Signalment & History
- Neutered male
- Purebred American Bulldog
- H/o otitis externa; chronic flaky, erythematous skin and intermittent pruritus, and malodor. Unresponsive to medical management; Diet: beneful free feed; HW Preventive: current on HW/Flea/Tick Prevention; Fecal/Parasite Exam: Submitted 2 months ago–neg. for ova
- Current Treatments: Janus kinase inhibitor, immunomodulating injection, hydrolyzed diet, essential fatty acid supplementation, oral antifungal medication
- Chronic skin issues
- Temp: 102.2; Pulse: 102; Respiration: pant; MM: p/m; CRT: 2s; BCS: 7/9; Weight: 95.1 lbs; Eyes: wnl; Ears: moderate amount of brown caseous debris accumulated bilaterally with minimal canal erythema; Mouth: Dental Disease = Grade 1; LN’s: wnl; Cardio: wnl; Resp: wnl; Abd: wnl; GI: wnl; MS: wnl; CNS: wnl; Skin: desquamation on lateral aspects of both distal hind limbs, lateral lumbar areas and lateral aspects of both shoulders; no intact pustules; diffusely red skin with brown flakes, malodor, and sensitivity to touch; Lumps: n/a; Urogen: wnl
What is on your differential diagnostics list?
- Primary idiopathic seborrhea
- Vitamin A-responsive dermatosis
- Zinc-responsive dermatosis
- Epidermal dysplasia
- Canine ichthyosis
- Sebaceous adenitis
- Microbial (pyoderma, Malassezia, dermatophytosis)
- Parasitic (flea, cheyletielosis, sarcoptic mange, demodectic mange, pediculosis)
- Endocrinopathy (hypothyroidism, hyperadrenocorticism)
- Allergic (food hypersensitivity, atopic dermatitis)
- Management (poor nutrition, inappropriate medication administration, poor compliance with topical therapies)
- Metabolic disease (liver disease)
- Immune mediated disease (adverse drug reaction)
- Paraneoplastic disorders
- Cutaneous T-cell lymphoma
What diagnostics/prognostics do you run?
- Genetic screening
- Skin scrape & cytology
- Fungal culture
- Food trial
- Trying different ectoparasite treatment
- Full CBC, chemistry, and thyroid testing
Click here to open genetics report
What is your plan? How will you follow up with this patient?
- Owner elected a confirmatory skin biopsy to diagnose a severe form of ichthyosis.
- They will begin managing him with judicious topical therapies (specialized shampoos, moisturizing rinses, and agents to remove excess scale and to reinstate the corneocyte lipid envelope).
- Discussed the need for dental cleanings with client.
- Skin concerns were not due to allergies alone. Genetic testing revealed predisposition to ichthyosis. Proper expectations and directed management have begun in light of incorporating genetic testing into clinical tools.
- Casal ML, Wang P, Mauldin EA, Lin G, Henthorn PS. A Defect in NIPAL4 Is Associated with Autosomal Recessive Congenital Ichthyosis in American Bulldogs. PLoS One. 2017;12(1):e0170708. Published 2017 Jan 25. doi:10.1371/journal.pone.0170708
- Mauldin EA, Wang P, Evans E, et al. Autosomal Recessive Congenital Ichthyosis in American Bulldogs Is Associated With NIPAL4 (ICHTHYIN) Deficiency. Vet Pathol. 2015;52(4):654-662. doi:10.1177/0300985814551425
- Briand A, Cochet-Faivre N, Reyes-Gomez E, Jaraud-Darnault A, Tiret L, Chevallier L. NIPAL4 deletion identified in an American Bully with autosomal recessive congenital ichthyosis and response to topical therapy. Vet Med Sci. 2019;5(2):112-117. doi:10.1002/vms3.149
- E.A. Mauldin, D. Crumrine, M.L. Casal, S. Jeong, L. Opálka, K. Vavrova, et al. Cellular and metabolic basis for the ichthyotic phenotype in NIPAL4 (Ichthyin)-deficient canines Am J Pathol, 188 (2018), pp. 1419-1429. https://doi.org/10.1016/j.ajpath.2018.02.008.
- Mauldin EA. Canine ichthyosis and related disorders of cornification. Vet Clin North Am Small Anim Pract. 2013;43(1):89-97. doi:10.1016/j.cvsm.2012.09.005
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