Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)

Abstract Background Despite the common use of topical ophthalmic corticosteroids in dogs, detailed reports on systemic and dermatologic adverse effects are limited. Results Nine purpose-bred research Beagles were treated with difluprednate 0.05% ophthalmic emulsion in one or both eyes 2–3 times dail...

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Autores principales:	Katelin Quantz, Amanda L. Anderson, Christine D. Harman, Erica L. Noland, Jacquelyn M. Del Valle, Laurence M. Occelli, Jessica B. Burn, Simon M. Petersen-Jones, Daniel K. Langlois, Chris G. Pirie, Annette D. Petersen, András M. Komáromy
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Alopecia Canine Corticosteroids Difluprednate (Durezol®) Follicular atrophy Hypothalamic-pituitary-adrenocortical (HPA) axis Veterinary medicine SF600-1100
Acceso en línea:	https://doaj.org/article/3ef3d59deba34f8196436fe5f73b6480
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spelling	oai:doaj.org-article:3ef3d59deba34f8196436fe5f73b64802021-12-05T12:16:51ZLocalized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)10.1186/s12917-021-03072-91746-6148https://doaj.org/article/3ef3d59deba34f8196436fe5f73b64802021-12-01T00:00:00Zhttps://doi.org/10.1186/s12917-021-03072-9https://doaj.org/toc/1746-6148Abstract Background Despite the common use of topical ophthalmic corticosteroids in dogs, detailed reports on systemic and dermatologic adverse effects are limited. Results Nine purpose-bred research Beagles were treated with difluprednate 0.05% ophthalmic emulsion in one or both eyes 2–3 times daily. Some difluprednate treated dogs developed mild to severe alopecia of the periocular region, face, and distal pinna (5/9). The median duration of treatment prior to onset of dermatologic signs for difluprednate treated dogs was 550 days (453–1160 days). Diagnostic testing included complete blood count (CBC) and serum biochemistry, adrenocorticotropic hormone (ACTH) stimulation testing combined with endogenous ACTH measurement, and skin biopsy. The CBC and chemistry were within normal limits for all dogs. There were varying degrees of suppression of the hypothalamic-pituitary-adrenocortical (HPA) axis with difluprednate treatment. Dogs with the most profound alopecic changes had less pronounced HPA axis suppression compared to dogs with no integumentary changes. Skin biopsies demonstrated follicular atrophy and follicular keratosis. When topical difluprednate was reduced to unilateral therapy, the hair regrew on the untreated side of the face. In addition to the affected research dogs, a 7-year old female spayed Chihuahua that was being treated as a clinical patient with long-term difluprednate 0.05% ophthalmic emulsion developed generalized hypotrichosis on the head and body and a potbellied appearance. ACTH stimulation testing revealed suppression of the HPA axis with a mild increase in serum alkaline phosphatase (ALP) activity and a urine specific gravity of 1.016. The combination of clinical signs and laboratory abnormalities was supportive of iatrogenic hyperadrenocorticism. Conclusions In dogs long-term use of difluprednate ophthalmic emulsion results in HPA axis suppression and in some cases iatrogenic hyperadrenocorticism. A novel pattern of localized alopecia is suspected to be related to dermal absorption and local action due to superior potency and penetration compared to other commonly utilized ophthalmic corticosteroids.Katelin QuantzAmanda L. AndersonChristine D. HarmanErica L. NolandJacquelyn M. Del ValleLaurence M. OccelliJessica B. BurnSimon M. Petersen-JonesDaniel K. LangloisChris G. PirieAnnette D. PetersenAndrás M. KomáromyBMCarticleAlopeciaCanineCorticosteroidsDifluprednate (Durezol®)Follicular atrophyHypothalamic-pituitary-adrenocortical (HPA) axisVeterinary medicineSF600-1100ENBMC Veterinary Research, Vol 17, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Alopecia Canine Corticosteroids Difluprednate (Durezol®) Follicular atrophy Hypothalamic-pituitary-adrenocortical (HPA) axis Veterinary medicine SF600-1100
spellingShingle	Alopecia Canine Corticosteroids Difluprednate (Durezol®) Follicular atrophy Hypothalamic-pituitary-adrenocortical (HPA) axis Veterinary medicine SF600-1100 Katelin Quantz Amanda L. Anderson Christine D. Harman Erica L. Noland Jacquelyn M. Del Valle Laurence M. Occelli Jessica B. Burn Simon M. Petersen-Jones Daniel K. Langlois Chris G. Pirie Annette D. Petersen András M. Komáromy Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
description	Abstract Background Despite the common use of topical ophthalmic corticosteroids in dogs, detailed reports on systemic and dermatologic adverse effects are limited. Results Nine purpose-bred research Beagles were treated with difluprednate 0.05% ophthalmic emulsion in one or both eyes 2–3 times daily. Some difluprednate treated dogs developed mild to severe alopecia of the periocular region, face, and distal pinna (5/9). The median duration of treatment prior to onset of dermatologic signs for difluprednate treated dogs was 550 days (453–1160 days). Diagnostic testing included complete blood count (CBC) and serum biochemistry, adrenocorticotropic hormone (ACTH) stimulation testing combined with endogenous ACTH measurement, and skin biopsy. The CBC and chemistry were within normal limits for all dogs. There were varying degrees of suppression of the hypothalamic-pituitary-adrenocortical (HPA) axis with difluprednate treatment. Dogs with the most profound alopecic changes had less pronounced HPA axis suppression compared to dogs with no integumentary changes. Skin biopsies demonstrated follicular atrophy and follicular keratosis. When topical difluprednate was reduced to unilateral therapy, the hair regrew on the untreated side of the face. In addition to the affected research dogs, a 7-year old female spayed Chihuahua that was being treated as a clinical patient with long-term difluprednate 0.05% ophthalmic emulsion developed generalized hypotrichosis on the head and body and a potbellied appearance. ACTH stimulation testing revealed suppression of the HPA axis with a mild increase in serum alkaline phosphatase (ALP) activity and a urine specific gravity of 1.016. The combination of clinical signs and laboratory abnormalities was supportive of iatrogenic hyperadrenocorticism. Conclusions In dogs long-term use of difluprednate ophthalmic emulsion results in HPA axis suppression and in some cases iatrogenic hyperadrenocorticism. A novel pattern of localized alopecia is suspected to be related to dermal absorption and local action due to superior potency and penetration compared to other commonly utilized ophthalmic corticosteroids.
format	article
author	Katelin Quantz Amanda L. Anderson Christine D. Harman Erica L. Noland Jacquelyn M. Del Valle Laurence M. Occelli Jessica B. Burn Simon M. Petersen-Jones Daniel K. Langlois Chris G. Pirie Annette D. Petersen András M. Komáromy
author_facet	Katelin Quantz Amanda L. Anderson Christine D. Harman Erica L. Noland Jacquelyn M. Del Valle Laurence M. Occelli Jessica B. Burn Simon M. Petersen-Jones Daniel K. Langlois Chris G. Pirie Annette D. Petersen András M. Komáromy
author_sort	Katelin Quantz
title	Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
title_short	Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
title_full	Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
title_fullStr	Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
title_full_unstemmed	Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)
title_sort	localized alopecia and suppression of hypothalamic-pituitary-adrenal (hpa) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (durezol®)
publisher	BMC
publishDate	2021
url	https://doaj.org/article/3ef3d59deba34f8196436fe5f73b6480
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Localized alopecia and suppression of hypothalamic-pituitary-adrenal (HPA) axis in dogs following treatment with difluprednate 0.05% ophthalmic emulsion (Durezol®)

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