What are the common features of endocrinodermatopathies?
Skin lesions usually seen later in course of these diseases.
- symmetrical hyperpigmentation
- nonpruritic, symmetrical alopecia
- abnormally thin(cushing) or thickened skin (hyperth)
- (+/- pruritus: sec. pyoderma, seborrhea)
- Course: usually chronic
- -> exclude those that are deadliest first! Cushing, hypoth, tumor producing hormones.
Name the endocrinodermatopathies
- hypothyroidism
- cushings
- DM
- sex-hormone dependant dermatoses
Hypothyroidism - skin manifestations, breed predisposition
~ Skin thickening (accumulation of mucopolysacch in dermis), hyperpigmentation, alopecia, coarse hairs
- myxodema - thickend skin - wider face! (Young)
- secundary: seborrhea sicca, pyoderma
- Young and middle-aged individuals
- Large dogs are predisposed
-> Retrievers, Dobermann Pinscher, Boxer,
Irish Setter, Schnauzers, Dachshund, Poodle,
(Shar pei, Chow Chow, Puli)
(Weight gain, cold intolerance, (hypothermia))
Cushings - skin manifestations, predisp. Breeds
~ Thin, atrophic skin, keratin plugs, alopecia, hyperpigmentation, calcinosis cutis (pathognominic, some covered wih strong adhering crust)
- Cushings typicl: raised skin folds (atrophic, thin, less elastic) dd from hypothyroidism
- Immunosuppression, fungal infections, bacterial pyoderma (demodex mange in old dog -> cushings!!! Old age demodicosis
- Middle-aged and old dogs: Poodle, Dachshund, Yorkshire terrier, Hungarian vizsla, Boxer
(Polyphagia!, centripetal obesity, abdominal enlargement, muscle wasting (mast. Mm)) not all fat!
- cat: like the dog but Alopecia, hyperpigmentation, keratin plugs are less pronounced. Skin very fragile, unkept hair coat.
DM - skin manifestations, breeds
weight loss, (Polyphagia initially, then complications ketoacidosis… -> anorexia)
~ no specific lesion, secundary pyoderma, seborrhea.
- thin skin, +/-alopecia, dull hair coat, flaking skin
- Poodle, Dachshund, Terriers, Beagle, Puli, Retrievers, (English cocker spaniel, Rottweiler)
- Middle-aged and old dogs
- Intact females are predisposed
Name the possible sex-hormone dependant dermatoses
🔺Male:
- Sertoli’s cell tumor (neoplasma testis)
- Hyperandrogenismus in male dogs
- Testosteron-responsive alopecia of the castrated male dog
- Castration responsive dermatosis of male dogs or hypogonadism of intact dogs (see Alopecia X)
🔺Female:
- Hyperoestrogenism in females
- Oestrogen responsive dermatosis in spayed females
- Hypogonadism in intact females
- alopecia X
Sertoli’s cell tumor
🔺Breeds: boxer, Shetland sheepdog, poodle,pekinese, collie, miniature schnauzer
any breed with cryptorchid testes
🔺Pathogenesis: excessive secretion of estrogen
🔺Clinical signs:
- alopecia: perineal, genital region, ventral abdomen, chest, flanks,
- hyperpigm., lichenification, gynecomastia (incr. breast tissue, nipple), preputial swelling, preputial linear dermatosis (Involving lesions or eruptions of the skin ), decr libido, attractive to other males, (test may cause bone marrow depression), testicles may be large
🔺 Treatment: castration
Hyperandrogenismus in male dogs
- Etiology: Leydig’cell tumor
- Occurrence: any breeds, middle to old age
- Clinical signs: circumanal gland’s hyperplasia,
prostatitis, tail gland hyperplasia (waxy excretions that result in hair loss and crusty lesions), perianal
adenoma, severe seborrhoea oleosa
(Testosterone: hyperplasia of sebaceous gl and prostate hyperplasia) - Treatment: castration (adenoma development!)
Testosteron-responsive alopecia of the castrated male dog
- Etiology unknown (? hypoandrogenismus, lacking androgens? Something wrong with androgen)
- Occurrence: any breeds, middle to old age
- Clinical signs:
- dull, dry haircoat, at the beginning it becomes lighter
- seborrhoea, scaling, thin, hypotonic skin
- symmetrical alopecia on the flank, and/or inguinal area
hypertrichosis - Treatment: methyltestosterone 1 mg/kg EOD
Castration responsive dermatosis of male dogs or hypogonadism of intact dogs (see Alopecia X)
- Occurrence: adult intact male dogs: Pomeranian, chow-chow, malamut, husky, keeshond
- Etiology: STH-deficiency?, testicular abnormalities?
- Clinical signs: 2-4 year of age, or later, fine “fluffy” coat, symmetrical alopecia: neck, perineum, caudomedial thighs, inguinal area, +/- hyperpigment., no testicular abnormalities, or decreased testis, or testicular neoplasia
- Treatment: castration
Hyperoestrogenism in females
- Occurrence: middle age to old bitches
- Etiology: cystic ovaries, cystic tumors
- Clinical signs: symmetrical alopecia(perianal and ing area the spread to abdomen cran/ventr -> generalization),
secondary seborrhea, lichenification,
enlarged vulva, nipples, abnormal cycle of estrus - 50% of cases see incr estrogen in blood?
- Treatment: ovariohysterectomy
+ symptomatic treatment for seborrhoea
Oestrogen responsive dermatosis in spayed females
- Occurrence, etiology: spayed females before the first oestrus, however hypoestrogenism has not been demonstrated
- Clinical signs: symmetrical hypotrichosis/alopecia in the perineal, genital region - caudomedial thighs, abdomen, chest, neck, …
- soft, puppy like haircoat, vulva and nipples are small
- Treatment: NO treatment, or 0.1mg/kg24h diethyl-stilbestrol for 3 weeks and 0.1-1 mg/kg per os weekly, but side effect: bone marrow supression! (better: estradiol valerate, estradiol benzoate)
Hypogonadism in intact females; types
Decreased functional activity of gonads
🔺 Primary hypogonadism: firstly infertility is diagnosed,
treated and there is no time for developing of skin
lesions
Predisposition: poodle, terriers, dachshund
Noncyclic alopecia(dont correlate with menstr cycle?): before 3 year of age, then slowly progression (on perineal, inguinal, abdominal and body area)
🔺 Secondary hypogonadism (primary hypothyreoidism,
Cushing-d. - must exclude these!!): irregular cycle, anoestrus.
Cyclic alopecia: starts with oestrus, then recovers, but after a while may not recover by the time of anoestrus.
Hypogonadism in intact females; signs, diagnostics, therapy
in short haired: perineal hypotrichosis, then on the body, in long haired: alopecia of primary hairs on the neck, inguinal, and caudal thighs a., symmetric flank alopecia
Histopath.: it differentiates from the non endocrin alopecia, but it can not prove the ovarian imbalance
Diff. diagn.: endocrinopathies(cush, hypoth), follicular dysplasia, seasonal flank alopecia
Diagnosis: to exclude hypothyreoidism and Cushing- disease, (measurement of sex hormons), recovery after spaying
Therapy: spaying, background causes to treat, maybe oestrus-induction (GnRH 2 g/kg im. 2*/nap, 10 days or FSH 0.75-2 IU/kg im. /day until estrus)
Alopecia X
(Northern double coated breeds - pomeranina, alaskan malamute, young age 1-3yrs)
- alopecia of primary then secundary hairshaft
- eventually whole body except head and paws
- dry, scaling, hyperpigm thin skin, broken hairshaft
- diagnosis?: ACTH stim test, measure sex hormones
- therapy? castration/spaying, melatonin, trilostan, STH, mitotan, tesztoszteron,traumatization , deslorerin
- spontanious recovery - reaccurrance
Etiopathogenesis is not clear, but the abnormality of
steroidogenesis may cause the symptomes… Affect the adrenal gland. The condition we call “alopecia X,” however, is not associated with the hormone imbalances that normally create endocrine alopecia. Its causes remain mysterious hence the name alopecia X.
Is it one or more (?) diseases, but the same nationale, history, symptomes, laboratory examinations, and
answers for different therapies - so may be several diseases which we dont know how to distinguish!
Other names: hyposomatotropismus, castration responsive dermatosis, sex hormon responsive dermatosis
Given that there are numerous therapies that work for some cases and not for others, and that many of these therapies seem to be in complete opposition, it may be that alopecia X is not one disease but several and we simply do not know how to distinguish them.
only beauty failure - treatment not really necessary + SE of them!!!
after trauma eg. A biopsy (of alopecia area) the hair grow back! Like it awakens the follicles!
Fun facts about the different sex hormone responsive dermatosis
Signs of hypogonadism are similar to „hypergonadism”
There is alopecia at physiological hormon-level
Or there is no alopecia at high hormon-levels
Similar localization at different sex hormon-imbalance
Many differences in breeds and individuals
Different diseases-similar therapy
The same disease respond different therapies
The treatment is „working” only for short term (1 year) in many cases
Sex hormone responsive dermatosis -alopecia with a typical localization ddx:
infectious causes: dermatophytosis, demodicosis, bacterial
folliculitis –skin scrape sampling;
endocrinodermatopathies: hypothyreosis, Cushing-diseases,
sex hormon producing tumors/cysts; (congenital and adult
onset) hyposomatotropism-hormontest
inherited/aquired alopecia: follicular dysplasia, pattern
alopecia, seasonal flank alopecia –histopathology;
sex hormon responsive dermatosis to differentiate: ACTH-
stimulation test for sex hormons
allergodermatitis (cerum. otitis externa, seborrhoea oleosa)
THERAPY OF SEX HORMON REPSONSIVE DERMATOSIS:
SPAYING/CASTRATION
- IN INTACT individuals we castrate/ spay
- Spayed/castrated - HORMON- SUPPLEMENTS
(Not 100% sure I understood right)
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Diabetes Mellitus31
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Adrenal Gland Endocrinopathies37
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Pituitary Gland Endocrinopathies20
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Obesity25
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Additional Examination Methods In Dermatology37
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Dermatology - General Principles Of Dermatological Treatment23
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Congenital Skin Disorders25
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Pyoderma, Fungal Skin Diseases, Normergic Dermatitis30
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Endocrinodermatopathies18
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Allergodermatitis24
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Diseases Of The Ear59
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Surgery Of The Endocrine Organs22
