Dermatology and behavior (Proceedings)


Dermatology and behavior (Proceedings)

Aug 01, 2011

There are many similarities between the specialties of dermatology and behavior including the importance of history in making the diagnosis, extended consultation time, deal often with chronic conditions, often try to manage versus cure the condition and success is often measured in months instead of days. In determining how much of a given behavior is dermatologic versus behavioral we are often trying to sort out whether we are seeing the result of a pruritic condition or the result of compulsive, Self-Injurious Behavior (SIB). In behavior, it is not unusual for us to first rule out pruritic behavior as not stemming from pyoderma, atopy or food allergy before tackling it as a potential compulsive disorder. While there is considerable overlap between patients with behavior problems and dermatologic conditions, there is little evidence that there is a cause and effect relationship between pruritus and issues such as anxiety, fear or aggression (Klinck, et al).

Acral Lick Dermatitis is characterized by alopecia, erosion, ulceration, hyperplasia and is often unilateral seen mostly on the carpus or metatarsus. The Great Dane and the Retrievers are most affected. Causes include atopy, food allergy, arthritis, wounds, neoplasia and external parasites. Behaviorally, boredom, anxiety, attention seeking behavior and compulsive disorder are suspected etiologies. Topical treatment with antibiotics and corticosteroids, denying access to the area (Elizabethan collars, for example), intralesional injections with steroids or NSAIDs, food trials and long term oral antibiotics (Shumaker, et al) are all common approaches. Behaviorally, the condition is managed with increased exercise, removing triggers of the behavior, use of counter conditioning and desensitization (CC/DS) to reduce the animal's response to those triggers, interrupting and redirecting the behavior along with the use of a head collar. Clomipramine (2-4 mg/kg bid) and Fluoxetine (1-2 mg/kg sid) often are effective in reducing the anxiety component.

Excessive Licking can be self-directed or directed externally. Rule outs include allergic dermatitis, external parasites, oral cavity disease and GI disease causing nausea. Behaviorally, anxiety, compulsion, attention seeking, displacement behaviors and normal grooming behavior can be responsible. Ruling out primary skin disorder via skin scraping, parasite therapy, food trial or steroid trial can be a good first step. Consider videotaping the behavior when the pet is alone to rule attention seeking or separation anxiety as possible behavioral causes. To manage the behavioral component ID triggers of the behavior and remove them along with reinforcers of the behavior, CC/DS, consistent exercise, do not punish and manage separation anxiety if present. The use of Clomipramine and Fluoxetine can be helpful.

Tail chasing/biting

Typical lesions seen in this condition include denuded tail, pyoderma, erythema, ulceration and lichenification. Potential dermatologic etiologies include moist dermatitis, flea allergy dermatitis, tail gland hyperplasia (stud tail), neurodermatitis, allergic dermatitis, and anal sac disease. Behaviorally, compulsive disorder and attention seeking behavior can result in tail chasing. To rule out a primary dermatologic problem treat possible secondary pyoderma with antibiotics, treat for external parasites, dermatophyte culture and rule out allergic dermatitis. Behaviorally rule out attention seeking behavior by having owners ignore the dog in ALL situations except for feeding and elimination needs for 2 weeks. If there is no change, assume you are dealing with a compulsive disorder. Symptoms are characterized by spinning behavior as well as tail biting and can occupy the majority of the dog's activities. Breeds that are commonly affected include English Bull Terriers, German Shepherds and Australian Cattle Dogs. Behavioral therapy includes increasing exercise, consistent training and play, removing triggers of the behavior, using CC/DS to reduce reactivity to those triggers, interrupt and redirect the problem behavior, and using a head collar to assist with redirecting the behavior. Clomipramine and Fluoxetine can be added to assist with the behavior modification program.

Flank sucking

Flank sucking can present as a unilateral or bilateral erythema and alopecia of the skin of the flank fold or present with no visible lesions. The most common breed affected is the Doberman. Differentially flank sucking needs to be distinguished from contact dermatitis, psychomotor seizures, neuropathies, attention seeking behavior and compulsive behavior. Flank sucking presents as the dog grabbing its flank in its mouth, possibly in response to some identifiable trigger or with generalized increase in activity. Can occur with the owner present (attention seeking) or if the owner is absent (compulsive disorder). Stress, frustration or conflict can contribute to the behavior. It can also occur as a component of Separation Anxiety. As with most compulsive behaviors, treatment involves removing identifiable triggers, using CC/DS, using response substitution, not using punishment, increasing play and exercise as well as using consistent interactions (command-response-reward). Consider utilizing Clomipramine and Fluoxetine.