seborrhoea and otitis in a springer spaniel author: ewan fergusoneditor: david lloyd © european...
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Seborrhoea and otitisin a springer spaniel
Author: Ewan FergusonAuthor: Ewan Ferguson Editor: David LloydEditor: David Lloyd
© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology
CLOSECLOSE History | Signs | Approach | Tests | Treatment | NotesHistory | Signs | Approach | Tests | Treatment | Notes
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• 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 presentingclinical 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
HistoryHistory
CLOSECLOSE History | Signs | Approach | Tests | Treatment | NotesHistory | 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 presentingclinical 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
HistoryHistory
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Clinical findings on first presentation - 1
SignsSigns
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Clinical findings on first presentation - 2
SignsSigns
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How would youapproach 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
ApproachApproach
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• 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
Caseinvestigation - 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
ApproachApproach
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Caseinvestigation - 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
ApproachApproach
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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
TestsTests
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Clinical appearance -comparison with littermate
TestsTests
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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 T4)• 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 T4)• Basal = 24.5 nmol/l• 6 hrs post TSH = 29.3 nmol/l
TestsTests
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What is yourdiagnosis?
• 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?
TestsTests
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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
TestsTests
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How would you deal with this case?
List the steps you would now take to treat:
• The hypothyroidism
• The Malassezia dermatitis
• The Pseudomonas otitis
TreatmentTreatment
List the steps you would now take to treat:
• The hypothyroidism
• The Malassezia dermatitis
• The Pseudomonas otitis
CLOSECLOSE History | Signs | Approach | Tests | Treatment | NotesHistory | Signs | Approach | Tests | Treatment | Notes
Treatment - 1
• Hypothyroidism• Oral levothyroxine given at 10-20 µg/kg bid
• Monitor 4 hour post-pill serum total T4 concentrations after 12 weeks
• Hypothyroidism• Oral levothyroxine given at 10-20 µg/kg bid
• Monitor 4 hour post-pill serum total T4 concentrations after 12 weeks
TreatmentTreatment
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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.
TreatmentTreatment
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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
TreatmentTreatment
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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
NotesNotes
• 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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Review
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NotesNotes