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The Davies Veterinary Specialists Building

Dermatology Service

The Dermatology Service (Andrea Volk at Higham Gobion on Mondays and Tuesdays; Carly Mason at Hyde Park on Fridays) accepts cases with skin and ear disorder. Typical situations we deal with are investigations into and long-term management of allergic dermatitis, chronic ear disease (including otitis media, polyp management and treatment of resistant bacterial infections), autoimmune / immune-mediated diseases, claw disease, keratinisation disorders, alopecia (hair loss), endocrinopathies (hormonal abnormalities) as well as diagnosing and treating parasitic, infectious, neoplastic and paraneoplastic skin diseases.

As in several dermatology patients the skin is not the only organ being affected by the disease, other disciplines, such as internal medicine, oncology, ophthalmology or neurology, might be consulted within our multi-disciplinary referral hospital, to form a mutual investigatory and management plan to achieve the best outcome for the patient.

For primary skin and ear diseases the beauty of dermatology is that the skin is an easily accessible organ. Thus, on the day of your pet’s appointment, we are able to fully examine the skin as well as taking surface samples. A clinicopathological assessment of these surface samples will be performed by the dermatologist immediately. Accordingly, in many cases a probable diagnosis can be formulated within the consultation. That also means, that most cases will visit for consultation, diagnostic tests and discharge as an outpatient, which means they are able to leave the hospital on the same day with their owners. As most skin conditions are of a chronic nature, re-examinations are common, usually also on an outpatient basis. Should specific investigations be necessary, they might be scheduled for the following re-examination, and - depending on the kind – your pet might be admitted to the hospital for the day, undergo the procedure and is likely to leave the hospital in the late afternoon / evening, all depending on the procedure and your individual pet. Such specific investigations might include:

  • Advanced diagnostic imaging of the external ear canal and middle ears (CT-, MRI scan)
  • Ear lavage including video-otoscopy
  • Myringotomy, investigating middle ear disease including sampling
  • Skin allergy tests (intradermal testing)
  • Skin biopsies

Should cases, particularly ear cases be either non-responsive to medical management or shown to be too advanced for medical management, they will be transferred to the Soft Tissue team within the hospital for appropriate surgical intervention.

Both Andrea and Carly thoroughly enjoy investigating the whole spectrum of skin diseases, and are fascinated by solving the ‘dermatological puzzle’. However, each of us has their own special interest: Carly’s include allergic cases and autoimmune diseases; whereas Andrea is very interested in atopic patients, with an emphasis on food hypersensitivity and ear disease as well as feline patients.

In addition, we are available for veterinary colleagues to discuss cases (phone or email); we unfortunately are unable to provide advice to owners prior to their first appointment with us.

What's your diagnosis?

For Veterinary Professionals - Diagnosis Questions and Answers from our DVS Newsletter Spring 2016

Case 1

A 16 year old female neutered domestic shorthair cat presents with several months' history of losing weight, mild polyuria/polydipsia, reduced appetite, reduced demeanour and recent hair loss with pruritus.

  • What are your differential diagnoses?
  • Which further test(s) might you perform?
  • How would you communicate this to the owner?

Differential diagnosis

With this age and presentation a paraneoplastic condition is the most likely. Particularly because, on very close inspection of the skin, the stratum corneum shows a very shiny appearance, which is pathognonomic for the so-called paraneoplastic alopecia in cats, which is predominantly associated with hepatic or pancreatic neoplasia.

A thorough physical examination is therefore essential and, in this case, revealed a hard irregular mass ventromedian in the cranial abdomen, which was not possible to discriminate from the liver. The remaining examination was unremarkable apart from smallish kidneys and an overall poor body condition.

Further Tests

The most effective clinical test would most likely be an abdominal ultrasound, to characterise the mass further and, possibly, gaining a fine needle aspirate. Skin biopsies, as well as surface samples for secondary infections might also be helpful.

Owner discussion

This is a tricky case as all the owner has seen is an ageing cat with just recently some weird skin problems. The subject of neoplasia and the poor prognosis of these cases will need to be approached very gently as well as which further diagnostics the owner may wish to have performed given the quality of life of these cases.

There is still wide speculation why some of these cases are pruritic, some appear to have secondary yeast infections (like this one on its claw folds); however allergic skin disease with onset at 16-y old is highly unlikely.

Case 2

A 6-month old male entire French Bulldog with at least four months’ history of hair loss and 2 week history of an abscess on its tail.

  • What are your differential diagnoses?
  • Which test(s) would you perform?
  • What are your differential diagnoses?

Differential diagnosis

  • Demodicosis
  • Bacterial folliculitis
  • Dermatophytosis

Tests

Skin scrapes showed numerous Demodex mites, alive and in various development stages. Exudate of one of the abdominal pustules showed neutrophils and numerous large cocci. The same applied for the pus on the tail fold.

Diagnosis

Juvenile-onset generalised demodicosis with deep pyoderma.

Prognosis

Is good, because generally healthy young dogs have a high chance of full recovery from demodicosis, even with severe deep pyoderma. Generalised demosicosis always takes longer to resolve and may, in some cases, require treatment for life, particularly in certain breeds, including some of the short-haired breeds.


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