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Dermatology 2 > Alopecia > Flashcards

Alopecia Flashcards

1
Q

Compare primary and secondary alopecia

A
  • Primary: failure to grow normally

- Secondary: grows normally but subsequently damaged or lost

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2
Q

What are the mechanisms of primary alopecia?

A
  • Lack of stimulation of growth
  • Abnormal growth factors
  • Elongation of telogen phase
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3
Q

Define true alopecia

A

Direct damage to the hair follicle unit, leading to loss of the whole hair follicle unit

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4
Q

Define apparent alopecia

A

Hair shaft damaged but not lostr from hair follicle unit

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5
Q

How should a case of apparent alopecia be investigated?

A

No damage to hair follicle unit, check this on trichogram. Likely due to pruritus so investigate as pruritus case

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6
Q

Identify the potential causes for true alopecia

A
  • Hair follicle inflammation e.g. folliculitis, furunculosis, bulbitis. Hair follicle unit damaged
  • Hair cycle abnormality e.g. endocrine
  • Hair morphological abnormalities: hair malformed, breaks off
  • Congenital aplasia: never grows
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7
Q

List the lesions commonly associated with alopecia

A
  • Pustules
  • Comedones
  • Follicular casts
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8
Q

What would pustules associated with alopecia be suggestive of?

A
  • Pyoderma

- Autoimmune disease

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9
Q

What would comedones associated with alopecia be suggestive of?

A
  • Demodicosis
  • Dermatophytosis
  • Hypothyroidism
  • HAC
  • Long term glucocorticoid use (iatrogenic Cushings)
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10
Q

What would follicular casts associated with alopecia be suggestive of?

A
  • Follicular disease
  • bacterial infection (pyoderma)
  • Demodicosis
  • Sebaceous adenitis
  • Primary keratinisation disorder
  • Endocrinopathy
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11
Q

Describe sebaceous adenitis

A
  • Immune mediated attack on sebaceous glands

- Occurs in certain breeds esp. poodles and poodle crosses

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12
Q

What is primary keratinisation disorder?

A

Body genetically programmed to produce lots of keratin inappropriately

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13
Q

Describe the appearance of follicular casts

A
  • When hair is epilated, comes out in clumps surrounded by keratin
  • Can be subtle (1 or 2 hairs) or whole collars
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14
Q

What conditions would you be most suspicous of in an animal with alopecia that started <1yo?

A
  • Demodicosis
  • Dermatophytosis
  • Superficial pyoderma
  • Congenital alopecia
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15
Q

What conditions would you be most suspicious of in an animal with onset of alopecia when middle aged/older?

A
  • Endocrinopathies

- Neoplasia

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16
Q

Give some examples of breed specific hair loss

A
  • Small terriers/boxers: predisposed to HAC
  • Dachshunds: pattern baldness
  • Doberman: dysplastic hair follicle diseases
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17
Q

Give an example of a cause of alopecia in entire males

A

Sertoli cell cell tumours

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18
Q

Give an example of a cause of alopecia in entire females

A

Post-partum telogen defluxion (hair loss after whelping, common for bitches, will grow back)

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19
Q

Give examples of how general history can indicate specific causes of alopecia

A
  • PUPD: HAC
  • Weight gain, lethargy: hypoT
  • Small hunting dogs: trichophyton infection
  • Lesions on owner/in contacts: dermatophytosis, ectoparasites
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20
Q

What aspects of the dermatological history can indicate specific causes of alopecia?

A
  • Hair growth after clipping
  • Seasonality
  • Response to past treatment
  • Pruritus
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21
Q

What conditions would lack of hair regrowth after clipping be suggestive of?

A
  • HypoT

- Post clipping alopecia (unknown cause, common in plush coated dogs, can take extremely long to grow back or never)

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22
Q

What condition would you be suspicious of in a dog with bilaterally symmetrical alopecia, obesity, bradycardia, lethargy and lack of regrowth following clipping?

A

Hypothyroidism

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23
Q

How do Sertoli cell tumours cause alopecia?

A

Produce excessive oestrogen causing endocrinopathies

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24
Q

List the differentials for localised alopecia

A
  • Key: Demodicosis, dermatophytosis, superficial pyoderma
  • Post-clipping alopecia
  • steroid injection/post-vaccine vasculopathy, rabies vaccine
  • Tail gland hyperplasia on older male dogs
  • Cicatricial alopecia (scarring)
  • traction alopecia (top knot too tight on Westies)
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25
Q

List the differentials for multi-focal/diffuse patchy alopecia

A
  • Key: demodicosis, dermatophytosis, superficial pyoderma

- Others: dermatomyositis, sebaceous adenitis, alopecia areata

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26
Q

What is alopecia areata?

A

An autoimmune condition that causes bulbitis

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27
Q

Explain what is meant by coat colour linked follicular dysplasia

A
  • Colour dilution alopecia
  • Paler than normal
  • Hairs often weaker and break off leading to alopecia
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28
Q

In all cases of alopecia, what are the top 3 differentials?

A
  • Demodicosis
  • Dermatophytosis
  • Superficial pyoderma
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29
Q

List the potential infectious causes of alopecia

A
  • Pyoderma
  • Dermatophytosis
  • Demodicosis
  • Leishmaniasis
30
Q

List the iatrogenic causes of alopecia

A
  • Anagen defluxion

- Post-clipping alopecia

31
Q

List the endocrinopathic causes of alopecia

A
  • Hypothyroidism
  • HAC
  • Recurrent flank alopecia
  • Hyperoestrogenism in males (Sertoli cell tumour)
  • Hyperoestrogenism in females (ovarian cysts)
  • Alopecia X
  • Other sex-hormone related
32
Q

List causes of alopecia other than infection, iatrogenic, endocrinopathic or coat-colour linked

A
  • Follicular dysplasia
  • Telogen defluxion
  • Pattern alopecia
  • Sebaceous adenitis
  • Epitheliotropic lymphoma
33
Q

What tests are typically used in the investigation of alopecia?

A
  • Trichogram
  • Skin scrapings (all cases)
  • Dermatophyte culture
  • Wood’s lamp
34
Q

When is dermatophyte culture typically used in the investigation of alopecia?

A
  • All cases of focal/multifocal alopecia
  • Young/elderly/immunosuppressed
  • Small hunting dogs, esp. on face
  • Dogs in household with cats
  • In contact people with lesions
  • High risk of zoonotic infection (living with children, elderly, immunocompromised)
  • If follicular casts are seen
35
Q

If no definitive diagnosis is made from the initial investigations of alopecia, what are the next steps?

A
  • Rule out pyoderma
  • Cytology of impression smears, pustule contents
  • Assess response to 3 week course of appropriate antibiotic or anti-bacterial baths
36
Q

If no response to antibacterial treatment for alopecia and pyoderma is ruled out, what are the next steps in the diagnosis of the cause alopecia?

A
  • Endocrine function tests if endocrinological cause suspected
  • Skin biopsy
37
Q

Describe the use of skin biopsy in the investigation of alopecia

A
  • Sample variety of sites, early lesions if possible, middle and periphery of expanding lesions, adjacent apparently normal area
  • Wedge biopsy across margin
  • Mark direction of hair growth
38
Q

Describe the histological appearance of endocrinopathic causes of alopecia on biopsy

A
  • Atrophic pattern
  • Atrophy of epidermis, hair follicles and sebaceous glands
  • Orthokeratotic hyperkeratosis and follicular keratosis evident
39
Q

What signs are commonly seen prior to alopecia, where the underlying cause is an endocrinopathy?

A
  • Ceruminous otitis
  • Recurrent microbial infection
  • Generalised seborrhea
  • Proceed to hairloss usually in 6 months
40
Q

List the common signs of hypothyroidism

A
  • Dull, dry hair coat
  • Hypotrichosis
  • Seborrhoea
  • Lack hair growth post-clipping
  • Weight gain
  • Lethargy/mental dullness
41
Q

List the uncommon signs of hypothyroidism

A
  • Alopecia
  • Pyoderma
  • Ceruminous otitis externa
  • Facial myxoedema
  • Wekaness
  • Exercise intolerance
  • Cold inteolerance
  • Ocular disorders
  • Bradycardia
42
Q

List the rare signs of hypothyroidism

A
  • Hypothermia
  • Reproductive disorders
  • Facial nerve paralysis
  • Laryngeal nerve paralysis
43
Q

Compare the alopecia seen in hypothyroidism and hyperadrenocorticism

A

HAC generally more symmetrical alopecia than hypoT. HypoT often shiny nose

44
Q

Describe the dermatological changes commonly seen with HAC

A
  • Symmetrical alopecia, sparing extremities
  • Poor hair re-growth
  • Comedones, seborrhoea
  • Skin thinning, reduced elasticity
  • secondary microbial infection/demodicosis
  • Macular hyperpigmentation on ventrum
45
Q

Describe the uncommon dermatological signs seen with HAC

A
  • Coat colour changes
  • Hyperpigmentation
  • Calcinosis cutis
  • Excessive bruising and poor wound healing
46
Q

In what dogs does alopecia X most commonly occur?

A
  • Young, 2-5yo

- Chows, Pomeranians, Samoyed, Husky, MIniature poodle

47
Q

Describe the appearance of alopecia X

A
  • Alopecia startin at the trunk/perineum, then spreads all over
  • Head and limbs spared
  • Remaining “puppy-like” coat
48
Q

How is alopecia X diagnosed?

A

Diagnosis by elimination of other endocrinopathies and biopsy

49
Q

Outline the treatment for alopecia X

A

Suggested:

  • Castration
  • Oral melatonin
  • Deslorelin implants
50
Q

Describe the clinical signs of Sertoli cell tumours

A
  • Alopecia, hyperpigmentation
  • Gynaecomastia (enlargement of mammary glands)
  • Linear preputial erythema (red line along prepuce)
  • Attraction to other male dogs
  • Occasional bone marrow suppression
51
Q

What treatment is indicated for Sertoli cell tumours?

A

Neutering (check for metastasis first)

52
Q

What is canine recurrent flank alopecia?

A

A common condition of alopecia associated with photoperiod, usually onset Nov-March

53
Q

Describe the signalment for canine recurrent flank alopecia

A
  • Mean onset 4yr, range 1.5-11yr

- Breeds predisposed: Boxers, Airedale, English bulldog, Schnauzer, Rhodesian ridgeback

54
Q

Describe the appearance of canine recurrent flank alopecia

A
  • Usually thoracolumbar
  • Abrupt onset
  • Well demarcated alopcia
55
Q

How is canine recurrent flank alopecia diagnosed?

A
  • Rule out hypoT, HAC, other follicular dysplasia

- Use endocrine tests and biopsy

56
Q

Outline the treatment of canine recurrent flank alopecia

A
  • Usually benign to no treatment, normally regrows spontaneously in 3-8mo
  • Oral melatonin (unlicensed) may be used at onset of alopecia
  • Warn owner of recurrence, but may not be yearly
57
Q

What is anagen defluxion?

A

Abrupt cessation of mitosis in anagen

58
Q

What is anagen defluxion usually associated with?

A
  • Severe systemic disease
  • Cytotoxic drugs e.g. chemotherapy
  • Toxins (e.g. selenium, rare)
59
Q

What is telogen defluxion?

A

Hair follicles go into premature telogen

60
Q

What is telogen defluxion usually associated with and how is it diagnosed?

A
  • stressful events e.g. pregnancy, parturition, lactation, anaesthesia
  • Regrow in several months once stressor removed
  • Diagnosed on biopsy
61
Q

Which breeds are predisposed to pattern baldness in the following locations:

a: pinnal
b: caudal thighs
c: post-auricular, ventral neck, ventrum, caudomedial thighs

A

a: Dachshunds
b: Greyhounds
c: Dachshunds, greyhounds, chihuahua

62
Q

How is pattern baldness diagnosed? Treatment?

A
  • Biopsy, suspect based on breed, clinical appearance and lack of anything else
  • Oral melatonin
63
Q

Describe the cause, appearance and diagnosis of follicular dysplasias

A
  • Heritable breed specific coat abnormalities
  • Usually give focal or diffuse symmetrical alopecia affecting dorsum and flanks
  • Diagnosis on biopsy
64
Q

What colours and breeds is colour dilution alopecia usually associated with?

A
  • Blue (dilute blck) or fawn (dilute brown) coat colours

- Esp. Doberman, Dachshun, Yorkie, whippet, Greyhound

65
Q

What is colour dilution alopecia often associated with?

A

Often secondary bacterial folliculitis

66
Q

Describe the occurrence and appearance of colour dilution alopecia dystrophic change

A
  • Dilute colour hair only
  • Large melanin granules and abnormally weakened hair
  • May lead to shaft fracture and alopecia
67
Q

Briefly outline black hair follicular dysplasia

A
  • Bi-coloured/tri-coloured puppies

- Melanin clumping on trichograms, defective hair shafts lead to fracture

68
Q

Compare alopecia in cats and dogs

A
  • Cats similar to dogs

- In cats, incidence of dermatophytosis higher and pyoderma lower

69
Q

Outline the investigation of alopecia in cats

A
  • Dermatophytosis top differential
  • Perform skin scrapes for demodicosis and investigations for dermatophytosis (trichograms, fungal culture, Wood’s lamp)
  • If no diagnosis based on these, biopsy
70
Q

Outline the significance of feline symmetrical alopecia

A
  • Is one of the 4 common cutaneous reaction patterns of cats
  • Total/partial acquired hair-loss
  • No other gross skin abnormalities
  • often symmetrical
  • Can be caused by many diseases, need systematic investigations to find primary cause

Dermatology 2 (23 decks)

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