# Skin Issues



## melissa mims (Jul 12, 2006)

Posting this for a friend.

Dog is almost 2 yrs old, no evidence of allergies till last summer. Had erution late summer after playing around weeds for a while, vet started steroids and antibiotics after trying other things (isolate, food change, etc). Cleared up for a while, now has reappeared. No weeds in the yard (we are SMOTHERED in snow right now), some diet changes recently. Was on Iam's, switched to Solid Gold, then tried Avoderm. Did well (this around the time of steroid therapy), recently cut humidity in house at the same time as gave Balance Allergy (ran out of food in snowstorm). Had a new eruption.

Pix:



































No itchy paws, but he does scratch his ears a lot, and has some hair loss there. It doesn't look like a food allergy to me, looks more like a contact dermatitis, but the food does seem to have an effect. Maybe a synergestic effect?

any thoughts? Yes, she has been to the vet, but no money at this time for allergy testing. Maybe the crate plastic? It is so localized and clearly defined on pressure points, that I think it may be something he has contact with on those places. Perhaps the carpet?

No ear infections, itchy red bumps, localized irritation, responsive to steroids. No skinscrapings as of yet.

Any imput would be appreciated!


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## Connie Sutherland (Mar 27, 2006)

melissa mims said:


> any thoughts? Yes, she has been to the vet, but no money at this time for allergy testing. Maybe the crate plastic? It is so localized and clearly defined on pressure points, that I think it may be something he has contact with on those places. Perhaps the carpet?
> 
> No ear infections, itchy red bumps, localized irritation, responsive to steroids. No skinscrapings as of yet.
> 
> Any imput would be appreciated!


Contact dermatitis is rare in dogs, though..... 

#1 (by a long way) is flea hypersensitivity; #2 is enhalant/environmental; #3 (and quite a way in the rear) is true food allergy. 

Allergies in dogs that manifest in skin pruritis are virtually always itchy. Is the dog scratching those spots in the pics, or is that spontaneous pruritis?

"Responsive to steroids" does indeed throw doubt on food allergies.

Has the owner tried short trials of hydroxyzine and chlorpheniramine? About 30% of atopic dogs respond to antihistamines (not so much Benadryl, although I've heard of a few who do).

I would definitely want a scraping done to decide whether it really is atopy, or sarcoptic mange, or yeast, and to check for bacterial infection. 

I would also eliminate grains from the diet (in case there is a yeast component, and GP to get the best diet into a dog with skin pruritis), and I would start fish oil (plus E, which is used in processing oil supplements) immediately. After mange and bacteria/yeast are ruled out, I'd start antihistamine trials. Steroids are indeed a magic bullet, but I'm sure you and the owner know about the long- and short-term side effects.

I would give a gram of fish oil (1000 mg) per ten pounds of dog weight daily, plus a 200-400 IU (depending on dog size) Vitamin E gelcap (preferably in the form of mixed tocopherols).

The allergy testing (scratch tests) is pricey, but it's the gold standard, so far, with about 70+% accuracy. (There is no reliable food allergy test except for the strict elimination diet; one way to know if your vet is woefully ignorant about allergies is if s/he suggests allergy tests for food allergens.)

If the diagnosis is indeed atopic dermatitis, I can tell you a couple of possible aids after the long-chain Omega 3s (fish oil) and E, and the antihistamine trials.

But I would get it looked at. Even if infection was not the trigger, infection often follows close behind when the skin is damaged like that.

Good for the owner to watch inside those ears.


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## Connie Sutherland (Mar 27, 2006)

BTW, I would do the fish oil and E no matter what the cause of that pruritis, for the anti-inflammation benefits of the long-chain Omega 3s.


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## Connie Sutherland (Mar 27, 2006)

I forgot to say that there has been recent research pointing to allergy benefit from probiotics, and my current allergic dog is now on daily plain live-culture yogurt (no sugar, no flavorings) plus a probiotic capsule. In order to get as many of the probiotics past the dog's corrosive stomach acid to the intestines, I give them first thing in the morning, when acid production is low.


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## melissa mims (Jul 12, 2006)

thanks for your input, Connie.

Yes, it is itching and gnawing in those spots.

Owner mentioned that he is responsive to Benadryl, but only for a little bit. No other antihistamines have been tried, so that avenue is still open.

Sorry, scrapings were done, neg for mange. No fleas at all (owner is a Groomer). 

She feeds kibble, will switch to a grain-free food. Does she have to calculate the Vit E in the kibble for the day's total? Or should she just supplement 2-400IU regardless (dog is 50#)?

This new outbreak happened a few days ago. Northern IL is getting hammered with snow right now; not a good time for non emergency trips to the vet. She is keeping an eye on it, if it gets worse in the short term. Last outbreak was in fall; vet felt it was a possible plant allergy, suggested and performed scrapings. Evidence of infection (I think), but that could be secondary, not primary, owner not sure (not a med type person). Abx and steroids did the trick, no more outbreak until now. 

So this could be a primary infection? But the itching points to auto immune.

If this were a food allergy, would it show up in the exact same place for 2 different eruptions?


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## Connie Sutherland (Mar 27, 2006)

The spots in the photos are common atopy locations. (The paws are even more common, though.) No surprise at the locations repeating themselves, even for food. Those locations are now extra-vulnerable. (The problem with food is the long stretch with no itching.)

Yes, the as you say, itching (poor dog :-( ) does suggest that if there is an infection, it's secondary to the allergy (or allergies).

The relief from Benadryl would definitely make me eager to try the statistically more successful hydroxyzine and chlorpheniramine, ten-day trials. (I say that so she doesn't pay for 30 days' worth of something that ends up unsuccessful.)

No, the vitamin E in the food doesn't need to be counted. There has not been a toxic dose observed of E in dogs, even at ridiculous lab levels. Still, I don't like to give a lot more than the therapeutic dose of anything. A 50-pound dog would be good with 200 IU, IMO. The E protects the delicate PUFAs in the fish oil.

Your friend would do well to start a log right away. I imagine that you (or she) do not know now whether the last outbreak coincided with a food change. But short of a real elimination diet, I'd probably go with a grain-free food that has a different protein source from the one the dog is now eating.

If it were summer..... then there would be all kinds of things to try, based on the probability of grass/pollen allergies. But now it seems to be narrowed down to something in the house or food. (Even if food is the lowest item on the totem pole, there certainly are plenty of dogs with food allergies.) The big flag, though, about food, is that steroids worked AND there has been a long itch-free interlude. 

BTW, true food allergies are allergies to a protein in the food; it doesn't have to be something we think of as a "protein food," though.

I have to go out, but I'll come back later and give you a couple of external "tricks" that have worked for me with severely allergic dogs.


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## Connie Sutherland (Mar 27, 2006)

So ... in order of what I have found most useful for atopy:

I'd start the fish oil and E.

I'd stop all grains.

I'd start the antihistamine trials, with hydroxyzine first.

I'd start with probiotics.

I'd use topical applications to try to break the itch cycle. Which ones will be dictated by the yeast results.

I'd bathe the dog and his bedding and vacuum, just in case there is a plant/tree/grass component. (As S. Messonnier, DVM says in The Allergy Solution, any drawbacks like slight skin oil removal are way outweighed by the benefit of getting the allergens off him; it's not a contact thing, but more a breathing-it-in-constantly thing.)

I'd check the house for mildew/mold and change the furnace filters.

If the dog does go onto any grassy areas, I'd clean off his undercarriage and paws before letting him back onto his bedding and the carpets. I use large unscented baby wipes.


For food allergies:

Absolute least is to change to a food with a different (novel) protein source. That's an individual thing, depending on the dog's eating history. Better is to do a real (strict) elimination diet for several weeks/months. Again, it has to be ingredients he has never eaten (because allergies develop over repeated exposure).

There's more, but it's specific to inhalant/food/yeast.


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## Connie Sutherland (Mar 27, 2006)

Oh, I forgot: Don't try to make the dog stop scratching. He will just do it in private and then you won't know how bad it is.

If it's causing sleep loss from itching, I do resort to short-term steroids in the lowest dose possible.

I'd get him checked for bacteria and yeast asap.

I'd keep checking those ears. Inflammation is much easier to combat than a full-blown infection.

All of this is scattershot, not knowing whether there's inhalant, food, and/or yeast involved. (You are sure that steroids worked and that there were no itchy incidents between then and recently? Definitely, I'd start a log. Steroids wouldn't help like that with a food allergy, but you don't know whether she also changed foods at the time of the steroids, right?)


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## Pauline Michels (Sep 1, 2006)

Connie you are so helpful with these types of posts. Thanks for sharing your knowledge with us.


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## Connie Sutherland (Mar 27, 2006)

You are very welcome.

This is the problem that drew me into studying canine nutrition, vaccinations, etc. -- a miserably allergic adopted dog, surrendered because her owners couldn't handle the vet bills, already deaf from repeated ear infections, smelly, bleeding from scratching, on daily Pred and showing Cushing's because of it ....

Talk about sink or swim with a switch to fresh food. This was way before the internet, and it was very scary for me to switch her to raw food, against everything the vets (and everyone I knew) said..... using one book..... I can make myself nervous all over again just by thinking about it. :lol:


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## melissa mims (Jul 12, 2006)

thanks so much for your input Connie. I was hoping you would reply!

I will pass on this info for my friend, I'm sure it will be a great help.

Yes she did switch foods right before this last outbreak; just asked her and she said that the next day, this eruption began. So I think we can safely say that it is at least a food allergy.

She is going to try your suggestions. About how long does it take for a response? I know with one of my allergic pets, after I switched her to raw, it took about 3 weeks for the issues to start clearing up; but she had a lot of secondary infection and inflammation to clear first.

You should write a book, ya know!

Thanks again!


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## Pauline Michels (Sep 1, 2006)

It's interesting to hear about how people end up going to raw diets for their critters. In many cases it ends up being due to a health issue that traditional medicine doesn't cure/help. 

In my case it was a rescue Dobe who was a mess emotionally and physically. He obsessively licked his rectal area till it bled, had horrible, horrible gas and bouts of projectile diarrhea. This was 10 yrs ago. Through tons of reading and a few phone conversations with "some helpful guy on the internet who knew about nutrition" we got him straightened out. (Wish I still knew who the man was who helped me.) 

Doesn't everyone remember serving that first feeding of raw with bones....the anxious waiting to see if something awful happens to the dog over the next few hours. I'll always feel bad about feeding my cats kibble.......


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