Tuesday, May 16, 2017

Winnie's Vitiligo

by Krista Magnifico, DVM


I met Winnie when she came to the clinic with vomiting and diarrhea after eating a rug 3 days before. (BAD! BAD Winnie!). On presentation, she looked very normal. Her physical exam also revealed no abnormalities in the GI tract, but her face!.

Her face was not only a terrific blog topic, but it was something her dad and I talked about for almost a half an hour.


Winnie is a 2 yr ear old Chocolate Lab who started out looking like every other Chocolate Lab. Brown from stem to stern..no spots, no color changes, no interruptions. She was one solid Hershey's brush stroke from nose to the tip of her tail.

Until one day about a year ago when a little pink spot on the left side of her brown nose appeared. 


For us, aging women, her liver spot was a bleached blemish. Her dad brought her in to see if there "might be some kind of skin disease occurring?"

The barely visible, not quite taking a stand, not really bothering anything lesions leave a general veterinarian with a finger on temple wondering with a puzzling pursed look pining over. I promise these are the lesions I lose sleep over.

I call them the "toss of the coin" lesions. 


(As a matter of personal pride I do not toss the coin in front of my clients..but I do sometimes admit to wanting to).

Such was the case with Winnie. That little pink smudge on the left half of her nose was odd. It wasn't raised, irregular, or bothering her. It sort of just looked like a pink paint smudge.

BUT, there are diseases that can cause the skin to change. 


And some of these are really bad diseases, like cancer, or immune-mediated diseases.

The immune-mediated diseases have to be beaten into submission with high doses of steroids, that if needed long enough will kill you! And, gosh, we hate to talk to parents of a one-year-old about cancer or disfiguring life stealing diseases. No one wants to be an alarmist, but we also don't want to ignore something that we might be able to treat to cure now, versus wait and try to treat (possibly too late to do so) later. Oh, the nail biting!

And there sat Winnie, smiling, wagging, and splotched. 


She thought that she was just fine. So, why would we argue with her? A  patient always tells you the most important pieces of the diagnosis. If the patient is down and out depressed, and not looking like they want to put any effort forth to struggle with your poking and prodding, something is WRONG!

But, if like Winnie they think everything is just honkey-dory then listen. A casual neglectful approach is sometimes the right decision. For Winnie, it was the correct diagnosis.

Vitiligo is a disorder that causes a lack of pigment due to the disappearance of the epidermal and/or follicular melanocytes. 


No one really knows why. It could be immune-mediated, it could be triggered by some unknown cause, it has a genetic link, but no identifiable etiology. It sort of slowly creeps up and then creeps along the skin erasing the color that used to be there. It affects about 1-4% of humans thereby making it an important area of study for dermatologists. Loss of pigment leaves skin more susceptible to sun damage which can increase the chance of skin cancer.

In dogs, it is usually seen around the face but can affect the whole body. 


It is characterized by loss of pigment in the skin causing the resulting hair in that area to grow out white.

Some dogs lose the hair, and when regrown it is white. There are no corresponding skin lesions. Dogs with skin infections, or trauma to the skin can lose hair, and it may grow back a different color, or not at all. But such dogs tend to lick, itch, traumatize the skin or have crusting, flaking skin, or pustules that resemble pimples or fluid filled bumps. Such dogs should be seen by a veterinarian and have a work-up to identify the source of the skin problem and receive an appropriate treatment plan to address the underlying cause and any subsequent secondary skin infection, etc.

Diagnostics for skin lesions can include blood work, skin scrapes, cytology, impression smears, cultures, and biopsy. 


If there is no lesion with loss of pigment of the skin, resultant white hair,  then the diagnosis is vitiligo.


There is no treatment for vitiligo. 


This is a cosmetic condition and will not affect Winnie in any way. She does need to be careful not to burn her skin, especially the non-haired areas like her nose and eyelids. There is a much higher incidence of skin cancer in white dogs and cats.

***

If you have a pet in need, you can find a community of helpful people at Pawbly.com. Pawbly is free to use and open to anyone who loves their pet and wants to help them.

I am also available for personal consults at Jarrettsville Veterinary Center in Jarrettsville Maryland. Or find me on YouTube or Twitter @FreePetAdvice.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tootsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story 
To Amputate Or Not To Amputate: Heidi's Story
Lessons From A Real-Life Veterinarian 
Charlie's Life-Saving Lipoma Surgery  
Understanding and Diagnosing The Limping Dog, Why To Probe The Paw 
Angus' Dog Fight And The Consequences
When To Induce Vomiting And When It's Not A Good Idea  
Abby's Survived Being Run Over By Car But Succumbed To A Mammary Tumor 
Palmer's Hemoabdomen: Nearly An Unnecessary Death Sentence
A Puppy That Doesn't Want To Eat Or Play Is An Emergency: Aurora's Story
Does Your Dog Like Chewing Sticks? Hank's Story  
Lexi's Bump 
Pyometra: Happy Ending for Pheonix 
Never Give Up: Bella's New Legs 
How Losing His Spleen Saved Buddy's Life 
Pyometra Emergency: Saving Chloe  
Limping Dog Checklist (part I): Did You Check the Toenails?
Limping Dog Checklist (part II): Did You Check between the Toes?
Limping Dog Checklist (part III): Foot Pads
Limping Dog Checklist (part IV): Broken Bones  
Limping Dog Checklist (part V): Joint Injuries
IVDD: Recovery, Post-Op Problems And How To Conquer Them All
Has Your Vet Given Up On Your Pet? Or You? Would You Even Recognize It If They Had?
Cervical Disc Disease: Hank's Story of Hope
Retained Testicles: Diesel's Story
Ear Tip Bleeds: Domino's Story
Leroy's Battle with Cancer

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