Alopecia is the medical term for baldness. A particular type of baldness has been described in the Nordic or double-coated breeds whereby the dog develops symmetrical coat loss on the trunk as well as darkly pigmented skin in the bald areas. This pattern of baldness is commonly called “endocrine alopecia” as it is common in several types of hormone imbalances (in particular, hypothyroidism.)
The condition we call “alopecia X,” however, is not associated with the hormone imbalances that normally create endocrine alopecia. Its causes remain mysterious hence the name alopecia X. Given that there are numerous therapies that work for some cases and not for others, and that many of these therapies seem to be in complete opposition, it may be that alopecia X is not one disease but several and we simply do not know how to distinguish them.
Alopecia X goes by many names:
- Black skin disease
- Growth hormone-responsive alopecia
- Castration-responsive alopecia
- The coat funk
- Pseudo-Cushing syndrome
- Biopsy-responsive alopecia
- Follicular dysplasia of the Siberian husky
- Adrenal sex hormone alopecia
- Hair cycle arrest
The following is what is currently believed about this confusing condition.
The good news is that alopecia X is a cosmetic condition only. There is no downside to the dog except for looking funny. For this reason, treatment with medications is frequently discouraged because drugs can have bodywide effects while the disease itself has none. Furthermore, treatment has been fraught with partial responses and can be frustrating if not expensive, depending on what therapy is selected.
The skin biopsy is particularly important in making a diagnosis of alopecia X. If possible, a pathologist who specializes in reading skin tissue should be requested. The biopsy will identify structures typical of alopecia X hair follicles and help rule out concurrent allergy or infection that might mimic alopecia X.
The University of Tennessee Hormone Profile
One option in the pursuit of effective alopecia X therapy is the adrenal sex hormone panel available at the University of Tennessee. This test is done by drawing a baseline blood panel, administering a pituitary hormone called ACTH, and drawing a second blood sample an hour later to compare. Samples are shipped to Tennessee for evaluation for numerous adrenal sex hormones. The results show not only which hormones respond abnormally but the university will make suggestions as to which therapy might be likely to work.
Testing is not inexpensive and results can take several weeks to obtain but may help in selecting what therapy makes sense to try next. Often, results are ambiguous and difficult to interpret. Different specialists have different opinions on the usefulness of information obtained.This blood test may be recommended by your veterinarian as part of the alopecia X work up so we mention it here.
The Typical Patient
The typical Alopecia X patient is a Spitz or Nordic breed such as an American Eskimo, Chow Chow, Pomeranian, Alaskan Malamute, Elkhound, or similar. Poodles have also been over-represented. Hair loss begins in early adulthood, usually by age three years. First the long primary hairs go, leaving a fuzzy, puppy-like coat but eventually that goes, too. The bald skin becomes hyper pigmented but is not itchy, and the skin does not usually get infected.
Part of the problem is that all hormone-based hair losses can look exactly like this, so some testing is needed to determine which of several conditions are occurring.
Expect your veterinarian to begin with:
- A blood panel
- A urinalysis
- Some kind of thyroid testing
- Some kind of adrenal hormone testing
- A skin biopsy
The purpose of this rather broad testing is to rule out diseases that look like alopecia X but for which well-defined treatment protocols exist. This means that two conditions must absolutely be ruled out before proceeding with the trial and error process of alopecia X treatment.
- Cushing’s disease
Both these hormone imbalances lead to endocrine alopecia and while they look like alopecia X, they have their own specific treatments.If your canine companion is suffering from hair loss, Urban Animal can help. Call us and schedule an appointment today!