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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
List the differentials for multi-focal/diffuse patchy alopecia
- Key: demodicosis, dermatophytosis, superficial pyoderma | - Others: dermatomyositis, sebaceous adenitis, alopecia areata
26
What is alopecia areata?
An autoimmune condition that causes bulbitis
27
Explain what is meant by coat colour linked follicular dysplasia
- Colour dilution alopecia - Paler than normal - Hairs often weaker and break off leading to alopecia
28
In all cases of alopecia, what are the top 3 differentials?
- Demodicosis - Dermatophytosis - Superficial pyoderma
29
List the potential infectious causes of alopecia
- Pyoderma - Dermatophytosis - Demodicosis - Leishmaniasis
30
List the iatrogenic causes of alopecia
- Anagen defluxion | - Post-clipping alopecia
31
List the endocrinopathic causes of alopecia
- Hypothyroidism - HAC - Recurrent flank alopecia - Hyperoestrogenism in males (Sertoli cell tumour) - Hyperoestrogenism in females (ovarian cysts) - Alopecia X - Other sex-hormone related
32
List causes of alopecia other than infection, iatrogenic, endocrinopathic or coat-colour linked
- Follicular dysplasia - Telogen defluxion - Pattern alopecia - Sebaceous adenitis - Epitheliotropic lymphoma
33
What tests are typically used in the investigation of alopecia?
- Trichogram - Skin scrapings (all cases) - Dermatophyte culture - Wood's lamp
34
When is dermatophyte culture typically used in the investigation of alopecia?
- 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
If no definitive diagnosis is made from the initial investigations of alopecia, what are the next steps?
- Rule out pyoderma - Cytology of impression smears, pustule contents - Assess response to 3 week course of appropriate antibiotic or anti-bacterial baths
36
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?
- Endocrine function tests if endocrinological cause suspected - Skin biopsy
37
Describe the use of skin biopsy in the investigation of alopecia
- 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
Describe the histological appearance of endocrinopathic causes of alopecia on biopsy
- Atrophic pattern - Atrophy of epidermis, hair follicles and sebaceous glands - Orthokeratotic hyperkeratosis and follicular keratosis evident
39
What signs are commonly seen prior to alopecia, where the underlying cause is an endocrinopathy?
- Ceruminous otitis - Recurrent microbial infection - Generalised seborrhea - Proceed to hairloss usually in 6 months
40
List the common signs of hypothyroidism
- Dull, dry hair coat - Hypotrichosis - Seborrhoea - Lack hair growth post-clipping - Weight gain - Lethargy/mental dullness
41
List the uncommon signs of hypothyroidism
- Alopecia - Pyoderma - Ceruminous otitis externa - Facial myxoedema - Wekaness - Exercise intolerance - Cold inteolerance - Ocular disorders - Bradycardia
42
List the rare signs of hypothyroidism
- Hypothermia - Reproductive disorders - Facial nerve paralysis - Laryngeal nerve paralysis
43
Compare the alopecia seen in hypothyroidism and hyperadrenocorticism
HAC generally more symmetrical alopecia than hypoT. HypoT often shiny nose
44
Describe the dermatological changes commonly seen with HAC
- Symmetrical alopecia, sparing extremities - Poor hair re-growth - Comedones, seborrhoea - Skin thinning, reduced elasticity - secondary microbial infection/demodicosis - Macular hyperpigmentation on ventrum
45
Describe the uncommon dermatological signs seen with HAC
- Coat colour changes - Hyperpigmentation - Calcinosis cutis - Excessive bruising and poor wound healing
46
In what dogs does alopecia X most commonly occur?
- Young, 2-5yo | - Chows, Pomeranians, Samoyed, Husky, MIniature poodle
47
Describe the appearance of alopecia X
- Alopecia startin at the trunk/perineum, then spreads all over - Head and limbs spared - Remaining "puppy-like" coat
48
How is alopecia X diagnosed?
Diagnosis by elimination of other endocrinopathies and biopsy
49
Outline the treatment for alopecia X
Suggested: - Castration - Oral melatonin - Deslorelin implants
50
Describe the clinical signs of Sertoli cell tumours
- Alopecia, hyperpigmentation - Gynaecomastia (enlargement of mammary glands) - Linear preputial erythema (red line along prepuce) - Attraction to other male dogs - Occasional bone marrow suppression
51
What treatment is indicated for Sertoli cell tumours?
Neutering (check for metastasis first)
52
What is canine recurrent flank alopecia?
A common condition of alopecia associated with photoperiod, usually onset Nov-March
53
Describe the signalment for canine recurrent flank alopecia
- Mean onset 4yr, range 1.5-11yr | - Breeds predisposed: Boxers, Airedale, English bulldog, Schnauzer, Rhodesian ridgeback
54
Describe the appearance of canine recurrent flank alopecia
- Usually thoracolumbar - Abrupt onset - Well demarcated alopcia
55
How is canine recurrent flank alopecia diagnosed?
- Rule out hypoT, HAC, other follicular dysplasia | - Use endocrine tests and biopsy
56
Outline the treatment of canine recurrent flank alopecia
- 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
What is anagen defluxion?
Abrupt cessation of mitosis in anagen
58
What is anagen defluxion usually associated with?
- Severe systemic disease - Cytotoxic drugs e.g. chemotherapy - Toxins (e.g. selenium, rare)
59
What is telogen defluxion?
Hair follicles go into premature telogen
60
What is telogen defluxion usually associated with and how is it diagnosed?
- stressful events e.g. pregnancy, parturition, lactation, anaesthesia - Regrow in several months once stressor removed - Diagnosed on biopsy
61
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: Dachshunds b: Greyhounds c: Dachshunds, greyhounds, chihuahua
62
How is pattern baldness diagnosed? Treatment?
- Biopsy, suspect based on breed, clinical appearance and lack of anything else - Oral melatonin
63
Describe the cause, appearance and diagnosis of follicular dysplasias
- Heritable breed specific coat abnormalities - Usually give focal or diffuse symmetrical alopecia affecting dorsum and flanks - Diagnosis on biopsy
64
What colours and breeds is colour dilution alopecia usually associated with?
- Blue (dilute blck) or fawn (dilute brown) coat colours | - Esp. Doberman, Dachshun, Yorkie, whippet, Greyhound
65
What is colour dilution alopecia often associated with?
Often secondary bacterial folliculitis
66
Describe the occurrence and appearance of colour dilution alopecia dystrophic change
- Dilute colour hair only - Large melanin granules and abnormally weakened hair - May lead to shaft fracture and alopecia
67
Briefly outline black hair follicular dysplasia
- Bi-coloured/tri-coloured puppies | - Melanin clumping on trichograms, defective hair shafts lead to fracture
68
Compare alopecia in cats and dogs
- Cats similar to dogs | - In cats, incidence of dermatophytosis higher and pyoderma lower
69
Outline the investigation of alopecia in cats
- 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
Outline the significance of feline symmetrical alopecia
- 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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