Skin - endocrinodermatopathies

Question 1

Common features of endocrinodermatopathies

Answer 1

• symmetrical hyperpigmentation
  nonpruritic, symmetrical alopecia
• abnormally thin (cushing) or thickened (hypertrhyroidism) skin
• +/- pruritis: secondary pyoderma, seborrhea
• Course: usually chronic

Question 2

Types of endocrinodermathopathies

Answer 2

• Hypothyroidism
• Hyperadrenocorticism
• Diabetes mellitus
• Sex-hormone dependent dermatoses (sertolis cell tumor, hyperandrogenismus in male, testosterone-responsive alopecia in castrated male, castration responsive dermatosis of male or hypogonadism of intact male, hyperestrogenism in females, estrogen responsive dermatosis in spayed female, hypogonadism in intact female, alopecia X)

Question 3

Sex-hormone dependent dermatoses:

- Sertoli´s cell tumor

Answer 3

• Breeds: boxer, shetland sheepdog, poodle, pekinese, collie, min schnauzer, any breed with cryptorchid testes
• Pathogenesis: excessive secretion of estrogen
• Clinical signs:
• alopecia: perineal, genital region, ventral abdomen, chest, flanks
• hyperpigm, lichentification, gynecomastia,
• preputial swelling, preputial linear dermatosis, (-) libido, attractive to other males, (bone marrow depression)
• Treatment: castration

Question 4

Sex-hormone dependent dermatoses:

- Hyperandrogenismus in male dogs

Answer 4

• Etiology: Leydig cell tumor
• Occurrence: any breeds, middle to old age
• Clinical signs:
• circumanal glands hyperplasia, prostatitis, prostatamegalia, tail gland hyperplasia, perianal adenoma, severe seborrhea oleosa (face, ears, interdigitally, axilla, inguinal)
• Treatment: castration

Question 5

Sex-hormone dependent dermatoses:

- testosterone-responsive alopecia of the castrated male dog

Answer 5

• Etiology: unknown (hypoandrogenismus?)
• Occurrence: any breeds, middle to old age
• Clinical signs:
• symmetrical alopecia (flank and/or inguinal area): thin, scaling, seborrhoes, hyotonic skin, hypertrichosis
• dull, dry haircoat, at the beginning it becomes lighter
• Treatment: methyltestosterone 1mg/kg EOD

Question 6

Sex-hormone dependent dermatoses:

- Castration responsive dermatosis of male dog or hypogonadism of intact dogs (see also Alopecia X)

Answer 6

• Occurrence: adult entire male dogs
• pomeranian, chow-chow, malamute, husky, keeshond
• Etiology:
• STH deficiency?, testicular abnormalities?
• Clinical signs:
• 2-4 years of age or later, fine “fluffy” coat, symmetrical alopecia: neck, perineum, caudmedial thighs, inguinal area, +/- hyperpigmentation
• no testicular abnormalities, or decreased testis or tessticular neoplasia
• treatment: castration

Question 7

Sex-hormone dependent dermatoses:

- Hyperestrogenism in females

Answer 7

• Occurrence: middle age to old bitches
• Etiology: cystic ovaries, cystic tumors
• Clinical signs:
• symmetrical alopecia in perineal and inguinal area, then spreads towards the abdomen cranial and ventral, generalization (except head, feet)
• secondary seborrhea, lichenification, enlarged vulva and nipples, abnormal cycle of estrus
• Treatment: ovariohysterectomy + symtomatic treatment of seborrhea

Question 8

Sex-hormone dependent dermatoses:

- Estrogen responsive dermatosis in spayed female

Answer 8

• Occurrence, etiology:
• spayed females before the first estrus, however hypoestrogenism has not been demonstrated
• Clinical signs:
• symmetrical alopecia in the perineal, genital region
• soft, puppy like haircoat
• vulva and nipples are small
• treatment:
• no treatment
• or 0.1mg/kg24h dietil-silbestrol for 3 weeks and 0.1-1mg/kg per os weekly, but side effects: bone marrow depression! (better: estradiol valerate, estradiol benzoate)

Question 9

Sex-hormone dependent dermatoses:

- hypogonadism in intact females (etiology, occurrence)

Answer 9

• decreased functional activity of gonads
• Primary hypogonadism:
• firstly infertility is diagnosed, treated and there is no time for developing of skin lesions
• predisposition: poodle, terriers, dachs
• non-cyclic alopecia: before 3 years of age, then slowly preogression (on perineal, inguinal, abdominal and body area)
• Secondary hypogonadism: primary hypothyroidism, cushing, irregular cycle, anestrus
• cyclic alopecia: starts with estrus, then recovers, but after a while may not recover by the time of anestrus

Question 10

Sex-hormone dependent dermatoses:

- hypogonadism in intact females (clinical signs, diagnosis, therapy )

Answer 10

• clinical signs:
• in short haired: perineal hypotrichosis, then on the body
• long haired: alopecia or primary hairs on neck, inguinal and caudal thighs
• histopath: differentiates from the non-endocrine alopecia, but it can not prove the ovarian imbalance
• Digg. diag: endocrinopathies, follicuar dysplasia, seasonal flank alopecia
• Diagnosis: exclude hypothyroidism and cushing, (measurment of sex hormones), recovery after spaying
• Therapy:
• spaying, background causes to treat
• maybe estrus induction (GnRH 2ug/kg im 2xday, 10 days or FSH 0.75-2 IU/kg im/day until estrus)

Question 11

Sex-hormone dependent dermatoses:

- Alopecia X

Answer 11

• Other names: adult onset STH-deficiency dermatopathy, hyposomatotropismus, STH-responsive alopecia, pseudo-cushing disease, congenital adrenal gland hyperplasia-like syndome, castrationresponsive dermatosis, sex hormone responsive dermatosis, adrenal gland-hormone imbalance, biopsy/Lysodren-responsive dermatois, s. hysky follicular dysplasia
• affects the adrenal gland and not the gonads!
• alopecia of young adults in nord breeds and miniature poodle
• in intact and in castrated males and spayed females
• firstly alopecia of the primary then the secondary hairshaft
• Localisation: neck, shoulders, groin, perianal area, thighs and caudomedial thighs then the whole body (except head and paws)
• dry scaling hyperpigmented thin skin, brocken hairshuft
• hair regrow after trauma (scin scrape, biopsy, sunshine)
• Diagnosis: ACTH stimulation test, measure sex hormones
• Therapy: castration/spaying, melatonin, trilostan, STH, mitotan, testosterone, traumatisation, deslorin