sebaceous adenitis
DESCRIPTION
March, 2010 - An assigned presentation topic for my dermatology rotation; reviews sebaceous adenitis, focusing on topical therapyTRANSCRIPT
Sebaceous AdenitisKatie Krimetz Turner
Western University, College of Veterinary Medicine4th Year Dermatology Rotation
Animal Dermatology Clinic, San Diego3/26/10
Presenting Problem… The owner of a dog with scaly and greasy hair
coat has been using a pet shop shampoo over the past 6 months. The dog has been diagnosed with sebaceous adenitis by another veterinarian.
Outline a more appropriatemanagement planfor topical therapy in this dog.Image Ref: Green
Sebaceous Adenitis Inflammation of the sebaceous glands
• Simple/branched alveolar glands
• Normally: produce oily secretion Retain moisture and maintain hydration of skin Acts as physical barrier (7) Sebum enters hair follicle contaminated with lipase-
producing bacteria free fatty acids (7)
(ORS)
Image Ref: Caceci
Sebaceous Adenitis Uncommon in dogs
• Rare in cats, rabbits, and humans
Autosomal recessive inheritance proposed for the Standard Poodle and Akita (2,6,7)• Orthopedic Foundation of America Registry
Unknown etiology
Pathogenesis Hypotheses: (2,6)
1. Heritable and developmental inflammatory destruction of sebaceous gland
2. Cell-mediated immunologic destruction
3. Cornification abnormality sebaceous duct and gland inflammation and atrophy
4. Anatomic defect in sebaceous gland leakage and foreign body response (2)
5. Defect in lipid metabolism cornification abnormality and sebaceous gland destruction
Clinical Signs Cessation of flow due to inflammation and atrophy
• Scaling• Follicular plugging, casts,
fronds from dilated hair follicles
Diminishing coat quality• Dull, dry, brittle broken hairs
Bilaterally symmetrical distribution• Dorsal trunk, temporal region, face, pinnae, rat tail
Usually nonpruritic unless 2° infection presentImage Ref: Rhodes
Clinical Signs Poodles
• Hyperkeratosis then alopecia, dull, brittle hair (w/ casts)
Akitas• Generalized, erythematous and greasy skin
Springer Spaniels (8)• Alopecia, seborrhea, pyoderma• More severe than poodles
Vizsla and short-coated breeds• Focal coalescing, firm, nodular lesions• Annular plaques with alopecia and fine, non-adherent scale (3,7)
Cats• Multifocal annular areas of alopecia with scaling, crusting, and follicular casting,
dark rims of black scales along margins of eyelids (7) Image Ref: Brooks
Clinical Signs
Image Ref: Noli
Examination/Diagnostic Findings Skin scrape and culture – negative
Hair casts are prominent• Yellow-brown keratosebaceous material
Trichogram• Broken hair shafts (3) • Follicular casts (4)
Images’ Ref: Boord
Diagnosis Differentials:
• Primary seborrhea• Ichthyosis• Vitamin A and Zinc responsive dermatosis• Demodecosis• Cutaneous leishmaniasis• Exfoliative cutaneous lupus erythematosus• Dermatophytosis• Endocrinopathy• Pemphigus foliaceus• Nodular forms – deep bacterial folliculitis and furunculosis
Definitive Diagnosis Biopsy
Site selection• Ensure sample from subtle
early lesions with scale without alopecia (2)
• However representing different stages and appearances will be helpful, too. (1) Best to find active sebaceous gland inflammation Chronic, alopecic sites usually show absent glands
• Multiple sites Confirms widespread inflammation and/or loss of glandsImage Ref: Boord
Histopathology Mild/Early perifollicular inflammatory cells at level of
isthmus of hair follicle (3) directed at sebaceous gland
Moderate/Chronic severe hyperkeratosis, follicular plugging, nodular, granulomatouspyogranulomatous inflammation around sebaceous gland (2,3)
Short coats – large granulomatous lesions (6)
Keratin ensheathed hair follicles
Diffuse absence of sebaceous glands is the most common feature of chronic sebaceous adenitis (2,3)
Histopathology
Complete lack of sebaceous glands
Nodular mononuclear cell infiltrate at usual site of sebaceous glands
Image Ref: NoliHaematoxylin and eosin, 10×
Treatment May see cyclic patterns of spontaneous
improvement and worsening, independent of therapy (6)
2 Goals : (1)1. Restore normal function of skin
Neutralize consequences of sebaceous gland destruction and loss of function
2. Slow/stop ongoing inflammation and destruction
Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function
Remove casts, scale, and open plugged follicles• Antiseborrheic shampoo therapy 3-4x/wk
Phytosphingosine, sulfer, salicyclic acid, benzoyl peroxide, SebaLyt/SeboRx, DermaSeb, Sulf OxyDex (5)
Clip long coats
Soft brushing to loosen scales and dead hair
Antiseptic topical shampoo• Chlorhexidine or benzoyl peroxide
Topical Treatment (1)Goal #1: Restore normal function of skin, reduce destruction and loss of function
Topical emollients and humectants are critical• Propylene glycol, glycerin, colloidal oatmeal, urea, lactic acid• Apply AFTER antiseborrheic shampoo
Restoring and normalize keratinocyte turnover (5)
Suggestions:• 50:50 bath oil and warm water directly to skin
Allow 2 hours contact time Remove oil with 3-7 baths Apply a final humectant rinse Repeat every 7 days for 4-6 weeks
• Between baths: spray-on emollients/humectants 50:50 propylene glycol and water 0.2% phytosphingosine spray (Duoxo Seborrhea Microemulsion Spray) 1% phytosphingosine pipette (Duoxo Seborrhea Spot-on)
Images’ Ref: Rampak
Bushi’s Topical Treatment… Bushi’s Story 4 year old Akita Germany
Inflammation tx w/ calendumed ointment
Flea comb to remove crusts• Repeat ointment until crusts
came off Applied Hettral Johanniskraut
Oil (2 hr soak) Bathe with Editerm, repeat Condition with Humilac Repeat every 10-14 days
Image Ref: Rampak
Bushi’s Topical Treatment… 5 months of topical treatment total Improvement noted in 4-6 weeks
• Continued baths every 14 days• Maintained on oil treatments every 3-4 weeks
Other Treatment OptionsGoal #2: Arrest ongoing inflammation and destruction of glands
Initial course of antiinflammatory then tapered to lowest effective dose – likely need for life
Rarely see spontaneous and/or complete remission (3,6)
Atopica is systemic treatment of choice (1)• May help with sebaceous gland regeneration (3)• Tetracycline and Niacinamide also possible (1)• Corticosteroids only if pruritic (1)
May respond to oral omega-6 and omega-3• Antiinflammatory action of omega-3 may be beneficial
Vit A and synthetic retinoids helpful in severe or refractory cases (1,6)• “Effective” = >50% reduction in scaling and alopecia (6)• Require 4-8 weeks therapy, usually for life• Helps with keratinocyte differentiation (3)Image Ref: ABC
Ideal Outcome(with systemic therapy)
Before and After 3 months of oral cyclosporin (5mg/kg q24hr)
Able to taper to EOD only
Images’ Ref: Noli
References1. Angus, John C. “How I Treat Sebaceous Adenitis.” 81st Western Veterinary Conference, 2009.
2. Gross, Thelma Lee, et al. Skin Diseases of the Dog and Cat Clinical and Histopathologic Diagnosis, 2nd edition. Oxford: Blackwell Science Ltd, 2005.
3. Linek, Monika, et al. “Effects of Cyclosporin A on clinical and histologic abnormalities in dogs with sebaceous adenitis.” JAVMA, Vol 226, No. 1, January 1, 2005.
4. Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.
5. Rosenkrantz, Wayne. “Practical Applications of Topical Therapy for Allergic, Infectious, and Seborrheic Disorders.” Western Veterinary Student Notebook. Circa >2005.
6. Scott, Danny, et al. Muller and Kirk’s Small Animal Dermatology, 6th edition. Philadelphia: W.B. Saunders Company, 2001.
7. Sousa, Candace A. “Sebaceous Adenitis,” Veterinary Clinics Small Animal Practice, Vol 36, 2006, Pg. 243-249.
8. Tevell, Elisabeth H., et al. “Sebaceous adenitis in Swedish Dogs, a retrospective study of 104 cases.” Acta Veterinaria Scandinavica, Vol 50, No. 11, May 25, 2008.
Image References1. ABC Online Pharmacy. http://www.abconlinepharmacy.com/ns/customer/home.php?cat=70 Accessed:
3/24/10.
2. Boord, Mona. Animal Dermatology Clinic, San Diego. Private Photograph Collection. Accessed: 3/25/10.
3. Brooks, Wendy; and Moore, Wendy. Mar Vista Animal Medical Center. http://www.marvistavet.com/html/body_sebaceous_adenitis.html Accessed: 3/24/10.
4. Caceci, Thomas. “Integument System II: Hair” Virginia-Maryland Regional College of Veterinary Medicine Veterinary Histology Course, VM8054 Exercise 15. August, 2008. http://education.vetmed.vt.edu/Curriculum/VM8054/VM8054HP.htm
5. Green, Linda. “Sebaceous Adenitis - Decisions, Responsibilities & Realities.” http://www.astrolyka.com/illness.html Accessed: 3/24/10.
6. Noli, Chiara; and Toma Stefano. “Three cases of immune-mediated adnexal skin disease treated with cyclosporin.” Veterinary Dermatology, Vol 17, Issue 1, 2006, Pg. 85-92.
7. Rampak, Michael. “Report about the successful treatment of Sebaceous Adenitisthrough self-invented therapy.” 2000. http://www.akita-friends.com/special/satreat.htm Accessed: 3/24/10.
8. Rhodes, Karen H. The 5-Minute Veterinary Consult, Clinical Companion: Small Animal Dermatology. https://www.vetconnect.com.au/5min/toc/img1055.htm Accessed: 3/24/10.
Questions and Discussion…
Thank you!
-Katie Krimetz