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InFocus

Idiopathic nasodigital hyperkeratosis

David Grant continues the series of dermatology briefs.

IDIOPATHIC nasodigital
hyperkeratosis is a condition
that manifests as excessive
accumulation of keratin on the
dorsum of the nasal planum and/
or footpads. Brachycephalic breeds
and cocker
spaniels may be
predisposed.

The characteristic
sign is thickened,
dry and hard keratin accumulating in
the sites mentioned. In the nose the
cause may be a failure of keratin to
wear away during frequent contact with
food bowls and hard surfaces due to
abnormal facial conformation.

In the footpads the keratin tends
to accumulate on the edges of the
pads, particularly in dogs with gait
abnormalities due to lack of contact
with hard surfaces. Fissuring and
ulceration is possible in untreated
cases. Corns may develop and press
on interdigital areas causing pain and
lameness.

Differential diagnosis

  • Canine distemper. Rare but could
    become more common due to decline
    in uptake of vaccination. History of
    severe systemic illness prior to onset of
    hyperkeratosis.
  • Zinc responsive dermatosis. Rare
    currently, suspect with dry generic
    diets.
  • Superficialnecrolyticdermatitis.
    Rare. Severely ill dog with liver or pancreatic disease diagnosed
    by abnormal liver or pancreatic
    blood parameters and ultrasound
    examination.
  • Hereditary nasal parakeratosis. Seen
    in young Labrador Retrievers and their
    crosses.
    Pemphigusfoliaceus. Usually lesions
    are more extensive and involve other
    sites – bridge of nose and pinnae, for
    example.
  • Systemic lupus erythematosus. Rare.
    Multisystem disorder. Dog will be ill.
  • Leishmaniasis.Historyoftravel
    to southern European country in
    Mediterranean region.

Diagnosis

  • In older dogs with no other lesions
    and otherwise well the diagnosis can
    be made on clinical grounds alone.
    Histopathological examination will
    con rm the diagnosis although this is not often needed.
  • Rule out
    diseases listed in
    the differential
    diagnosis above.

Clinical management

  • Excess keratin may be trimmed
    prior to treatment.
  • Rehydrate the skin with warm
    water soaks and then apply petroleum
    jelly once daily for 10 days. In digital
    hyperkeratosis cases, bandaging of
    the feet is advised for a few hours to
    avoid mess in the home. Removal of
    the bandages is followed by additional
    warm water soaks and cleaning.
  • Further removal of excess keratin
    may be undertaken at this stage so
    that normal anatomical features are
    restored, although care should be taken
    not to overdo the procedure as this
    may provoke fissuring due to thinning
    of the pads.
  • Where fissuring and ulceration has
    occurred, the above treatment can be
    preceded by once daily application of a
    steroid/antibiotic cream.
  • Weekly application of petroleum
    jelly and trimming as required aims to
    prevent excessive build-up of keratin
    once control has been achieved.

Prognosis

The owner should be informed that
idiopathic nasodigital dermatitis is a
condition that can be controlled, but
life-long treatment is required.

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