Seborrhoea and otitis in a springer spaniel Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology.

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


• 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


Clinical findings on first presentation - 1

SignsSigns


Clinical findings on first presentation - 2

SignsSigns


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


• 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


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


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


Clinical appearance -comparison with littermate

TestsTests


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


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


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


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


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


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


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


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


Review

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NotesNotes

Seborrhoea and otitis in a springer spaniel Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology.

Documents

signs slide

littermate tests

nmoll tests

culture tests

glucocorticoids history

principle diagnosis

littermate minimal response

active skin scrapings