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Managing sebaceous adenitis and symmetrical lupoid onychodystrophy (Proceedings)
A symmetrical partial alopecia and excess scaling with follicular casts. Remaining hair is dull and brittle
- May be an immune mediated disease
- May be a genetically inherited defect – autosomal recessive trait.
- Keratinization abnormality with obstruction of sebaceous duct?
- Abnormality in sebaceous lipids?
- Clinical features ? 2 forms
- Sebaceous Adenitis with Hyperkeratosis – Long Coated Breeds
- Seen in all color variants of standard poodles (may be similar in other long?coated breeds of dogs such as Samoyeds and Akitas).
- A symmetrical partial alopecia and excess scaling with follicular casts. Remaining hair is dull and brittle.
- Affects dorsal planum of the nose, top of head, dorsal neck and trunk, tail and pinnae.
- Non?pruritic and no offensive odor
- May develop secondary bacterial folliculitis with pruritus.
- Hair may become straight and lose its “curl”.
- Granulomatous Sebaceous Adenitis – Short Coated Breeds
- Affects short?coated breeds of dogs ? Vizslas, Weimaraners
- Begins as a moth?eaten alopecia with minimal to no scaling.
- Primarily affects the trunk, head and ears.
- Initial nodular granulomatous to pyogranulomatous inflammation at the level of the sebaceous glands.
- Depending on the type, there may or may not be prominent hyperkeratosis.
- Chronic cases develop a complete loss of sebaceous glands with fibrosis, atrophy of hair follicles and in some cases complete loss of the adnexa with fibrosis.
- Propylene glycol ? a hygroscopic lipid solvent that penetrates the horny layer and increases water content. 50?75% propylene glycol with water?applied daily as a spray.
- Bath Oil Treatments (light mineral oil) – 50:50 mixture of bath oil and water, spray over the entire body, rub into the hair coat well, allow to soak for 1-2 hours. Remove oil by bathing with dish soap 2-3 times, and then finish with a moisturizing shampoo and conditioner/crème rinse for the final bathing. Repeat q 7 days for the first month, the q 14-30 days prn.
- EFA Supplement - Derm Caps ES - 1 capsule BID; Evening Primrose Oil (EPO) - 500 mg BID.
- Anti?seborrheic shampoos, conditioners and emollients have been of little benefit.
- Treat secondary pyoderma if present.
- Isotretinoin (Accutane®) - 1 mg/kg SID-BID.
- Acetretin (Soriatane®) - 1 mg/kg SID-BID
- Cyclosporine (Neoral, Gengraf, Atopica) - 5 mg/kg BID.
- Vaseline Intensive Care Lotions daily without washing.
- Allerderm Spot-On – apply daily or from 1-3 times/week prn.
- Dermoscent Essential 6 – apply once weekly prn.
- Douxo Calm Shampoo and Spray – apply 3 times weekly.
- Douxo Seborrhea Shampoo and Micro-emulsion Spray – apply twice weekly.
- Essential fatty acid dietary supplement (Derm Caps ES) – 1 capsule BID + Evening primrose oil – 500 mg BID.
- High empirical dosages of purified fish oil daily (1000 mg?) – Marshall, Williams – Adv Vet Derm, Vol 1:446, 1990.
- Vitamin A – 8,000-10,000 I.U. – SID-BID x 3 months, then up to 20,000-30,000 I.U. – BID. Needs to be esterified for stability and from a quality controlled and reliable manufacturer (DSM Nutritional Products – formerly Roche; Bio-Tech Pharmaceutical). Mark Papich – 600-800 I.U./kg SID.
- Tetracycline and Niacinamide – 10 mg/lb of each drug, not to exceed 500 mg TID of each drug.
- Doxycycline – 5-10 mg/kg SID, with or without concurrent Niacinamide.
- Akitas – tends to be more severe, chronic recurrent pyoderma more of a problem, possible signs of systemic illness.
Standard Poodles – aesthetic disease, secondary pyoderma rare, difficult to regrow “normal” hair coat.
- Short Coated Breeds – occasionally “cured” by treatment.
- Suspected to be a lupus-like, immune-mediated disease
- Secondary bacterial paronychia common (esp. Staphylococcus intermedius)
- A possible “novel” reaction pattern to “common” underlying diseases
- Food Allergy
- Atopic Dermatitis
- Clinical Features
- German Shepherd dogs predisposed
- Acute onset of sloughing of one or more nails
- Nails avulse by lifting up distally from the corium, and continuing proximally to the claw fold
- Lameness associated with avulsion of each nail
- Subsequent loss of all nails may occur over several weeks to months
- Regrowth characterized by short, malformed, soft, dry, brittle nails
- Rule out potential underlying disease processes:
- CBC, Profile, U/A
- ANA, Cold Agglutinins
- Elimination diet trial testing
- Intradermal skin testing
- Macerated tissues culture of nail
- Bacterial culture and sensitivity
- Fungal culture
- Nail biopsy techniques:
- P3 amputation
- Longitudinal punch biopsy (8 mm)
- Nail trim flush to the nail fold
- Hydropic degeneration of basal cells
- Lichenoid interface dermatitis
- Treat underlying disease process if possible
- Hypoallergenic diets
- Allergen-specific Immunotherapy (ASIT)
- Essential fatty acid supplements - Derm Caps SID
- Vitamin E - 400-800 IU's – BID
- Tetracycline and Niacinamide - 10 mg/lb of each TID
- Doxycycline – 5-10 mg/kg SID (with or without concurrent Niacinamide)
- Biotin (Appearex®) – 2.5 mg/dog SID
- Pentoxifylline – 15-30 mg/kg TID
- Cyclosporine – 5 mg/kg SID
- Systemic antibiotics based on culture and sensitivity for secondary paronychia
- Cephalexin - 15 mg/lb BID x 2-4 months
- Possible cure if underlying disease process is identified and treated
- Food Allergy – lifelong hypoallergenic diets
- Atopic Dermatitis – lifelong ASIT
- Discontinuation of therapy invariably results in relapses
- Regrown nails are usually malformed, soft, and friable
- Process of avulsing nails and lameness is halted
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