Good evening everybody and welcome to another in the dermatology series. My name is Bruce Stevenson and I have the pleasure of chairing tonight's session. I don't think we have any new people in tonight, but then if we do, just a reminder, if you want to ask our presenter a question, simply just click on the Q&A box, type in the questions, and they'll come through to me and Hillary has very kindly agreed to answer all those questions at the end, but we will hold them over to the end.

So Hillary graduated from the Royal Dickwit School of Veterinary Studies in Edinburgh, where she later returned to complete a residency in veterinary dermatology. Since then, she has worked in academia, both at the University of Bristol and North Carolina State University. And she is now in private practise at the dermatology referral service in Glasgow.

She has a specific interest in canine atopic dermatitis. And adverse food reactions and he's a member of the International Committee for atopic Diseases in Animal. Hillary, welcome back to the webinar vet and it's over to you.

Thank you very much, Bruce, and welcome to everybody that's sitting down and listening to me tonight and wishing they were outside in this lovely weather. For those of you that have sat the whole thing out, we're now at the tail end of these lectures, having done ears, paws, noses, and now we're at the back end. So, We're going to approach this, the caudal end of the animal in a problem-oriented approach.

And first we're gonna look at pruritus. This is mostly dog oriented. It's not something we see generally in cats, but I'm gonna touch on a couple of feline conditions.

So first of all, we're gonna start with pruritus. So pruritus in the dog usually manifest manifests as biting, nibbling the perianal area or the tail base area. They often scoot or rub, and you can also get some dorsal lumbar pruritus, which might be referred from abnormal sensations around the perineal and perianal area.

So what differential diagnosis should we consider when an animal presents like this? Well, the obvious one would be an anal sacculitis in the dogs, and I'm not going to talk much about that. These are dogs that develop either don't empty the anal sacks properly, or they develop an infection there, you empty the anal sacks and the prices and scooting behaviour settles down.

I'm gonna focus more on those animals that don't settle down when the anal sacks are emptied. The differential diagnosis we should consider would be some parasitosis, such as pre-allergic dermatitis. Certainly with the dorsal pruritus, I would also consider calatiella.

It's also important to consider those dogs that scoot might actually not have perianal problems, but they might have some perivolval, problems as well. And those could be some irritation or perianal infection, secondary infections or secondary colonisation. It's a recognised manifestation of both food allergy and atopic dermatitis, which we're gonna consider as well.

And not to forget that with these brachycephalic breeds, which might be blunt in the noses, but also blunt in the tails, tail full dermatitis is also a specific differential we need to consider. So what should we consider? Well, I think there's some important rules out, and if, as we said, you need to consider if the anal sacks are emptied, which is the obvious thing to go for, does this improve or negate clinical signs, because there are some dogs where When you empty the anal sacks, the scooting behaviour completely resolves.

However, I see a lot of dogs where it doesn't. It either improves it slightly or they don't improve at all. And the other important thing to do is ensure that the dog is on adequate fleet and tick control because it's very easy to miss flea parasitosis.

Particularly in Scotland where, we don't get the best weather usually, and people tend to think that fleas don't exist up here or they're very sporadic. But flea control, adequate flea control, I'm not gonna go into this in great detail, but it does require either monthly or 3 monthly depending on what product you're using. Flea control on all animals in the household and also if you've had a flea infestation, then the household needs to be treated as well.

So those are the important rule outs and now we're going to consider some of the other differentials. So we're going to do this on a case-based session tonight, and we're gonna look at case one, which is a 10 month old bulldog, and here she is. This is Casey, and she was very happy to be in the clinic.

I can see she's got a lot of skin faults and she was really scooting around on her back end. And this was getting to the point where she was actually doing, when I was talking to her owner, she was rubbing and she was burling around on her back end whilst I was talking to the owner. And you can see that she, her, tail fold area is really quite, deep.

So what are differentials, well, oh sorry, so this is the typical area that we look at. This is a very deep facial fold. I think all brachycephalic owners need to be educated when they get these animals to clean these folds, and the wipes we have available nowadays are great for that.

CLX wipes or or yo wipes, whatever you're using. But these areas, just from the nature of the introgenous or skin fold, they will fester with malacio, bacteria. It's a great culture plate in there, so they need to be cleaned.

But I think what's overlooked is the other end of the dog, and here's the other end of the bulldog I was talking about. And this is a cotton tip. Can you see how far into that half the cotton tip actually goes into the deep tail fold area that this dog had.

And when we did cytology from that, you can see the numerous bacteria and degenerate inflammatory cells in this area. So this dog was actually suffering from a really deep fold, tail fold dermatitis. I haven't mentioned that this dog will not countenance you looking or touching her back end.

We had to sedate the animal to do this, get the samples. And to instructed the owner who had young children, and I'm mentioning that because she said the animal, the dog was actually 10 months old, was getting quite aggressive and biting anybody that touched that area, and she certainly wasn't very happy about me looking at the back end. And I was really concerned if the owner had young children that this was going to be a problem.

However, the owners insured me that she could, the dog would let her do anything, and we, . Advised that this area be cleaned. Now, how are you going to do that?

Well, it really depends on what the dog and the owner can do. So you may have this situation on the right hand side, where the dog is absolutely not wanting a bath. And I must admit I got this one off the internet, I thought it was great, and the dogs absolutely love a bath.

I usually sit down with my clients and have a really good discussion about, you know, this is what we need to do. We need to treat the area topically. Are we going to be able to use a shampoo, such as the pio of shampoo and Mala, can you do that effectively, can you do that 2 or 3 times a week, or is it going to be easier to use something like a wipe or to fire foam?

Which has lorhexine in it to clean the area. Sometimes it's a combination of the two, so you may be bathing the dog a couple of times a week and using the foam of the wipes in between times. Certainly for a tail fold area, these wipes, be it wipes the ducts of pile wipes or CLX wipes, they're great for getting in areas around the face and around the tail fold.

And I have to report this particular case, came back to see me after 3 or 4 weeks and she was doing great. She stopped her. Now the, the owner had been instructed on how to clean it.

She was actually doing really well, and this is going really well at home and there was no problem there. So case two, this is a 4 year old Jack Russell terrier, which, presented with a perianal pruritus. And he would scoot around and you can see the erythema here under his tail, around his perineum.

No improvement with empty anal sacks, and he had a non-seal pruritus. He was also licking his paws. So our differential diagnosis included atopic dermatitis and adverse food reaction for this.

And this, as I said before, is a common manifestation of atopic dermatitis or concurrent food reaction. And to back that up, here's the publication for your interest, which is in the veterinary dermatology magazine. Journal, and they looked at perianal pits in 250 dogs with skin disease, and these were dogs, where anal sacculitis had been ruled out, and they found the majority of dogs with peralitis had atopic dermatitis or adverse food reactions.

But the important thing is you could not be used to differentiate between these, so just because they're rubbing their bottoms or licking or biting around that area, you couldn't necessarily say that this was related to food. It could be either a food or an environmental component that was allergen that was causing the reaction. So how do I work these up?

Well, it's important to do skin surface cytology because these often get secondarily infected. If you think about this, it's a skin fold and skin folds often get secondarily infected with either bacteria or malacasia. And in this case, we did cytology and we're able to demonstrate malaesthesia.

So our plan was to initiate topical therapy daily, probably with some wipes or some foam. And as an initial approach, we would institute a diet trial to rule out food allergy prior to investigating environmental allergies as well. So I'm not going to go into great detail here about food allergy allergy workup.

Suffice to say, sorry, that's the cytology from the dog. Suffice to say that to to make a diagnosis of an adverse food reaction. You need to demonstrate some improvement either with a limited antigen or a hydrolyzed diet, and for how long, well, a critical evaluation has recently shown that probably 6 weeks minimum for a dog, and I would usually go somewhere between 6 and 8 weeks.

And you need to document relapse and challenge, and that's really important because you might start your diet trial say in September. Well, in September in Scotland, we're going into October, November. There's a seasonal change there and if you see some improvement, that might be related to seasonal change due to decreed environmental allergens rather than a response to your diet trial.

So it's really important to document your relapse and challenge. No diet is ideal, so it's a question I've, I'm often asked what to use. It's really important to take a very detailed diet history.

There are issues with owner recall about what the animals being fed, and you may only get one. Owner in the consult room with you, and there may be multiple people involved in this dog's care, like the, dog walker or family to look after the dog when the owners at work. Protein contamination, it's recently been shown that many diets are recommended, and these are novel protein diets recommended for use in food trials are actually contaminated by foreign proteins, which are not on the label.

And it's also important to consider cross reactivity of proteins. So for example, if you dogs on a chicken-based diet, then I would not use a turkey or duck-based diet for my food trial, as there is some cost or activity between proteins, poultry proteins. Home cooked diets, well, these avoid additives, they might be better accepted by the pets, but they do require good client education, and they have been shown to be associated with poor compliance.

I like food, . Cooked diets, it's not something I use all the time, but if the dog is already on a home cooked diet, then we will discuss with the owner using alternative proteins and carbohydrates for their, their dog's diet. Hydrolyzed diets if you're going to use a commercial diet, are currently the gold standard, and yon c cannon and allergenic, would would probably be the gold standard for me.

This is a chicken feather hydrolysate, but it has been shown that, a small number of dogs, but 10 dogs with confirmed chicken allergy. We fed this royal canon diet and did not react whereas those had CD Ultra. Which is also is a chicken protein hydrolyzate, 40% of them develop pruritus.

So I think it's important to bear this in mind. They are more expensive and some dogs won't eat a pure kibble, but if that's what I was going to, to use, then angenic would be my choice. With regards to the novel protein diets, just briefly I said consider protein cost reactivity.

If they've been on a chicken-based diet, don't go for a duck or turkey diet and rubinants. We're going to avoid, beef, lamb, and milk. So getting back to case two, our 4 year old Jack Russell, he had a poor response to the diet trial challenge, which leaves us with by process of elimination with a diagnosis of atopic dermatitis.

Now I'm not going to get into a discussion about a management and treatment of atopic dermatitis, but certainly in my practise, we were, talk to the owner about considering some sort of allergy testing, and I practise intradermal testing, or possibly serum allergy testing. And that's with a view to putting in the dog on allergens specific immunotherapy. I know.

There are a lot of allergy treatments out there, but bear in mind this is the only treatment which is effective at modulating the dogs or any animal's response to allergens, . So it, it has been shown to modify the or down regulate the response to allergens in dogs that respond and it's a safe long-term treatment. OK, we're going to move on now to the non-re alopecia of the tail end and here specifically we're talking about the tail.

So we're going to look at a number of cases here, and I'm going to present the cases to you, one by one, and then we're gonna go back and have a look at them. So case one was an eight year old border terrier, and she presented to me with an 8 month history of progressive alopecia of the tail, which is non-pre and you can very clearly see the alopecia on the tail. She didn't have too many other clinical signs, and seemed otherwise well.

Case 2 was a similarly aged Labrador. Now, he had more systemic clinical signs. You can see he's a little bit overweight.

He's got some hypotrichosis or hair loss. Some hypertrichosis and hair loss over his nose and a very alopeciic tail. And case 3 is a 6 year old spaniel, which has a generally poor hair coat, but here's his tail.

The owners are concerned that he'd lost the feathering in his tail, and it really does look quite sparse for a spaniel. If we look a little bit closer, you can see that some excoriations here. And clip, this is clipping the area.

Now it's really important to clip an area of affected skin so you can actually see what's happening underneath the, the thick or not so thick otherwise hair coat. And if you have a look closely, you can see this is really scaly. And you can also see that the scale is adherent to the hairs here.

And this is a close up, a slightly different hue, but you can see these little areas on the hairs, and these are follicular casts. So what this tells me is that there is something going on in the hair follicle. It's not specific for a disease, but it tells me there's a disorder in that hair follicle.

But the follicular cast represents caratous sebaceous material that is sticking to the hair as it comes out of the hair follicle. Case 4, it's a 3 year old can terrier, and it's got alopecia of the tail tip here. And case 5 is a 3 year old labrador, similar age, with some alopecia along the tail, which is a little bit scaly and thickened.

Right, so what's that differential diagnosis in general for a non-critic alopecia? Well, I would consider demidiosis. Any sort of follicular disease, you should have the inflammatory follicular disease on your list.

So dermatocosis lives in the hair follicle should be on the list. Domatophytosis, like some invade the hair follicle, should be on the list, and a bacterial folliculitis. So these are the three things that I would really want to rule out in any sort of alopecia scaly.

Hair loss condition. That hypothyroidism can cause fail failure of hair regrowth, hyperadrenal corticism, so these are endocrine diseases. You've got a condition called sebaceous adenitis, which we'll talk about a bit later, and some sort of vasculitis which is causing ischemic damage to the hair.

So the diagnostic tests that I would perform based on that differential diagnosis list would definitely, definitely include skin scrapings we want to make sure Demodex isn't an issue. Trichograms to like Demodex as well because sometimes you'll find Demodex mites more on the skin scrapings, sometimes more on the trichograms. We should look formatophytes that might include a culture, PCR or wood lamp, and we'll discuss the pros and cons of those.

If we're considering considering endocrinopathy, routine bloods might be indicated. And finally, and finally skin biopsy. Now skin biopsy is something that I don't do very commonly, and it's really only in those conditions where I've Work through my list and I'm wanting to diagnose or rule out something specific.

It's not a very useful procedures to do, say for example, if you've got pratic skin disease, it may be more useful in this situation where we've got an alopeciic skin disease. So case 1 and 2, well, we've got these two animals with alopecia of the tail. Well, these animals ended up being diagnosed as hypothyroid.

Now that's an interesting condition. The hair loss, what the thyroid, hormone does is it initiates hair regrowth. So you first see hair loss at areas of wear.

So you can see them on the tail where they're sitting on their tails. You can see hair loss around the collar. You may see it as an area where the animals being clipped and their hairs fail to regrow.

So those are the, clinical signs, this cutaneous clinical signs that make me suspicious of hypothyroidism. Obviously there are other signs like, I mean our Labrador here, he had some. Other hair loss, he had some weight gain, he had some hair loss of his nose, it might be highly suspicious.

And if you've got some lethargy and other clinical signs, obviously that would make you index suspicion for the diagnosis higher. The border terrier, however, just had presented with this alopecia area on her tail, and she really didn't have much else in the way of clinical signs, so I think this was an earlier case of hyperthyroidism. Our diagnosis would be confirmed and I always run routine bloods first to screen for these animals.

And if you're in a hyperthyroid animal, I would expect to see possibly a non-regeninemia in about 40% of cases, elevated CK, hypercholesterolemia or hyper triglyceridemia. And you get might get some mild elevations of liver enzymes. Now you're not gonna get all those abnormalities in these cases, but that's certainly that pattern would make me, along with the clinical signs would make me suspicious.

As a routine for the hyperthyroidism, I would run a total T4 TSH. And some anti-thyroglobulin antibodies. And so if you've got an active thyroiditis, your anti-thyroglobulin antibodies should be high.

A total T4 in most cases, is sufficient along with the TSH. I would only run a free T4 if I was, there were some other factors, that would make me. Concerned like the dog was hypoalbuinemic, or there were some other dogs on board which might affect my total T4 levels.

I'm willing to discuss that in more detail if you wish. But these both these dogs responded well to thyroid replacement therapy. Case 3, well, this dog we biopsied and this is a case of spaceous adenitis, and this is a disease that it's an immune mediated attack on the spacious glands and you actually get complete ablation spacious glands by an inflammatory process.

And we see it, the breeds that are affected tend to be Akitas, they tend to be, Poodles, but we do see it, quite frequently in this country, spaniels. Treatment, they, because of the disruption to the follicular area and destruction spacious gland, they often get secondary infections. So you need to control the secondary infections with topical antibacterial treatment agents.

They generally respond to oral cyclosporin. And it's also important to give them oral or topical essential fatty acids to replace some of those oils that have been lost in the inflammatory process. Cbolytic shampoos, and these are shampoos which will actually lift the scale of the coat, are important.

In those cases that are refractory to cyclosporin and vitamin A might be helpful. And that is not they're not saying they're vitamin A deficient, vitamin A acts like a a modulator of epidermal turnover and spacious land activity and can be useful in this situation. This is generally a lifelong treatment for these animals and .

You may titrate the treatment, so you might start with cytosporin daily, but in my experience, sometimes they can be maintained on a a pulse dose of cyclosporin long term. But case 4, this was a little bo area that had a bald tail. Now this is ischemic damage and what's happened here is the blood vessels have been damaged by an inflammatory process and that's actually, but it's been a slow damage and what's happened is you've got hypoxia to the hairs and it's actually destroyed the hair follicles themselves.

And this dog also had some lesions around its face, which are very similar to the one I showed, showing here on the Sheltie where you've actually got this butterfly passion pattern of what we call sickotricial alopecia. So the slow anoxic damage in the blood vessels has caused anoxia to the hair follicles and secondary alopecia. Which is permanent.

This is a condition called dermatomyositis, and the tomato part is the hair follicle damage. It's caused by a vasculitis, but they can also have varying involvement of muscles, and the classic breed that's affected with this is the rough collie or the Shelty. And we don't see it that often, but they often develop these skin lesions around 4 or 5 months of age, and in severe cases where they've got pronounced muscle damage, they can also have problems with mastication or walking.

The can terrier that whose tail I've got here presented to me around 5-6 months of age with the classic cutaneous lesions, but she also had some problems with ambulation and was unable to jump up on things. This is confirmed by a skin biopsy where we can develop demonstrate the ischemic damage. It's a condition that in my experience, unless they're really severely damaged, often improves with age, and in fact the skin terriers now offer any treatment for dermatomyositis and just had some permanent alopecia at the end of her tail.

But it can be quite severe in the younger animal less than 12 months of age. And requires treatment, often they'll respond to immuno expressive doses of prednisolone and sometimes we'll add pentoxihyin in which's a realological agent which improves circulation through the blood vessels and can help to improve the the clinical signs in these animals. I just put this in cause it's another example.

This is a cat that presented with some vascular damage. We don't know what has happened to this cat. Oops sorry.

But you can see the tips of the ears, the nose, the tail, lost the tail completely, vascular damage, it's more pronounced at the extremities of the animal. So by the time this cat presented, we didn't know what agent had actually caused the problem, but clearly it was some. Sort of damage, insult on the vascular system.

Case 5, well, this scaly tail ends up being a case of dermatophytosis. Now, dermatophytosis can be you can microscoum or, or trichophysin infections. Confirmation, well, there's various things that we can do to confirm a diagnosis of dermatophytosis.

The gold standard, would necessarily be culture where you would actually put it on tomatify test medium or sabrosdextrose and demonstrate that you've got this fluffy white growth and you could speciate that by taking samples from the top of that and looking at the back of chydia. Adjunctive, treatment, sorry, diagnostic tests would be the woods lamp. Now remember that the woods lamp is pretty effective in picking up cases of microsorum infection in dogs and cats, and where it's not been affected, it's been shown to be really more technique than actually .

The, the species of fungus itself, but it won't tophyte and infections will not fluoresce or other types of fungus. This is an example where we've actually looked at the hairs under the microscope where you can demonstrate the arthrospores in the hairs. And this is a biopsy where you can very nicely see the the spores as well.

And you can actually see in this case, you can see the hyphae in the invading the hairs as well. OK. Now, these were the sort of Traditional tests.

Now we've got fungal PCR that you can do. I think it's important things to say about fungal PCR, it is very sensitive and it can be too sensitive sometimes. So remember that if you've submitted a sample for fungal PCR.

You need to pluck hairs from the affected area. And It will quite nicely pick up lots of infections, but it can also pick up contaminants. So it's important that you look at the results in context of the clinical presentation and whether that's relevant to the case.

And I think in that respect, I think it's more useful for diagnosis than monitoring treatment because the problem with monitoring treatment is that you repeat your PCR. Remember, it can also pick up a dead fungus, so, you're not actually knowing whether it's an active infection or an infection that has resolved. Typically, treatment for dermatophytosis would include both topical and systemic triazoles.

So you could use something like myconazole shampoo or Dexopyo shampoo, something of that nature. They contain myconazole or climbazole or enoconazole dip. We would recommend that you dip the whole animal or shampoo the whole animal because they're probably carrying fungal spores elsewhere in the body.

And also systemic treatment with the triazoles, the currently recommended or licenced product for dogs would be ketoconazole, which actually in my experience is not that great for dermatophytosis. I would prefer to use itraconazole. But, that's going off label.

But treatment would be continued for a period until you've got clinical resolution which may be about 6 weeks. Depending on the severity of the lesions. OK, so we've done alopecia, we've done pruritus, now we're going to look at ulceration.

Now, for those of you that were with me at the nose lecture, we did consider some of these differentials for the nose. I'm gonna start by looking at peralpal dermatitis. Now I, I know we're talking about the tail end, but I've certainly seen dogs that have been presented for looking around the back end, and they've actually had some perialal female dogs who had perivolal rather than perianal irritation.

And this is often a very uncomfortable and often painful condition if it's ulcerated. And in chronic cases, we've certainly seen pseudomonas species involved very much like some of those spaniels get pseudomonas infections in their lifold dermatitis, . Certainly, I would recommend doing cytology from these cases.

You want to know what sort of bacteria or yeast are involved, and it may be if you're suspecting a gramme or there's evidence of rods there, you might want to do a culture as well. The differential diagnosis for this, well, this could be as straightforward as being an intertrigo or confirmational problem, and certainly we see this problem in overweight bitches where they've got a deep skin cold and it's just getting us, . A manifestation, and, of that confirmation problem.

But it can be if they've got skinful dermatitis that can be a issue exacerbated by atopic dermatitis or adverse food reaction. With the mucuscutaneous ulceration present, we might want to consider primary ulcerative diseases such as cutaneous lupus or erythema multiloma. It's also worth considering that there are complications of chronic perialgal dermatitis.

You can get ascending urinary tract infections or if there is significant ulceration present, then dysura can also be a clinical sign. So, as I said before, cytology, we want to treat the secondary infections, often with topical agents, and that's gonna depend very much on what we see there. If you treat the secondary infections and you get complete resolution, then this is probably a mucuscutaneous derma, and it may be related to some confirmation problems into trigo.

Some of these do require surgery to ablate the skin folds. But if the erosion or ulceration persists, then you might want to consider some of these primary ulcerative conditions, such as we're going to get to go on and discuss, and these would warrant a biopsy. And obviously if there's UTI signs, you want to just take a urine sample, and in this case, you would want to perform a culture by cystocyesis to avoid the bacteria associated around the ulva.

So, just to move on and I'm, I'm sort of considering the vulval area along with the peroneal ulceration in some of these conditions, but due to the body sight, bacterial contamination is inevitable around the anal area. And it's, but it's often important to, minimise this involvement before you were to do any biopsy, because many of these diagnoses that we're going to talk about rely on histopathology, but you don't want the bacteria there because they're going to any inflammation associated with the bacterial colonisation or infection. It's gonna draw in a secondary inflammatory process which is really gonna mask your primary pathology.

So it really is imperative to treat bacterial colonisation first before you consider doing any sort of further diagnostics. OK, so case one, a 6 year old German shepherd dog, and I'm sure you all recognise this condition. Oh, we're jumping to case 3.

Sorry, I'm not sure what count to case 2, but this is a 5 year old crossbred. You see some, mucusanous ulceration around the perineum. And another German shepherd dog with some ulceration, again, around this site.

So what are our differential diagnosis here? Well, perianal ulceration. Consider acutaneous pyoma.

We discussed that in our previous lecture on the noses, becutaneous lupus, again, we've discussed that, but we'll just touch on it here. German shepherd dog, anopharylosis, and then there's a condition called erythema multiforme, which can also cause muccucutaneous ulceration. So, my first step, as we said, would be cytology and you want to do appropriate antimicrobial treatment, .

And often what you'll see are a lot of cockey rods, which may be faecal contamination, but they warrant treatment and here we've got some degenerate inflammatory cells as well. Our usual approach is to institute fairly intense topical treatment. So you might use something like Clorhexine washers, .

With hippie scrub or shampoos or wipes or a combination of those until we get these, this under control. So this German shepherd dog, and clearly this is a case of anal ronchilosis, and we do see the, a few of these and they tend to be quite severe. Secondary bacterial colonisation often complicates recovery, and I think it's, it's easy to say, well, that's a ronchilosis, therefore we need to put it on cyclosporin or some other immunosuppressive agents without considering the fact that you've got some bacterial colonisation or active infection there.

Just remember, if you're going to use an immunosuppressive agents or immunomodulatory agents, they're not gonna be very effective if there's an infection present, so you need to get infection under control as well as your immunomodulation. This is an interesting disease and it's thought to be, many people think it might be related to Crohn's disease in people. And often these dogs have an associated colitis, .

And it might be worth addressing their diet. We do put these dogs on elimination diets and in these cases I often use a hydrolyzed diet and I think that's an important part of management. An anti-inflammatory treatment, the mainstay of that currently would be oral cyclosporin for a case as severe as this.

We would look to treat these with oral cyclosporin. For 23 months, whatever it takes to minimise these lesions and get them under control, and then we might add in topical tacrolimus, which is another cycle, calcium urine inhibitor which can be used topically. And once you've got these dogs under control, you can often maintain them with topical treatment.

But don't forget about that topical antibacterial washes or antibacterial treatment as well, because it's really important to keep this area clean and minimise contamination with bacteria. Right, so case 3, case . This was a case of erythema multiforme.

Now erythema multiforme is quite an interesting condition, and it's a condition we see in people and in people it's usually associated with the herpes virus, not herpes virus infection, but herpes virus particles itself, and they can create this immune mediated reaction. Which can be persistent and can cause ulceration. Severe cases can be associated with drug eruptions.

Now, certainly the cases we see in dogs can vary from very mild lesions affecting the head skin. To nucleotta's involvement, such as we see here where you've got the perianal ulceration and really severe involvement around the lips and the oral cavity. So this would be more consistent with the human counterpart of Steven Johnson's syndrome, which is considered a really severe life threatening reaction, .

And in this case, certainly in dogs where it's been looked at, the more severe the reaction is, and you've got a lot of muccutaneous involvement, then it's much more likely to be associated with drugs. The milder cases, we really don't know what causes those. So the diagnosis would be confirmed with both the history and biopsy findings and in this case, we would see an interface dermatitis, but you can see apoptosis occurring in all levels of the epidermis.

Now it's important to take a thorough drug history. Now, when we're talking about drugs that might be recent antibiotic use, it might be. Drugs that they're on for joint pain, but do remember that flea treatments, vaccinations, worming, anything that's used prophylactically can also be considered as a potential initiator of this disease.

So you need to withdraw or change any previous treatment. And the mainstay of treatment, they generally do respond to immunosuppressive doses of prednisolone, starting at 2 milligrammes per kilogramme and tapered to effect. So it's certainly the cases I've seen.

Do have an indolent course of action, and they do tend to flare up from time to time, and I do think that in in some of these cases, they are a chronic disease which is can be sometimes quite difficult to control. Now we considered muscutaneous lupus. Remember when we were talking about the nose, and so I haven't got any noses here, but you've got the periocular perilabal lesions, and we discussed that these could also have some peranal and periggenital lesions as well.

And just a reminder, there's been a publication looking at these cases, remember that at least half of these dogs were German shepherd dogs and The bacteria are commonly involved, often as secondary infections, but I certainly consider that the bacteria may be a player in the pathogenesis of this disease. Maybe there's some bacterial antigen that is involved in stimulating the the persistence of the lesions. But our diagnosis relies on no or any partial response to appropriate antibacterial therapy.

Biopsy, remember, we're gonna biopsy those. We want to look at the lupus, compatible histopathology, and these two responses to respond to immunomodulation, but it's also important to institute topical antimicrobial treatment too. And I haven't mentioned a cat.

So we've got two cats' tails here, . So tail pruritus, well, major consideration, the cat would be flea allergy dermatitis or other a parasiticide. Also adverse food reaction, atopic dermatitis or atopic syndrome, which is sometimes called nowadays, or another parasite, demodex gato, which we don't see very much in this country.

A demodex gao is a demodex that we see in cats which causes pruritus, and and usually that can be contagious, so you might see multiple cats in the household affected with Deinex catoid. It's much more common in the southwestern United States than certain parts of Europe. So case one, this is a 4 year old domestic short hair and she's got some mi lesions along the tail.

So my primary differential diagnosis for this would be an ectoparasytosis. And if you look carefully, you've got some self-induced alopecia and these little focal excoriated papules. Which is important because we'll look at another tale in the minute, and it looks quite different.

So my dear friend, my diagnostic approach here, we want to do coat brushings and skin scrapes. But remember, if your cat is over grooming, and, and then it's most likely removing the evidence, the ectoparasites, so you know maybe not find the fleece or Kalla or any parasite you might be looking for. So one trick might be to do a faecal flow.

Sometimes we'll see the parasites on the in the faeces, or we might just want to see whether we've got a response to parasiticides, and we touched on that at the beginning of the lecture. Important to do, treat everyone in the house and make sure you treat the house as well to rule out fleas. Somillary lesions, they can be associated with either fleas, food, or, atopic dermatitis.

Although those reaction patterns in cats, are not very diagnostic, with regard to what's causing the problem, probably the millary lesions are the one that is most tightly associated with actopparasiticism. So I would certainly want to like act parasites in this case. The second case, this is a, 10 year old, Persian cat.

Can you see how it looks a little bit different here? This is an inflammatory tail gland hyperplasia. Now the tail gland is an area of modified modified sebaceous glands, which in the cat actually extends all the way along the tail.

And these spacious glands, act as, are under androgenic, hormonal influence. They can become infected. You can get demodex involved as well as well.

It can be very painful condition and this cat didn't really like its tail being touched. And can you see there's quite a lot of fibrosis and scarring along this tail as well. So it's been repeatedly secondarily infected and inflamed and it's become quite a painful tail.

So in this case, you want to identify any secondary infections, and it would definitely benefit from some anti-inflammatory treatment as well. You'd probably want to evaluate the cat for anything that might be causing excessive grooming, any intercurrent problems. It's said that these tail gland problems can arise in cataries where you've got, entire male cats that are a bit bored.

But certainly the cases I've seen have been in, just household cats, whether it's not been necessarily any behavioural factors. And we do see it sporadically, but just something to look out for. Canine tail gland hyperplasia, again, it's quite common.

This is an area which is a little bit different from the cat. You've got the tail gland just in the proximal third of the tail. Again, modified spacious glands.

There are two examples here. They're often quite swollen. I've had clients come in and say they're worried about the swelling on the dog's tail thinking it was some sort of neoplasm, but it's just been the area of the modified spacious glands which become hypoplastic and alopecia.

Here's an example where the tail gland has actually become quite nastily infected. This area is clipped up, you can see, the area that's involved. Interesting that the tail gland, as I said, it's, under angiogenic influence, common change in entire male dogs where you may see tail gland hyperplasia, just from chronic angiogenic stimulation.

But if you've got an intact, a male, sorry, a muted male or female, just remember this can be associated with hypogenic corticism where the, affected adrenal gland is actually producing. Not only hypercortisollemia, but it does, produce, steroid intermediates, such as androgens which can cause hyperplasia of the tail gland. So we often see that in the context of hydrogen, of course.

With the hyperplasia, you can get secondary infection, with the immunosuppression associated with hypergeniccotemiosis can occur and in case we see neoplasia of the area as well. So, obviously things to consider when you seek to find hyperplasia and things to work up. So we want to do cytology, skin scrapes, and then consider, possibly what the underlying cause of the hyperplasia might be.

So I think that brings us nicely to the end of the tale. And thank you for listening and I'm happy to take any questions. Hillary, that was fabulous and it just puts things really nicely into perspective and as you said, we've now come to the end of, of the animal and it's, it's been a great series to you and to your colleagues, thank you very much for the time and that, that you have put into this.

Couple of questions for you. In hyperthyroid dogs, have you or can you see skin changes only without the lethargy and the weight gain and all that sort of thing? Yeah, I mean that Porter I, I presented actually had just the tail, the alopecia on the tail.

And I think I, I think in, in the endocrine diseases, often we're taught by the endocrinologists that that, you know, for Cushing's disease, it has to be polyphagic and polydipsic, and then you'll see the alopecia. One of the earliest signs that we see in hyperthyroidism is actually failure of hair regrowth, and we do pick up these cases, I think quite early and they can be quite difficult to diagnose on your thyroid profiles as well because maybe we are picking them up early. And and the same goes for hypergen in the course of them, the cases we see are not polyphagic and polydipsic, they might have other more subtle cutaneous signs.

Yeah Right. Christian wants to know what other differential diagnoses exist for follicular casts? I can see follicular casting, obviously the case I presented is spacious ainitis, but, certainly you can see it in endemiosis, bacterial folliculitis, those would be common ones, and then you, I mean certainly some other less common diseases, this, sebrhea we see in cocker spaniels, sometimes you can see follicular casting in that.

So anything that disrupts hair follicle turnover or the spacious cs you can see follicular casts. So it's really just a sign that's telling you there's something wrong with the hair follicle. OK.

. When when you were talking about your case of the dog with a dermatophytosis, you said to make sure you shampoo the whole dog because they could be carrying spores elsewhere on the coat. Is it possible to get asymptomatic carriers of dermatophytosis or are they always symptomatic somewhere on the body? Yeah, that's a really good question, Bruce, and actually, certainly in cats.

So if you've got, say you've got a multi-cat household, and, and it's not, not so common in dogs cause dogs don't really present that commonly with microsporum. But if you've got a cat with a multi an affected cat in a multi-cat household, I bet there's some carriers in there. So what we would usually recommend is doing what we call a toothbrush technique where you give the owner.

Just a, a clean toothbrush and have them go home and brush all the cats and just culture those cats, and you might find this carrier in there, particularly Persian cats, but yeah, you can get asymptomatic carriers. And, and would they become symptomatic in time? Not always, but they're going to remain and I just, you know, potential carrier for the other animals and, and humans because it's, that's why we we're so keen to treat it because it's a zoonotic diseases.

Yeah, yeah. Another question for you. Is chemical castration effective in dogs with tail gland hyperplasia?

Never done it. I would imagine so. Yeah, I, I think I've, I've certainly seen cases.

It's not some, it's not a technique we use in our practise, but I don't see why not. I mean, you're shutting down the androgen producing production, so yeah, it should be effective. Excellent.

Well, that's the end of our questions and the end of our webinar. Once again, Hillary, thank you so much for your time tonight. And thank you for wrapping up the tail end of this dermatology series.

You're welcome. Thank you for listening. And to all the attendees, I hope you've enjoyed it.

Remember that these sessions are all recorded and you can go back and listen to those pieces that you may have missed or that you want to hear again. And we look forward to seeing you on another webinar going forward. So to all of you, thank you and good night and to Anna my controller in the background.

Thank you for everything you've done. Goodbye.