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Case report
Abstract A 2-year-old, male neutered, domestic semi-long-haired cat was presented with a 1.5-year history of
progressive, initially nonpruritic alopecia and malodorous greasy exudate affecting the distal extremities, trunk
and neck but sparing the head and tail. The extensive alopecia and seborrhoea were associated with severe thickening of the skin and fold formation on the dorsal head and distal extremities as well as the lateral thorax and
abdomen. The hair was easily epilated, numerous milia were seen on the ventral abdomen and the caudal and
lateral thighs, and mild paronychia was present. Histopathological examination of skin biopsies revealed marked
cystic dilation of hair follicles and sebaceous glands with follicular hypoplasia, infundibular hyperkeratosis and
variable associated inflammation. Systemic glucocorticoid therapy in combination with topical washes with
chlorhexidine and miconazole resulted in a marked improvement and some hair regrowth, but the cat was
subsequently lost to follow-up. The dermatosis resembles a number of conditions in other species, but it is not
clear whether it is a counterpart to the hairless mutant mouse or is a unique dermatosis.
CASE H ISTORY
An approximately 2-year-old, male neutered, domestic
semi-long-haired cat weighing 3 kg was presented to
the Dermatology Unit of the Royal (Dick) School of
Veterinary Studies, The University of Edinburgh, with
a 1.5-year history of progressive, initially nonpruritic
alopecia and malodorous greasy exudate affecting the
distal extremities, trunk and neck but sparing the head
and tail.
At approximately 6 months of age, when it was
adopted as a stray by the present owner, a veterinary
surgeon, the cat was noted to lack undercoat. At 9
months of age, alopecia and excessive skin fold formation began to develop on the distal extremities of all
four limbs. The alopecia resolved without therapy, but
recurred 3 months later expanding proximally to
involve the abdomen and lateral thorax. Concurrently,
patches of hyperpigmentation and a malodorous,
greasy exudate were also seen. A combination of 2%
chlorhexidine and 2% miconazole (Malaseb, Leo
Animal Health, Princes Risborough, UK) baths once
weekly and oral cephalexin (Rilexine, Virbac Bury,
St Edmonds, UK) at a dosage of 25 mg kg1 twice daily
led to only slight improvement, and treatment was
Correspondence: Keith L. Thoday, The University of Edinburgh,
Dermatology Unit, Division of Veterinary Clinical Studies. E-mail:
k.l.thoday@ed.ac.uk
2006 The Authors. Journal compilation 2006 European Society of Veterinary Dermatology
63
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AE Neuber et al.
Table 1. Results of haematological and biochemical examinations
Figure 1. The cat at first referral. Note the extent of the alopecia.
Haematology test
Units
Reference range
6.29 1012 L1
0.283 L/L
9.4 g dL1
45.0 f L1
33.2%
8.5 109 L1
5.1 109 L1
0.0 109 L1
2.55 109 L1
0.68 109 L1
0.17 109 L1
0.0 109 L1
5.500 10.000
0.24 0.45
8.000 14.000
39.000 55.000
30.0 36.0
7.000 20.000
2.500 12.800
1.500 7.000
0.070 0.850
0.000 1.000
0.000 0.200
300.000 600.000
Biochemistry test
Units
Reference range
Total protein
Albumin
Globulin
Bile acids
Alanine aminotransferase
Alkaline phosphatase
(AMP)
Bilirubin
Glucose
Creatinine
Urea
Chloride
Calcium
Inorganic phosphate
Sodium
Potassium
62.0 g L1
28.8 g L1
33.2 g L1
0.5 mol L1
61.0 IU L1
9.0 IU L1
1.4 mol L1
12.2 mmol L1
123.0 mol L1
7.4 mm L1
116.0 mmol L1
2.33 mmol L1
1.720 mmol L1
147.0 mmol L1
4.6 mmol L1
69.00 79.00
28.00 39.00
23.00 50.00
0.00 7.00
6.00 83.00
10.00 100.00
0.00 6.80
3.30 5.00
40.00 177.00
2.80 9.80
117.00 140.00
2.100 2.900
1.400 2.500
145.00 156.00
4.00 5.00
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2006 The Authors. Journal compilation 2006 European Society of Veterinary Dermatology
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AE Neuber et al.
After 4 weeks of prednisolone therapy, dermatological examination revealed a reduction in greasiness and
odour and a complete resolution of the over-grooming
behaviour. Cytological examination of material from
the claw folds was unchanged. To determine whether
the clinical improvement on glucocorticoid therapy
was reflected histologically, repeat skin biopsies were
taken. These had pronounced cyst development similar
to those seen in the initial series. Additionally, in one
sample taken from the palpable cystic lesions on the
left lateral thigh, there was pyogranulomatous inflammation associated with rupture of one of the cysts and
release of contents. This inflammation extended from
the mid-dermis to the subcutis.
Prednisolone therapy was continued as previously,
and the owner was advised to continue cleaning the
claw folds.
After a further 4 weeks, some hair regrowth was
noted on the dorsal neck. Dermatological examination
2006 The Authors. Journal compilation 2006 European Society of Veterinary Dermatology
D ISCU SSION
To the authors knowledge, this condition is unique,
not having been previously reported in any species,
including humans. Similarities were found to a number
of conditions described in humans or mice, but none
was identical, either clinically or histopathologically,
to the disease described in this case report.
The condition in this cat most closely resembles that
in the hairless mutant mouse. Mice with the hairless
mutation1 develop a syndrome characterized by loss of
hair after growth of the first pelage, rudimentary mammary gland development, abnormal growth of the nails
and a high incidence of thymic lymphoma. The skin of
these mutants is characterized by the formation of pilary
cysts, dilated sebaceous gland ducts, granulomatous
inflammation in the dermis associated with rupture of
hair follicles and generalized acanthosis and orthokeratotic hyperkeratosis. In the first 14 days of life, these mice
develop a normal pelage and subsequently lose the coat
in a cephalocaudal pattern to remain entirely naked.1
It has been shown that in these mice, loss of function
of the hairless (h) gene causes dysregulation of catagen
as a result of premature apoptosis of the proximal
hair bulb and destruction of normal hair follicle
architecture.1
Numerous other hairless variants of mice have been
described, e.g. the rhino mutation, which is an allele to
the hairless gene and is a more severe manifestation of
this mutation and the Yurlovo (hrrhY) mice, which are
characterized by complete hair loss during the first 3 to
5 weeks after birth, as well as extensive skin thickening
and folding caused by formation of cystic structures in
the dermis.1
The cystic changes identified in this cat were clearly
associated with both hair follicles and sebaceous glands.
However, it was not possible to determine from which
tissue the cysts emanated. Additionally, in this case,
the hair loss began on the limbs and then spread
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AE Neuber et al.
AC K N OW L E D G E M E N T S
The authors thank veterinary surgeons W. Balmain
and A. Blyth for referring the case. They are particularly
grateful to colleagues Dr D. W. Scott, College of Veterinary
Medicine, Cornell University, New York, USA, Dr G.
M. Kavanagh, Department of Clinical Sciences and
Community Health, The University of Edinburgh,
Edinburgh, Scotland, and Dr R. M. Porter, Cancer
Research UK Cell Structure Research Laboratory,
University of Dundee, Scotland, for their valued opinions
about the clinical images and the histological sections.
REFERENCES
1. Panteleyev AA, Paus R, Ahmad W et al. Molecular and
functional aspects of the hairless (hr) gene in laboratory
rodents and humans. Experimental Dermatology 1998;
7: 24967.
2. Chase HB, Rauch R, Smith VW. Critical stages of hair
development and pigmentation in the mouse. Physiological
Zoology 1951; 24: 18.
3. Takashima I, Kauragishi I. Comparative Study of Hair
Growth in Mammals, with Special Reference to Hair
Grouping and Hair Cycle, and Hair Growth in the Juvenile
Stumptailed Macqaque. Baltimore: Park Press, 1976.
4. Lavker RM, Bertolino AP, Freedburg IM et al. Biology
of hair follicles. In: Freedburg IM, Eisen LA, Eisen AZ
et al. eds. Dermatology in General Medicine, 5th edn.
New York: McGraw-Hill, 1999: 23044.
5. Covello SP, Smith FJ, Sillevis Smitt JH et al. Keratin 17
mutations cause either steatocystoma multiplex or pachyonychia congenita type 2. British Journal of Dermatology
1998; 139: 47580.
6. Reed WB, Horowitz RE, Beighton P. Acquired cutis laxa.
Primary generalized elastolysis. Archives of Dermatology
1971; 103: 6619.
7. Fitzsimmons JS, Gilbert G. Variable clinical presentations
of cutis laxa. Clinical Genetics 1985; 28: 28495.
8. Schot JDL. Granulomatous slack skin. British Journal
of Dermatology 1989; 120: 807.
9. Noto G, Pravata G, Arico M. Granulomatous slack skin:
a report of a case associated with Hodgkins disease and
a review of the literature. British Journal of Dermatology
1994; 131: 2759.
10. Moritz DL, Silverman RA. Steatocystoma multiplex
treated with isotretinoin: a delayed response. Cutis 1988;
42: 4379.
11. Lonnie L, Cole A. Steatocystoma multiplex. Archives of
Dermatology 1976; 112: 14379.
Rsum Un chat europen mle castrg de 2 ans a t prsent pour une alopcie non prurigineuse et un exudat
des extrmits distales, du tronc et du cou, pargnant la tte et la queue, voluant depuis un an et demi. Lalopcie
extensive et la sborrhe taient associes un paississement svre de la peau, et la formation de plus
sur la tte et les extrmits distales ainsi que sur les faces latrales du thorax et de labdomen. Les poils taient
facilement pils, de nombreux milia taient nots sur labdomen et sur les cuisses et une paronychie modre
tait observe. Lexamen histopathologique a montr une dilatation kystique des follicules pileux et des glandes
sbaces avec une hypoplasie folliculaire, une hyeprkratose infundibulaire et une inflammation variable. Un
traitement systmique avec des glucocorticoides et des bains de chlorhexidine et de miconazole ont permis une
amlioration marque et une repousse pilaire, mais le chat a t perdu de vue. La maladie ressemble des maladies
dcrites dans dautres espces, mais il nest pas clair sil sagit dun modle de la souris mutante sans poil ou dune
maladie nouvelle.
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Resumen Un gato castrado de dos aos de edad, de pelo semilargo se present con una historia clnica de 1.5
aos con alopecia sin prurito y con exudado graso y maloliente afectando la parte distal de las extremidades,
el tronco y el cuello, pero sin afectar la cabeza ni la cola. La extensa alopecia y la seborrea se asociaron con
engrosamiento de la piel y la formacin de pliegues en la parte dorsal de la cabeza y la parte distal de las extremidades, as como en los laterales del trax y en el abdomen. El pelo se depilaba fcilmente, y numerosos quistes
de queratina (millium) se observaron en el vientre, y en la parte lateral y caudal de los muslos, as como ligera
paroniquia. El examen histopatolgico de las biopsias de piel desvel una marcada dilatacin qustica de los
folculos pilosos y de las glndulas sebceas, acompaado de hipoplasia de los folculos, hiperqueratosis infundibular e inflamacin de variada intensidad. El tratamiento sistmico con glucocorticoides en combinacin con
baos tpicos con clorexidina y miconazol result en una marcada mejora y algo de crecimiento del pelo, pero
lamentablemente no se obtuvo ms seguimiento clnico. Esta condicin parece tener semejanza con otras condiciones descritas en diferentes especies, pero no esta claro si representa el mismo proceso que el ratn mutante
sin pelo o si es una dermatosis de caractersticas nicas.
Zusammenfassung Ein 2-Jahre alter, kastrierter, halblanghaariger Hauskater wurde mit einer eineinhalbjhrigen
Anamnese eines progressiven, ursprnglich nicht juckenden Haarausfalls und mit belriechendem schmierigen
Exudat vorgestellt, welches sich an den distalen Extremitten, am Rumpf und Hals befand, jedoch nicht am Kopf
und Schwanz. Die ausgedehnte Alopezie und Seborrhoe traten zusammen mit starker Hautverdickung und
Faltenformation dorsal am Kopf und distal an den Extremitten, sowie am lateralen Thorax und Abdomen auf.
Die Haare konnten leicht ausgezupft werden, zahlreiche Milia (Hautgrie) waren am ventralen Abdomen sowie
an den kaudalen und lateralen Oberschenkeln zu sehen und milde Paronychia war vorhanden. Die histopathologische Untersuchung der Hautbiopsien zeigte eine deutliche zystische Dilatation der Haarfollikel und Talgdrsen
mit follikulrer Hypoplasie, infundibulrer Hyperkeratose und einem unterschiedlichen Ausma an Entzndung.
Systemische Glukokortikoidtherapie kombiniert mit topischen Chlorhexidin und Miconazol Waschungen
resultierte in einer markanten Verbesserung und etwas Nachwachsen der Haare, aber die Katze wurde in der
Folge fr eine Nachuntersuchung aus den Augen verloren. Dieser Zustand hnelt zahlreichen Zustnden bei
anderen Spezies, aber es ist unklar, ob es sich um das Pendant zur haarlosen Mausmutante handelt oder um eine
einzigartige Dermatose.
2006 The Authors. Journal compilation 2006 European Society of Veterinary Dermatology