Good evening, everybody, and welcome to tonight's webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing tonight's webinar. Don't think that we have any new people with us, but just in case we do, a little bit of housekeeping, the usual, questions into the Q&A box, and we will keep those over until the end of the webinar if we have time.

If we don't have time, we will still get to answer them. But we will do our best to get through as many as we can. So our presenter tonight is Rosario Cerondolo.

Rosario graduated from the vet school in Naples in Italy in 1987. In 1995, he started a residency at the Royal Vet College in London. 1997, saw him gaining his certificate in veterinary dermatology.

And in 1998, the European diploma in Veterinary Dermatology. 2000, he became an RCVS specialist in veterinary dermatology. And in 2020, he was granted a fellowship title to the RCBS.

Until 2009, Rosario was associate professor in veterinary dermatology at the University of Pennsylvania. And currently, Rosario works at Dick White Referrals in Six Mile Bottom. He's also a consultant at Bayswater Referral Clinic in West London.

Rosario is an honorary associate Professor of veterinary dermatology at the University of Nottingham. Rosario, welcome back to the webinar, vet, and it's over to you. Thank you, Bruce, for the nice introduction.

And, good evening, everyone. I, I hope you had a great day. Not too busy.

I know that it's probably late in the day, to listen to a webinar. So some of you may probably be, listening and watching this webinar later, . Whenever you have more time.

So, I was really pleased when I was asked to talk about, alopecia in dogs and why dogs will get bolder and bolder. And how do we stop it? Because alopecia is one of my favourite topics.

One of the area which I've been studying and doing research for a long time in the different places where I've been working so far. I thought that I will keep this lecture quite practical for you because probably the large majority of you are in, in practise, in general practise. So you don't want to hear about the pathogenesis, or the cytokines which are involved probably in the health.

Follicle cycling and, why they affect the, hair growth. So I thought I will keep quite practical showing you a lot of pictures, cases which I've seen, which hopefully will be more helpful in your daily practise. And, let's start, talking about, how do I approach, a dog with alopecia.

What type of plan you need to have in mind when you are presented with a dog with alopecia. I'm showing you this picture because I would like you to think about doing the presentation. And which breed is the one that is pictured here on the cover of, our veterinary dermatology, journal.

I'll tell you at the end which breed is. So, think about, and guess, and perhaps we could see if at the end you can make it up, which is the breed of this, cute puppy. So how do I approach alovision dogs?

What do I think when I see a patient with, alopecia? I, I definitely look at the dog and say, OK, which breed is this? And then has this dog got a peculiar coat colour or not, what's the age of this dog?

Oh, at what age the dog has developed the alopecia? And is the sex playing a role in the hair loss in this patient or not? So the signalment is definitely the first things that I try to, think about.

You may be presented with a dog, which looks like an adult dog, one year old. But then if you don't know that this is one of those, very uncommon breeds that are characterised by Hereditary alopecia is a solo quinti, which is a Mexican hair loss dog. You may be probably thinking, wow, what's wrong with this dog?

It's got some kind of hormonal problem. No, you need to know if the owner has not told you that it's not a crossbred, but it's kind of peculiar, quite expensive breed. That's how they look like.

Completely bald with very few hairs left on the head and on the rest of the body. But talking about the breeds that we see more commonly in our daily practise, I'm sure you see a lot of English bulldogs, as I see, with a lot of allergies and ear problem. But many of them may come probably to your practise because the owner, It's probably concerned about the progressive hair loss showing up on the side of the flank, the thorax, and perhaps maybe symmetrical, slightly in different shape, but affecting both sides of the body.

Is that something unique for this breed? Well, definitely, yes. There are a number of breeds that are predisposed to this condition.

Characterised by progressive hair loss, hyperpigmentation of the skin, and it's a so-called canine recurrent flunk alopecia, which is something that happened in so many breeds and it's so commonly seen during the autumn, the winter, with dogs spontaneously regrowing the hair in the, in the spring, summertime. But then the dog on the right side looks like it's got something similar. But then we need to know the breed because if you know that this is an Irish water spaniel, which is a breed that is characterised by a genetic predisposition to develop alopecia in adult, life.

Then you could say, well, that's not really, even if it's affecting the flats, it's not definitely. The same things as the English bulldogs. There must be something more.

So this is a breed that is characterised by this type of alopecia, which, unfortunately, may be permanent. and there is almost nothing that can be done. So far, we have not really discovered the cause of this problem, despite I've been studying this condition in this breed for a number of years at the Royal Veteran College.

And then we need to look at the coat colour. I, I hope you can appreciate from the, this last episode here on the top that the white coat looks pretty long and normal, but then if you look at this patch here on the side. Which looks like probably something similar affecting the dog on the right.

Another English bulldog with seasonal flu alopecia. But this one, the hair loss seems to be so well confined to the black area of the coat. So that should probably make you to think about why this dog hair loss is affecting the flanks, but it's not touching at all the white coat.

It's just the black coat. So that, that's again a kind of unique condition affecting dogs which are black and white, black, white. Tan, and there's a condition called black hair follicular dysplasia because the hair follicle has got some unique abnormality of the melanization process, which caused the hair loss only in the black area of the coat, which may be the head, maybe the tail, the back.

And then the age, I mean, if you're presented by A breeder with puppies, a Labrador, that looks like this. Well, that's pretty easy to say, Well, this dog was definitely born with this type of alopecia here. And then while the puppy grows, you can see that definitely there is no hair growing at all compared to the litter mates.

So the same on the head, the ventral part of the body. So that's definitely a dog. It has got a congenital type of alopecia.

There is never going to grow back there. So you may be presented with this dog at a few weeks of age, but perhaps much later in life. So it's important to ask the question about the litter mates, the breeder, and so on.

So hopefully that will help you to figure it out if, that's a congenital alopecia or not. Then if the alopecia is affecting a young dog, or it's affecting an old dogs, makes a huge difference because a dog at this age, very few, weeks, couple of months of age. I mean, I cannot have many condition causing this problem, this progressive, this lack of hair in this part of the body.

But if you're presented with a dog at this age, maybe probably 1012, 14 years of age, with all these Lesions all over the body. This almost generalise hair loss. But there is also edoema.

There is also, scabs and crusts. That's something probably much more serious. So you need to think about condition that may affect dogs at this age, like cutaneous lymphoma.

And then what about the sex? The sex, well, is this one an intact female? Is this one an intact male?

Yes. So if they're intact, make sure that you look at the testicles in this dog because this dog has definitely got prominent nipple, a pendular spray fuse. We can't really see this.

Crotum behind the tail here, but one testicle was much larger than the other. So there is definitely a testicular tumour there, likely producing hormones which are inducing the alopecia. The same will be also in female.

They may have, abnormality of the easter cycle, which may induce this pattern of hair loss on the back of the. Thighs. In some breeds, maybe probably even, almost common normal, like ducksund.

But in other breeds where they're supposed to have hair, if they have an abnormal length of the easter cycle, you may wonder if there is probably something wrong with the ovary. So suggesting perhaps an, ultrasound of the ovaries. Then the next step, when I have looked at all the, Sas things from the signal, then I, I think about, OK, what type of question do I need to ask this person, the owner of the dog?

So I usually ask questions about the dog family and the environment. Do they have any knowledge about the litter mates or the parents? Were they affected?

Are they still in contact? Can I get in contact with the other litter mates owner to find out if there is a similar problem in their pets? Are other animals that are living in the same environment affected by any type of skin or coat problem?

What's the type of environment that the dog is exposed? Isn't a dog living in the countryside, in a farm, or is a dog living in an apartment, in a house? And then question about the dog general health.

Is this patient showing any clinical signs which may suggest a systemic condition or has been probably affected by a condition systemically and now it's recovering? Has there been perhaps any procedure like a surgical intervention, I don't know, blood loss for some reason, like a car accident, or was the bitch perhaps pregnant, was lactating, or perhaps any stressful event in the life of this dog, which may affect the hair cycling? Then when we get more specific about the coat and the skin, I definitely would like to know at what age the hair loss started, which part of the body the alopecia started and has progressed, and how has progressed.

Has been a slow progression, has spread to other parts of the body, has been waxing and waning. Any relation perhaps with the season of the year? Is the dog entire?

Any correlation with this cycle? Has the dog been shaved and the coat is not growing back? Like, for example, this dog, this dog was presented, to me, because the hair was not growing back after being shaved.

And this was a dog that was hypothyroid, so could not show. Any hair regrowth because there was no stimulus for the hair follicle to grow back hair. But this other dog which again was shaved.

And you can see that the only part that was not shaved was the limbs, the tip of the tail, the head was not growing back to the head at all after several months. But then when you look at the belly, you can see that it's slightly round, so kind of pot belly appearance. And then if you ask more questions, probably you may find out that perhaps there are other clinical signs that may point toward the hyperadrenal cortices.

And then ask question about the skin. If the dog is sporadic, it's causing a hair loss because he's scratching so much. Is the skin perhaps greasy or smelly?

Are there area of redness or are they a bit pigmented, or perhaps other lesions like the dog with cutaneous lymphoma that I showed you before, where the dog is presented with scabs and crusts and pupils and pusilles? And then is this dog showing, or The hair loss, because it's been treated with some medication that perhaps may play a role in the hair cycling. Has not been treated with any medication that may or may not have helped, stimulating the hair regrowth?

So when you have a good idea about what has been going on in this dog, then do a physical examination and don't forget that the physical examination is still an important part. I know that probably in general practise you may not have a lot of time, and by the time you have asked all these questions, probably you have already run out of time. But if you're presented or if you know that the dog with a complicated, clinical, presentation is coming to see you, you probably better have a double slot booked, so you have more time.

Then you need to do a proper physical examination and then do a dermatological examination. Is the type of alopecia. Localised in a focal or multifocal pattern, or is symmetrical and diffuse.

Here we have two dogs. The dog on the left has got just a, a localised, spot of hair loss on the top of the tail base, yeah. And when you look at the skin, the skin, it's red, a bit of scaling and crusting.

This was a dog that had the ringworm. Only one lesion. It probably was just the first lesion.

But then the dog on the right, which was a dachshund, was presented to me with multiple, area of hair loss. So we will define this as a multifocal alopecia. And this dog, among all the tests that I did, skin scraping was one of them and showed plenty of demondex mites.

And then. This was a, a dog, a Labrador that was presented for this focal area of alopeci on the flanks, even if they don't look identical, but they're symmetrical. The skin hyperpigmentation.

Probably the history will tell you that they started to show hair loss, probably in the winter. And perhaps this dog is not the first time. So the history again will tell you that this is the classic pattern of canine recurrent flan alopecia.

Differently from this one, that has got a more chronical alopecia with a rat tail. I mean, this one, you will probably consider all conditions that cause rat tail and probably generalise vision, some weight gain. And so think about hypothyroidism.

And then if you look at these two Yorke, they may probably look like they may have a similar condition because most of the trunk is affected. But then will be the diagnostic test that will help you to tell what type of condition is affecting the one on the left and which one, the one on the, on the right. So the one on the left, .

If you are able to have a close look at the skin, you will probably see that this dog has got scaling. There are patchy area also on the head. So you may want to consider probably ringworm as one of the differential.

But the do here on the right, it's again one of those dogs that is showing the hair loss, affecting just the blue part of the body. You can see that the, coat that is normal, the blonde part is definitely longer. What is the, the one that has got the blue collar that is completely missing.

So this is one of those dogs that showed those abnormality of the hair shaft, which suggests the, colour delusion alopecia, which is something similar to the black hair follicular dysplasia that I told you before. So these are two conditions that affect the coat colour. And then what about the location of the alopecia?

Is the alopecia just localised on the nose and the pin, like in this Yorkshire area? Well, that's probably quite common in this breed. It's probably has to do with the genetic predisposition.

We Called this pattern baldness, because it's the same pattern, which is quite unique for this breed. And many dogs of this breed will have this type of pattern of alopecia. And then this is the same breed that I showed you at the beginning.

But if you don't know the breed, you will probably be thinking about, wow, this dog has got a rat tail, must have a a hormonal problem. Actually, it's not. This one is a very healthy dog, but it's got a rat tail because it's a breed characterised by a rat tail.

The Irish water spaniel, it's very well known and it is actually a breed standard requisites to have a rat tail, otherwise they may be excluded by the ring if they go a show dog. And then just for your curiosity, if the dog has got probably some hair, the breeder will probably shave the tail to make it look like a rat tail. So that's perfectly normal.

And then we need to have a close look at the skin and the coat. And then, what we need to, ask ourselves and probably try to find out is that is the skin dry and scaly, greasy, smelly, or normal? As the skin colour changed, it's still pink or turn dark.

Are there other lesions, primary or secondary, in addition to the alopecia? Well, if I see a dog having erythema and then papulum pustule, I would probably think about a bacteria or yeast infection. But if I see excreation, erosion, ulceration, perhaps even pruritus, then I will think about, OK, that's an inflammatory response to a pruritic condition, maybe probably an allergy.

But then if I see that the skin is getting thinner and thinner, and then perhaps I can even see the subcutaneous vessels. Some dogs may have calcium deposition, so-called calcinosis cutis. Then I will consider probably hyperadrenal cortices.

And then if I see on the opposite side, thickening of the skin in dermatology, we call that lichenification, then I will say, well, that's a chronic condition. There is probably something going on there, which is probably going on for a, for a, for a while. And this usually happens when dogs have a politic dermatitis.

And if there is also skin hyperpigmentation, then I will say, well, That's maybe probably related to a hormonal problem like the hypothyroidism, the flunk alopecia, which we believe it's also hormonal, or alopecia X, which is a condition I'll show you in a second the picture. Or, or could be the response of the body to the chronic inflammation, as we commonly see in dogs with, allergy. you have seen probably plenty of those Westie or any other breed with the, lichenification and hyperpigmentation.

So here we have two Pomeranian. The one on the left showed the erythema, the redness, some lesions around the neck. And this is the dog that is very itchy.

And that's the reason why he has been, losing the fur from the scratching. But on the right side, you see a dog and the owner will probably tell you that the dog is not itchy at all, but has been showing a progressive hair loss over several months. With loss of the primary hair, then eventually become very woolly and then become completely bald.

And that's what we called alopecia X. X, because nobody knows exactly why certain breeds will develop this condition. But it's progressive.

I mean, it can be treated. Nowadays, we have several options between melatonin, castration, chemical castration. Trial of stain and I published a lot of study on this condition and the different modality of treatment.

This is the picture I've shown you before about a dog with a number of lesions on, on the, body, not just the hair loss, which should probably suggest that we are dealing with something quite serious, like cutaneous lymphoma. But then when we look at the code, we need to wonder, OK, is the code missing, broken, or it's not growing back after it's been clipped? And then what about the court near the alopeic, area?

Is that normal or not? And can I easily cool out the fur or not? Or perhaps can be easily broken when I stroke the dog.

Does the coat looks greasy. There is a yellowy. Smelly, seboroic stuff attached to the coat.

And then is the dog missing both, the primary and secondary hair? Some dogs have undercoats, some dogs have just the primary long coat. So, which one are we missing?

And then when we look at the animal overall, it's just a general sparse hair loss or is in patches? is the hair density change, which means, do we have less number of hair per whatever centimetre in square? And what about the coat colour?

It's perhaps also changed in colour. You might have seen probably some dogs with Cushing that they may change from the original colour to a very light colour. Like, for example, this dachshund.

You can see the dog when was presented with Cushing, had suddenly become brown. But then when it was treated, with midotane at the time, but nowadays we would use probably Trilostine. The coat collar, went back to a normal, and in black colour.

Now, after we have examined the patient, I really would like you to have this type of algorithm, which is stuck in my mind. And perhaps you may have this chart on the wall in your practise, or if you can remember, the different steps, because that will be extremely helpful to navigate you through the different type of alopecia and try to help. So, for example, Is this dog presented with a congenital alopecia or not?

And we have already discussed some of the breeds that are presented by congenital alopecia. But then if the alopecia has been acquired later in life, then we need to look at the skin, as I've already said before. Is the, skin red?

This dog has probably been very, very itchy. That's the reason why the skin is also so red. That's the reason why it's missing most of the coat.

But the dog on the right. It's not really itchy at all. It's, it's just been presenting with a progressive hair loss, which did not respond to any type of supplementation.

But then, probably other colleague before me had missed the important question about is the dog drinking more, urinating more, eating more? And this was a dog with hyperadrenal corticism. And then treating for Cushing is definitely Regain most of the code.

But And then when you look at the skin, if you can spot the scar, that will be, I mean, interesting because it means that something quite serious happened to this dog here. And so we can see that there is a large area of alopecia on the flank, like in this English bulldog. Now we have learned that the British bulldog here on the right has got the so-called canine recurrent flunk alopecia.

Where, it's, bilateral hyperpigmentation of the skin. But this dog may be presented probably with something similar only on one side. But what is interesting here is the skin is not really darker, or at least it's slightly darker at the periphery here.

But there is a large patch of white skin. And then when we look closely, we can probably see that it's not normal skin, but it's actually a scar. So it's important to recognise normal skin versus a scar and wonder why there is a scar.

Has this dog been, traumatised there? Well, this was a dog that was sitting for a dental cleaning on a heating pad, which apparently got overheated, so developed necrotic tissue, and a huge ash scar. And then eventually the skin sloughed off and ended up with a large patch of, necrotic tissue that healed by second intention, which with a scar.

Then can be iatrogenic. For example, this Yorkshire terrier here, came to me with this patch of hair loss. I mean, the rest of the body is fine.

There is just one patch there. But when I look at the skin, I could see some kind of, unusual, mineral deposition within the skin. So I biopsied the area.

And then the pathologist told me that they could spot some, Some material within the skin. So that was probably the site of an injection. A long-term antibiotics, steroids, or, or a vaccine.

I mean, you will need to go back and look at the medical record and see what was injected on the right side of the neck and then link the two. Eventually, the hair will grow back after a while. And then things happen probably and it's unexpected because the owner in this particular Yorkie had applied a spot on, as probably he had done with all the other dogs in his life.

And this dog, which was, one year old, had a spot on application, and suddenly all the fur fell off. It was just a dramatic hair loss all over the body. Really hard to explain why this will happen, why this dog would have such a severe reaction to a spot on application, because nothing else has happened in this dog life.

Well, I had no explanation apart from a kind of reaction to the spot on. So I told you that, well, I biopsied, confirmed that the hair follicle were there. They had suddenly shed the hair shaft.

I told you that the hair will grow back. And then this dog eventually came back at some point, oops. Sorry.

This dog came back at some point, for other reason in our hospital and look how beautiful was the coat, almost a year later, more than a year later. Of course, the owner didn't apply anymore that's spot on and decide to go for oral anti-flea, anti-thick products. Then the other question is, OK, if the hair loss has not been caused by something that we have done to the patient, could this be called collar linked?

I've shown you before the picture of the Yorkie with the so-called coat collar alopecia or the last ups with the blacker follicular dysplasia. The difference is that this coat is black, this one is blue. So unless you are, either good in recognising the coat colour, you may want to rely on the, on the pedigree or, or, I don't know, asking the owner about the the coat collar if you are aware about the coat colour of the dog that they bought.

And then we are left with these core groups. It's either infectious. Or could be hormonal, or there is a large group called follicular dysplasia, and then there is another group of miscellaneous condition.

So, we don't have time tonight to touch the dogs with follicular dysplasia, although I mentioned the Irish for the Spaniard already, but there are so many other that will be presenting with follicular dysplasia will take another hour just to discuss about this condition. And then a few others which are under the umbrella of miscellaneous because they don't fall in any of the other category, which honestly are quite uncommon. So, I, I think the aim of this webinar tonight is try to guide you among the most common, because that's what you need to be good at diagnosis.

The most common type of alopecia. So if you are, If you have ruled out the infection, the hormonal disease, then you're probably almost justified to recommend referral to a dermatologist for some help, because you may be dealing with something quite unusual. But if there is an infection causing hair loss, so if there is, there is a hypothyroidism, no cushion causing her loss, I think you have probably enough, tools in your practise to diagnose them and treat them successfully.

So, for example, this dog, which was, as you can see a yellow Labrador but was presented with this Diffuse spreading pyoderma, that was affecting almost all the trunk. You can recognise all the lesions that were also present on the skin. And once this dog was treated for pyoderma, then the hair grew back.

Or if it's a hormonal problem, like for example, this bloodhound, this dog was severely hypothyroid and then eventually this dog grew back in the cold when it was supplemented with the right amount of thyroxine. Or perhaps this dog could have either Cushing, and this is probably the classic potbelly appearance in this miniature poodle. A little bit of rat tail.

But then this other miniature poodle, poodle has got, no potbelly appearance. Slightly darker skin. Well, this is another breed that is commonly characterised by the, affected by the alopecia X.

So remember, Pomeranian, Nordic breeds, miniature poodle, they have the so-called alopecia X, and they, will require a completely different approach from From the, dog with Cushing, although triloan could be something that we may be using in both. But then nowadays, we would use something like melatonin or chemical castration, because it's much safer. It doesn't not require the routine testing that we see in dogs that are on Prilosan when they're pushing.

Now, I don't want to go through all the diagnostic tests, that, you may probably know already how to do, but there is only one that I want to stress how important will be because, it's probably one of the most important tests done in patients that have, alopecia, the trichogram. Trichogram basically means blocking the fur and looking under the microscope. So you may use your finger.

You may use a Twitter, you may use one of these hemostat. So you don't need, you need to be careful not to traumatising the hair. Otherwise, you may see some changes, which are actually caused by the, the tool that you are using.

So that's the reason why I covered the Arms of the chemostat with the, rubber tubes. And then what do we do when we put the hair on a slide with a drop of paraffin oil, cover slip and look under the microscope? Well, we look at the hair because it's important to know if the hair shaft are all in annogen, some are in tilogen, or there is a predominance of tilogen which may suggest probably a hormonal condition.

And then we look, we need to look at the opposite end, like the tip. So is the hair. Ending with a normal fine tip or the end of the hair shaft has got a kind of chewed, ending, like a fried end.

So, which means from the dog has been chewing and with the teeth has been probably breaking the hair follicle, the shaft. Differently from hair shaft, which has been probably clipped because you can see a sharp. Cut, yeah.

So that's the difference between a Hersha cut with scissors or clipper and one where the dog has been chewing. But then we also look at the hair shaft. Why the hair shaft will be covered by so much debris and stuff.

So this is all the keratino sebaceous material which accumulates along the hair shaft in dogs like, this chow with sebaceous adenitis, which is another immuno-mediated condition affecting the hair follicle and the sebaceous glands. But then if the hair shaft shows this abnormality, you have probably enough information to make a diagnosis of colour delusion alopecia like this Yorkie or the black hair follicular dysplasia, like in this last apso because that's the genetic abnormality that is present in dogs with diluted colour. Now, I'm going to show you a number of patients that With the Types of hair loss which have been probably caused by either the The owner or perhaps what has been recommended to the owner to use.

Like, for example, this poodle, which came to see me because I had the allergy. Then we did the workup for allergy, decide that the symptoms were really mild. The dog was a little bit itchy on the paws, on the side of the, trunk.

So I told you, OK, well, you can just manage probably these, flare-ups with the hydrocortisone sepoate, spraying the feet, spraying the trunk. But then what did the owner did, kept using this spray daily for almost a year. So the owner then came back one day and said, oh, why my dog is losing the fare?

Has he got something else? And then questioning the owner, I found out that she had not used the spray for a week or two and then occasionally, but she had been using that every day for a year. She, so she had caused a kind of localised hyperadrenal corticism.

Then eventually stop spraying the dog with hydrocortisone, the dog regained the, coat. This is one of the breed that is suffered from the follicular dysplasia. I've already mentioned to you the Irish for the spaniel with the funny rat tail.

So, when I was doing my study, I, I saw a number of these dogs. And so this was just another one. But if I was not totally, and I was not doing all the diagnostic tests, I would probably missed that this dog.

Was having, also ringworm on top of the follicular dysplasia. So you may just say to you, OK, there is nothing to do with follicular dysplasia. No, because this dog could have something else going on at the same time, which may be, something important to diagnose.

So don't think about that. You can, ignore all the diagnosis tests. You need to still to rule out parasites, infections, dermatophytes.

Before you can decide, OK, that's the plan for this patient. I mean, some dogs will need steroids like this dog in the eyes because they have probably an eye condition which will require long-term steroids. But I always question my colleague and say, OK, Can we use probably something else rather than daily steroids in this dog eyes?

Otherwise, the localised alope around the eyelids is going to stay there forever and probably get slightly worse if more steroid drops will leak outside the eyes. And then this heating pad problem, are something that I see quite often. Dogs coming for many reasons.

And then when I question, I find out that the alopecia, which has been there probably for a while, was probably related to a procedure like spaying or dental flip. Because something went wrong on the, on the setting of the temperature. And so the dog got burned, which eventually led to a scarring alopecia.

I'm not sure how many of you will do anaesthesia. I'm not saying that, that you should stop doing epidural anaesthesia because sometimes it's definitely needed. In, some patients, especially for some type of orthopaedic procedures.

But you need to keep in mind that if you're doing epidural anaesthesia, in any breed, the hair may not grow back for months. I mean, this dog had been shaved 6 months before. The hair was still missing.

It looked like it had just been shaved the day before. I mean, in some dogs, for some reason, and it's really still not fully understood. If it's something to do with the needle, the drugs, the location, why they would not grow back the hair in this part of the body.

So warn the owner that, that's, there is a possibility that the dog may end up with a bald patch for a long period of time. Then talking about Nordic breeds, make sure that you tell the owner that if you need to shave. One of these breeds, anywhere on the body.

The hair may not grow back for months. So if these are show dogs, you can imagine how much the breeder and the owner will be upset because the hair, it's not growing back for months. I mean, this dog was presented to me because the owner was questioning why the hair was not growing back following, clipping, to do an abdominal ultrasound.

Well, I told you that that was a breed that was showing a prolonged hair cycling. So we were going to wait for the new hair cycle, and that will take between 369, 12 months for the hair to grow back. Standard poodle.

This is a breed that is commonly affected by a condition sebaceous adenitis. It's not something uncommon, but I have seen a number of these patients where a colleague in practise were starting to test the thyroid, doing all sorts of medicated baths. Starting on thyroid supplementation.

And this particular dog, had been on thyroid supplementation for a long time without making any difference until I diagnosed aba adenitis. And then eventually this dog regained a good acceptable coat. And then, this is something that is quite interesting because there are some women that during the menopause, they may be using some cream containing oestrogen, and usually they apply the cream on the legs or the arms, and then they pick up the dog.

Or the dog is sitting on the owner laps. And then the dog eventually comes in contact with the oestrogen that has been applied on the owner body, and they will absorb the oestrogen and day after day after day affects the hair cycling. So this was a dog that, Was, used to sit on the owner laps.

And when I discovered that the owner was using the oestrogen cream, I told you I had to stop applying different part of the body. And then eventually the hair grew back and so the coat grew completely back. Now, these two particular cases are part of of an article which just came up on, in practise.

So if you'd like to hear more about the story of these two dogs, I mean, feel free to look at the full article that has been published this month. And so you can read, these two dogs story plus 2 other more, and I think you may find it interesting. And also you may probably be learning how to better use, hormonal test when presenting, presented with dogs with alopecia.

Let me just tell you another couple of cases in this last, few minutes. The first one is a Labrador. This was a Labrador that was 2 years old that was presented for this, symmetrical bilateral flank alopecia.

By now, I'm sure that you're going to say, oh, I know what it is. It's the classic pattern of alopecia. Yes.

But unfortunately, this dog, as you can see from the history, Went through a long process of, testing, treatment for ringworm, more treatment for ringworm, more, For a number of months, because probably the colleague that was in charge didn't know this condition. So just thought that probably was a localised type of ringworm. And then even more, this dog had gone through all sorts of blood tests.

To look at the folate, cobalamin TLI haematology, biochemistry, T4, . So all of them were normal, so there was no abnormality. But then, unfortunately, this dog, as was not growing back to the fur, went for further tests like ACTH steam, low dose dexazos.

Think about how much money has been wasted in this dog from the owner, from the insurance. Because they were all normal at the end, but then if the colleague had known that the hair will grow back anyway after a few months, it was just a question to wait. Then a lot of money and time could have been saved.

The next interesting case, I hope it's this one, it's Max. Max was a Tibetan terrier. When I saw Max, he was already 10 years old.

And as you can see, it was presented with, quite a dramatic type of truncal alopecia, which was affecting, the whole body. Also the neck, the ventral chest, the thighs, but what is important from the history, if we go back for a second, is that this dog was entire. And you can see that the testicle, the scrotum is here.

But what happened to this dog? This dog was presented. These are all cases.

And the reason why I'm presenting these old cases probably because whoever was in charge of this patient perhaps has forgotten, just in case it's one of you guys that are watching this webinar. So nobody hopefully will be upset if I'm presenting these cases. I mean, this dog went through a lot of tests.

More or less, they were normal. The thyroxine was low. The cortisol was OK.

So I think it was making sense to supplement with thyroxine. But The dog suddenly became probably manic, overactive, so the thyroxine was reduced to once daily. Yeah.

There was some kind of hair regrowth, but then most of the chest was still bald. The thyroid supplementation seems to be in the normal, range when it was tested. Well, despite that, then the Sooxin was slightly increased, but only once daily.

Then the alopecia was still there. Tyroxine this time was slightly low, but I'm not sure about the timing. It was, sampled after for 6 hours for post pill.

But then anyway, the saloxin was increased. This time, the thyroxine seems to be adequately supplemented. Then probably the colleague said, OK, let's try to supplement.

Perhaps we should measure other hormone and see if there's something else going on. Let's do up an ACTH steam. But then this was normal.

So I guess at this point, the colleague didn't know what else to do and then referred to me. But when I looked at Marx, and I saw that it was intact. And I touched the testicle, which of course was, they were not completely abnormal, but I felt that probably we will need to know more about the testicles.

I said, let's go for an ultrasound. So both the adrenals were normal. But the problem was with the testicles.

There were 3 nodules in the right testicles. There was another nodule in the, 2 nodules in the left testicle. Then there were, the dog was castrated.

The testicles were sent for histopathology. And we found that this dog had an interstitial cell tumour. Now, it's interesting because the interstitial cell tumour normally will produce testosterone, not oestrogen.

But perhaps, who knows, this dog was affected anyway by the abnormal hormonal changes produced by the, testicle. I told you I had to stop the thyroid supplementation because I I really wanted to know if the dog, Hair loss was caused by the testicular tumour on the thyroid or bones. So the dog was OK, 3 months after castration, but unfortunately, the head has not regrown back.

So I said, OK, now let's look at the thyroid function, but let's do a proper Thyroid panel. So I did T4, TSH3 T4 by equilibrium dialysis and Tyroglobulin antibodies. Well, definitely the T4 was low.

The free T4 was also low. So no doubt that this dog was hypothyroid. So I told you, well, this dog also needs thyroid supplementation.

Now, restarting the dog on thyroid supplementation, who knows? And also, after being castrated and probably took longer for the, hormones, in the body, To be metabolised, then eventually the dog regrew back some code. The pictures are not high quality because these are pictures sent by the owner to me by email, probably using their phone.

But you can see that the code and somehow regrown back was not probably beautiful, but at least was acceptable. So, what I hope you have learned about this webinar tonight is that it's extremely important to do a very good, history. Take a good history, in addition of the general and dermatology clinical examination.

Remember the breed-oriented approach that we use nowadays for many conditions in many discipline, breed predisposition to certain conditions. And then make sure that you do a very good dermatological examination, look at the area of the body that are affected, do the routine dermatological tests that you think are the best to be done. And then rule out the most common causes of alopecia.

Because if you are dealing with the most complicated one, nobody will blame you for not, properly diagnosing it. You better refer. The owner will be happy.

You will probably be even happier and you can deal with probably many more cases rather than spending a lot of time. And try to figure it out what's wrong, what's the next step, and so on. Don't rush in doing biopsy because most of the time, biopsy may not be very helpful.

There are some conditions where a biopsy may be helpful, but perhaps you may, you may want to leave to the dermatologist to decide when a biopsy needs to be done. I mean, even, myself, who just does dermatology, I still do biopsy, honestly, once in a while. But I see that quite commonly colleague in practise will biopsy any dog coming through the door with skin issue.

That will be just a waste of time and money for the owner and insurance. Well, I hope this webinar was impressing and, probably when you go back to clinic the next day, you will be. Feeling more confident in dealing with dogs with hair loss.

So, by the way, this one was a Rottweiler. Rottweiler presented with congenital alopecia. Somehow, for some genetic problem, this dog had developed or was born hairless.

And unfortunately, he grew up, but was still bald. So, I'm not sure if there are any questions, and I'm asking Bruce now for help or if you have any question and you watch this webinar later on, at your leisure in the future, you can always email the webinar. And they will forward me the question.

I'll be happy to, help any time I can. You have my email address on the first slides. If you have any questions, if you have anything interesting that you want to share, I will be very happy to help.

I hope you enjoyed it. Have a good evening or good day whenever you are going to watch this webinar. Rosario, thank you very much.

That was really, really insightful and a really nice logical approach to, dermatology, which I think, most of us get, a little bogged down in, in, as you said, you know, jumping to biopsies and that sort of thing without taking that step back. So your approach was absolutely fantastic. I have to be honest with you, not in a million years would I have called that a Rottweiler.

So I've, I'm glad I didn't take any bets on what greed it was. Thank you, Bruce. Thank you for your comment.

We have no questions. I'm sure people like myself will think afterwards, oh, but what about this and what about that? So thank you for your very kind offer to email those questions through to you and, anybody that is watching this, tonight or Recording, as Rosario said, if you've got questions, just drop them into Dawn at the webinar vet and we will hopefully then be able to get them through to Rosario and in not to just a long delay, get those answers to you.

But Rosario, thank you so much for your time tonight. I really appreciate it. And to everybody who attended, as well as Dawn, my controller in the background, thank you for making everything happen seamlessly.

From myself, Bruce Stevenson, it's good night, everyone. Goodbye everyone. Thank you Bruce.

Thank you, Dan.