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com

Alopecia is, at first sight,

a difficult and confusing
problem to manage

Symmetrical alopecia
in the dog ROSARIO CERUNDOLO

ALOPECIA is characterised by the absence of hair or by its loss from areas where it is normally present.
It may be congenital or acquired and may reflect a cutaneous problem or may be the consequence of
underlying internal diseases, the recognition of which is fundamental for the health of an animal.
A variety of pruritic and non-pruritic diseases, such as those caused by ectoparasites (eg, scabies and
demodicosis), dermatophytes, bacterial or yeast infections, and hypersensitivities, may initially show
patterns of focal or multifocal alopecia which, if incorrectly managed, can progress to produce a more or
less symmetrical generalised alopecia. In this article, however, discussion is restricted to the approach to
the diagnosis of diseases causing symmetrical alopecia in dogs, including diseases of the endocrine glands
Rosario Cerundolo and of the hair follicle unit. These are usually characterised by a non-inflammatory, non-pruritic,
graduated from progressive alopecia affecting the head, neck, flanks, perineal area and/or thighs.
Naples in 1987. After
a period in small
animal practice, he
joined the medicine SIGNALMENT
unit of the University
of Veterinary
Medicine in Naples. Age
In 1995, he started a Congenital alopecia is likely to be caused by an ectoder-
residency in
dermatology at the mal defect. However, some breeds are genetically pre-
RVC and is currently disposed to alopecia and have been specifically selected
completing his
doctorate in for this feature on aesthetic grounds.
veterinary medicine Hair loss commencing during the first year of life
in Naples. His may be caused by hair follicle abnormalities such as
research interests
include canine black hair follicular dysplasia and colour dilution alope-
alopecia and cia (Roperto and others 1995). Alternatively, it may be
melanoma in pigs.
He holds the
certificate in
veterinary
dermatology and is
a diplomate of the
European College Yorkshire terrier with colour dilution alopecia. Hair loss has
of Veterinary occurred in areas of the body with diluted coat colour. The
Dermatology. head and the ventral body, which have a tan coat colour,
have normal hairs. Reproduced with permission from Roperto
and others (1995)

caused by late phase dermatomyositis (Ferguson and

Chinese crested dog with congenital alopecia. In this breed,
a variable amount of hair is usually present on the head and
limbs
others 1999).
Adult dogs developing alopecia may be suffering
from alopecia X (formerly called growth hormone
responsive dermatosis or congenital adrenal hyperplasia-
like syndrome) (Schmeitzel and others 1995), follicular
dysplasia (Miller and Scott 1995), pattern baldness, post-
clipping alopecia, sebaceous adenitis or endocrine abnor-
malities (see table on page 357).

350 In Practice * JULY/AUGUST 1999

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Dachshund with pattern

baldness, showing alopecia
of the caudal aspect of the
hindlegs and the genital
area

Shetland sheepdog with dermatomyositis. Areas of scarring

alopecia with crusts are present on the face Yorkshire terrier
with pattern baldness.
Progressive alopecia and
Breed hyperpigmentation of the
ear pinnae has occurred
Certain breeds are predisposed to alopecic conditions since two years of age
such as alopecia X, dermatomyositis, follicular dyspla-
sia, pattern baldness, post-clipping alopecia, seasonal
flank alopecia (Curtis and others 1996) and sebaceous
adenitis (see table on page 352).

Coat colour
Coat colour may provide useful diagnostic information
in pigment-related alopecia such as black hair follicular
dysplasia and colour dilution alopecia. Careful evalua-
tion of the coat may be required, as some dilute colours
Crossbred with post-clipping
are subtle. alopecia. Four months after
clipping there was no sign
of hair regrowth
Sex
In males and females neutered early in life a progressive
alopecia may occur. Sertoli-cell tumours in dogs and
hyperoestrogenism in bitches may also lead to alopecia.

(above and below) Pomeranian with alopecia X, showing

progressive hair loss on the nodec and along the dorsum.
Cutaneous hyperpigmentation Is commonly present in the
affected areas

Standard poodle with sebaceous adenitis. There is

marked hair loss, which started on the dorsal midline and
is progressing on both sides. Follicular casts were evident
on plucked hairs. Hypothyroidism had previously been
suspected and trial therapy with L-thyroxine had been
undertaken for a few months before referral; this had
not produced any hair regrowth

In Practice * JULY/AUGUST 1999

351
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Seasonal flank alopecia German shepherd

in an Airedale terrier dog with a Sertoli-
(top) and boxer cell tumour.
(bottom). In both cases, Alopecia is
progressive hair loss affecting the
and hyperpigmentation ventral tail, perineal
started on the flanks in area and hindlegs.
December and Palpation of the
spontaneous hair scrotum revealed
regrowth and that one testicle
resolution of the was abnormal in
hyperpigmentation shape and size.
was evident the Histopathology
following spring confirmed
the suspected
diagnosis. Picture,
Dr Fabia Scarampella,
Italy

ical events, such as pregnancy and lactation, or patholog-

HISTORY
Consideration of the dog's age at the time of onset of
alopecia, its rate of onset, its resolution or progression,
and the presence of a cyclical pattern relating to the time
of year, will help in compiling a list of differential
diagnoses.
Age and time of onset
The onset of alopecia should always be related to the
dog's age, and any physiological and/or pathological
event, management change or therapeutic treatment.
Alopecia sometimes occurs a few weeks after physiolog-
ical events, such as severe systemic disease, shock or
surgery (eg, telogen effluvium). Alopecia may also occur
a few days after the administration of cytotoxic agents,
such as methotrexate and cyclophosphamide, or toxic
substances, such as selenium, thallium and arsenic (eg,
anagen defluxion), although this is quite rare. Failure of
hair regrowth after clipping is suggestive of either
hypothyroidism or post-clipping alopecia. In dogs of any
age, there may be concurrent demodicosis contributing
to the hair loss.
Seasonal pattern
Alopecia with a cyclical pattern related to the time of
year is seen in Portuguese water dogs with follicular dys-
plasia, and in dogs with seasonal flank alopecia.
Location and progression of alopecia
Progressive alopecia in areas of the body with black or
diluted hair colour is suggestive of black hair follicular
dysplasia or colour dilution alopecia. In adult dogs with
endocrine abnormalities, progressive hair loss usually
affects the trunk and tail and then extends over the body.
The presence of alopecia with cutaneous hyperpigmenta-

Black hair Colour dilution Dermatomyositis Follicular Pattern Post-clipping Sebaceous Seasonal flank
Alopecia X adenitis alopecia
follicular alopecia dysplasia baldness alopecia
ayspiasia
,r4ICn la cia

Bernese mountain Beauceron Alaskan Boston terrier Alaskan Akita inu Airedale terrier
Chow chow Basset hound Border collie
Beagle dog Chow chow malamute Boxer malamute Border collie
Keeshond Chow chow English springer Bouvier des Flandres
Pomeranian Bearded collie Chihuahua German shepherd Curly-coated Chihuahua
Poodle Border collie Chow chow dog retriever Dachshund German spaniel Boxer
Crossbred* Kuvasz Irish water Greyhound shepherd dog German Dachshund
Samoyed Cavalier King shepherd dog Dobermann
Charles spaniel Dachshund Lakeland terrier spaniel Pinscher Keeshond
Welsh corgi
Dobermann Rough collie Portuguese Weimaraner Samoyed Samoyed English bulldog
Crossbred* Standard French bulldog
Gordon setter Great Dane Shetland sheepdog water dog Whippet Siberian husky
Welsh corgi Siberian husky poodle Golden or labrador
Jack Russell Greyhound Vizsla retriever
terrier Irish setter Poodle
Pointer Newfoundland Rhodesian ridgeback
Saluki Pinscher Schnauzer
Poodle Scottish terrier
Saluki
Schipperke
Shetland
sheepdog
Silky terrier
Staffordshire bull
terrier
Whippet
Yorkshire terrier
* Any crossbred with two or three coat colours

352 In Practice * JULY/AUGUST 1999

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tion confined to the flanks is suggestive of seasonal flank

alopecia or a Sertoli-cell tumour. Seasonal flank alopecia
resolves spontaneously with the change of the season
while Sertoli-cell tumours usually progress to the caudal
thighs, perineal, genital and ventral abdominal areas; in
addition, cutaneous thickening may be seen. In hypo-
estrogenism and hyperoestrogenism, the alopecia usually
occurs first in the genital and perineal areas and then
progresses to involve the ventral abdomen, caudal and
medial thighs, and the neck. Telogen effluvium and ana-
gen defluxion are characterised by sudden-onset alope-
cia, which occurs a few months or a few days/weeks,
respectively, after an insult to the hair follicle. Slow-
onset alopecia is typical of endocrinopathies, follicular
dysplasia, pattern baldness or sebaceous adenitis. The
Irish water spaniel with follicular dysplasia. Progressive
progression of alopecia may also be related to other. hair loss has affected the dorsum, rump and subsequently
concurrent conditions such as demodicosis or hypersen- the lateral trunk. Concurrent hypothyroidism had been
sitivity disorders. diagnosed and treated with L-thyroxine but no hair
regrowth occurred over a one-year follow-up period

Concurrent cutaneous lesions

* The presence of papules and pustules in alopecic Miniature poodle with
areas may suggest pyoderma, which commonly occurs hyperadrenocorticism.
Progressive alopecia has
secondarily to follicular dysplasia or endocrinopathies. affected the trunk, neck
* Cutaneous hyperpigmentation and thickening may and limbs
occur in cases of Sertoli-cell tumour, seasonal flank
alopecia, hypothyroidism or hyperoestrogenism.
* Scales and follicular casts are seen in dogs with
endocrine disorders and in sebaceous adenitis.
* Ulceration with scales and crusts and subsequent
scarring alopecia is common in dermatomyositis.
* Comedones and secondary pyoderma present in some
endocrinopathies may also be a sign of a concurrent
demodicosis.

Concurrent pruritus
In many dogs, alopecia is the result of pruritus. The pres-
ence or absence of pruritus is an important factor to be
considered in the investigation of the alopecia.
Ectoparasites and secondary bacterial infections are
common causes of pruritus and may complicate any of
the conditions discussed in this article. Therefore,
antiparasitic or antibiotic therapy should be instituted as
part of the initial approach, where appropriate.
Previous diseases or therapies
A history of previous dermatological or other non-
dermatological diseases and information regarding
previous or current medications, such as antitumour
antimitotics (eg, doxorubicin), may help to explain the
hair loss. Prolonged therapy with glucocorticoids may
lead to iatrogenic hyperadrenocorticism.
A lack of response following trial therapies, such as
hormonal supplementation (eg, L-thyroxine), may indi-
cate that the diagnosis needs to be reconsidered.
Other clinical signs
Concurrent clinical signs may suggest internal diseases.
Polyuria, polydipsia, polyphagia and a pendulous
abdomen indicate possible hyperadrenocorticism, while
lethargy and obesity may suggest hypothyroidism.
Abnormalities of the oestrous cycle may point to
hypothyroidism, hyperadrenocorticism or hyperoestro-
genism. In hyperoestrogenism, gynaecomastia and
vulval enlargement may also occur. Lack of hair
regrowth in previously clipped areas may indicate an
underlying endocrinopathy.
CLINICAL APPROACH
General physical examination
A general physical examination should always be
conducted in order to detect any abnormality present in
other organs which may be related to the alopecia or
which may influence further tests to be carried out
(eg, care should be taken when carrying out a skin biop-
sy under general anaesthesia in dogs with cardiac, hepat-
ic and/or renal failure). Examination of the genitals
might help to rule out the presence of a testicular mass
such as a Sertoli-cell tumour or identify abnormal vulval
enlargement in cases of hyperoestrogenism.
Dermatological examination
A careful dermatological examination should be under-
taken to evaluate the distribution of the alopecia. The
condition of the hair- for instance, whether it is easily
epilated or broken - in non-affected areas and at the
edge of the lesions should be assessed. The presence of
concurrent primary or secondary cutaneous lesions may
give useful clues as to the cause of the alopecia. The
thickness of the skin is decreased in hyperadrenocorti-
cism, but increased in hypothyroidism.
Differential diagnosis
A list of differential diagnoses should be compiled so
that dermatological investigations can be selected on a
rational basis.

In Practice * JULY/AUGUST 1999 355

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DIAGNOSTIC APPROACH
Initial investigations
Coat brushing, cytology, skin scrapings, tape strips and a
Wood's lamp examination should always be carried out.
Plucked hairs should be examined both macroscopi-
cally for the presence of follicular casts, such as those
seen in sebaceous adenitis, and microscopically (tri-
chogram) to identify the hair cycle stage, the presence of
ectoparasites (eg, Demodex species) or fungal spores. A
trichogram is also a useful tool to evaluate the hair
structure; for example, hair abnormality may lead to
fragility as seen in colour dilution alopecia. Examination
of epilated hair from the edge of the alopecic areas will
allow the hair cycle stage to be identified (eg, telogen or
anagen) and may help to detect the possible cause of
alopecia. A predominance of telogen hairs may suggest,
for example, telogen effluvium or endocrinopathies. Hair
shafts which are damaged or distorted, or reduced in size
usually indicate anagen defluxion.
Further investigations
If the results of the above tests have failed to produce a
definitive diagnosis, albeit having allowed the list of sus-
pected diseases to be narrowed, further investigations are
necessary. These should be selected according to the
index of suspicion. Bacterial culture should be carried out
in cases where recurrent pyoderma has already been treat-
ed with several antibiotics. Haematology, biochemistry
and urine analysis may be useful to evaluate the general
health status of adult dogs with a permanent or recurrent
alopecic condition or if a systemic disease, which may
lead to alopecia, is suspected. Hormonal tests should be
carried out if the clinical signs and results of blood and
urine analysis suggest an endocrinopathy. The serum or
Suggested approach to the diagnosis of symmetrical alopecia
I I
i
Congenital Juvenile onset
Black hair follicular
dysplasia
Colour dilution Endocrine
alopecia
Dermatomyositis
Thyroid
IT,
Male
Hypogonadism
Sertoli-cell tumour
356
Hair plucked from an area of diluted coat colour of the
Yorkshire terrier pictured on page 350. There is an abnormal
amount of melanin in the hair medulla and cortex.
Magnification x 560
plasma concentration of endogenous thyroid stimulating
hormone (TSH) and total thyroxine (T4) give a good indi-
cation of thyroid function, although a TSH stimulation
test remains the best test to check thyroid function.
Determination of endogenous adrenocorticotropic hor-
mone (ACTH) level, as well as ACTH stimulation and
low-dose dexamethasone suppression tests, can be used
to diagnose hyperadrenocorticism. A sex hormone profile
may be carried out to confirm a suspected Sertoli-cell
tumour, hyperoestrogenism or alopecia X. An abnormally
high level of 17-hydroxyprogesterone (1 7-OHP) pre- and
post-ACTH stimulation is commonly found in alopecia
X, but the correlation of this increase with the presence of
alopecia is still unclear. Radiographs and ultrasound
investigations are useful to assess internal organs (eg,
adrenal andlor testicular mass, and the presence of metas-
tases). Skin biopsy is usually necessary when the previ-
ous investigations have not led to a definitive diagnosis.
Histopathology may show evidence of the cause of alope-
- O-3
I
II
Adult onset
I
Non-endocrine
Gonads Adrenals Alopecia areata
Alopecia X Anagen defluxion
Hyperadrenocorticism Black hair follicular
dysplasia
Colour dilution
alopecia
Follicular dysplasia
Pattern baldness
Female Post-clipping alopecia
Hypoestrogenism Sebaceous adenitis
Hyperoestrogenism Telogen effluvium
In Practice o JULY/AUGUST 1999
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Plucked normal hair base, showing the Plucked normal hair in the
typical appearance of an anagen hair. telogen phase. Magnification x 560
Magnification x 560

lin1=1VI ISEIaI-11cl z :XUl I mizl-

M ;{TO S 9 71 I40l1 IIDIIS :^t
,lS S - 0

Aetiology Location of alopecia Concurrent cutaneous Concurrent clinical signs Specific diagnostic tests Treatment
lesions
Anagen defluxion Systemic diseases, Diffuse NP Depends on underlying Trichogram Treatment of underlying
chemotherapy cause disease, withdrawal of
chemotherapy if possible
Black hair follicular Abnormal Areas of black coat Secondary pyoderma NP Trichogram, skin biopsy None
dysplasia distribution of colour
melanin
Colour dilution Abnormal Areas of diluted coat Secondary pyoderma NP Trichogram, skin biopsy None
alopecia distribution of colour
melanin
Dermatomyositis Immune mediated? Face, limbs, tail Erythema, scales, Myositis Skin biopsy, Pentoxifylline
crusts, scarring neurological tests
Follicular dysplasia Abnormality of hair Neck, trunk, hindlegs Secondary pyoderma, NP Skin biopsy None
follicle function comedones
Pattern baldness Unknown Pinnae, neck, hindlegs, Hyperpigmentation NP Skin biopsy None
inguinal area
Post-clipping Abnormality of hair Clipped areas Hyperpigmentation NP History of previous None
alopecia follicle function clipping
Sebaceous adenitis Unknown Head, trunk Scales, follicular casts NP Trichogram, skin biopsy Retinoids, essential
fatty acids
Telogen effluvium Stressful events Diffuse NP Depends on underlying Trichogram Spontaneous resolution,
(parturition, cause treatment of underlying
surgery, systemic disease
disease)
Alopecia X Unknown Neck, trunk, tail, Hyperpigmentation NP Blood tests (ACTH None
hindlegs stimulation test to
measure 17-OHP)
Hyperadreno- Pituitary or adrenal Trunk, tail Secondary pyoderma, Polyuria, polydipsia, Blood test (ACTH Mitotane,
corticism tumour, iatrogenic calcinosis cutis, polyphagia, pot-belly stimulation test, low
comedones
adrenalectomy
dose dexamethasone
suppression test), urine
analysis, ultrasound
Hypotnyroudism Primary, secondary Trunk, tail ..

Secondary pyoderma, Various (eg, lethargy, Blood tests (T4 and

comedones
T4 supplementation
obesity, neuromuscular, TSH determination,
cardiovascular, TSH stimulation test)
reproductive and
gastrointestinal disorders)
Seasonal flank Unknown Flanks Hyperpigmentation NP Skin biopsy
alopecia Spontaneous resolution,
melatonin
Sertoli-cell tumour Tumour of the Neck, rump, perineal Hyperpigmentation, Cryptorchidism, Blood test (oestrogens),
Sertoli cells Castration
and genital area linear preputial gynaecomastia, ultrasound
dermatosis pendulous prepuce,
attraction of
other males
Hypoestrogenism Spayed bitches Perineal and genital Hyperpigmentation NP None
area, neck, trunk, thighs Oestrogen
Hyperoestrogenism Cyst or tumour of Perineal and inguinal Hyperpigmentation, Oestrous cycle Blood test (oestrogen),
the ovary area, flanks comedones abnormalities ultrasound
Ovariectomy
NP Not present, ACTH Adrenocorticotropic hormone, 17-OHP 17-Hydroxyprogesterone, T4 Total thyroxine, TSH Thyroid stimulating hormone

In Practice * JULY/AUGUST 1999 357

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cia and will also provide information about the piload-
nexal unit, cycle of the hair follicle and its integrity. In
most cases, histopathology is not diagnostic; however, if
the pathologist's report is evaluated together with the
dog's history, clinical signs and the results of the blood
tests, it may help to achieve a diagnosis.
THERAPEUTIC APPROACH
The therapeutic approach should be directed at both the
primary cause and the concurrent secondary disease, if
present. Some examples of therapeutic approaches are
given below, although these are not exhaustive.
* Initial treatment of PYODERMA may resolve the con-
current pruritus, ruling out causes of pruritic alopecia.
However, if there is no hair regrowth during or soon
after a course of antibiotics, further diagnostic tests are
required before attempting any therapy.
* ANAGEN DEFLUXION and TELOGEN EFFLUVIUM do not
usually require any therapy. In anagen defluxion, with-
drawing the offending drug, if possible, or resolution of
the underlying disease will result in hair regrowth. In
telogen effluvium, hair will regrow as the dog recovers
from the stressful event(s) which led to the hair loss.
* In BLACK HAIR FOLLICULAR DYSPLASIA and COLOUR
DILUTION ALOPECIA, hair loss is permanent. Essential
fatty acids or retinoids, and antibiotics, if necessary, may
help to reduce the presence of concurrent skin lesions.
* In DERMATOMYOSITIS, alopecia is permanent.
Pentoxifylline and vitamin E may help to reduce the
severity and progression of the cutaneous lesions.
* In dogs with FOLLICULAR DYSPLASIAS, no specific
therapy has been reported although essential fatty acid
supplementation may help the follicular function.
Antibiotic courses may also be necessary to control
secondary bacterial infections.
* No specific therapy has been reported for PATTERN
BALDNESS. Trial therapy using melatonin has been anec-
dotally reported.
* POST-CLIPPING ALOPECIA does not require any therapy
as the hair will grow back after a few weeks or months.
* In SEBACEOUS ADENrrIS, the hair cycle is not affected
and hair regrowth may occur. Essential fatty acids,
retinoids and/or topical therapies, such as propylene gly-
col, reduce the severity of the cutaneous lesions caused
by the destruction of the sebaceous glands.
Endocrinopathies
Most of the endocrinopathies can be easily treated as
they respond either to hormonal supplementation, surgi-
cal removal of the tissue responsible for the altered hor-
mone production, medical therapy to diminish hormone
production, or withdrawal of the hormonal treatment.
The institution of therapeutic trials without first carrying
out specific hormonal tests is to be discouraged, as they
may produce no hair regrowth and sometimes cause side
effects.
* ALOPECIA X has been reported to respond to growth
hormone supplementation, castration, or adrenolytic
drugs. However, in the author's opinion this condition
should not be treated in any of these ways, as the alope-
cia is only an aesthetic problem and the animals are
otherwise healthy. Trial therapy is not recommended but,
if used, owners should be informed of the possible side
effects which may be more serious than the simple
In Practice * JULY/AUGUST 1999
Same standard poodle as
pictured on page 351,
showing hair regrowth
following essential fatty
acid supplementation and
topical application of
propylene glycol
presence of alopecia. Scientific studies are currently
being carried out to identify the underlying pathology of
alopecia X. Development of a specific treatment for this
condition will be dependent on a full understanding of
the underlying pathogenesis.
* SEASONAL FLANK ALOPECIA is only an aesthetic prob-
lem as dogs are otherwise healthy and no hormonal
abnormalities have been detected in affected dogs. Hair
regrowth usually occurs spontaneously at the end of
spring or the beginning of summer. Anecdotal reports of
therapeutic trials using melatonin have suggested that
this hormone may prevent hair loss, but further studies
are necessary to confirm this finding or to identify alter-
native therapies.
* Alopecia associated with SEXUAL HORMONE IMBAL-
ANCE (eg, Sertoli-cell tumour, hyperoestrogenism,
hypoestrogenism) is easily treated by surgical removal of
the abnormal gonad or by hormone supplementation.
SUMMARY
Alopecia can be caused by a wide variety of conditions
and is, at first sight, a difficult and confusing problem to
manage. A methodical approach, involving consideration
of the dog's signalment, thorough history taking, a com-
plete clinical examination and appropriate selection of
diagnostic investigations is essential for achieving an
accurate diagnosis and, thus, for both treatment and
prognosis. The diagnosis is sometimes complicated by
the presence of concurrent diseases which may, or may
not, contribute to hair loss. It is important to remember
that hair loss per se is not life threatening. Where the
problem is only aesthetic, treatment of the alopecia may
not be necessary.
References
CURTIS, C. F., EVANS, H. & LLOYD, D. H. (1996) Investigation of the
reproductive and growth hormone status of dogs affected by
idiopathic recurrent flank alopecia. Journal of Small Animal Practice
37, 417-422 Further reading
FERGUSON, E., CERUNDOLO, R., LLOYD, D. H., REST, J. & CAPPELLO, MORIELLO, K. (1995) Alopecia.
R. (1999) Dermatomyositis in the UK: five cases in the Shetland In Handbook of Small Animal
sheepdog. Veterinary Record (In press) Dermatology. Eds K. A. Moriello
MILLER, W. H. & SCOTT, D. W. (1995) Follicular dysplasia of the and 1. S. Mason. Oxford,
Portuguese water dog. Veterinary Dermatology 6, 67-74 Pergamon. pp 75-91
ROPERTO, F., CERUNDOLO, R., RESTUCCI, B., VINCENSI, M. R., DE SCOTT, D. W., MILLER, W. H. &
CAPRARIIS, D., DE VICO, G. & MAIOLINO, P. (1995) Colour dilution GRIFFIN, G. E. (1995) Endocrine
alopecia (CDA) in ten Yorkshire terriers. Veterinary Dermatology 6, and metabolic diseases.
171-178 Congenital and hereditary
SCHMEITZEL, L. P., LOTHROP, C. D. & ROSENKRANTZ, W. S. (1995) defects. In Muller & Kirk's Small
Congenital adrenal hyperplasia-like syndrome. In Kirk's Current Animal Dermatology, 5th edn.
Veterinary Therapy XII. Small Animal Practice. Ed J. D. Bonagura. Philadelphia, W. B. Saunders.
Philadelphia, W. B. Saunders. pp 600-604 pp 627-719, 736-805
359
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Symmetrical alopecia in the dog

Rosario Cerundolo

In Practice 1999 21: 350-359

doi: 10.1136/inpract.21.7.350

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