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Abstract We report 11 new cases of hereditary nasal parakeratosis in Labrador retrievers. The disease was first
observed when the dogs were 6 months to 2 years of age, and affected dogs of either sex and all coat colours.
Hyperkeratosis and depigmentation were confined to the nasal planum, and affected dogs were otherwise healthy.
The principal histological findings in biopsy specimens were marked diffuse parakeratotic hyperkeratosis, multiple intracorneal serum lakes and superficial interstitial-to-interface lymphoplasmacytic dermatitis. Topical
applications of propylene glycol in water or white petrolatum were often effective for treatment of the dermatosis.
However, continued applications were required to maintain a beneficial response. A retrospective histological
study of parakeratotic inflammatory diseases of canine haired skin and inflammatory diseases of the canine nasal
planum was performed. The degree of parakeratotic hyperkeratosis and the number and size of intracorneal
serum lakes were evaluated. The degree of parakeratotic hyperkeratosis was greater in hereditary nasal parakeratosis specimens than that seen in discoid lupus erythematosus and Malassezia dermatitis. There were more
serum lakes in hereditary nasal parakeratosis specimens than in specimens from dogs with discoid lupus erythematosus, Malassezia dermatitis, primary seborrheic dermatitis or zinc-responsive dermatosis. Significant
differences in sizes of serum lakes (if present) were not seen.
Keywords: dog, hereditary nasal parakeratosis, histopathology, intracorneal serum lakes, Labrador retriever,
parakeratotic hyperkeratosis, skin.
INTRODUCTION
Hereditary nasal parakeratosis (HNP) is a newly described disorder of Labrador retrievers and their crosses.1,2
An autosomal-recessive mode of inheritance is suspected.
Nasal lesions are first noticed between 6 and 12 months
of age and affected dogs are otherwise healthy. Histopathological findings include moderate-to-marked parakeratotic hyperkeratosis, moderate lymphocytic and
neutrophilic exocytosis, mild-to-moderate superficial
interstitial-to-interface dermatitis, and often marked
multifocal accumulations of proteinaceous material (serum
lakes) between keratinocytes.
Other known causes of clinical hyperkeratosis (excessive scale crust) of the nasal planum in dogs include
discoid lupus erythematosus (DLE), distemper, ichthyosis, leishmaniasis, necrolytic migratory erythema (NME),
pemphigus erythematosus, pemphigus foliaceus (PF),
primary seborrheic dermatitis (PS), systemic lupus erythematosus and zinc-responsive dermatosis (ZRD).2
Correspondence: Danny W. Scott, Department of Clinical Sciences
College of Veterinary Medicine, Cornell University, Ithaca, NY
14853, USA. E-mail: shb3@cornell.edu
2003 European Society of Veterinary Dermatology
198
J. Peters et al.
RESULTS
Labrador retrievers with hereditary nasal parakeratosis
Clinical information on the 11 dogs with HNP is given
in Table 1. Eight dogs were from New York, two were
from Connecticut and one was from Pennsylvania.
Typically, the owners first noted clinical hyperkeratosis
(excessive scale) and depigmentation of the nasal planum (Figs 4 and 5). Crusting, ulceration and fissures
developed in six, three and one dog, respectively. Pruritus or pain was not reported. The dermatosis progressively worsened in nine dogs, waxed and waned in one
dog, and seemed worse from autumn to spring in one
dog. All dogs were otherwise healthy. There was no
obvious relationship between the onset of the dermatitis
2003 European Society of Veterinary Dermatology, Veterinary Dermatology, 14, 197 203
199
Age
(years)
1
2
3
4
5
6
7
8
9
10
11
1.5
5
3
1
1.5
2.5
3
9.5
5
4.5
3
Sex*
Coat
colour
Duration of disease
( years)
M
MC
F
M
F
F
FS
MC
MC
M
FS
Yellow
Black
Yellow
Chocolate
Chocolate
Black
Chocolate
Black
Black
Chocolate
Black
1
4
1
0.5
0.8
2
2.3
8
Years
Months
2.5
Following biopsy diagnosis, eight dogs received treatment. Five of these dogs were treated topically, every 12 h,
with propylene glycol (Butler Co., Columbus, OH, USA)
mixed with equal volumes of water. All five dogs had a
good response (8590% improvement), but required continued therapy to maintain the response. One dog was
reported to have a satisfactory response to topical white
petrolatum every 12 h. One dog (case 3) had a good response to large doses (2 mg kg1 every 24 h) of prednisone,
and another dog had a good response to a combination
of immunomodulatory agents (case 11).
The principal histological features of the nasal plana in
these 11 dogs were as follows: marked diffuse parakeratotic hyperkeratosis (Fig. 6); numerous variably sized
serum lakes measuring up to 350 m in diameter and
occasionally associated with a few neutrophils (Figs 1,
6 and 7); mild-to-marked epidermal hyperplasia which
was often irregular; mild-to-moderate superficial
interstitial-to-interface lymphoplasmacytic dermatitis
with smaller numbers of histiocytes, neutrophils and
mast cells (Fig. 7); multifocal neutrophilic and lymphocytic exocytosis; multifocal intracorneal pustules with
degenerate neutrophils; and mild to moderate pigmentary incontinence (Fig. 7). Less common findings included mild superficial lymphoplasmacytic perivascular
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J. Peters et al.
Previous therapy
Subsequent therapy
1
2
3
4
5
6
7
8
None
White petrolatum topical
Prednisone PO
None
Propylene glycol topical
Lost to follow-up
Propylene glycol topical
Propylene glycol topical
9
10
11
2003 European Society of Veterinary Dermatology, Veterinary Dermatology, 14, 197 203
201
Table 3. Number and size of serum lakes in biopsy specimens from dogs with parakeratotic skin disorders or inflamed nasal plana
No. (%) of serum lakes
Diagnosis
Nasal planum
HNP* (n = 11)
DLE (n = 24)
ZRD (n = 5)
PF (n = 3)
Total (n = 43)
Comparison
Haired skin
ZRD (n = 32)
PSe (n = 24)
NME** (n = 17)
MD (n = 18)
Total (n = 91)
Comparison
Intermediate
(11 20)
Few
(1 10)
10 (91)
6 (25)
4 (80)
2 (67)
22 (51)
0
1 (10)
9 (90)
1 (10)
4 (40)
5 (50)
3 (50)
1 (17)
2 (33)
3 (50)
1 (17)
2 (33)
1 (25)
2 (50)
1 (25)
3 (75)
1 (25)
0
2 (100)
0
0
0
1 (50)
1 (50)
6 (27)
4 (18)
12 (55)
7 (32)
7 (32)
8 (36)
HNP > DLE
HNP, DLE, PF and ZRD = no significant difference
HNP and DLE vs. PF and ZRD = no significant difference
22 (69)
17 (77)
2 (9)
11 (46)
10 (91)
1 (9)
13 (77)
8 (62)
2 (15)
6 (33)
6 (100)
0
52 (57)
41 (79)
5 (10)
HNP > MD, PS, ZRD
HNP, NME, and PF = no significant difference
Many
(> 20)
3 (14)
0
3 (23)
0
6 (11)
Small
(1 50 m)
Medium
(51 250 m)
10 (46)
9 (40)
7 (64)
4 (36)
6 (46)
5 (39)
4 (67)
2 (33)
27 (52)
20 (38)
HNP, MD, NME, PF, PS, ZRD =
no significant difference
3 (14)
0
2 (15)
0
5 (10)
*Hereditary nasal parakeratosis. Discoid lupus erythematosus. Zinc responsive dermatosis. Pemphigus foliaceus. Primary seborrheic
dermatitis. **Necrolytic migratory erythema. Malassezia dermatitis.
Table 4. Amount of parakeratotic hyperkeratosis in biopsy specimens from dogs with parakeratotic skin disorders or inflamed nasal plana
Amount of parakeratotic hyperkeratosis (%)
Diagnosis
Nasal planum
HNP* (n = 11)
DLE (n = 24)
ZRD (n = 5)
PF (n = 3)
Total (n = 43)
Comparison
Haired skin
ZRD (n = 32)
PS (n = 24)
NME** (n = 17)
MD (n = 18)
Total (n = 91)
Comparison
Mild (2 5 layers)
Moderate (6 15 layers)
0
0
9 (37)
10 (42)
1 (20)
0
0
2 (67)
10 (23)
12 (28)
HNP > DLE
HNP and DLE vs. PF and ZRD = no significant difference
11 (100)
5 (21)
4 (80)
1 (33)
21 (49)
6 (19)
11 (34)
5 (21)
8 (33)
1 (6)
2 (12)
5 (28)
8 (44)
17 (19)
29 (32)
HNP and NME > MD
HNP, MD, and NME vs. PS and ZRD = no significant difference
15 (47)
11 (46)
14 (82)
5 (28)
45 (49)
*Hereditary nasal parakeratosis. Discoid lupus erythematosus. Zinc responsive dermatosis. Pemphigus foliaceus. Primary seborrheic dermatitis.
**Necrolytic migratory erythema. Malassezia dermatitis.
DISCUSSION
The clinical features of the Labrador retrievers with
HNP described herein are mostly in agreement with
those reported previously by Pag et al.1 A young age
at onset, no sex predilection and no coat colour predilection are typical findings. The disorder is usually
limited to the nasal planum, although two of the dogs
described by Pag et al. had scaly, crusty lesions on the
bridge of the nose, and one of those dogs had hyperkeratotic footpads.1 Pruritus and pain are not usually
present, and affected dogs are otherwise healthy.
The cause and pathogenesis of HNP are not known.
Data presented by Pag et al. suggested an autosomal
recessive inheritance.1 We were unable to obtain information on the relatives of the majority of our cases. We
found no obvious association with drug administration
or vaccination.
The histopathological features of skin biopsy
specimens from our Labrador retrievers with HNP are
identical to those reported by Pag et al.1 The most
characteristic changes include marked diffuse parakeratotic hyperkeratosis, large numbers and size of serum
lakes within the parakeratin, and a lymphoplasmacytic
superficial interstitial-to-interface dermatitis.
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J. Peters et al.
Spontaneous remission of HNP has not been reported. The oral administration of antibiotics, zinc, vitamin
E, vitamin A and omega-6/omega-3 fatty acid preparations were ineffective where administered to the dogs
reported herein and by Pag et al.1 Large doses of prednisone PO were effective in two of our cases. However,
the HNP relapsed when prednisone treatment was stopped. In addition, the administration of such a potent
and potentially harmful therapeutic agent to healthy
dogs with a localized, usually asymptomatic dermatosis
seems unjustified.
Many dogs in our study and that of Pag et al.1 responded well to the topical application of propylene
glycol in water. A smaller number of dogs in both studies responded satisfactorily to the topical application
of white petrolatum (petroleum jelly). Continued application of either agent was required to maintain the beneficial response. Regardless of the therapeutic agent used,
no dogs nose became 100% normal. Again, because
affected dogs are usually healthy and apparently untroubled by their nasal dermatosis, observation without
treatment might be an option in some cases.
The accumulation of serum between keratinocytes
appears to be unique to skin lesions with parakeratotic
hyperkeratosis. The authors have not recognized serum
lakes in skin diseases with orthokeratotic hyperkeratosis. Although the presence of intracorneal serum lakes
is not a unique feature of HNP, 91% of the cases examined in this study had serum lakes. In addition, in 90%
of the cases of HNP that had serum lakes, the lakes were
numerous and of intermediate or large size. There were
significantly more serum lakes in biopsy specimens of
HNP than specimens of DLE, ZRD (haired skin), PS
and MD. The lack of a significant difference between
HNP and ZRD (nasal planum) and PF might be due to
the small sample sizes. There were significantly more
serum lakes in HNP than in haired skin specimens, but
not nasal planum specimens, of ZRD. Again, this might
be due to the small sample size of nasal planum vs.
haired skin from ZRD. The lack of significant difference
REFERENCES
1. Pag, N., Paradis, N., LaPointe, J.M. et al. Hereditary
nasal parakeratosis in Labrador retrievers. Veterinary
Dermatology 2003; 14: 103110.
2. Scott, D.W., Miller, W.H. Jr, Griffin, C.E. eds. Muller and
Kirks Small Animal Dermatology, 6th edn. W.B. Saunders
Co., Philadelphia, 2001: 711124.
3. Dawson, B., Trapp, R.G. Basic and Clinical Biostatistics,
3rd edn. Appleton & Lange, Norwalk, CT, 2001: 179.
4. Gross, T.L., Song, M.D., Havel, P.J. et al. Superficial
necrolytic dermatitis (necrolytic migratory erythema) in
dogs. Veterinary Pathology 1993; 30: 7581.
5. White, S.D. Diseases of the nasal planum. Veterinary Clinics
of North America, Small Animal Practice 1994; 24: 887
95.
Rsum Nous rapportons 11 nouveaux cas de parakratose nasale hrditaire chez le Labrador retriever. La
maladie a t observe initialement lge de 6 molis 2 ans, chez des animaux des deux sexes et sans prdisposition de couleur de pelage. Les animaux ne prsentaient pas datteinte de ltat gnral et les lsions hyperkratosiques et dpigmentes taient localises la truffe. Les modifications histopathologiques consistaient en une
parakratose diffuse, des cavits remplies de srum dans la couche corne et une dermatite superficielle ou dinterface lympho-plasmocytaire. Lapplication de propylne glycol ou de ptrole localement a souvent permis un
contrle de la dermatose, mais des applications continues taient ncessaires pour viter les rcidives. Une tude
histologique rtrospective des maladies inflammatoires parakratosiques de la peau du chien a t ralise. Le
degr dhyperkratose parakratosique et le nombre et la taille des fissurations intracornes ont t valus. La
parakratose tait plus importante pour la HNP quen cas de lupus discode ou de dermatite Malassezia. Les
fissurations intracornes taient plus nombreuses en cas dHNP que de lupus discode, de dermatite Malassezia,
de sborrhe primaire idiopathique ou de dermatose amliore par le zinc. Aucune diffrence de taille na en
revanche t observe.
Resumen Se documentan 11 nuevos casos de paraqueratosis nasal hereditaria (PNH) en perros de raza Labrador retriever. La enfermedad apareci cuando los perros tenan entre 6 meses y 2 aos de edad, afect a ambos
sexos y en perros de todos los colores de capa. La hiperqueratosis y la despigmentacin estaban confinadas al
plano nasal y los perros afectados, exceptuando dicha alteracin, estaban sanos. Los principales hallazgos histolgicos en las muestras de biopsia eran: una hiperqueratosis paraquerattica difusa marcada, mltiples lagos
2003 European Society of Veterinary Dermatology, Veterinary Dermatology, 14, 197 203
203
intracorneales sricos y una dermatitis superficial linfoplasmactica con una distribucin intersticial a interfase.
Los usos tpicos de glicol de propileno en agua o petrolato blanco fueron a menudo eficaces para el tratamiento
de la dermatosis. Sin embargo, fue requerido un uso continuado para mantener una respuesta beneficiosa. Un
estudio histolgico retrospectivo de enfermedades inflamatorias paraqueratticas en la piel con pelo canina y de
enfermedades inflamatorias del plano nasal canino fue llevado a cabo. El grado de hiperqueratosis paraquerattica as como el nmero y el tamao de los lagos intracorneales sricos fueron evaluados. El grado de hiperqueratosis paraquerattica fue mayor en muestras con PNH que el observado en casos de lupus eritematoso
discoide o en dermatitis causadas por Malassezia. Haba ms lagos sricos en muestras de PNH que en aquellas
muestras de perros con lupus eritematoso discoide, dermatitis por Malassezia, dermatitis seborrica primaria o
dermatosis con respuesta al zinc. No se observaron diferencias significativas en el tamao de los lagos sricos
(si estaban presentes).
Zusammenfassung Wir berichten ber 11 neue Flle von hereditrer nasaler Hyperkeratose (HNP) bei
Labrador retrievern. Die Erkrankung wurde im Alter von 6 Monaten bis zu 2 Jahren festgestellt und betraf
Hunde beiderlei Geschlechts und aller Haarfarben. Hyperkeratose und Depigmentierung waren auf das Planum
nasale beschrnkt und die betroffenen Hunde waren ansonsten gesund. Die wichtigsten histologischen Befunde
in den Biopsien waren ausgeprgte diffuse parakeratotische Hyperkeratose, multiple intrakorneale
Serumakkumulationen und oberflchliche, lympho-plasmazellulre Dermatitis des Interstitiums und der dermoepidermalen Grenzzone. Zur Behandlung der Erkrankung erwiesen sich sowohl die lokale Anwendung von
Propylenglykol in Wasser als auch von weiem Vaselin als in vielen Fllen erfolgreich. Allerdings waren
permanente Anwendungen ntig, um den Behandlungserfolg aufrechtzuerhalten. Es wurde eine retrospektive
histologische Studie ber parakeratotische entzndliche Erkrankungen der behaarten Haut und des Planum
nasale beim Hund durchgefhrt. Dabei wurde der Grad der parakeratotischen Hyperkeratose und die Anzahl
und Grsse der intrakornealen Serumakkumulationen bewertet. Der Grad der parakeratotischen Hyperkeratose
war bei HNP-Proben grsser als bei Proben von Hunden mit diskoidem Lupus erythematosus und MalasseziaDermatitis. Die Anzahl der Serumakkumulationen war bei HNP-Proben grer als bei Proben von Hunden mit
diskoidem Lupus erythematosus, Malassezia-Dermatitis, primrer seborrhoeischer oder auf Zink ansprechender
Dermatitis. Signifikante Unterschiede in der Grsse der Serumakkumulationen konnten nicht festgestellt
werden.