About a year ago, Humphrey's coat began thinning, starting on the hind legs, and gradually affecting the tail, and the lower half of his body. Wearing the cone of shame also led to hair loss and skin damage on the back of his neck. Luckily, the front of his body remains fine (for now).
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| Despite alopecia, Humphrey is currently looking good and feeling great! |
Extensive diagnostic testing revealed no medical explanation. Blood tests sought answers, especially thyroid/hormonal irregularities (such as Cushings) that are often associated with symmetric patterns of hair loss like Humphrey experienced. His blood tests have remained clear for a full year.
He was checked for parasites (such as dermodex mites), infections, and yeast/fungus. Scrapings and a lab culture revealed nothing wrong. Initially, an examination under a Woods Lamp revealed an excess of possible yeast. So, for a year, he endured Nizoral baths, with the hope that the active ingredient (the antifungal ketokonazole) would eliminate any excess yeast. For periods of time, he was bathed every 2 days, otherwise weekly. He was also prescribed several courses of antibiotics to help with management. It made little difference.
This is a fantastic overview of dog hair loss by Dr. Karen Campbell, a veterinarian and Professor Emeritus at the University of Missouri, titled "The Bald Patient" - with photos and all!
With everything else ruled out, it appears that Humphrey may be suffering from an autoimmune disorder called sebaceous adenitis - but this is a tentative diagnosis of exclusion. Lucky for Humphrey, sebaceous adenitis does not pose any health risks, and the resulting alopecia and skin dryness is purely cosmetic.
Beginning this summer, Humphrey will undergo some interventions to see if the hair loss can be stopped, and perhaps even regrown! The best overviews of the affliction and its treatment, upon which the following is based, are:
- Smith & McKay's overview in the journal "Compendium"
- Rosenkrantz's "Topical and Systemic Therapy for Sebhorriec Disorders" which appears in the proceedings
Here's an overview of the recommended, non-systemic treatments.
Supplements (should be monitored by a veterinarian)
- Melatonin has been shown to work on various alopecias (hair loss) in animals. The dose should be 1 mg for dogs under 10 lbs, and 2mg or 3mg for dogs 10 to 20 lbs (larger doses for larger dogs) for a period of 8 to 12 weeks. Melatonin is widely used to treat dogs with various anxiety disorders. Melatonin can be applied topically - and topic treatment has been shown to be effective in humans.
- Biotin can improve alopecia in cases where a dog has a biotin deficiency. The recommended dose is 5mg per 10 kg of body weight for 4 to 6 weeks. In a study of 119 cases, all responded to some degree, but only about half achieved significant improvement.
- Vitamin A, 1000 IU per kg of weight, not to exceed 20,000 IU
- Omega 3 essential fatty acids, 180mg per 5 kg of mody weightin in a formulation of EPA and DHA. Ascenta/NutraSea is a widely available,cost-effective option formulated for dogs.
- In some cases, Zinc supplementation may be warranted, where the skin quality shows signs of possible Zinc deficiency (and Zinc also helps to keep Vitamin A in one's system). Dosing of Zinc depends on the type: Zinc sulfate: 10mg/kg; Zinc guconal/gluconate, 2mg/kg.
Topical Washes
- SALICYLIC ACID WASH. For at least 4 weeks, shampooing with a salicylic acid shampoo after a few hours of intense moisturization (mineral oil or baby oil) is recommended. The salicylic acid removes excess topical oil, but also de-scales and exfoliates dead and dry skin that can block hair growth. Widely available options include Sebcur and Neutrogena T/Sal.
Topical Ointments and Oils (all are recommended, to work together to heal the skin)
- MINERAL OIL. A first line of defense is a weekly, 2 hour soak with baby oil or another mineral oil. The purpose of this is to moisturize the top layer of the skin, which is typically dried out in cases of sebaceous adenitis. After applying oil to the whole body (which is sometimes recommended in a 50% water dilution), the excess can be washed away. Upon results in 4 to 8 weeks, the frequency of this step can be decreased.
- ESSENTIAL FATTY ACIDS (EFAs). In between the intense baby oil soaks, less oily but constant moisturization is recommended. First is using topical essential fatty acids (EFAs), which are widely available in beauty products in the form of botanical oils. For instance, sunflower oil, chia oil, and others are effective EFAs. Many are available at low cost. The Ordinary offers a pure chia oil for under $8 Canadian. Peas in a Pod offers Bottoms Up "bum spray" for babies that contains various EFAs and other moisturizing agents. Finally, Verb Ghost Dry Oil and Briogeo Farewell Frizz (a leave-in conditioner) both provide spray-on formulations that contain EFAs without too much mess. Studies published in medical journals on humans as well as on rats reveal that EFAs have benefits for healing and preventing lesions that far exceed mineral oil (e.g., those prone to pressure ulcers). For those with sebaceous adenitis, EFAs provide moisture to heal the skin and possibly hair follicles.
- MOISTURE-LOCKING TOPICALS. The research on sebaceous adenitis also recommends applying a moisture-locking preparation daily - usually a propylene glycol spray. This does not replace EFAs (which moisturize), but rather locks the moisture into skin and hair. Commercially, Naked Manicure Hydrating Hand and Body Serum is a non-greasy, propylene glycol solution. Alternately, there may be value in using a hyaluronic acid preparation to lock moisture into the skin and hair, such as The Ordinary's Hyaluronic Acid 2%.
- ANTI-INFLAMMATORY TOPICALS (E.G., PHYTOSPHINGOSINE). Research suggests value in applying phytosphingosine, which has anti-inflammatory properties and is part of the skin's natural lipd layer. It often appears in ceramide-based cosmetic creams for humans (since phytosphingosine is part of the ceramide structure) which can be used. It is a main ingredient in the Douxo Calm line for dogs (e.g., the Douxo Calm Mousse). A multi-tasking product from The Ordinary called Natural Moisturizing Factors + HA contains ceramides as well as hyaluronic acid may be a good substitute for the much more costly Douxo products (though may be more difficult to apply than the Douxo spray or mousse)
- MELATONIN is sometimes applied topically.
Other interventions may contribute to managing sebaceous adenitis that should be further explored. These include:
- Red light therapy, that is effective in human dermatology and hair loss.
- Microneedling (AKA, the Kim Kardashian Vampire Facial) has been effective in treating dogs with alopecia X that are resistant to other treatments. In addition to a study published in a veterinary journal, it is now practiced at Colorado State University's veterinary school (check out the dramatic before-and-after photos on their site). Nobody in Canada is currently practicing microneedling on dogs.
- Urea-based creams that moisturize and may contribute to gentle exfoliation and de-scaling.
- Vitamin A topicals that could assist with exfoliation and skin quality, such as Mad Hippie Vitamin A Serum (it is all natural and contains EFAs) or The Ordinary's Retinol 1% in Squaline (a bargain at $6!). Vitamin A is harsh on the skin - so must be used in small quantities and definitely not more than once weekly to start. However, since topical Vitamin A (Retinol) cause skin renewal, it might be beneficial for the exfoliation process, and avoids the dangers of oral retinoids which are sometimes prescribed to dogs. One caution is that topical Vitamin A causes sun sensitivity, so the skin to which it is applied should be covered when outdoors.
- Various essential fatty acid (EFA) masks and leave in treatments, such as Kiehl's Ginger Leaf and Hibiscus Firming Mask, or Weleda's Skin Food, could enhance the skin's moisure. These are rich oil-based pastes, so may pose some challenge in application on a dog with a dense coat.
- Omega 6 promotes dermal healing, both topically and orally (see Silva et al., 2018). While the earlier research emphasizes Omega 3 supplementation, it may be beneficial to also supplement Omega 6 (topically, sunflower oil is perhaps the best source of Omega 6).
- Peppermint and rosemary essential oils (diluted in a carrier base of sesame and sweet almond oils) stimulate hair follicles and deliver moisture when massaged.
So now, we apply lotions and potions, and wait a month or two. Fingers crossed that these work!
UPDATE: 4 months later, Humphrey is experiencing some hair regrowth! The regrowth remains patchy, but the vet and the groomer commented on it without prompting. It seems that his progress may be related to the following:
- 0.25 mg melatonin, orally, every night. This is about 1/12 the recommended dose for a dog his size experiencing Alopecia X, but it seems to work. Biotin supplements had no effect and were tried for about 6 weeks before melatonin.
- Oral Omega 3 supplement for dogs daily as directed on packaging.
- Weekly shampooing with Nizorol and a salicylic shampoo (a good option is LaRoche-Posay), and if necessary a wipe down with Clean & Clear's lemon exfoliating wipes.
- Weekly serum treatment with Elizabeth Arden ceramide pods on the affected areas right after bathing. The Elizabeth Arden pods (even when used mid-week) seem to cause immediate exfoliation of any dark spots that materialize. They also seem to deliver more sustained moisture to the skin than other products (perhaps this has to do with ceramides which purport to be identical to the skin).
- Daily moisturizing with a rotation of Avene Cicalfate (it contains zinc, moisturizes without being gooey, and is a good barrier cream for bare skin in harsh weather), the sesame oil tincture containing peppermint essential oil, and an EFA treatment with Yves Rocher creme riche. It seems that Humphrey's skin's needs changed based on the weather, so his treatments are adjusted from day to day with this group of products.
- Occasional red light therapy using the now-defunct Tanda Luxe device (other options remain on the market). Humphrey does not love sitting still long enough to do a proper treatment, but it's a harmless process that probably yields some benefit to the skin if not hair follicles. The vet wondered if this wasn't the deal-maker in his progress.
On a related note, we have spoken with the vet about microneedling, and he is fascinated but (not surprisingly) unwilling to try. Presently, no local vets in Canada nor US locations surrounding Humphrey's home offer it. Depending on Humphrey's progress, we may attempt a DIY with the help of women who are skilled at doing their own (human) microneedling at home and swear it is not uncomfortable.
UPDATE: 4 months later, Humphrey is experiencing some hair regrowth! The regrowth remains patchy, but the vet and the groomer commented on it without prompting. It seems that his progress may be related to the following:
- 0.25 mg melatonin, orally, every night. This is about 1/12 the recommended dose for a dog his size experiencing Alopecia X, but it seems to work. Biotin supplements had no effect and were tried for about 6 weeks before melatonin.
- Oral Omega 3 supplement for dogs daily as directed on packaging.
- Weekly shampooing with Nizorol and a salicylic shampoo (a good option is LaRoche-Posay), and if necessary a wipe down with Clean & Clear's lemon exfoliating wipes.
- Weekly serum treatment with Elizabeth Arden ceramide pods on the affected areas right after bathing. The Elizabeth Arden pods (even when used mid-week) seem to cause immediate exfoliation of any dark spots that materialize. They also seem to deliver more sustained moisture to the skin than other products (perhaps this has to do with ceramides which purport to be identical to the skin).
- Daily moisturizing with a rotation of Avene Cicalfate (it contains zinc, moisturizes without being gooey, and is a good barrier cream for bare skin in harsh weather), the sesame oil tincture containing peppermint essential oil, and an EFA treatment with Yves Rocher creme riche. It seems that Humphrey's skin's needs changed based on the weather, so his treatments are adjusted from day to day with this group of products.
- Occasional red light therapy using the now-defunct Tanda Luxe device (other options remain on the market). Humphrey does not love sitting still long enough to do a proper treatment, but it's a harmless process that probably yields some benefit to the skin if not hair follicles. The vet wondered if this wasn't the deal-maker in his progress.
On a related note, we have spoken with the vet about microneedling, and he is fascinated but (not surprisingly) unwilling to try. Presently, no local vets in Canada nor US locations surrounding Humphrey's home offer it. Depending on Humphrey's progress, we may attempt a DIY with the help of women who are skilled at doing their own (human) microneedling at home and swear it is not uncomfortable.
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