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

2. CLOSE History | Signs | Approach | Tests | Treatment | Notes 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 and presenting clinical signs - 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. CLOSE History | Signs | Approach | Tests | Treatment | 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 and presenting clinical signs - 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. CLOSE History | Signs | Approach | Tests | Treatment | Notes Clinical findings on first presentation - 1 Signs

5. CLOSE History | Signs | Approach | Tests | Treatment | Notes Clinical findings on first presentation - 2 Signs

6. CLOSE History | Signs | Approach | Tests | Treatment | Notes How would you approach this case? 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 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 Approach

7. CLOSE History | Signs | Approach | Tests | Treatment | 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 - 1 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 Approach

8. CLOSE History | Signs | Approach | Tests | Treatment | Notes Case investigation - 2 Samples Deep and superficial skin scrapings, tape strippings and impression smears for cytology, biochemistry and haematology panels, swabs from ears for bacteriology Tests TSH response test, elimination diet Samples Deep and superficial skin scrapings, tape strippings and impression smears for cytology, biochemistry and haematology panels, swabs from ears for bacteriology Tests TSH response test, elimination diet Approach

9. CLOSE History | Signs | Approach | Tests | Treatment | Notes Test results - 1 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 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 Tests

10. CLOSE History | Signs | Approach | Tests | Treatment | Notes Clinical appearance - comparison with littermate Tests

11. CLOSE History | Signs | Approach | Tests | Treatment | Notes Test results - 2 Blood tests Mild normochromic, normocytic anaemia Fasted serum cholesterol = 8.2 mmol/l Elimination diet No change in clinical signs TSH response test (total plasma T 4 ) Basal = 24.5 nmol/l 6 hrs post TSH = 29.3 nmol/l Blood tests Mild normochromic, normocytic anaemia Fasted serum cholesterol = 8.2 mmol/l Elimination diet No change in clinical signs TSH response test (total plasma T 4 ) Basal = 24.5 nmol/l 6 hrs post TSH = 29.3 nmol/l Tests

12. CLOSE History | Signs | Approach | Tests | Treatment | 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. CLOSE History | Signs | Approach | Tests | Treatment | 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. CLOSE History | Signs | Approach | Tests | Treatment | 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 Treatment List the steps you would now take to treat: The hypothyroidism The Malassezia dermatitis The Pseudomonas otitis

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

16. CLOSE History | Signs | Approach | Tests | Treatment | Notes Treatment - 2 Malassezia dermatitis Whole body baths with 1% w/v selenium sulphide shampoo followed by 2 mg/ml enilconazole rinse. Treatment repeated every 4 days If response was poor, systemic ketoconazole at 10 mg/kg bid might be considered. Not first choice of therapy in this case, in view of concurrent endocrinopathy. Malassezia dermatitis Whole body baths with 1% w/v selenium sulphide shampoo followed by 2 mg/ml enilconazole rinse. Treatment repeated every 4 days If response was poor, systemic ketoconazole at 10 mg/kg bid might be considered. Not first choice of therapy in this case, in view of concurrent endocrinopathy. Treatment

17. CLOSE History | Signs | Approach | Tests | Treatment | Notes Treatment - 3 Pseudomonas otitis Flush canals under general anaesthetic to remove debris and inspect tympanic membranes Bulla radiographs if otitis media suspected In this case, 0.02% chlorhexidine washes followed by Tris-EDTA drops and 0.3% gentamicin drops were used Pseudomonas otitis Flush canals under general anaesthetic to remove debris and inspect tympanic membranes Bulla radiographs if otitis media suspected In this case, 0.02% chlorhexidine washes followed by Tris-EDTA drops and 0.3% gentamicin drops were used Treatment

18. CLOSE History | Signs | Approach | Tests | Treatment | Notes Response to treatment 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. Otitis now resolved 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. Otitis now resolved

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