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Scaling Dermatitis of Dogs

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Scaling Dermatitis of Dogs Clinical Approach to Scaling Dermatitis. OUTLINE • What is scale? • Huge differential list. A cause-based clinical approach • Symptomatic therapy • Examples: – Golden retriever ichthyoisis – Idiopathic nasal hyperkeratosis Dr. Rob Hilton BVSc (Hons) MACVSc (Canine Medicine) Cert.VD MRCVS – Hepatocutaneous syndrome – Sebaceous adenitis Crust and scale are NOT the same. Crust What is scale ? = dried exudate with blood and/or leucocytes • Dry Scale = seborrhea sicca = accumulations of mature epidermal keratatinocytes (corneocytes) = orthokeratosis and/or immature epidermal keratinocytes (parakeratosis) +/- • Hair follicle keratinocytes (principally external and internal root sheaths) +/- • Excess sebaceous secretions (seborrhea oleosa) 1 Dry Scale (Seborrhea sicca) Seborrhea oleosa Demodicosis •Congenital & nevi Hypothyroidism •Malassezia •Bacterial overgrowth syndrome •Male feminization syndrome Alopecia and dry scale on the flank Follicular Casts secondary to exposure from endocrine alopecia. •Dry Scale adhering to hair shafts •Severe follicular pathology 2 Comedones Follicular Casts and dry scale •Commonly associated with Cushing’s disease or demodicosis. •Indicate severe follicular disease •Keratin/sebum plugs in hair follicles. A cause-based approach to (1) Excessive production of the stratum scaling disorders corneum The list of differentials is very long. • Congenital defects ( Primary seborrhea, Nevi) • Reaction to physical agents (UV radiation , irritant chemicals, trauma.) 1. Excessive production of the stratum • Infection (bacteria and dermatophytes and yeast) corneum • Ectoparasites (Fleas, Sarcoptes , Demodex , Cheyletiella ) • Reactions to disease within the epidermis or dermo-epidermal 2. Ineffective exfoliation of the stratum junction - Pyoderma , immune-mediated disease, lymphona corneum. • Metabolic causes - Zinc responsive dermatitis, hypothyroidism, hepato-cutaneous syndrome, vitamin A responsive dermatosis, 3. Defects of epidermal hydro-lipid film feline thymoma, poor diet • Idiopathic keratinization defects (e.g. ear margin dermatosis, naso/digital hyperkeratosis, feline acne) 3 (2) Insufficient or defective destruction and exfoliation of the stratum corneum Idiopathic keratosis/Nevi • Congenital ichthyosis • Lack of grooming in sick cats (3)Protective surface lipid film defects •Defects of production •Lack of essential fatty acids (from poor quality diets or improper storage and oxidation). •Destruction of the sebaceous glands (sebaceous adenitis, Leishmania) Idiopathic keratosis Epidermal dysplasia •Hypothyroidism •Excessive shampoos that remove surface lipids Scaling with collarettes and crusts. Scale as a reaction to pyoderma DDX Pyoderma or Pemphigus Foliaceus • Especially Nordic breeds • DDX includes – Zinc responsive dermatosis – Malassezia – Sebaceous adenitis – Pemphigus 4 Scaling dermatitis due to disease at Scaling form of pemphigus dermo-epidermal junction foliaceus. Lesions not limited to head so <> P. erythematosus Lupoid dermatosis of German Short-haired Pointers Don’t forget: Sarcoptes, Dermatophytosis trichogram: Demodex and Dermatophytes “rotten log appearance” 5 Full history, clinical and dermatological Symptomatic management of examination scale •Superficial skin scrapings, deep skin scrapings Parasites •Sticky tape cytology identified : • Shampoo therapy •Trichogram and fungal Treat culture • Hydration of skin •Ectoparasite elimination Response: • Systemic therapy trial Search for •Antimicrobial response underlying cause trial • Control of secondary infection If not complete resolution, skin biopsy and metabolic function tests. Symptomatic management of Sulfur and Salicylic acid scale General properties of • Keratolytic & keratoplastic shampoos • Detergent (Dissolve lipids/sebum) • Synergistic actions at 2% • Keratolytic (Break cohesion concentration between the corneocytes ) • Moderate antimicrobial • Keratoplastic (“Normalize” the turnover of the epidermis and the action process of keratinization due to their effects on the basal epidermal cells.) • Generally tolerated by • Antibacterial and anti-Malassezia cats • Moisturizing • Not aggressively drying 6 Selenium sulfide 1% Benzyl Peroxide • Keratolytic and keratoplastic with degreasing action • Disinfectant, astringent and • Also causes excess drying . Needs to be keratolytic properties. combined with hydration of skin • Reputed capacity to flush debris • Useful for initial therapy of heavy or greasy from hair follicles . scale or in cases refractory to less aggressive • Good degreasing action • Causes excessive drying of the therapy . skin . Hydrating conditioner is required after each bath. • Dark coated dogs tend to bleach or Coal Tar products. discolour . •Very aggressive keratolytic and keratoplastic • Do not use in cats . Toxic if ingested. •Variable contents of tar components • Generally used short term •No longer registered for Veterinary use Hydration of the Skin Hydration of the Skin • Hygroscopic agents • Emollients (humectants) • High molecular weight • Decrease epidermal molecules that hydrate the water loss. epidermis osmotically via dermal vasculature. • E.G. paraffin oil • Urea, glycerin, lactic acid and propylene glycol. • Used as a post-bath • Propylene glycol has conditioner after the antiseptic, lipid solvent and skin has been keratolytic properties. hydrated. • 25-33% propylene glycol in water for hydration or 45-70% as a keratolytic 7 Systemic therapy - Retinoids Other systemic agents • Act directly on nuclear receptors • Vitamin A (600-800 IU/kg daily) is less potent than • “Normalize” keratinocyte and differentiation. synthetic retinoids, acting on cytoplasmic receptors and • Benefits are not evident until 2-3 months of therapy. then on the nucleus via transport molecules. • Dose can be tapered down for maintenance. • Vitamin D3 (calcitriol 10ngm/kg daily) has off label • Potential side effects of retinoid therapy include retinoid-like action but has the potential of causing keratoconjunctivitis sicca, liver damage and alterations in severe disturbances in calcium/phosphorous lipid metabolism. metabolism. Monitoring is required. • Highly teratogenic, and should not be used in breeding • Fatty acid supplements improve dry scale. Linoleic acid , animals. Effects may extend for years after as found in sunflower or safflower oil, decreases scale administration has ceased. Clients need to be informed and improve coat quality. No specific dose rates have of the teratogenic potential of these agents and should wear gloves during administration. been clinically trialed, but doses of 1ml /2-4 kg are indicative. Excessive use can result in diarrhea. • Expensive, cost may limit their use. Acitretin 1mg/kg Omega3/6 fatty acid supplements (1ml/4kg daily) have an anti-inflammatory effect. Golden Retriever Ichthyosis Golden Retriever Ichthyosis Clinical signs • Inherited . Autosomal recessive or • May present from 12 weeks – 4 years of incomplete dominance age. • Recognized clinically but only recently • Flakes of dry scale from small to 1cm 3 +/- characterized focal areas of flakey seborrhea oleosa. • Primary keratinization defect with electron- microscopic membrane lesions in strata • Scale accumulation in ears +/- otitis granulosum and corneum and retention of externa desmosomes between mature • Not pruritic unless secondary bacterial or keratinocytes. yeast infection present. 8 Golden Retriever Ichthyosis Golden Retriever Ichthyosis Typical scale Focal greasy scale Golden Retriever Ichthyosis Golden Retriever Ichthyosis Management • Differential diagnosis • Shampoo therapy . Selenium sulfide – Allergic dermatitis (pruritic/inflammatory) initially (if severe) -> maintenance with – Demodicosis and other skin parasites – Primary or secondary pyoderma /Malassezia sulfur/salicylic acid shampoo weekly . infection • Vitamin A – Hypothyroidism • Definitive diagnosis is histological after • Linoleic acid supplementation secondary infection has been resolved. • Control of secondary infections 9 Hereditary nasal parakeratosis of Idiopathic Nasal Hyperkeratosis Labrador retrievers and crosses • Hereditary nasal parakeratosis of • Autosomal recessive Labrador retrievers and crosses. • Lesions usually appear before 12 months of age. • Adherent accumulations of dry scale. In more severe • Nasal Hyperkeratosis Associated with cases, fissures and erosions Xeromycteria "Parasympathetic nose” develop. • Secodary infection and inflamation may lead to depigmentation of the • Senile idiopathic naso/digital remaining nasal planum. • Not exacerbated by UV light hyperkeratosis. exposure. • Sometimes clinically seen in other breeds Inherited nasal hyperkeratosis Nasal Hyperkeratosis Associated with Xeromycteria ("Parasympathetic" nose) • The lateral nasal gland of the dog is responsible for the moisture of the nasal mucosa. Duct opens 2cm from nares and moisture translocates over the surface of the planum. • Parasympathetic innervation (together with lacrimal glands) with the facial nerve. • May be injured in otitis media • Lesions may be unilateral or bilateral. • Resolution of otitis media (if present) may result in Photos courtesy of Dr Judith Nimmo spontaneous improvement . 10 Senile idiopathic naso/digital Nasal Hyperkeratosis, diagnosis hyperkeratosis • Immune mediated disease • Older dogs • Mucocutaneous pyoderma • Increased horny tissue on the • Solar dermatitis nose and/or footpads • Hepatocutaneous syndrome accompanied in some cases by • Zinc responsive dermatosis fissures and secondary • Neoplasia infection. • Post distemper hyperkeratosis
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