Dermatology Case - Help wanted

Re: Dermatology Case - Help wanted

Richard Fox — Thu, 13 Jan 2011 08:47:33 GMT

I think this is a case which needs to be worked up systematically rather than stabbing in the dark? One needs to remember more than one thing is often occurring at the same time in skin cases whether primary or secondary!

Re: Dermatology Case - Help wanted

Cinzia Gandini — Thu, 13 Jan 2011 01:13:47 GMT

Has it ever been abroad or coming from abroad? Like France or other mediterranean countries? Because Leishmaniasis can temporarily improve with steroids even if it's not the correct treatment...

Re: Dermatology Case - Help wanted

Kevin Castle — Wed, 12 Jan 2011 22:27:46 GMT

You have never mentioned what diet the dog is on. Adverse reactions to food can manifest in many ways. Are they feeding a diet such as Baker's which I often find triggers otitis and other skin complaints?

Re: Dermatology Case - Help wanted

Jonathan Wood — Wed, 12 Jan 2011 22:11:43 GMT

[quote user="Vikki Halliday"]

[quote user="Jonathan Wood"]Yes willing to trial atopica [/quote]

Er, I'd be very wary of using such a powerful drug without getting a diagnosis.

Ask them how they would feel if their doctor repeatedly refused to test them for disease, and instead they spent 6 months on tablets which did nothing and made them ill?

[/quote]

Fair point and that is my argument. Ideally I would like to test T4/TSH, and then biopsy and skin scrapes. Will see what the dog looks like today.

Re: Dermatology Case - Help wanted

Vikki Halliday LLB — Wed, 12 Jan 2011 12:13:05 GMT

[quote user="Jonathan Wood"]Yes willing to trial atopica [/quote]

Er, I'd be very wary of using such a powerful drug without getting a diagnosis.

If for example the dog is hypothyroid, you will potentially further compound the problem by using ciclosporin. With the proce of Atopica for a dog of that size, you would be cheaper doing T4 TSH or biopsy surely?

Owners really do often want a "quick fix" and are more often willing to try any pill before doing a proper investiagation, however I would try and persuade them otherwise as they could ned up spending more money and having a dog in a diseased state for longer without a proper workup.

Ask them how they would feel if their doctor repeatedly refused to test them for disease, and instead they spent 6 months on tablets which did nothing and made them ill?

Re: Dermatology Case - Help wanted

Richard Carter — Tue, 11 Jan 2011 11:24:29 GMT

Is spayed as well with different coat on flanks/ trunk on your body photo in endocrine pattern. Had a golden retriever with nasal depigmentation/ alopecia/ crusting disorders and weird growth in nails that turned out to be hypothyroid. If money doesn't extend to bloods for endocrine and you having hair fall out peri-ocular, (and skin scrapes/ plucks exclude demodex) trial on incurin?

Re: Dermatology Case - Help wanted

Jonathan Wood — Tue, 11 Jan 2011 01:01:28 GMT

Thanks for responses - No evidence of Uveitis or depigmentation. I did consider a Uveodermatological syndrome but eyes are aok. The dog is also non pruritic according to the owners but I have my doubts that they are noy the most observant. They did not notice the dog put on 5kg in 18months.

Yes willing to trial atopica but for some reason they are very anti a g/a and biopsy !

All pads on all legs are equally affected - due for a check up this week. Will upload more pics then.

Re: Dermatology Case - Help wanted

Richard Fox — Mon, 10 Jan 2011 20:59:38 GMT

Just noticed the peri-ocular alopecia - bit odd that esp on pred? I presume there is no evidence uveitis or depigmentation? It's not pruritic is it as you might have 2 things going on i.e. Parakeratosis and an allergy?

The only other thing that concerns me is the crusting around the foot pads - Hmmm. I that were me I think I would bx the nose and the foot pad/skin junction :)

Re: Dermatology Case - Help wanted

Rob Loxley — Mon, 10 Jan 2011 20:09:24 GMT

[quote user="Jonathan Wood"]Plan is to check clinical response and then check T4 or start of cyclosporine[/quote]

Biopsy is going to be the most cost effective way of sorting this IMHO, and if you are considering putting a labrador on Atopica there must be some money to spend?!

Re: Dermatology Case - Help wanted

Laurence Webb — Mon, 10 Jan 2011 18:32:55 GMT

[quote user="chris jones"]

Don't you just hate it when clients want a diagnosis and treatment plan but they don't want any expensive workup.

[/quote]Jonathan, I assume that you're planning to bill the clients an hourly rate for you photographing the dog, uploading the photos and time spent on this thread to save them the cost of investigation

Re: Dermatology Case - Help wanted

Richard Fox — Mon, 10 Jan 2011 14:19:14 GMT

POTTER!!

Re: Dermatology Case - Help wanted

Vikki Halliday LLB — Mon, 10 Jan 2011 13:34:59 GMT

I'd also second the EFA supplement, however in the long term the proper supplement could cost more than a proper biopsy........

Re: Dermatology Case - Help wanted

Vikki Halliday LLB — Mon, 10 Jan 2011 13:33:45 GMT

[quote user="Richard Fox"]

This is my crystal ball :(

[/quote]

It appears to be broken?

I can just visualise you in long flowing black robes and a wizard's hat Richard, LOL!

Re: Dermatology Case - Help wanted

Richard Fox — Mon, 10 Jan 2011 12:28:56 GMT

This is my crystal ball :(

Re: Dermatology Case - Help wanted

Anonymous — Mon, 10 Jan 2011 11:09:50 GMT

dietry possibly lack of EFAs trial epo supplement maybe.

I agree doesnt look like pf (my own dog had it badly). as before parakeratosis is high on the list.

Don't you just hate it when clients want a diagnosis and treatment plan but they don't want any expensive workup. We used to have a crystal ball in the practice for just such cases but it didn't work very well!

good luck

chris

Re: Dermatology Case - Help wanted

Richard Fox — Mon, 10 Jan 2011 10:18:28 GMT

Then I'd go down the symptomatic therapy if the client can't afford bx but yes maybe work ruling out PF but looking at it it doesn't resemble PF :)

Re: Dermatology Case - Help wanted

Jonathan Wood — Mon, 10 Jan 2011 10:16:29 GMT

Thanks David, Laurence and Richard

I forgot to mention that the dog is on a zinc supplement too.

So far the owners have declined biopsy and HP - although the idea of looking at an impression smear of the crust will definitely be worth a go.

Re: Dermatology Case - Help wanted

Richard Fox — Mon, 10 Jan 2011 09:45:13 GMT

+1 David - but maybe also do blood biochem for glucose and liver parameters (inc bile acid stim) just to rule out NME - Only other thing I could think of :) I do not think it is mind you - I agree Nasal Parakeratosis at this age unless proved otherwise - nasal biopsy should be fairly definitive :)

Re: Dermatology Case - Help wanted

Anonymous — Mon, 10 Jan 2011 09:29:55 GMT

Crusty nose looks a bit like nasal parakeratosis of labradors, but I guess that's really a H/P Dx, and wouldn't expect periocular alopecia I don't think (though could have more than one dermatological condition - seen a chocolate lab with both nasal parakeratosis and atopy before). I would do H/P on the nose and probably do a thin strip rather than punch biopsy and make sure not to prepare pre-op and keep crust on biopsy etc (would be best not to be on any steroids etc pre-biopsy and no topical treatments maybe 7days) + maybe 3 punch biopsies elsewhere to include healthier looking nasal skin (most labs charge fixed rate for up to 4 biopsies - so may as well get your money's worth). You could also do impression smear from underside of bit of nose crust that you 'picked' off and look at in-house if can't afford biopsy - you might pick up acanthocytes suggestive of pemphigus or something or even secondary malassezia infection.

Nasal parakeratosis of labradors responds reasonably well to topical vaseline or propylene glycol diluted 1:1 with water and applied topically (and therefore also responds to some topical treatments containing these ingredients along with immunomodulators etc...) and it would do no harm to try a trial treatment if money tight and this seems a possible Dx, but could make it more likely for misdiagnosis on H/P if biopsy after topical treatment trial. Secondary infection sometimes needs to be dealt with, especially if long course of steroids etc given for treatment of suspected DLE or similar originally and then turns out to be nasal parakeratosis.

See:

Hereditary nasal parakeratosis in Labrador retrievers: 11 new cases and a retrospective study on the presence of accumulations of serum ('serum lakes') in the epidermis of parakeratotic dermatoses and inflamed nasal plana of dogs. Peters J, Scott DW, Erb HN, Miller WH. Vet Dermatol. 2003 Aug;14(4):197-203

Hereditary nasal parakeratosis in Labrador Retrievers. Pagé N, Paradis M, Lapointe JM, Dunstan RW. Vet Dermatol. 2003 Apr;14(2):103-10.

Re: Dermatology Case - Help wanted

Laurence Webb — Mon, 10 Jan 2011 09:03:43 GMT

If money's tight I often try these dogs on zinc supplements which can help some of them.