1. Sebaceous Adenitis Katie Krimetz Turner Western University, College of Veterinary Medicine 4th Year Dermatology Rotation Animal Dermatology Clinic, San Diego 3/26/10
2. 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 appropriate management plan for topical therapy in this dog. Image Ref: Green
3. 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)
5. 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
6. Pathogenesis Hypotheses: (2,6) Heritable and developmental inflammatory destruction of sebaceous gland Cell-mediated immunologic destruction Cornification abnormality sebaceous duct and gland inflammation and atrophy Anatomic defect in sebaceous gland leakage and foreign body response (2) Defect in lipid metabolism cornification abnormality and sebaceous gland destruction
7. 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 present Image Ref: Rhodes
8. 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
10. 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
11. 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
12. 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 glands Image Ref: Boord
13. 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)
14. Histopathology Complete lack of sebaceous glands Nodular mononuclear cell infiltrate at usual site of sebaceous glands Image Ref: Noli Haematoxylin and eosin, 10×
15. Treatment May see cyclic patterns of spontaneous improvement and worsening, independent of therapy (6) 2 Goals : (1) Restore normal function of skin Neutralize consequences of sebaceous gland destruction and loss of function Slow/stop ongoing inflammation and destruction
16. 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
17. 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)
18. 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 HettralJohanniskraut Oil (2 hr soak) Bathe with Editerm, repeat Condition with Humilac Repeat every 10-14 days
19. 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
20. 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
21. 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
22. References Angus, John C. “How I Treat Sebaceous Adenitis.” 81st Western Veterinary Conference, 2009. Gross, Thelma Lee, et al. Skin Diseases of the Dog and Cat Clinical and Histopathologic Diagnosis, 2nd edition. Oxford: Blackwell Science Ltd, 2005. 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. 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. Rosenkrantz, Wayne. “Practical Applications of Topical Therapy for Allergic, Infectious, and Seborrheic Disorders.” Western Veterinary Student Notebook. Circa >2005. Scott, Danny, et al. Muller and Kirk’s Small Animal Dermatology, 6th edition. Philadelphia: W.B. Saunders Company, 2001. Sousa, Candace A. “Sebaceous Adenitis,” Veterinary Clinics Small Animal Practice, Vol 36, 2006, Pg. 243-249. Tevell, Elisabeth H., et al. “Sebaceous adenitis in Swedish Dogs, a retrospective study of 104 cases.” ActaVeterinariaScandinavica, Vol 50, No. 11, May 25, 2008.
23. Image References ABC Online Pharmacy. http://www.abconlinepharmacy.com/ns/customer/home.php?cat=70 Accessed: 3/24/10. Boord, Mona. Animal Dermatology Clinic, San Diego. Private Photograph Collection. Accessed: 3/25/10. Brooks, Wendy; and Moore, Wendy. Mar Vista Animal Medical Center. http://www.marvistavet.com/html/body_sebaceous_adenitis.html Accessed: 3/24/10. 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 Green, Linda. “Sebaceous Adenitis - Decisions, Responsibilities & Realities.” http://www.astrolyka.com/illness.html Accessed: 3/24/10. 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. 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. 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.
