Page 482 - Cote clinical veterinary advisor dogs and cats 4th

216 Cornification Disorders

• Immune-mediated disease: pemphigus • Essential fatty acid (EFA) oral supplementa- inflammation. In severe cases, a more potent
foliaceus, systemic or cutaneous lupus tion (omega-3 and omega-6); rarely provides topical glucocorticoid or a short course of
VetBooks.ir • Neoplasia: cutaneous epitheliotropic lym- • Topical therapy: clipping of haircoat may • Nasal and digital hyperkeratosis: moisturize
oral prednisone 1 mg/kg PO q 24h may be
complete control of scaling but may be
erythematosus, adverse drug reaction
indicated.
beneficial as adjunctive therapy
phoma, exfoliative dermatitis associated with
thymoma in cats
Primary cornification disorders: usually benefit topical therapy affected area with water or wet dressings, and
then apply petrolatum jelly. More severely
○ Topical veterinary antiseborrheic products,
genetically determined; may be multifocal and including those containing phytosphin- affected animals may benefit from topical
generalized or localized: gosine, essential oils, or a ceramide-fatty application of an ointment containing sali-
• Multifocal and generalized acid spot-on, may be of benefit. cylic acid and urea, or 50%-75% propylene
○ Idiopathic primary seborrhea (dogs) ○ Greasy, scaly skin in dogs can be degreased glycol, or 0.025% or 0.01% tretinoin gel
○ Hereditary seborrhea oleosa (cats) using products containing benzoyl per- (Retin-A).
○ Vitamin A–responsive dermatosis oxide, or selenium sulfide (not in cats).
○ Zinc-responsive dermatosis These products should be followed with a Drug Interactions
○ Sebaceous adenitis conditioner. NOTE: Shampoos containing Cyclosporine: concurrent use of cyclosporine
○ Epidermal dysplasia benzoyl peroxide are drying and bleach with other permeability (P)-glycoprotein
○ Schnauzer comedo syndrome fabric. inhibitors or substrates can increase blood
○ Sebaceous gland dysplasia ○ Mild, dry scaling may respond to cyclosporine levels. This may be beneficial (e.g.,
○ Canine ichthyosis moisturizing or hypoallergenic sham- lowers the dose of cyclosporine required by
• Localized poos. Conditioners containing lipids or one-half when administered with ketoconazole)
○ Nasal parakeratosis of the Labrador humectants (agents that help the skin to but can also increase the potential for toxicosis.
retriever (autosomal recessive) retain moisture) are beneficial.
○ Footpad hyperkeratosis in dogues de Possible Complications
Bordeaux and Irish terrier Chronic Treatment • High fatty acid treatment may increase the
○ Feline acne Generalized disease: potential for gastrointestinal (GI) disturbance
○ Stud tail • Primary idiopathic seborrhea: topical therapy or pancreatitis.
○ Ear margin dermatosis as already described; EFA supplementation; • Retinoids: keratoconjunctivitis sicca, con-
antibiotics administered as already described. junctivitis, pruritus, hyperactivity, stiffness,
Initial Database Consider retinoids: acitretin (Soriatane) mucocutaneous junction erythema, vomit-
• Comprehensive evaluation for ectoparasites 0.5-1 mg/kg PO q 24h or cyclosporine ing, diarrhea, teratogenicity, elevated liver
(skin scrapings, flea combing, acetate tape 5 mg/kg PO q 24h. enzymes
preparations, fecal evaluation, ectoparasiticide • Vitamin A–responsive dermatosis: topical • Cyclosporine: diarrhea, vomiting, anorexia,
response trial) therapy and antibiotics as already described; gingival hyperplasia, gingivitis, papillomato-
• Skin cytologic examination (to rule out vitamin A 625-800 IU/kg PO q 24h; sis, renal effects, monitor animals for tumors
bacterial and yeast involvement) (p. 1091) usually 10,000 IU PO q 24h, lifelong, for
• Fungal culture (dermatophytosis) the average cocker spaniel. Dosages up to Recommended Monitoring
• CBC, serum biochemical profile, urinalysis 1200 IU/kg PO q 24h are reported to be • Vitamin A, retinoids: monitor liver enzymes
(as appropriate, to look for evidence of safe. Improvement is noted by 3-8 weeks. and tear production.
underlying disease) • Zinc-responsive dermatosis: zinc supple- • Cyclosporine: physical examination (tumor,
mentation is recommended at 2-3 mg/kg infection, gingival hyperplasia), urea, creati-
Advanced or Confirmatory Testing elemental zinc PO q 24h. nine, urinalysis, and liver enzymes; blood
• Skin biopsy: useful for many disorders after • Sebaceous gland dysplasia: antiseborrheic pressure. Check trough serum cyclosporine
infectious and parasitic causes have been shampoos followed by conditioners, fatty levels if adverse reactions are noted or there
ruled out acid supplementation, vitamin A, and 50% is a poor clinical response (p. 1333).
• Elimination diet trial to rule out food allergy propylene glycol spray may aid in control.
(if pruritic) • Schnauzer comedo syndrome: benzoyl PROGNOSIS & OUTCOME
• Intradermal and serum allergy testing for peroxide shampoos help the condition
atopic dermatitis (if pruritic) by follicular flushing. Systemic or topical Primary causes often require lifelong therapy;
• Response to dietary management (if poor- antimicrobial treatments to control bacterial secondary syndromes usually recover with
quality diet) folliculitis. In some cases, retinoids such as correction or control of underlying cause.
• Thyroid function testing isotretinoin (Accutane) 1 mg/kg PO q 24h
• Adrenal function testing or divided q 12h may be helpful but can be PEARLS & CONSIDERATIONS
• Genetic tests available for carriers of Ameri- costly. Wean to alternate-day therapy after
can bulldog ichthyosis and golden retriever 4 weeks if a favorable response is noted. Comments
ichthyosis • Canine ichthyosis: antiseborrheic shampoos • Control secondary microbial dermatitis, and
and a topical spray conditioner containing evaluate thoroughly for other underlying
TREATMENT propylene glycol and humectants can be secondary causes before diagnosing a primary
useful. Try isotretinoin (Accutane 1-3 mg/ seborrheic syndrome.
Treatment Overview kg PO q 24h for 8-12 weeks, decreasing to • The term seborrhea as a diagnosis should be
The goal of treatment is to address the underly- alternate-day therapy if effective) in more limited to the breed-specific diseases (e.g.,
ing cause specifically if possible. In primary severe cases. idiopathic primary seborrhea of cocker
conditions, it is important to control secondary • Sebaceous adenitis (p. 901) spaniel, primary hereditary seborrhea oleosa
microbial dermatitis while controlling the Localized disease: of Persian cats). Use other descriptive terms
amount of scale produced. • Feline acne (p. 15) such as scaling, exfoliation, crusting, greasiness,
• Ear margin dermatosis: local use of an malodor to characterize skin changes rather
Acute General Treatment antiseborrheic shampoo q 24-48h. If inflam- than the nonspecific term seborrhea.
• Systemic and/or topical antimicrobial treat- mation is moderate, topical glucocorticoid • Many dermatologists doubt that idiopathic
ment as needed (pp. 247, 614, and 851) such as 0.5%-1% hydrocortisone may reduce primary seborrhea is a true entity in dogs.

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