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Case report
Abstract An 18-month-old cross-breed dog developed multiple skin nodules, which over 8 months had
increased in size and number. Biopsy samples were submitted for histopathological examination and revealed
multiple benign pilomatrixomas. The dog was treated with 1 mg kg1 isotretinoin daily, which led to a stabilization of the size and number of the lesions. Attempts to lower the dosage to an every other day regimen led to an
increase in the nodules size and number. Monthly complete blood count and chemistry tests and Schirmer tear
tests were performed to monitor any adverse effects of the retinoid treatment. No adverse effects were noted. To
the authors knowledge, this is the first report of multiple pilomatrixomas arising in a young dog and successfully
controlled with oral retinoids.
I NTRO D U CTI ON
C A S E R E P O RT
Case history
347
348
D ISCU SSIO N
In this report, a case of pilomatrixoma that responded
to medical therapy with oral retinoids is described.
Pilomatrixoma is a benign skin tumour arising from
the matrix of the hair bulb.1 Usually, it occurs as a
solitary, well-encapsulated, sometimes ulcerated dermal
and/or subcutaneous nodule.6 In humans, this tumour
occurs predominantly in children.3 In dogs, the age of
onset for pilomatrixoma may be as young as 1 year,
with an average age of onset of 6.5 years.6 The dog in
this report was 1.5 years of age, younger than the average for the development of this disease. In humans,
occasionally multiple lesions are reported and are
considered inherited as an autosomal dominant condition.3 Because of the age of onset and wide distribution
of lesions, a congenital or inherited defect is suspected.
Currently, there is no published report in veterinary
medicine to confirm this hypothesis.
Canine pilomatrixomas are usually 110 cm in
diameter, frequently ulcerated, and show predilection
for the neck, shoulders, back and tail.1,5,6 In our case,
the nodules were 0.57 cm in diameter and the larger
ones were ulcerated. Lesions in this case were mainly
located on the head, neck, thorax and back, in accordance with previous reports. Furthermore, the dog in
this report had nodules noted on the lateral and medial
aspect of the left foreleg. Interestingly in humans, the
upper limbs, face and neck are considered predilection
sites.3
Cytological features of samples obtained by fineneedle aspiration from pilomatrixomas include high
cellularity and numerous clusters of basaloid cells with
evenly distributed chromatin and small distinct nucleoli surrounding sheets of ghost cells (fully keratinized
cells with a visible unstained nucleus).8 Amorphous
keratinized material can also be observed.8 In our case,
the cytological examination of samples obtained by
fine-needle aspiration revealed the presence of amorphous keratin, but significant amounts of epithelial
cells were not present. This may be because of the fact
that the cytological sample was probably obtained from
the centre of large cysts filled with keratin, which were
present in the nodules sampled. The presence of amorphous keratin and the absence of significant amounts
2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 346 350
349
AC K N OW L E D G E M E N T S
The authors would like to thank Dr Irene Bertoldo
for referring this case and Dr Natalie Perrins for the
English review of this article.
REFERENCES
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2. McKee P. Essential Skin Pathology. London: Mosby
International Ltd, 1999: 160.
3. Du Vivier A, McKee P. Benign tumours of the skin. In:
Du Bivier A ed. Atlas of Clinical Dermatology. London:
Gower Medical Publishing, 1993: 8.118.12.
4. Theilen GH, Medewell BR. Veterinary Cancer Medicine.
Philadelphia: Lea and Febiger, 1987: 257.
5. Scott DW, Anderson WI. Canine hair follicle neoplasms:
a retrospective analysis of 80 cases (19861987). Veterinary Dermatology 1991; 2: 14350.
6. Goldshmidt MH, Shofer FS. Skin Tumours of the Dog
and Cat. Oxford: Butterworth-Heinemann, 1992: 125
30.
7. Scott DW, Miller WH, Griffin CE. Small Animal
Dermatology. Philadelphia: W.B. Saunders Co., 2001:
2413.
8. Masserdotti C, Ubbiali FA. Fine needle aspiration cytology of pilomatricoma in three dogs. Veterinary Clinical
Pathology 2002; 31: 225.
9. Johnson RP, Johnson JA, Groom SC et al. Malignant
pilomatrixoma in an Old English Sheepdog. Canadian
Veterinary Journal 1983; 24: 3924.
10. Van Hamm L, van Bree H, Maenhout T et al. Metastatic
pilomatrixoma presenting as paraplegia in a dog. Journal
of Small Animal Practice 1990; 32: 2730.
11. Rodriguez F, Herraez P, Rodriguez E. Metastatic pilomatrixoma associated with neurological signs in a dog.
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12. Vercelli A, Taraglio S. Multiple, locally malignant, pilomatrixoma in Briard. Proceedings of the 9th Annual
Congress of the European Society of Veterinary Dermatology and European College of Veterinary Dermatology.
Rome 1992; 535.
13. Fritsch PO. Retinoids in psoriasis and disorders of keratinization. Journal of the American Academy of Dermatology 1992; 27: S8S14.
14. Peck GL, DiGiovanna JJ. Retinoids. In: Fitzpatrick TB,
Eisen AZ, Wolff K et al. eds. Dermatology in General
Medicine. New York: McGraw-Hill, 1987: 2582608.
15. Kwochka KW. Retinoids in dermatology. In: Kirk RW
ed. Current Veterinary Therapy X. Philadelphia: W.B.
Saunders, 1989: 55360.
16. Power HT, Ihrke PJ, Stannard A et al. Use of etretinate
for treatment of primary keratinization disorders
(idiopathic seborrhea) in cocker spaniels, West Highland
white terriers, and bassett hounds. Journal of the
American Veterinary Medical Association 1992; 201:
41929.
17. Power HT, Ihrke PJ. Synthetic retinoids in veterinary
dermatology. Veterinary Clinics of North America:
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18. White SD, Rosychuk RAW, Scott KV et al. Use of
isotretinoin and etretinate for the treatment of benign
350
Rsum Un chien croisg de 18 mois a dvelopp de nombreux nodules cutans, qui ont augment de taille
et en nombre en 8 mois. Des biopsies ont montr des pilomatrixomes multiples bnins. Le chien a t trait avec
1 mg kg1 disotretinoine par jour, ce qui a permis une diminution du nombre et de la taille des lsions. Des analyses sanguines et un test de Schirmer mensuels nont pas montr danomalie. A la connaissance des auteurs, il
sagit de la premire description clinique de pilomatrixomes chez le jeune chien rpondant un traitement avec
les rtinodes.
Resumen Un perro de raza mixta de 18 meses de edad desarroll numerosos ndulos en la piel, que a lo largo
de ocho meses haban crecido en tamao y nmero. Se tomaron biopsias para el estudio histopatolgico
resultando en un diagnstico de pilomatricomas benignos. El perro recibi tratamiento diario con isotretinona
a 1 mg /kg, resultando en una disminucin del nmero y tamao de los ndulos. Los intentos de disminuir la dosis
a un rgimen de das alternos producan un empeoramiento clnico que se manifestaba con los ndulos
aumentando en tamao y nmero. Para vigilar reacciones adversas al tratamiento con retionides, cada mes se
realizaron recuentos completos de sangre y bioqumica sangunea, as como la prueba de Schirmer para evaluar
la produccin de lgrimas. No notamos ningn efecto adverso. Segn indican nuestras revisiones, este es el primer
caso descrito de mltiples pilomatricomas en un perro joven y su control con retinoides va oral.
Zusammenfassung Ein 18 Monate alter Mischlingshund entwickelte multiple Hautknoten, die ber einen
Zeitraum von acht Monaten an Gre und Anzahl zugenommen hatten. Biopsieproben wurden fr eine histopathologische Untersuchung eingeschickt und zeigten multiple gutartige Pilomatrixome. Der Hund wurde mit
1 mg kg1 Isotretinoin tglich behandelt, was zu einer Abnahme der Gre und Anzahl der Lsionen fhrte. Versuche die Dosierung auf jeden zweiten Tag zu verringern, fhrte zu einer Zunahme der Gre und Anzahl der
Knoten. Monatliches Blutbild und chemische Blutuntersuchungen sowie Schirmer Trnen Tests wurden durchgefhrt, um eventuelle Nebenwirkungen durch die Behandlung mit Retinoiden zu berwachen. Keinerlei Nebenwirkungen wurden festgestellt. Soweit dem Autor bekannt, ist dies der erste Bericht von multiplen
Pilomatrixomen, die bei einem jungen Hund auftraten und mit oralen Retinoiden erfolgreich kontrolliert wurden.
2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 346 350