1. Alopecia of the flank in a female Glen of Imaal Terrier Author: Cathy CurtisEditor: David Lloyd © European Society of Veterinary Dermatology

2. History | Signs | Differentials | Tests | Therapy | Notes Click to reveal the text on this screen Click the forward arrow to jump to the next screen History 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 History

3. History | Signs | Differentials | Tests | Therapy | Notes General clinical examination was unremarkable Clinical signs Signs The flanks showed Bilateral, well-demarcated areas of alopecia Intense hyperpigmentation of the underlying skin

4. History | Signs | Differentials | Tests | Therapy | Notes How would you approach this case? Signs 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

5. History | Signs | Differentials | Tests | Therapy | Notes Case investigation - 1 Differentials 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

6. History | Signs | Differentials | Tests | Therapy | Notes Case investigation - 2 Tests Initial tests Skin scrapings, hair plucks and fungal culture Haematology and biochemistry profiles Urinalysis

7. 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 areas showed all hairs to be in telogen Haematology and biochemistry profiles Routine haematology and biochemistry profiles were unremarkable Urinalysis Unremarkable Tests

8. History | Signs | Differentials | Tests | Therapy | Notes What now? Tests 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?

9. History | Signs | Differentials | Tests | Therapy | Notes Additional procedures Tests 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

10. History | Signs | Differentials | Tests | Therapy | Notes Additional diagnostic procedures - 1 Tests 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) Skin biopsy

11. History | Signs | Differentials | Tests | Therapy | Notes Results of additional tests Tests Thyroid testing Endogenous TSH – within normal range Total T4 – within normal range

12. History | Signs | Differentials | Tests | Therapy | Notes Results of ACTH stimulation test Tests

13. History | Signs | Differentials | Tests | Therapy | Notes Additional diagnostic procedures - 2 Tests 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

14. History | Signs | Differentials | Tests | Therapy | Notes Additional diagnostic procedures - 3 Tests Morphological diagnosis Atrophic dermatosis

15. History | Signs | Differentials | Tests | Therapy | Notes What is your diagnosis? Do the investigations permit a definitive diagnosis? Are there any additional investigations which you think may need to be done? Tests

16. History | Signs | Differentials | Tests | Therapy | Notes Diagnosis Canine idiopathic flank alopecia Tests

17. History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? What is your prognosis? How will you advise the owner? What treatment would you consider? Therapy

18. History | Signs | Differentials | Tests | Therapy | Notes Prognosis 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 Therapy

19. History | Signs | Differentials | Tests | Therapy | Notes Action Therapy Client education and conservative treatment

20. History | Signs | Differentials | Tests | Therapy | Notes Comment 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 Therapy

21. History | Signs | Differentials | Tests | Therapy | Notes Final diagnosis Canine idiopathic cyclic flank alopecia Therapy

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