1. Scaling and crusting and otitis in a springer spaniel Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology

2. History | Signs | Differentials | Tests | Therapy | Notes Entire 8-year-old male Welsh springer spaniel Weight 36 kg Non-seasonal dermatosis of 2 years duration Moderate erythema and severe lichenification of pinnae, periaural skin, ventral neck, tail and abdomen. Moderate hyperpigmentation present Click to reveal the text on this screen Click the forward arrow to jump to the next screen Entire 8-year-old male Welsh springer spaniel Weight 36 kg Non-seasonal dermatosis of 2 years duration Moderate erythema and severe lichenification of pinnae, periaural skin, ventral neck, tail and abdomen. Moderate hyperpigmentation present History - 1 Entire 8-year-old male Welsh springer spaniel Weight 36 kg Non-seasonal dermatosis of 2 years duration Moderate erythema and severe lichenification of pinnae, periaural skin, ventral neck, tail and abdomen. Moderate hyperpigmentation present History

3. History | Signs | Differentials | Tests | Therapy | Notes Generalised “seborrhoea”, strong odour and dull brittle coat. Purulent discharge from ears. Affected areas severely pruritic Thirst and appetite unchanged. Alert but less active than littermate Minimal response to appropriate doses of systemic antibiotics and glucocorticoids History - 2 Generalised “seborrhoea”, strong odour and dull brittle coat. Purulent discharge from ears. Affected areas severely pruritic Thirst and appetite unchanged. Alert but less active than littermate Minimal response to appropriate doses of systemic antibiotics and glucocorticoids History

4. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 1 Signs How would you describe the lesions?

5. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 2 Signs Alopecia, lichenification, erythema and crusting affecting the groin and the medial aspects of both thighs

6. History | Signs | Differentials | Tests | Therapy | Notes How would you describe the skin lesions? 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 How would you approach this case? How would you describe the skin lesions? 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 Signs

7. History | Signs | Differentials | Tests | Therapy | Notes Next steps A thorough physical examination is mandatory Comparison with littermate would be valuable Principle differential diagnoses Primary problems: hypothyroidism, demodicosis, ectoparasitism, food intolerance, atopy Secondary problems: Malassezia dermatitis, pyoderma bacterial otitis Case investigation Next steps A thorough physical examination is mandatory Comparison with littermate would be valuable Principle differential diagnoses Primary problems: hypothyroidism, demodicosis, ectoparasitism, food intolerance, atopy Secondary problems: Malassezia dermatitis, pyoderma bacterial otitis Differentials

8. History | Signs | Differentials | Tests | Therapy | Notes Samples Deep and superficial skin scrapings, tape strippings and impression smears for cytology, biochemistry and haematology panels, swabs from ears for bacteriology Tests Thyroid tests (total T4 and TSH), elimination diet Tests - 1 Tests Samples Deep and superficial skin scrapings, tape strippings and impression smears for cytology, biochemistry and haematology panels, swabs from ears for bacteriology Tests Thyroid tests (total T4 and TSH), elimination diet

9. History | Signs | Differentials | Tests | Therapy | Notes Comparison with littermate Obese, less active Skin scrapings No ectoparasites or fungal elements Tape strippings Many Malassezia yeasts in all samples Aural swabs Smears show yeasts and Gram-negative rods Pseudomonas spp. on culture, resistant to all commonly used antibiotics except polymyxin B Tests - 2 Comparison with littermate Obese, less active Skin scrapings No ectoparasites or fungal elements Tape strippings Many Malassezia yeasts in all samples Aural swabs Smears show yeasts and Gram-negative rods Pseudomonas spp. on culture, resistant to all commonly used antibiotics except polymyxin B Tests

10. History | Signs | Differentials | Tests | Therapy | Notes Clinical appearance - comparison with littermate Tests

11. History | Signs | Differentials | Tests | Therapy | Notes Blood tests Mild normochromic, normocytic anaemia Fasted serum cholesterol = 8.2 mmol/l Elimination diet No change in clinical signs Thyroid evaluation Total T4 = 10.4 nmol/l (range 13-52 nmol/l) TSH = 3.9  mol/l (normal <0.41  mol/l ) Tests - 3 Blood tests Mild normochromic, normocytic anaemia Fasted serum cholesterol = 8.2 mmol/l Elimination diet No change in clinical signs Thyroid evaluation Total T4 = 10.4 nmol/l (range 13-52 nmol/l) TSH = 3.9  mol/l (normal <0.41  mol/l ) Tests

12. History | Signs | Differentials | Tests | Therapy | 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

13. History | Signs | Differentials | Tests | Therapy | Notes Diagnosis Hypothyroidism with secondary Malassezia dermatitis and otitis with Pseudomonas sp. infection It would probably be difficult to accurately assess any concurrent disease until these problems have been controlled Hypothyroidism with secondary Malassezia dermatitis and otitis with Pseudomonas sp. infection It would probably be difficult to accurately assess any concurrent disease until these problems have been controlled Tests

14. History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? List the steps you would now take to treat: The hypothyroidism The Malassezia dermatitis The (Pseudomonas) otitis Tests List the steps you would now take to treat: The hypothyroidism The Malassezia dermatitis The (Pseudomonas) otitis

15. History | Signs | Differentials | Tests | Therapy | Notes Therapy - 1 Hypothyroidism Oral levothyroxine given at 10-20 µg/kg bid Monitor 4 hour post-pill serum total T 4 concentrations after 12 weeks Therapy Hypothyroidism Oral levothyroxine given at 10-20 µg/kg bid Monitor 4 hour post-pill serum total T 4 concentrations after 12 weeks

16. History | Signs | Differentials | Tests | Therapy | Notes Therapy - 2 Malassezia dermatitis Whole body baths with a 2% w/v miconazole and 2% w/v chlorhexidine shampoo (Malaseb, Leo Animal Health), 2-3 times weekly Therapy Malassezia dermatitis Whole body baths with a 2% w/v miconazole and 2% w/v chlorhexidine shampoo (Malaseb, Leo Animal Health), 2-3 times weekly

17. History | Signs | Differentials | Tests | Therapy | Notes Pseudomonas otitis Flush both ear canals with saline until clean and inspect tympanic membranes (under general anaesthetic) Bulla radiographs if otitis media suspected In this case, both tympanic membranes were intact. Both ears were to be cleaned twice daily with EpiOtic (Virbac), followed by Otomax (Schering- Plough) twice daily one hour after cleaning. Therapy - 3 Pseudomonas otitis Flush both ear canals with saline until clean and inspect tympanic membranes (under general anaesthetic) Bulla radiographs if otitis media suspected In this case, both tympanic membranes were intact. Both ears were to be cleaned twice daily with EpiOtic (Virbac), followed by Otomax (Schering- Plough) twice daily one hour after cleaning. Therapy

18. History | Signs | Differentials | Tests | Therapy | Notes Treated with 400 µg/kg bid. Washes applied once weekly Weight reduced from 36 kg to 31 kg after 6 months. Post-pill TT4 32 nmol/l Good hair regrowth in all affected areas. Some seborrhoea still present. Odour, lichenification, erythema and hyperpigmentation greatly reduced Minimal pruritus. Otoscopy normal on both sides, no micro-organisms on ear smear cytology Response to therapy Notes Treated with 400 µg/kg bid. Washes applied once weekly Weight reduced from 36 kg to 31 kg after 6 months. Post-pill TT4 32 nmol/l Good hair regrowth in all affected areas. Some seborrhoea still present. Odour, lichenification, erythema and hyperpigmentation greatly reduced Minimal pruritus. Otoscopy normal on both sides, no micro-organisms on ear smear cytology

19. History | Signs | Differentials | Tests | Therapy | Notes Topical antimicrobial therapy was continued for another two months Malaseb once or twice weekly EpiOtic twice weekly Thereafter, only thyroxine supplementation was required. Clinical examination and post-pill tests were performed every 6 months. Notes Topical antimicrobial therapy was continued for another two months Malaseb once or twice weekly EpiOtic twice weekly Thereafter, only thyroxine supplementation was required. Clinical examination and post-pill tests were performed every 6 months.

20. History | Signs | Differentials | Tests | Therapy | Notes Review If you would like to review this case, please use the navigation buttons below Notes If you would like to review this case, please use the navigation buttons below