondary bacterial and/or malassezia. Perhaps I miss the non-infected ones.

Skin scrapings are extremely easy to do. Impress the clients no end and they will get the thrill of a lifetime if you can show them a mite or two! You can charge for them as well, of course.

I generally go for vetasept but will be more enthusiastic now we have the first malaseb copy at a more sane price!

Every skin case is likely to be multifactorial which is an excuse when some of mine don't respond! Probably my inadequacy but I struggle to find sarcoptes. I just treat them in case!

Re: Hypothyroidism and cutaneous allergy

Kate Richardson — Wed, 10 Jun 2015 13:56:42 GMT

[quote user="An On MRCVS"]

The lab said that the pattern of T4/TSH would be consistent with non thyroidal illness but with the free t4 is more consistent with hypothyroid. He is a dog who has had several courses of steroids/antibiotics etc so there could be some interference there, but the distribution of the lesions and the appearance of the skin are for me suggestive of hypothyroid as well - but then why the itching?

I will definitely get him up to date on parasite treatments and consider doing some skin scrapes

[/quote]

Secondary bacterial infection and/or demodex most likely, if truly hypothyroid. Don't conside the skin scrapes, do them!

And no demodex and no improvement with itch on antibiotics, (you may need to give a minimum of 3 weeks before assessing), then consider atopy as well

Re: Hypothyroidism and cutaneous allergy

An On MRCVS — Wed, 10 Jun 2015 13:47:44 GMT

Thanks all for your help so far :-)

The dog was diagnosed in 2013 with hypothyroidism on the basis of a low T4 level and a high thyroid antibody antigen (this isn't something I'm really familiar with). No treatment was initiated to do with the thyroid at this time.

With us in 2015 the lab results were re-run and were:

Total T4 < 3.9 nmol/l 10.0 - 55.0

FT4d < 3 pmol/l 6.6 - 40.0

TSH 0.41 ng/ml 0.01 - 0.60

I will definitely get him up to date on parasite treatments and consider doing some skin scrapes. The shampoo we are using was initially Malaseb (when he was on Cephalexin as well) and is now Sebocalm. Is there any interaction with using Thyrofon together with Atopica or steroids - and once we stabilise the thyroid should I try and withdraw the other medications (e.g. atopica) as the general skin condition might improve?

Thanks