Sebaceous AdenitisKatie Krimetz Turner

Western University, College of Veterinary Medicine4th Year Dermatology Rotation

Animal Dermatology Clinic, San Diego3/26/10

Presenting Problem… The owner of a dog with scaly and greasy hair

coat has been using a pet shop shampoo over the past 6 months. The dog has been diagnosed with sebaceous adenitis by another veterinarian.

Outline a more appropriatemanagement planfor topical therapy in this dog.Image Ref: Green

Sebaceous Adenitis Inflammation of the sebaceous glands

• Simple/branched alveolar glands

• Normally: produce oily secretion Retain moisture and maintain hydration of skin Acts as physical barrier (7) Sebum enters hair follicle contaminated with lipase-

producing bacteria free fatty acids (7)

(ORS)

Image Ref: Caceci

Sebaceous Adenitis Uncommon in dogs

• Rare in cats, rabbits, and humans

Autosomal recessive inheritance proposed for the Standard Poodle and Akita (2,6,7)• Orthopedic Foundation of America Registry

Unknown etiology

Pathogenesis Hypotheses: (2,6)

1. Heritable and developmental inflammatory destruction of sebaceous gland

2. Cell-mediated immunologic destruction

3. Cornification abnormality sebaceous duct and gland inflammation and atrophy

4. Anatomic defect in sebaceous gland leakage and foreign body response (2)

5. Defect in lipid metabolism cornification abnormality and sebaceous gland destruction

Clinical Signs Cessation of flow due to inflammation and atrophy

• Scaling• Follicular plugging, casts,

fronds from dilated hair follicles

Diminishing coat quality• Dull, dry, brittle broken hairs

Bilaterally symmetrical distribution• Dorsal trunk, temporal region, face, pinnae, rat tail

Usually nonpruritic unless 2° infection presentImage Ref: Rhodes

Clinical Signs Poodles

• Hyperkeratosis then alopecia, dull, brittle hair (w/ casts)

Akitas• Generalized, erythematous and greasy skin

Springer Spaniels (8)• Alopecia, seborrhea, pyoderma• More severe than poodles

Vizsla and short-coated breeds• Focal coalescing, firm, nodular lesions• Annular plaques with alopecia and fine, non-adherent scale (3,7)

Cats• Multifocal annular areas of alopecia with scaling, crusting, and follicular casting,

dark rims of black scales along margins of eyelids (7) Image Ref: Brooks

Clinical Signs

Image Ref: Noli

Examination/Diagnostic Findings Skin scrape and culture – negative

Hair casts are prominent• Yellow-brown keratosebaceous material

Trichogram• Broken hair shafts (3) • Follicular casts (4)

Images’ Ref: Boord

Diagnosis Differentials:

• Primary seborrhea• Ichthyosis• Vitamin A and Zinc responsive dermatosis• Demodecosis• Cutaneous leishmaniasis• Exfoliative cutaneous lupus erythematosus• Dermatophytosis• Endocrinopathy• Pemphigus foliaceus• Nodular forms – deep bacterial folliculitis and furunculosis

Definitive Diagnosis Biopsy

Site selection• Ensure sample from subtle

early lesions with scale without alopecia (2)

• However representing different stages and appearances will be helpful, too. (1) Best to find active sebaceous gland inflammation Chronic, alopecic sites usually show absent glands

• Multiple sites Confirms widespread inflammation and/or loss of glandsImage Ref: Boord

Histopathology Mild/Early perifollicular inflammatory cells at level of

isthmus of hair follicle (3) directed at sebaceous gland

Moderate/Chronic severe hyperkeratosis, follicular plugging, nodular, granulomatouspyogranulomatous inflammation around sebaceous gland (2,3)

Short coats – large granulomatous lesions (6)

Keratin ensheathed hair follicles

Diffuse absence of sebaceous glands is the most common feature of chronic sebaceous adenitis (2,3)

Histopathology

Complete lack of sebaceous glands

Nodular mononuclear cell infiltrate at usual site of sebaceous glands

Image Ref: NoliHaematoxylin and eosin, 10×

Treatment May see cyclic patterns of spontaneous

improvement and worsening, independent of therapy (6)

2 Goals : (1)1. Restore normal function of skin

Neutralize consequences of sebaceous gland destruction and loss of function

2. Slow/stop ongoing inflammation and destruction

Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function

Remove casts, scale, and open plugged follicles• Antiseborrheic shampoo therapy 3-4x/wk

Phytosphingosine, sulfer, salicyclic acid, benzoyl peroxide, SebaLyt/SeboRx, DermaSeb, Sulf OxyDex (5)

Clip long coats

Soft brushing to loosen scales and dead hair

Antiseptic topical shampoo• Chlorhexidine or benzoyl peroxide

Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function

Topical emollients and humectants are critical• Propylene glycol, glycerin, colloidal oatmeal, urea, lactic acid• Apply AFTER antiseborrheic shampoo

Restoring and normalize keratinocyte turnover (5)

Suggestions:• 50:50 bath oil and warm water directly to skin

Allow 2 hours contact time Remove oil with 3-7 baths Apply a final humectant rinse Repeat every 7 days for 4-6 weeks

• Between baths: spray-on emollients/humectants 50:50 propylene glycol and water 0.2% phytosphingosine spray (Duoxo Seborrhea Microemulsion Spray) 1% phytosphingosine pipette (Duoxo Seborrhea Spot-on)

Images’ Ref: Rampak

Bushi’s Topical Treatment… Bushi’s Story 4 year old Akita Germany

Inflammation tx w/ calendumed ointment

Flea comb to remove crusts• Repeat ointment until crusts

came off Applied Hettral Johanniskraut

Oil (2 hr soak) Bathe with Editerm, repeat Condition with Humilac Repeat every 10-14 days

Image Ref: Rampak

Bushi’s Topical Treatment… 5 months of topical treatment total Improvement noted in 4-6 weeks

• Continued baths every 14 days• Maintained on oil treatments every 3-4 weeks

Other Treatment OptionsGoal #2: Arrest ongoing inflammation and destruction of glands

Initial course of antiinflammatory then tapered to lowest effective dose – likely need for life

Rarely see spontaneous and/or complete remission (3,6)

Atopica is systemic treatment of choice (1)• May help with sebaceous gland regeneration (3)• Tetracycline and Niacinamide also possible (1)• Corticosteroids only if pruritic (1)

May respond to oral omega-6 and omega-3• Antiinflammatory action of omega-3 may be beneficial

Vit A and synthetic retinoids helpful in severe or refractory cases (1,6)• “Effective” = >50% reduction in scaling and alopecia (6)• Require 4-8 weeks therapy, usually for life• Helps with keratinocyte differentiation (3)Image Ref: ABC

Ideal Outcome(with systemic therapy)

Before and After 3 months of oral cyclosporin (5mg/kg q24hr)

Able to taper to EOD only

Images’ Ref: Noli

References1. Angus, John C. “How I Treat Sebaceous Adenitis.” 81st Western Veterinary Conference, 2009.

2. Gross, Thelma Lee, et al. Skin Diseases of the Dog and Cat Clinical and Histopathologic Diagnosis, 2nd edition. Oxford: Blackwell Science Ltd, 2005.

3. Linek, Monika, et al. “Effects of Cyclosporin A on clinical and histologic abnormalities in dogs with sebaceous adenitis.” JAVMA, Vol 226, No. 1, January 1, 2005.

4. Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.

5. Rosenkrantz, Wayne. “Practical Applications of Topical Therapy for Allergic, Infectious, and Seborrheic Disorders.” Western Veterinary Student Notebook. Circa >2005.

6. Scott, Danny, et al. Muller and Kirk’s Small Animal Dermatology, 6th edition. Philadelphia: W.B. Saunders Company, 2001.

7. Sousa, Candace A. “Sebaceous Adenitis,” Veterinary Clinics Small Animal Practice, Vol 36, 2006, Pg. 243-249.

8. Tevell, Elisabeth H., et al. “Sebaceous adenitis in Swedish Dogs, a retrospective study of 104 cases.” Acta Veterinaria Scandinavica, Vol 50, No. 11, May 25, 2008.

Image References1. ABC Online Pharmacy. http://www.abconlinepharmacy.com/ns/customer/home.php?cat=70 Accessed:

3/24/10.

2. Boord, Mona. Animal Dermatology Clinic, San Diego. Private Photograph Collection. Accessed: 3/25/10.

3. Brooks, Wendy; and Moore, Wendy. Mar Vista Animal Medical Center. http://www.marvistavet.com/html/body_sebaceous_adenitis.html Accessed: 3/24/10.

4. Caceci, Thomas. “Integument System II: Hair” Virginia-Maryland Regional College of Veterinary Medicine Veterinary Histology Course, VM8054 Exercise 15. August, 2008. http://education.vetmed.vt.edu/Curriculum/VM8054/VM8054HP.htm

5. Green, Linda. “Sebaceous Adenitis - Decisions, Responsibilities & Realities.” http://www.astrolyka.com/illness.html Accessed: 3/24/10.

6. Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.

7. Rampak, Michael. “Report about the successful treatment of Sebaceous Adenitisthrough self-invented therapy.” 2000. http://www.akita-friends.com/special/satreat.htm Accessed: 3/24/10.

8. Rhodes, Karen H. The 5-Minute Veterinary Consult, Clinical Companion: Small Animal Dermatology. https://www.vetconnect.com.au/5min/toc/img1055.htm Accessed: 3/24/10.

Questions and Discussion…

Thank you!

-Katie Krimetz