ALOPECIA X

 (Graphic courtesy of Dr. Carol Foil. Used with permission)

Alopecia is the medical term for baldness. The term does not specify a particular type, pattern or cause of baldness; it is a general term. There are many types of alopecia/baldness. One particular type of baldness has been described in the Nordic or plush-coated breeds whereby the dog develops coat loss on the main body as well as darkly pigmented skin in the bald areas. The legs and head are generally spared and retain a normal coat. This pattern of baldness is commonly called "endocrine alopecia" as it is common in several types of hormone imbalances (in particular, Cushing's Syndrome, 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's Syndrome
• Biopsy responsive alopecia
• Follicular dysplasia of the Siberian husky
• Adrenal sex hormone alopecia
• Hair cycle arrest

This web page attempts to create an update of what is currently believed about this confusing condition.

THE TYPICAL PATIENT 

The typical Alopecia X patient is a Spitz or Nordic breed such as a Chow Chow, Pomeranian, Alaskan Malamute, Elkhound, or similar. Poodles have also been over-represented. Hair loss begins in early adulthood, usually by age 3 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.

DIAGNOSTIC TESTING

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 is present. 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
• Hypothyroidism

Both these hormone imbalances lead to "endocrine alopecia" and while they look like Alopecia X, they have their own specific treatments.

The good news is that Alopecia X is a cosmetic condition only. There is no downside to the dog except that he or she will look funny. For this reason, treatment with medications is frequently discouraged because drugs can have body wide effects while the disease itself has none. Further, 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.

THERAPY

Now that it has been determined that the dog in question has Alopecia X, it would be great if we could wake up the sleeping hair follicles and regrow some hair. It turns out there are several therapies to choose from. The problem is that while some dogs will respond with hair growths to a therapy course, other dogs will not respond at all. Let's see what the choices are:

STERILIZATION

This is the same dog as above, after being neutered.
(Graphic courtesy of Dr. Carol Foil. Used with permission) 

Alopecia X seems to be a sex hormone imbalance in at least some cases and didn’t earn the name “Castration Responsive Alopecia" for nothing. For this reason, the first step in treatment is to sterilize the patient; unspayed females should be spayed, intact males should be neutered. There are health benefits to sterilization regardless of whether or not there is a hair loss issue, and many animals will grow their hair back (though possibly not permanently) so this is where we start rather than investing in complex and confusing diagnostics. If this does not work or the pet is already sterilized, then we move on to melatonin supplementation.

MELATONIN

Melatonin can be obtained in 3 mg tablets at most health food stores or vitamin retail outlets. Approximately 40% of dogs will show some response within 6 to 8 weeks. The medication should be given for at least 2 or 3 months before giving up but if hair regrowth occurs, the medication is continued until hair growth seems to have plateaued. After maximal hair regrowth has been achieved, the dose is gradually tapered down to a weekly dose over several months. Some dogs can ultimately discontinue medication though it is important to realize that if you discontinue the medication and the hair falls out again, the condition may not be responsive to melatonin a second time.

Recently melatonin implants have become available in the U.S. These are implanted in a similar manner to a microchip and dissolve under the skin over time. These can be used as an alternative to the oral product.

MELATONIN SIDE EFFECTS AND ISSUES:

• Melatonin has been used as a sleep aide. Some owners find the sedating side effect to be unacceptable. Consider giving it at bedtime so that drowsiness is less noticeable.
• Melantonin should not be used in diabetic patients as it has been found to create insulin resistance.
• Beware of melatonin brands containing xylitol. Xylitol is an innocuous sugar substitute for people but is a poison for dogs.
• Since melatonin is a nutritional supplement, rather than a prescription medication, the FDA does not insist on the same quality control it does for drugs. There may be tremendous differences in the amount of melatonin contained in pills between brands. Nature's Bounty^® brand has been a preferred brand but any major supplement brand should be acceptable.
  

If neither sterilization nor melatonin have been fruitful and we know the dog does not have Cushing's disease or hypothyroidism, then it is important to realize that the therapies left to try have potential side effects.

Consider this: Alopecia X is a cosmetic condition. It may make the dog look funny, but it does not cause harm.

You will need to weigh the potential side effects of therapy against the appearance of the pet. That said, there are other therapies that can be attempted.

MICRO NEEDLING

Alopecia X is sometimes called "Biopsy Responsive Alopecia." After the skin biopsy samples are taken in the diagnostic process described above, some dogs will regrow a small tuft of hair in the biopsy areas. The theory is that the inflammation associated with healing has awakened the hair follicles in that local area. This concept is applied more broadly with micro needling.

In micro needling, a roller of tiny needles is rolled over the skin creating tiny punctures and putting the skin into a healing mode. This procedure is widely used in human aesthetics to generate collagen, remove wrinkles and brighten skin complexion. The needles can be painful or at least uncomfortable so the patient may require sedation or numbing with topical anesthetics. The skin is somewhat tender for a day or so after the procedure. Different studies report different success rates from 40% to 90%. Because some discomfort is afforded the patient and sedation is typically needed plus Alopecia X is of cosmetic concern only, use of this treatment is of some controversy.

DESLORELIN IMPLANTS

Deslorelin is a veterinary hormone that curtails the production of both estrogen and testosterone and is usually used to time ovulation in mares. It is available as an implant and was recently tested in Alopecia X. Within 3 months, 60% of the unneutered male dogs experienced hair regrowth. None of the spayed females experienced hair regrowth. No side effects were noted during the one year period of testing. This may pan out as a treatment strategy for unneutered male dogs.

MEDROXYPROGESTERONE ACETATE

Injections of this long-acting progesterone were used monthly for 4 months in a group of Pomeranians with Alopecia X. Some responded partially, one completely regrew hair, and some did not respond at all. None of the dogs had side effects during the time of the study; however, progestins are famous for inducing mammary tumors, uterine infections, and diabetes mellitus so their use should be weighed against their potential for problems.

TRILOSTANE

Cushing's disease is a disease of adrenal cortisone excess. The production of cortisone is complex and some of the pathways are common to sex-hormone production. For this reason, therapy for Cushing's disease sometimes works on Alopecia X. Trilostane is a medication used in the treatment of Cushing's disease to suppress the production of steroid hormones, which includes the sex steroids. Trilostane has potential to create a dangerous deficiency in adrenal steroids so it is not without risk even though it has been effective in causing hair regrowth in some patients.

Alopecia X is a frustrating condition and will remain frustrating for years to come. Research is on-going and progress comes gradually.

Page last updated: 5/23/2022