Rosario Cerundolo graduated from the University of Naples veterinary school in 1987. He owes his dermatology training to the RVC, where he began a residency in 1995 under the supervision of Professor David Lloyd. The residency enabled him to obtain the RCVS certificate in veterinary dermatology in 1997 and a year later he passed the examinations to become a Diplomat of the European College of Veterinary Dermatology. He was subsequently an Associate Professor in Veterinary Dermatology at the University of Pennsylvania until 2009, when he returned to the UK. He now divides his time between Dick White Referrals and the Bayswater Referral clinic.
The first slide is from the front cover of a recent edition of Veterinary Dermatology and you are invited to state the breed of dog –all is revealed at the end. The content of this veterinary webinar concentrates heavily on the diagnostic approach, but there are many clinical photos of dogs in varying states of alopecia throughout. As each condition is shown Rosario discusses relevant diagnostic points and briefly treatment.
The Diagnostic Approach comprises:
- Signalment –breed colour age and sex
- History-emphasising asking the correct questions
- General physical examination
- Dermatological examination
-Pattern of Alopecia (focal or multifocal/symmetrical or diffuse)
-Location of Alopecia
-Examination of the skin and the coat
-Algorithm of Alopecia
For each of the above headings, after general advice, clinical photos follow-nine just on signalment. In all there are around twenty-five alopecic conditions mentioned and illustrated. This is testament to Rosario’s particular research interest in alopecia over many years. Among others there are good illustrations of cyclic flank alopecia, hypothyroidism, follicular dysplasias, Sertoli cell tumours, dermatophytosis, alopecia X, Cushing’s disease, colour dilution alopecia, and sebaceous adenitis. There are also some cases of iatrogenic disease, due mainly to steroids, with an amazing case in a dog coming into contact with his owner’s postmenopausal oestrogen cream. Only a very good history would have led to that diagnosis!
A simple algorithm guides you through the various categories of alopecia, which should help with the diagnostic approach outlined above. Rosario lists the diagnostic tests-skin scrapings, fungal culture, skin biopsy and cytology for example, but chooses to emphasise just one-the trichogram. We are shown hairs in anagen and telogen, chewed hairs, and the use of trichograms in diagnosing colour dilution alopecia and black hair follicular dysplasia.
There is a section on mistakes to avoid including iatrogenic causes of alopecia as mentioned above. Apart from the oestrogen case there are some missed dermatophytosis cases, long term use of hydrocortisone aceponate, topical ocular steroids causing periorbital alopecia, alopecia following epidural anaesthesia, scarring alopecia following heating pad burn and post clipping alopecia in Nordic breeds.
The main thrust of this excellent webinar is to help colleagues follow a diagnostic path, which will in most cases lead to an accurate diagnosis, and crucially avoid expensive unnecessary tests. The webinar ends with two cases that illustrate this point. Both dogs had been investigated comprehensively and hundreds of pounds spent before referral, without a clear diagnosis and therefore a resolution of the problem. Having watched this webinar I am sure you will be able to diagnose these cases. And if you identified the dog breed on the cover of Veterinary Dermatology hats off to you!
This is a very pictorial webinar that will be helpful to first opinion colleagues with an interest in dermatology and will hopefully inspire many more to join them.