Lethal Acrodermititis (L.A.D.) In Bull Terriers

Lethal Acrodermatitis is a relatively new disease having only been investigated in the last few decades. Lethal acrodermatitis has certain features of a nutritional or infectious disease but since it only occurs in Bull Terriers it is now suspected to be a genetic disease. It was first recognized in the genetics clinic of the University of Philadelphia (Jezyk and others 1986) and a further two cases studied in West Germany (Trauvetter 1985).

At birth, the lethal acrodermatitis puppy is often the smallest in the litter and looks rather pink as they often lack pigment. The first indication is usually a restless, hungry puppy. Although appearing to suckle well from the dam, test weighing will reveal the puppy is not getting any milk. (Test weigh the pup before it suckles and again after, the difference being the contents of the stomach). The puppy can be fed using a Catac major and teat, as the teat is long and will reach the back of the mouth. Within three weeks a size difference will be noticed, the lethal acrodermatitis puppy will be markedly smaller than its littermates.

At weaning the puppy will lap successfully at milk but as the meals get more solid, difficulty in mastication and swallowing can be observed. The unusually high arch of the palate causes a problem, as food tends to stick to the roof of the mouth. Liquidising the food can help the puppy considerably.

At approximately 6-10 weeks of age, crusted skin lesions can be seen developing between the toes that are distinctly splayed; the footpads are hard and cracked. The foot lesions progress rapidly with the nail bed being involved and the growth of the nails being somewhat distorted. The area of the pads not in direct contact with the floor takes on a frond like appearance due to the excessive development of hard skin (keratin) and the feet look deformed. At about the same time, papular or pustular lesions appear around the body orifices, most noticeably on the face and around the eyes. Inflammation of the hair root is most pronounced on the friction areas, e.g. elbows and hocks. The third eyelid protrudes and sight can also be affected.

The size difference is very marked and the puppy looks thin and stunted. The puppy tends to stand with its legs splayed and there is a marked problem with co-ordination. Coloured LAD pups will start to lose the colour at about eight weeks of age (e.g. a pup born tri-colour will fade to a chocolate colour or fawn).

Diarrhoea can develop early in the disease and this can vary in severity from loose stools to profuse bloody diarrhoea with accompanying dehydration. Respiratory tract infections can be present with mucropurulent nasal discharge. Pneumonia can often be diagnosed by stethoscope or x-ray examination.

Between 4-8 weeks of age the behaviour may also be abnormal as the puppy may be aggressive and may even need to be isolated because it is biting its littermates. As the puppy gets older, activity decreases and responses to external stimuli diminishes. They often spend periods staring at objects. The more severely affected, the more the puppy will sleep. The puppy will normally die by fifteen months and the usual cause of death is an intractable respiratory infection.

The bitches do not appear to come in season but the male dogs appear to be grossly oversexed and will mount anything which stays still long enough (e.g. dogs, cats or your limbs).

The condition resembles acrodermatitis enteropathica in man and lethal trait A46 in black pied cattle; these are defects in intestinal absorption of zinc (zinc deficiency). High doses of zinc will reverse the clinical signs in humans and calves, however, Bull Terriers do not respond to zinc therapy, and it is believed there exists in the lethal acrodermatitis puppy some other block to the zinc metabolism.

The incidence of lethal acrodermatitis in British Bull Terriers is not known. It is thought that so little is known of the condition that puppies born with lethal acrodermatitis are being euthanized as deformed, diagnosed as zinc deficiency syndrome, or are dying within a few days of birth without ever being recognized for what they actually are.

Written by T.M. Heath

Validated by Mr N. McEwan MRCVS BVM&S., MVM, DVD, DipECVD, MRCVS

March 1992

Lethal Acrodermatitis Update

Since the article on lethal acrodermatitis in Bull Terriers (above) was first published in 1992, quite a lot of progress has been made in the diagnosis and management of the L.A.D. puppy.

As with everything, there are different degrees that vary from mildly affected to grossly deformed. A mildly affected L.A.D. puppy will often be sold to a pet home as ‘the small puppy in the litter’ but to the experienced eye there is always something not quite right about the puppy apart from the size. The gait is usually different as there is nearly always some deformity of the hips, a twist on the femur (thigh bone) and a luxating patella because of this. Operating to correct the patella luxation is a useless project as the twist on the femur negates the deepening of the trochlear groove (the groove which houses the patella) and could in some cases cause extreme pain in the knee joint. However the L.A.D. puppy copes very well with this deformity where there is no surgical intervention but can be considerably helped by giving PLT (predoleucotrophin) – a quarter of a tablet, and they seem to do well on this small dose of painkiller. Homeopathic Rhus Tox 30c can be given in instead of PLT.

No matter how mildly or severely the L.A.D. puppy is affected, the immune system does not function to optimum level which leaves the L.A.D. puppy susceptible to infection, being particularly susceptible to upper respiratory infections. In degree this can vary from mild sniffles to bronchitis and pneumonia. As a prophylactic measure it is advisable to give an antibiotic daily. One-quarter ceporex 250mg daily is the drug of choice; as to the best of my knowledge this antibiotic does not give rise to keratoconjunctivitis (dry eye). As a personal preference I also include Vitamin B compound giving one tablet daily, cod liver oil to help joint function, evening primrose oil for coat condition and a garlic capsule as an antiparasitic.

In the average dog, steroids are to be avoided but the L.A.D. puppy needs prednisalone – half tablet daily and this I have found does improve the quality of life and deterioration can be observed when the prednisalone is withdrawn. One L.A.D. puppy I have known lived to six years old and was on steroids all her life with good effect.

The front feet are nearly always affected, with the toes splayed and giving the appearance of being down on the pasterns. Almost invariably keratitis develops (overgrowth of the hard skin of the pads), deforming the feet. This definitely causes problems, being very painful and affecting the dog’s ability to walk. The best treatment I have found when keratitis develops is Stockholm Tar. There are two methods of application.

  1. In milder cases where the condition has been recognized early, the spray version of Stockholm Tar can be used preferably sprayed on the tops and undersides of the feet before going out on exercise (being a tar preparation it is not kind to carpets). By the time exercise is over (20-30 minutes) the tar has dried on the foot and the pup can safely be allowed indoors again.
  2. Where the keratin growth is more pronounced it may be necessary to use the regular Stockholm Tar. Spread Stockholm Tar over the entire foot, pack between the toes with cotton wool, cover the foot with cotton wool and bandage in place with kling conforming bandage and secure by covering the entire bandaged area with elastoplast or the self adhesive vetwrap or equiwrap. This gives the puppy a nice soft cushion to walk on and prevents the tar soaking through onto upholstery. The bandage should be left in place for four days only; the foot is left uncovered for three days. The treatment should be carried out on a weekly basis until all evidence of the excessive keratin has disappeared.

The joints on the front legs are particularly weak and the front feet will tend to bend inwards so that the puppy is walking on the side of the foot instead of the pads. When it is noticed the foot is bending in you can help the puppy a lot by splinting the leg. As this is a fast growing stage the splint is normally used one week on and one week off until the growth period is almost over, normally round about the eighth month. An excellent material to use is Orthabord. The foot and leg is padded with cotton wool and this is bandaged in place. Soak the Orthabord in hot water until it is pliable and mould it round the leg above the foot, i.e. the foot is left clear. Your vet would normally do this procedure and care must be taken to observe the dog closely to ensure the splint remains comfortable while in place. Any undue stress, remove the splint at once.

Skin lesions can also develop on the face, feet and pressure points, e.g. elbows and hocks, and these can be treated successfully by cleaning with surgical spirit and applying either Fucidin H or zinc and castor oil. Nail bed infections could also have a fungal implication and this is treated with Nizarol, a quarter tablet daily.

The big question remaining is ‘What are they like as pets?’ – in a word – wonderful! Given the same socialization and affection as a normal Bully they repay with a joy of life that is delightful to see. I am not advocating rearing L.A.D. puppies from choice – recognized soon after birth I would recommend euthanasia. However, milder affected L.A.D. pups are being sold as pets. Unrecognised by the average vet when the syndrome develops at approximately 12 weeks of age, wrong diagnosis and treatment can be expensive and heartbreaking. People who have them need support and advice on correct medication, feeding and training. It would be extremely difficult for someone who has loved and cared for the pup from 6-8 weeks of age to voluntarily opt for euthanasia, as by this time the personality has developed and the puppy is well and truly under the owner’s skin. It has to be accepted that the life span will be shorter (approximately 2 years), but a lot of happiness for the puppy and the owner can be crammed into that time – but only with help and support from Bully breeders who know the condition, accept its existence and have gone to the trouble of finding out how to improve the L.A.D. pup’s quality of life. Unfortunately these are rarely the people who sell them on as pets, so we have to rely on the good old grapevine and offer assistance where needed.

Written by T.M. Heath

August 1996

Feeding The L.A.D. Puppy

The LAD puppy usually has a very high arch to the palate which makes feeding with normal puppy food difficult as the food tends to stick to the roof of the mouth, causing the pup a great deal of discomfort. Food can be dislodged from the roof of the mouth gently using the handle of a teaspoon but even so it will be found that they are very messy eaters and it is better all round if the food is liquidised which makes it easier for the pup to eat and ensures the correct quota of food goes down the pup instead of all over the floor.

The more natural the food the better for the puppy, i.e. fresh meat, sardines, tuna, pilchards, vegetables, porridge oats (all raw if possible), rice and pasta (cooked) and put through the food processor until the consistency is relatively liquid. Cheese is also a great favourite and scrambled eggs go down very well. The cereal of choice for breakfast is Weetabix softened with hot water and milk added to form a liquid consistency.

There are very many commercial diets on the market but it is absolutely essential that the chosen diet for the LAD puppy must be free of all additives, preservatives and colourings. Due to the predisposing susceptibility of the LAD pup to skin conditions, anything that could aggravate the skin condition must be avoided.

There is a very good food on the market called James Wellbeloved Lamb and Rice and the puppy version soaks down well in cold water after a couple of hours. Do not use hot water to soak, as this will destroy the vitamin content of the feed. A tin of sardines added not only improves the palatability but also adds the omega 3 & Omega 6 essential fatty acids and vegetable oil for the coat. A little cod liver oil and a little calcium helps with bone formation that is usually weak in the LAD puppy. Using one cup of James Wellbeloved Lamb and Rice soaked in sufficient water to really soften it and adding the sardines etc. then putting the mixture through the food processor to liquidise it will make up sufficient feed for a couple of meals increasing slightly the size of the meal as the puppy grows and requires more food.

Although the meals require to be liquidised it does not mean the pup should have no hard food. The pup should be encouraged to eat the occasional dog biscuit and be given a raw chicken wing or lamb rib bone to chew taking most of the meat off initially until the teeth are sufficiently well developed to chew the meat off the bone without attempting to swallow big lumps of meat before they have learned to chew it into a manageable size first.

LAD pups can develop allergies to food and one must be constantly vigilant when monitoring the faeces output. Bouts of diarrhoea or skin rashes when fed a certain food could indicate just such an allergy. Do not feed the suspected food for a week and if the diarrhoea or rash returns when it is reintroduced into the diet you could safely deduce an allergy and remove that particular food from the pups diet altogether. These allergies can and often do severely restrict the variety of food you can give to a LAD pup but this is not a worry if the food that can be tolerated contains all the nutrients for a balanced diet.

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