Questions about possible diagnosis

[Nesor77]

Hello All -

Brand new to the forum. Glad to see there is a place to ask questions of people who have gone through this before!

Our 6.5 yr old min pin - terrier mix (rescue mutt) has been having some add skin issues over the past 9 months. During the summer he had a number of instances on his back of hair/skin coming off in clumps (skin still attached to the hair). It never irritated or itched him at all. We went though fungal/bacterial/thyroid tests at the time; all negative. This went Way on its own after special shampoos and steroids did nothing. Over the holidays he developed a pink spot on his upper lip and chin area. Again no bother to him at all. Still remains today. In the last month he. Has started to go grey very quickly. This is most seen around his eyes (eyelids) and a few spots on his back legs and torso area and inside of his ear. Banfield thought nothing of it, but we asked for a Cushing test anyways. They only did an ACTH which came back at 19.3. They suggested an LDDST which is currently pending. All blood work from his annual exams (June 16 and Jan 17) have been normal.

Any history of positive Cushing diagnoses with skin related symptoms only? Not lethargic, no incontenance, no excessive panting eating drinking, loves the warmth and hates the cold! Leaving the country for a month next week so nervous to hear back on test and see what to do!!

Thanks -

Max

[labblab]

Hi Max, and welcome! However, I must tell you I am highly sceptical of a Cushing's diagnosis given the situation you are describing. Your boy's skin issues do not sound typical of Cushing's, and from what I can tell, he doesn't exhibit any other observable nor lab symptoms that are consistent with Cushing's, either. Regardless of the outcome of the LDDS, I wouldn't consider beginning Cushing's treatment without first consulting a specialized veterinary dermatologist. I'm assuming you've perhaps had cultures and skin scrapings done of the areas of hair/skin loss, but actual tissue biopsies of the affected areas may be helpful.

Cushing's tends to result in generalized areas of bilateral hair thinning on the flanks and haunches, vulnerability to skin infection (which you say has been ruled out) and sometimes a specific condition called calcinosis cutis (which would not spontaneously resolve on its own in the face of elevated cortisol). So none of the skin issues that you are describing seem to correspond with these problems. Plus, it would be highly unusual for a Cushpup not to evidence any laboratory irregularities whatsoever. So as I say, I'd want the input from a specialist trained in skin conditions before considering moving on to Cushing's treatment, regardless of the LDDS result. Sometimes dermatologists are the first to suspect Cushing's in dogs who are referred to them for consultation. But this occurs when the skin problems and labwork are consistent with the disease, which I don't believe is the case for your boy.

Marianne

[Nesor77]

Thank you for your reply. I feel much better! Seems its a better chance that his skin issues are purely dermatoligcal or coincidental. Will check LDDST test and then go to a vet dermatologist.

[Joan2517]

Hi and welcome from me as well. Do you think he might be allergic to something? Does he rub against something in your yard maybe? My boy Gable is constantly rubbing his back and face in our boxwoods in our backyard. He has lost his fur on both sides of his flank and some on the middle, but then it comes back like puppy fur.

We have had his blood tested as I was afraid we were going to go through Cushing's again, but only his Thyroid levels came back off. We are going to test again in a few months.

After our Lena died last year, he seemed to age and started getting white, eyelids, top of head and around his mouth...has there been any trauma that might have upset him?

Just throwing out some thoughts....

[Nesor77]

Thanks, Joan. He has had allergy issues in the lst. A few years ago, during the summer, he lost muhc o f the hair around his eyes. Benadryl curbed the itching and that subsided. If the recent occurences, no itching at all! Oddly though, the pink lip spot and greying came after a trip to CO which started with bentley finding droppings in the backyard and rubbing himself all over it! I think it was from a neighbors dog, but not sure. I hadnt though about that until now. I will say the hair loss this summer was not associates with anything in the yard, etc. we would pet him and hair/skin would cole right off. Very odd!

The overnight greying is what concerns me. Perhaps its because its the 3rd or 4th skin/fur related issue, or the ine which i know wont reverse itself.

Once we get his LDDST results and Cushings is HOPEFULLY off ghe table, we will find a dermatolgist for him. Sadly that will wait a month as we leave the country next week for vacation and he stays in CO with my inlaws.

[labblab]

I just want to warn you that the LDDS is more vulnerable than the ACTH to "false positives" when something else is amiss in the body other than Cushing's. That's why, due to what seems to be a total lack of consistent Cushing's symptoms, I wouldn't start treatment right now no matter how those test results turn out.

I wonder if Bentley could have picked up some sort of parasitic infestation from the Colorado droppings? Probably very unlikely, but just a wild card to throw out there...

Marianne

[Squirt's Mom]

Hi Max, welcome to you and your baby boy! :)

I agree - I don't see Cushing's in what you describe but if his thyroid has not been checked lately I would spend my money on that testing instead of Cushing's tests. I would ask for the full thyroid panel, not the simple T4 the health screen looks at. ;) That and allergies seem much more possible than Cushing's to me.

Let us know how things are going!
Hugs,
Leslie and the gang

[Nesor77]

Re: Trauma - he has awful seperation anxiety from my wife. He had some issues in 2015 when we were in Italy for our wedding and required a trip to the vet for some medication and as developed digestive problems and was going so much he had back/leg fatigue. This subsided and was an isolated incident. My wife works from home 40% and is on the road 60%. This is a new job with the travel. Perhaps not having her around is adding to stress. Thats why he is staying with her parents when we go on vacation for the month. We figured he needed to be around people he knows and have less commotion than his daycare facility.

[judymaggie]

Hi, Max! I don't have anything to add at this time to the suggestions you have already received about what may be causing the issues you are seeing but wanted to add my welcome. I hope you can get answers soon!

[molly muffin]

Stress can certainly do a number on our furbabies.
I'm inclined to think that if an ACTH test is within normal range, then an LDDS test that was positive would be suspect.

The reason why is because, think of an ACTH as like a sponge. You test first for what cortisol is just in their bodies normally. Then after the injection, it's like a sponge and they dump any excess cortisol that is in the adrenal gland. So if that is normal then they don't usually have any excess being made by adrenals.

An LDDS test work to see how they suppress producing cortisol The first is what is in their bodies normally, and then the injection and they test blood at 4 hour and 8 hours to see if they have suppressed making any excess cortisol. So it's a suppression test.

I would opt for a biposy of the affected skin area, to see if there is anything there that you should know about, but other than that if all test results are within normal range, then that leaves stress or natural aging as a factor.
Hair follicles go through cycles that take months, so likely the grey started months ago, and then has come in on the new cycle of growth as grey rather than normal color. It might have even started changing during the time that the sore and hair loss was occurring and now you are seeing the results of that. As anything like that causes a stress to the body, even if not seen in personality.