Facial alopecia, scaling and erosions in a Jack Russell terrier Author: Ross Bond Editor: David Lloyd © European Society of Veterinary Dermatol
Mar 28, 2015
Facial alopecia, scaling and erosions in a Jack Russell terrier
Author: Ross BondAuthor: Ross Bond Editor: David LloydEditor: David Lloyd
© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
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History - 1
HistoryHistory
• 10 year-old entire male Jack Russell terrier
• Good general health
• Progressive facial skin disease of 4 months duration
• No response to ampicillin and prednisolone
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
History - 2
HistoryHistory
• Dog lives in rural environment
• Lesion began as focal area of erythema and scaling caudal to nasal planum
• Progressed caudally over face despite therapy
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
SignsSigns
• Severe skin disease; lesion well-demarcated
• Smooth-silvery skin at healing areas rostrally
• Alopecia, scaling, erosions
• Nasal planum unaffected
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
How would youapproach this case?
SignsSigns
• 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
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
DifferentialsDifferentials
• Principle differential diagnoses• Dermatophytosis• Demodecosis• Deep pyoderma• Pemphigus foliaceus
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Tests - 2
TestsTests
• Diagnostic tests• Skin scrapings• Wood’s light examination• Fungal and bacterial cultures• (Skin biopsy)
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results - 1
TestsTests
• No evidence of parasites & fungal elements on microscopy
• No fluorescence on Wood’s light examination
• Fungal growth evident on mycobiotic agar within 7 days of incubation
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Results - 2
TestsTests
• White colonies with granular texture
• Dark tan / brown reverse pigment
• On microscopy, numerous microconidia and thin-walled cigar-shaped macroconidia
• Trichophyton mentagrophytes (granular form)
Fungal culture: Sabouraud’s dextrose agar, 5 days
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What is yourdiagnosis?
TestsTests
• Do the investigations permit a definitive diagnosis?
• Are there any additional investigations which you think may need to be done?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
TestsTests
• Dermatophytosis caused by T. mentagrophytes
• Historical and clinical features strongly suggestive, supported by culture results
• Skin biopsies confirmed hair shaft and follicle invasion by fungal elements
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
How would you deal with this case?
• What is your prognosis?
• How will you advise the owner?
• What treatment would you consider?
TestsTests
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Prognosis
TestsTests
• Prognosis is good• However, lengthy antifungal therapy is often
needed with Trichophyton infections in dogs
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Therapy
TherapyTherapy
• Griseofulvin orally at 50 mg/kg (divided twice daily)
• Enilconazole (Imaverol) emulsion applied every 4th day
• Good clinical response after 8 weeks of therapy, but repeat cultures still positive
• Cultures negative and complete clinical response after 12 weeks of treatment, which was withdrawn at this time
• No relapse over a 6 month follow-up period
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Comment -1
NotesNotes
• Owner’s lesions were present in this case, illustrating the zoonotic potential of canine dermatophytosis
• Jack Russell terriers are predisposed to sylvatic dermatophytosis in the U.K.
• The peripherally expanding, well-demarcated lesions on the face were suggestive of dermatophytosis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Comment -2
NotesNotes
• Lesions of dermatophytosis vary in appearance and severity
• Severely inflamed Trichophyton lesions on the face are misdiagnosed as pemphigus foliaceus
• Absence of focal crusted lesions (“footprints” of vesicopustules) and nasal planum involvement made PF much less likely in this case
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Review
NotesNotes
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