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in
n Sm
mall An
nim
mal Derm
mattolo
ogyy

Carla Dedola
Giordana Zanna
 COMPLEX
Clinical Cases
in Small Animal Dermatology
Copyright © 2022 Grupo Asís Biomedia, SL
Plaza Antonio Beltrán Martínez n.º 1, planta 8 - letra I
(Centro empresarial El Trovador)
50002 Zaragoza - Spain

First printing: January 2022

Illustrator:
Jacob Gragera Artal

ISBN: 978-84-18339-32-5
DL: Z 1772-2021

Design, layout and printing:

Grupo Asís Biomedia, SL
www.grupoasis.com
[email protected]

All rights reserved.

Any form of reproduction, distribution, publication or transformation of this book is only permitted
with the authorisation of its copyright holders, apart from the exceptions allowed by law. Contact
CEDRO (Spanish Centre of Reproduction Rights, www.cedro.org) if you need to photocopy or
scan any part of this book (www.conlicencia.com; 0034 91 702 19 70/0034 93 272 04 47).

Warning:
Veterinary science is constantly evolving, as are pharmacology and the other sciences. Inevitably, it is
therefore the responsibility of the veterinary surgeon to determine and verify the dosage, the method
of administration, the duration of treatment and any possible contraindications to the treatments given
to each individual patient, based on his or her professional experience. Neither the publisher nor the
author can be held liable for any damage or harm caused to people, animals or properties resulting
from the correct or incorrect application of the information contained in this book.
 COMPLEX
Clinical Cases
in Small Animal Dermatology

Carla Dedola
Giordana Zanna
 THE AUTHORS V

THE AUTHORS
CARLA DEDOLA
Dr. Carla Dedola graduated in Veterinary Medicine from the Uni-
versity of Sassari (Italy) in 2001. After fulfilling her degree, she
worked as a general practitioner in a private Veterinary Clinic in
Monza (Italy), starting to develop her passion in small animal
dermatology. In 2007, she obtained a position as resident in
Dermatology at the Royal (Dick) School of Veterinary Studies at
the University of Edinburgh (Scotland). In 2010, she sustained
and passed the European College exam in Veterinary Dermatol-
ogy becoming a European Diplomate in Veterinary Dermatology.
She has been secretary of the Italian Society of Small Animal
Dermatology (SIDEV) in Italy from 2014 to 2019. Since 2011,
she has been working as freelance in Sardinia (Italy) collabo-
rating with numerous Veterinary Clinic over the territory. She is
the director and the scientific mentor for dermatological courses
organized by the Italian Scientific Society of Veterinary Medicine
for small animal (SCIVAC).

GIORDANA ZANNA
Dr. Giordana Zanna graduated in Veterinary Medicine from the
University of Bari (Italy) in 2000. After working in general prac-
tice in Italy and doing externships at Universities of Liverpool
and Bristol (UK), she undertook a residency in Veterinary Der-
matology at Universitat Autònoma de Barcelona (UAB) in Spain,
gaining her Diploma of the European College of Veterinary Der-
matology in 2010. At the same Institution, she fulfilled her PhD
studies on the pathogenesis of mucinosis-hyaluronosis in Shar
Pei dogs in 2010. Vice-president of the Italian Society of Small
Animal Dermatology (SIDEV), secretary of the Italian Companion
Animal Veterinary Association (SCIVAC), she is the director and
scientific mentor of the Italian course of Dermatology. Giordana
now works at Instituto Veterinario di Novara (Italy) as a private
practice dermatology specialist, and she regularly provides lec-
tures in national courses both in Italy and Spain and gives talks
at international conferences. She has written several articles
published in national and international journals and she also
enjoys research with a special interest in non-invasive diagnostic
techniques such as dermoscopy.
VI COMPLEX CLINICAL CASES IN SMALL ANIMAL DERMATOLOGY

FOREWORD
After 40 years of profession, I am totally convinced that the essential requirements to provide excellent clini-
cal care for patients is a problem-oriented approach and a commitment to lifelong learning. All we know that
clinical problems are not always straightforward to solve, and animals may present with a number of different
clinical signs.

Traditional methods of teaching often do not meet the criteria for contextual learning. In contrast problem-based
learning (PBL) mimics real life situations to stimulate learning, the integration of knowledge and lifelong learning
skills. Within veterinary medicine, clinical cases lend themselves easily to this method of learning. It is impor-
tant that genuine clinical cases are selected because these tend to be complex, with frequently unpredictable
outcomes.

I had the chance to work with Dr Dedola and Dr Zanna in several postgraduate veterinary courses and I had the
opportunity to appreciate their enthusiasm and ability in teaching dermatology and problem-oriented approach.
With great pleasure I have found the same enthusiasm and ability in this book. The reader is transported here
across several clinical scenarios that are excellent examples of “real-life” in veterinary dermatology.

Fabia Scarampella
DVM, MSc, Dipl. ECVD
 yÝĄKŚÝĄAӕĀĄKy:K VII

PREFACE
This book aims to present a range of complex dermatological clinical cases in both dogs and cats. “Complex”
means all those situations for which it is not easy or straightforward to find a solution or an answer. Starting from
this point, the authors selected challenging dermatological cases for which reaching a final diagnosis was not as
simple or linear as in other situations. Difficulties might have been arisen from the unusual clinical presentation,
from unexpected results of the diagnostic tests or from the lack of positive answer to a therapeutic protocol that
was considered adequate for that specific case. The complexity of the cases might derive from the patient, its
genotype or phenotype, from its immunological status, from the presence of comorbidity or simply from the fact
that the clinicians won’t expect that specific disease in that patient for different reasons (i.e. not predisposed
breed, unusual age).

The readers will go through the development of the cases following the thoughtful way explained by the authors
themselves. Each case has a problem-based approach, incorporating its respective history, physical and der-
matological examinations, diagnostic tests and results, treatment and outcome. The authors will end up with
some considerations as well as the key elements for a better interpretation of each specific case.

The authors
VIII COMPLEX CLINICAL CASES IN SMALL ANIMAL DERMATOLOGY

TABLE OF CONTENTS
CASE 1. Generalised partial alopecia with scaling
Ǟȁ‫ٶ‬ƊƮȌǐ ....................................................................................................................................................................... 1

CASE 2. ǶȌȯƵƧǞƧ‫ة‬ɐǶƧƵȲƊɈƵƮƊȁƮ‫ٶ‬ƵȲɯɈǘƵǿƊɈȌɐȺ
ǿƊȺȺٌǶǞDzƵǶƵȺǞȌȁȌȁɈǘƵɈƊȲȺƊǶȲƵǐǞȌȁǞȁ‫ٶ‬ƊƧƊɈ ........... 9

CASE 3. (ǞƊǐȁȌȺɈǞƧƊȯȯȲȌƊƧǘɈȌǿɐǶɈǞǏȌƧƊǶƊǶȌȯƵƧǞƊ
Ǟȁ‫ٶ‬Ɗ‫ٶ‬ƮȌǐɐȺǞȁǐƮƵȲǿȌȺƧȌȯɯƊȺƊȁƵɩɈȌȌǶ........................ 17

CASE 4. ÇǶƧƵȲƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƮȌǐ .......................................................................... 25

CASE 5. wɐƧȌƧɐɈƊȁƵȌɐȺɐǶƧƵȲƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺ
in a dog ....................................................................................................................................................................... 33

CASE 6. wɐǶɈǞǏȌƧƊǶƊǶȌȯƵƧǞƊƊȁƮƮǞǏǏɐȺƵ‫ة‬
ȺƵɨƵȲƵƵɮǏȌǶǞƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƧƊɈ ............................................... 41

CASE 7. JƵȁƵȲƊǶǞȺƵƮȯɐȺɈɐǶƊȲƮƵȲǿƊɈǞɈǞȺǞȁƊƮȌǐ ........................... 51

CASE 8. wɐǶɈǞȯǶƵȯǞǐǿƵȁɈƵƮǶƵȺǞȌȁȺǞȁƊƧƊɈ ................................................. 61

CASE 9. JƵȁƵȲƊǶǞȺƵƮƵɮǏȌǶǞƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƮȌǐ.................... 69

CASE 10. ȺƵɨƵȲƵƵɮɐƮƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƧƊɈ........................................ 79

CASE 11. mǞƧǘƵȁȌǞƮƮƵȲǿƊɈǞɈǞȺǞȁƊƮȌǐ........................................................................... 87

 TABLE OF CONTENTS IX

CASE 12. Multiple subcutaneous ulcerated nodules

Ǟȁ‫ٶ‬ƊƮȌǐ ....................................................................................................................................................................... 95

CASE 13. wɐǶɈǞǏȌƧƊǶƊǶȌȯƵƧǞƊǞȁ‫ٶ‬ƊƮȌǐ................................................................................... 103

CASE 14. yƊȺƊǶȯǶƊȁɐǿƵȲȌȺǞɨƵٌɐǶƧƵȲƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺ‫ٶ‬

in a dog ....................................................................................................................................................................... 113

CASE 15. RɯȯƵȲDzƵȲƊɈȌɈǞƧƧȲɐȺɈɯƮƵȲǿƊɈǞɈǞȺǞȁ‫ٶ‬Ɗ‫ٶ‬ȯɐȯȯɯ ............. 121

CASE 16. yȌƮɐǶƊȲɐǶƧƵȲƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƧƊɈ ......................................... 131

CASE 17. ǶȌȯƵƧǞƊƊȁƮɐǶƧƵȲƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺǞȁƊƮȌǐ................ 139

CASE 18. Generalised alopecia with spontaneous

ǘƊǞȲȲƵǐȲȌɩɈǘǞȁ‫ٶ‬Ɗ‫ٶ‬ƮȌǐ......................................................................................................... 149

CASE 19. ǶȌȯƵƧǞƊƊȁƮƵɮǏȌǶǞƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺ

in an atopic dog.................................................................................................................................... 157

CASE 20. 0ɮǏȌǶǞƊɈǞɨƵƮƵȲǿƊɈǞɈǞȺƊȁƮȌƵƮƵǿƊɈȌɐȺ

ȺɩƵǶǶǞȁǐǞȁƊȁǞǿǿɐȁȌƧȌǿȯȲȌǿǞȺƵƮƧƊɈ.......................... 167

REFERENCES .......................................................................................................................................................................................... 175

 CASE 1
{KÇKĄ¸ŽČKAĀĄěŽ¸
¸ÝĀK:ŽŚŽě‰Č:¸ŽÇ{
ŽÇԝAÝ{
COMPLEX CLINICAL CASES IN SMALL ANIMAL DERMATOLOGY
 3

CASE 1. GENERALISED PARTIAL ALOPECIA

WITH SCALING IN A DOG

SIGNALMENT
■ Species: dog
■ Breed: Pomeranian
■ Age: 3-year-old
■ Sex: female
■ Lifestyle: indoor

INTRODUCTION of small white adherent scales and hair casts on the trunk, the
head and both ear pinna (Fig. 2a–c).
This case represents an opportunity for every clinician to recall
the importance of following step by step a correct diagnostic Differential diagnosis
approach, which is fundamental to confirm or dismiss a clinical Based on the signalment, history and clinical findings, the differ-
suspicion. The diagnosed disease is not particularly uncommon ential diagnosis lists as follow:
or difficult to recognize, but it could have been missed or con- ■ Idiopathic granulomatous sebaceous adenitis.

fused with another condition presenting similar clinical aspects ■ Leishmaniosis (see Box 1).

much more commonly described in the reported dog breed. ■ Hair cycle arrest (alopecia X).

■ Demodicosis.

■ Generalised dermatophytosis.

CLINICAL HISTORY
The dog began to show hair loss and presence of scales approx-
imately 6 months before consultation. The systemic antibiotic
treatment prescribed by the referring veterinarian, amoxicil-
lin and clavulanate at a dosage of 15 mg/kg (BW) two times
daily for 14 days, did not help in the hair regrowth. The hair loss
started from the head and extended to the trunk, the tail and
the extremities.

EXAMINATION
{KÇKĄ¸Ā‰ťČŽ:¸KŤÎÇěŽÝÇ
No abnormalities were detected.

DERMATOLOGICAL EXAMINATION
The examination revealed a diffuse partial alopecia and lack of
Figure 1. Generalised partial alopecia, especially evident on the trunk and
secondary hairs. Poor, dry and dull hair coat was also observed the caudal aspect of the legs (arrow). Secondary hairs are lacking, with a
(Fig. 1). A closer observation was helpful to identify the presence lusterless hair coat.
4 COMPLEX CLINICAL CASES IN SMALL ANIMAL DERMATOLOGY

a b c

Figure 2. Small adherent scales on the head (a) and scales on the pinna clumping together with many hair shafts (b and c).

DIAGNOSTIC TESTS RESULTS

During this case, it was decided to perform: ■ Microscopic hair examination: keratin debris accumula-
■ Microscopic hair examination: this is considered the most tion on hair shaft with hairs often clumping together was
helpful test to observe hair shaft and hair bulb in case of observed; those findings are compatible with the so-called
suspicion of a disease affecting those structures. Moreover, hair casts (Fig. 3; see the key elements of the case). The
although this is not considered the gold standard, this test majority of the hair bulbs were in the telogen (hair cycle
makes possible to identify Demodex mite and fungal hyphae
or spores.
■ Deep skin scraping: it is considered the gold standard test

for the diagnosis of demodicosis. The material was collected

and placed on a slide with some mineral oil and a coverslip
on top. It was examined with the low-power objectives of the
microscope (4× and 10×).
■ Fungal culture: some hairs and scales were collected by

plucking and scraping and send to a specialised laboratory in

order to perform a fungal culture.

As part of an exhaustive physical examination, and because

leishmaniosis was one of the considered differential diagnosis,
the following further tests were performed:
■ Complete blood count (CBC).

■ Serum biochemical profile.

■ Serological immunofluorescence antibody test (IFAT) for

Leishmania antibodies.

Multiple skin biopsies were planned in case a diagnosis was Figure 3. Numerous keratinosebaceous debris surrounding hair shaft
not reached after performing the previously cited tests. (hair casts).
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