Skin Disease in WestieQ: Hi Dr Richards I have an 8 year old West Highland white terrier who is suffering skin problems. When he sweats his skin secretes a yellowy fluid which crust and causes him great distress and irritation. If left untreated he will attempt to chew the scabs and ends up pulling his hair out in the process. Along his back he also has tiny scabs that come off like dandruff – some are light skin colour, but some are quite black; there are also 5-6 inter-dispersed lumps which look like boils or warps (their presence and size fluctuate with the condition of his skin - at one point they disappeared completely). I have to brush him every day and wash him every second day using a soft brush to remove the scabs. His skin can become sticky, particularly under his armpit, where is has been quite mucusy, more recently though this has all but disappeared under his arms, but the yellowy secretion still happens on his chest, lower legs and bottom (it is more pronounced in the folds and cracks of his skin). He has been treated for a number of years for allergies and problems with his immune system. 3 years ago he began a program whereby he was injected with allergens to trigger his immune system to function correctly. This appeared to be successful, his skin improved greatly and his fur grew back. Unfortunately, he was then placed in kennels for 2 weeks and his skin deteriorated drastically; he contracted a bacterial skin infection whilst he was there which was mistakenly attributed to his immune problem, so went untreated for about a month during which time his skin deteriorated further. Following antibiotic treatment for the infection, his skin slowly started to recover but never made it back to where it was before he went into kennels. In January this year, a second opinion was sought from another vet who, after examining his skin, prescribed a course antibiotics and nizoral (ketoconazolo), followed by the continued (reduced) use of nizoral coupled with a Atoplus (ciclosporina), an animal auto-immune equivalent drug of sandimum - the cover of the box describes its use as for chronic dermatitis . At the same time a blood test (Jan 2005) was carried out which produced the following anomalies (expected reading in brackets): BILT0.11(0.1-0.6) ALTP534(0-90) PT9.3(5.3-7.6) ALB2.6(3.0-4.7) Na+158.7(145-155) Following the exam, it was suspected that he may be suffering from copper-toxicosis; a biopsy was performed which, whilst identifying some liver degradation, came up negative for copper-toxicosis. But for over a week following the biopsy, his skin improved dramatically; his skin was in the best condition it had been for about a year (all his hard skin became soft, there was no skin seepage and no skin flaking) and he was only taking post-op antibiotics About a week before the second opinion (before the biopsy), Major started to eat excessively (about twice his normal intake), but was loosing weight. Over the next month he lost about 3rd of his body weight (thankfully he has appeared to have stabilized at around 9kg). He has been on the nizoral and autoplus for one month now and whilst there does not appear to be a worsening of his condition, there has been no significant improvement. I should point out, that I have been varying my washing routine over that time which has now steadied at one wash every 2 days with an antiseptic shampoo (more frequently causes his skin to become red and irritated) cleaning the scabs off with a soft brush. The latest blood tests (March 2005) show the following changes: BILT0.23(0.1-0.6) in rangeALTP339(0-90) reductionPT9.2(5.3-7.6)ALB2.8(3.0-4.7)Na+147.3(145-155) reduction. A number of symptoms which I feel have not been adequately explained, are: 1. the sudden weight loss coupled with his increased appetite 2. his dramatically improved skin condition following his biopsy I have spoken to my vet and she is happy for me to approach you for an alternative opinion on what you think may be the problem with Major. I look forward to hearing your thoughts on subject. Regards, Tracy A: Tracy- I think that your vets have been doing the right things in working towards a diagnosis and you are doing the right things, too, so I guess the best thing to do is simply to explain what skin diseases West Highland White Terriers are prone to that might be impacting on this case and o make one small cautionary statement -- it is possible that there are two more more causes of the skin disease and that the skin disease may be an entirely separate issue from the rises in liver enzyme levels, as well. I do have a small problem with the blood test reports -- the abbreviations do not match those most commonly used in the U.S. and it is possible that ALTP could mean either alanine transferase (generally called ALT in the U.S.) or serum alkaline phosphatase (generally abbreviated ALKP here). There is a difference in the meaning of rises in either of these enyzmes individually which I'll try to explain as I go along. These are the inherited skin diseases and skin diseases that might not be inherited but that appear to be more common in Westies than in other breeds:
- primary seborrhea -- this is a defect in the way that the skin produces keratin. Most dogs affected by this condition develop signs when they are young but sometimes the disease is mild in its primary form but becomes severe when it also becomes a secondary condition to another disorder such as food allergies, atopy, Malassezia (yeast) infection or bacterial pyoderma. Since primary seborrhea can't be cured the skin has to be maintained with frequent bathing and the use of anti-seborrheic shampoos, conditioners, etc.
- epidermal dysplasia -- This is a very severe skin disease in which a defect in the skin seems to be coupled with a tendency to get secondary yeast infections. Generally it shows up by the time the dog is a year of age, doesn't respond well to any type of treatment (except getting rid of the yeast can be helpful) and can be diagnosed by skin biopsy
- ichthyosis (lamellar ichthyosis?) -- another congenital disease that usually shows up in young westies and doesn't respond well to treatment. This disease produces scaling, which you seem to be seeing, so it may be a consideration if his original problems started when he was young. This can also be diagnosed by a skin biopsy but it is really important to ensure that the pathologist who examines the slide is very interested in skin disease (dermatohistopathologist). In the U.S. the most reliable lab for diagnosing this condition is probably Texas A&M's lab. If skin biopsies are done it would be a good idea to ensure that the pathologist is contacted first for advice about taking samples and preserving them. atopy (allergy to pollens and other environmental irritants) food allergies
The thing that you have to do with lists like this is try to think back to the very first time you were aware he had skin disease. How old was he? If he was less than a year old then primary seborrhea, ichthyosis, epidermal dysplasia and food allergies are most likely. If he was over a year of age then atopy, malassezia infection (perhaps secondary) and secondary seborrhea (can occur in any breed) become more likely. If the problems started when he was young and he has not had skin biopsies then it would be a good idea to consider doing these to try to rule out epidermal dysplasia and ichthyosis. If these have been ruled out this is obviously not necessary. I can't explain why his skin would get better after surgery with certainty but I suspect that this favors a diagnosis of primary seborrhea for the simple reason that this disease is characterized by very rapid growth of skin cells and big stresses like surgery could slow that growth. In addition primary seborrhea can be altered by hormonal influence, especially changes in thyroid hormone levels and these drop in times of major stress, as well. But that's just a guess -- I really don't know for sure what to make of that particular symptom. I am thinking that the liver enzyme rise is actually in alanine transferase (ALT). If this is the case it is an indication of damage to liver cells (ALT is released when liver cells are severely damaged or die). Rises don't always indicate a severe problem but continued rises are worrisome. Ketaconazole can cause liver damage so this has to be kept in mind, even though I think its use is definitely justified. If the rise is in alkaline phosphatase (ALP or ALKP) then this is more likely to be an indication of other problems such as Cushing's disease. I think that your vet wouldn't have pushed for a liver biopsy with a rise in alkaline phosphatase alone, though -- so it makes more sense that the rise was in ALT. My thinking is that this is likely to be a separate problem that will have to be sorted out over time but since the values are improving it seems unlikely that ketaconazole is causing problems and that the situation may also continue improve, in which case a diagnosis may not be necessary. Weight loss with an increase appetite always worries me. The most common cause of that in dogs in our practice is early diabetes. Once in a while we don't get much blood sugar rise (usually stays high normal or just above normal) for a few months even after other clinical signs like drinking a lot and urinating a lot or weight loss occur. Diabetes probably isn't present since you don't report unusual blood sugar levels from the lab work -- but I'd still keep it in the back of my mind. Unfortunately the other common cause for unexplained weight loss in middle aged or older dogs in our practice is cancer. This can be very hard to detect early on but keeping a watchful eye for any continued signs of cancer like continued weight loss, unusual lumps, lethargy, coughing, etc. would be a good idea. Hopefully cancer isn't present. Sometimes itchy dogs lose weight rapidly due to restlessness. Dogs with liver disease and heart disease can lose weight very rapidly but most dogs with these problems have a decrease in appetite. All I can really suggest is keeping an eye out for problems and periodically checking urine or blood for increases in sugar indicative of diabetes. I am not sure if this information will help or not. Dr. Hnilca also maintains a web site utskinvet.org, that can be helpful for veterinarians who need information on skin diseases. Good luck with this. I am happy to answer further questions if something I wrote isn't clear or generates further questions. Michael Richards, DVM 3/16/2005
Sebaceous Adenitis Are Possible in Weimaraners
Q: Hi, Thanks for a great site, I've learned a lot. I saw in your Weimaraner section that a common disorder is "color mutant dermatitis", but there was no further information on it that I could find. I live in Northern Baja California and am using a Mexican vet. He's okay, but tends to oversimplify everything. Daisy is almost 5 years old, a purebred, but definitely non-AKC quality, Weimaraner born in Colima, Mexico. I have a male 3 months her senior with no skin problems. We took her home at only 6 weeks of age because the vet said that the breeder was mistreating her. She hid food in her cheeks for several weeks and had very weak rear leg muscles, but recovered quickly and has always been a jumper and very energetic. She is about normal weight (a couple of pounds overweight), spayed before the first heat, and has been remarkably healthy up until recently. She suffers from severe incontinence, which had its onset as a puppy, with a "break" of about 4 years before it returned in spades. She has been taking 25 mg per day of Proin for the last two weeks and it's worked amazingly well. About 6-8 months ago she suddenly started growing a coarse, wavy coat from the neck to the tailbone which became itchy, flakey and then hair started falling. The vet said "dermatitis" (Uh yeah, it's ALL dermatitis) and gave her an anti-histimine and a rank-smelling tar shampoo, prescribing 4x weekly- then semi-weekly baths and the pills 2x day. It got better, though her hair never grew back in smooth again. It's quite thick and noticeably a different texture from the coat she used to have. We eventually wound down to once a month baths and after about 4 months, the itchiness and hair loss started again. Took her back again, same treatment. Gave her the pills for about a week, until she stopped the scratching and am now back to bathing her only once a week. In this last month, I noticed a light spot growing in her fur near the neck and now it's 4-5 shades lighter than the rest of her coat and about 2 inches by 3 inches, sort of an irregular rectangle in shape. That's what made me notice the "color mutant" dermatitis note. We live near the ocean, she does get walked on the beach, though neither dog is allowed in the water anymore due to suspected pollution in the ocean here. Daisy is a "roller", but she is never out alone and not allowed to roll in anything, so it's rare that she actually gets into anything. We do not have a yard, she is taken to the empty lot next door several times a day, which has little to no vegetation. She is walked in a grassy park twice a day and once a day takes a 90 minute walk on the beach. In the 4 years we've lived here, neither dog had even a hint of a flea or tick, but I recently found a tick on Daisy and a flea in my bed, so they were treated with Frontline Plus a couple of days ago. The vet said the heavy rains here this year probably increased the pest population. About 4 months ago, both of them suddenly came down with diarrhea and vomiting, the vet took them off kibble altogether for a couple of months, both recovered quickly. Only Ziggy had a recurrance about 2 months ago, which we again treated with antibiotics and removal of kibble from the diet. The second time, no pork products were involved, so I have no idea where he got it. Daisy is taking a supplement twice a day for her liver (honestly, no idea what it is, they are reddish/pink capsules). She's been on the supplement for about 2 months. The vet had taken blood samples the first time the dogs were ill and said he was concerned about the liver enzymes in both. We repeated the tests in 6 weeks, Ziggy was normal, Daisy remained slightly elevated, which is when he put her on the supplements. I'm feeding both dogs a small amount of Iam's Reduced Fat (my male was grossly porcine), with some rice, de-fatted homemade chicken broth and a bit of home-cooked chicken (a holdover from their illness). Both dogs have lost quite a bit of weight on this diet. They are given almost no table scraps. Daisy is very close to normal weight now, Ziggy is about 5lbs to go. They are continuing to slowly lose weight. They are given cookies/biscuits I get from a friend who makes them at home that contain no eggs or additives. No more pig ears or other treats that made them so fat before. The vet claimed that the dogs got ill from pork skin products, so they were discontinued completely. I occasionally give them a Dentabone, but it's rare. The biscuits they get every time they go out are about 1/2 in diameter, just cavity-fillers. Turns out they can't tell the difference between them and a pig ear...it's the "thought" that counts. Who knew? Daisy's dermatitis didn't coincide with any particular changes in diet or lifestyle, she had it when fat, eating pork products, and got it again after losing weight and being on the new diet. Ziggy seemed to have ear/allergy problems with Hill's, Eukanuba and Royal Canin foods, they both seem to do well with the IAM's. Ziggy has a gorgeous coat, but I'm starting to notice some slightly dry-seeming spots on his rear flanks. Could be my imagination. Sorry for the long letter, but I wanted to give as much history as possible. Is this color mutant dermatitis? Is there anything else we can do for her? Any hope to recover a smooth coat? Thanks in advance for your time. Regards, Deanna A: Deanna- I am not sure why we have a subject line for color mutant alopecia in the Weimaraner section of the breed problems listing. Color mutant alopecia is usually called color dilution alopecia now. It is a problem in dog breeds that have "blue" and "fawn" variations in hair coloring. It affects most Dobermans that are blue or fawn and it occurs in a number of other breeds to a lesser extent but it is not a problem in Weimaraners. This is just a mistake on our part. I have notified Michal and we'll get it fixed soon. I do think that there are some other things to consider in Daisy's case that might be helpful, though. There is a condition, sebaceous adenitis (sometimes called granulometous sebaceous adenitis) that could cause changes in the hair color. It usually causes hair loss over time, though. It can start as scaling or look just like a skin infection. The only really good way to diagnose this condition is by skin biopsy. This may be a good idea if the affected area goes on to lose hair or if it starts to grow in size or if new similar areas appear elsewhere in the hair coat. I have not heard of changes in the hair coat resulting in changes in hair texture from this disease, at least not associated with a coarse or wavy hair coat appearing. I am not sure what bearing this might have on Daisy's condition but there are long haired Weimaraners. This would usually be a trait that showed up within the first two or three months of life but I'm not sure if an underlying tendency towards long hair could surface later in life if things like hormonal changes occurred. The onset of the itchiness falls within the normal range for onset of atopy (allergies to pollens, etc.) in dogs but it is late. Most dogs with atopy will show signs when they are between 1 and 5 years of ages so she does fall within this "norm". The pattern of the itchiness and skin disease isn't highly suggestive of atopy, which often causes itchy feet, itchy ears and hair loss on the front half of the body. Unfortunately there is a lot of variation in this so it is not possible to rule out atopy just based on when it occurs and where it causes itchiness. You could have Daisy allergy tested if you wanted to know more about this possibility, though. Antihistamines are often prescribed as a first line of treatment for atopy. The early onset of incontinence (presumably after spaying) may have been due to a decrease in estrogen levels. If so there is a small chance that this could also cause skin or hair coat changes. This would be pretty hard to confirm, though. There are tests for two enzyme levels associated with the liver included in most general lab panels. The first is ALT or alanine transferase. The second is alkaline phophatase (SAP, alk phos, other names). Rises in ALT are more closely restricted to liver damage. Rises in SAP can be associated with administration of prednisone or other glucocorticoids, hyperadrenocorticism (Cushing's disease) and with liver disorders. If Daisy had a rise in SAP but not a rise in ALT then it would be reasonable to test her for hyperadrenocorticism with the changes in hair coat and lab work. Five years of age would be a young onset for this disease but again it falls within the normal range. Most dogs with Cushing's disease are 9 years of age or older but it has been reported in much younger dogs. If the rise in liver enzyme levels is for ALT alone, then a liver disorder of some sort is more likely. It would be good to review these findings to see if you can get a hint about what is going on. If it seems like liver disease is unlikely it may be best to consider testing for hypoadrenocortcism to see if is present and even to think about testing for hypothyroidism, another hormonal skin disease. Lastly, there would be a small chance of excessive growth hormone with the changes seen. I think that the University of Tennessee has a blood test for growth hormone but I am not sure of it. Growth hormone excess (acromegaly) has been associated with greasy haircoats, scaling and can eventually contribute to the development of diabetes. It would be rare for this condition to be present but is is possible. If follow-up lab work does reveal a bigger problem with the liver or persistent elevations in alkaline phosphatase it would be best to figure out what is causing the rises. If there is no way to prove or disprove liver damage then it would make sense to concentrate on the skin disease hoping it will improve. If it doesn't happen you might consider asking your vet about the possibility a skin biopsy (or several) to try to sort through this problem. Mike Richards, DVM 5/2/2005 Michal Input: It's fixed. Its mentioned as a problem in my older Genetic Aspects of Pure breed dogs but all other sources I looked at since then do not list it. It is not listed in George Pagett's Canine Genetic diseases or Kirks.
Epidermal Dysplasia and Malassezia Infection
Q: I have a WHWT (Westie) that was born with the genetic disorder Westie Seborrhea also known as Epidermal Dysplasia. My little girl Krissy is going on five (5) months of age and symptoms are already predominate. The only information that I have been able to obtain to date is that Westie's with this problem have been euthanized in the past, not a very promissing future I might ad. It is heart breaking to see my little girl going through such an ordeal. I would like to know if there has been any advances in this area of subject matter? I have heard of a medication called chlorosporine (sorry about the spelling) a.k.a. NEORL. Apparently this is an immune suppressant. How would this medication benefit Krissy? Any information you can provide is greatly appreciated. If you do not have any information on this disease can you direct me to a site that can provide me with additional information in this area? Your time and consideration is appreciated. Jennifer A: Jennifer- There is some disagreement among veterinary dermatologists about the origins and treatment of epidermal dysplasia, especially in Westies. This reference "Epidermal Dysplasia and Malassezia Infection in Two West Highland White Terrier Siblings: An Inherited Skin Disorder or Reaction to Severe Malassezia Infection?" by CS Nett, et al, Vet Dermatology Oct 01, is an example of the controversy. In this article the authors question whether this an actual congenital condition or a secondary response to atopy (allergies) and malassezia (yeast) infection. Their conclusion is that the condition developed as a response to these underlying conditions in the two patients they examined. I have also seen a similar article written about the same skin condition in other breeds, suggesting that it may be a secondary response to hormonal diseases (CB Chastain, et al, Small Animal Clinical Endocrinology, 1999). Atopy usually occurs in dogs that are a little older than five months of age but it can occur in West Highland White Terriers and other breeds at a younger age. Secondary yeast infections apparently occur quite readily in this breed and the combination appears to cause pathologic changes in the skin that either are, or resemble, epidermal dysplasia. I do not know how this diagnosis was made, other than skin biopsy. If testing for atopy and/or food allergies was not done it would be best to do these tests. In addition, it would be a really good idea to try to rule out a secondary yeast infection through impression smears of the skin or possibly even treatment, if there is sufficient reason to suspect it based on clinical appearance. It may be best to consider asking for referral to a board certified veterinary dermatologist, if it was not a dermatologist who made the diagnosis. These things would help to rule out a primary cause that was leading to the pathologic changes in the skin. I could not find information on treating epidermal dysplasia with cyclosporin but it makes sense that this might work. Cyclosporin seems to help patients with atopy and it can stop self-destruction of tissue because it interferes with the immune response, which is the reason that it works as a drug to help prevent rejection of kidney or other organ transplants. This may not be necessary to use if it did turn out that atopy and yeast infection were present, since treatment for the yeast and for the atopy with less expensive and easier to regulate medications might be equally or more effective. I have seen photographs of a Westie at a recent dermatology seminar which had atopy and secondary Malassezia infection at a very early age and was able to live a normal life with appropriate therapy, although it sounded like it did take a really intensive effort on the part of the owners and the veterinary dermatologist to keep things under control. Good luck with this. Mike Richards, DVM 2/7/2002
Vasculitis, Folliculitis, Hepatocutaneous Syndrome Possible in German Shepherd
Q: Hi Dr. Richards, I discovered your site today and was very impressed and signed up immediately. My question concerns my dog, Lucy, a german shepherd mix who is about 11 years old. We rescued her about 4 years ago from a very bad environment. Last year she started showing signs of arthritis and was put on 100 mg Rimadyl daily. Everything was fine for about a year. This March, I took her for her annual exam and routine vacination--Distemper (DHLPP). My regular vet was not in but an associate examined Lucy and gave her Duramune Max 5/4L DA2P+Pv/LCI-GP. About a month after the visit, Lucy's arthritis worsened and the medicine no longer helped. She also developed a lump near one of her nipples. She was put on antibiotics, but the lump continued to grow, become very painful, and runny (blood and pus). She then had a mastectomy and things seemed to be improving. Within a few weeks, however, the area began to develop similar symptoms as before, but even more intense. All blood tests and biopsies were normal. She was put on a different antibiotic, but the problem persists and begins to worsen. She now has developed open, running lesions on the inside of her front and back legs. The vet is puzzled and said that Lucy's skin seems to be breaking down, but with no signs of infection (fever, loss of appetite, etc.) other than the sores and pain. He sent new samples off for biopsy once again but is concerned that in 25 years of practice, he's never seen a skin infection like this. If the biopsy comes back negative again, he said he will send it to his veterinary college. Since March, Lucy has lost about 7 pounds--going from 58 to 51 pounds. I love the vet, and I have confidence in him. I'm looking for any information that can lead us to a cure for Lucy. Could there be a connection to the new vaccine? Have you heard of such a skin problem? Do you have any recommendations? I would appreciate any information you can provide. Thank you so much for your help. A: Mary- There are several possible problems that might fit what Lucy is experiencing. The skin biopsies are a good idea and I hope that they are helpful in providing a more definite diagnosis. The first thing that came to mind reading your note is a disorder in German shepherds in which they develop deep skin infections (folliculitis, furunculosis and/or cellulitis) that are more severe than those seen in most dog breeds. These infections can come on quickly and seem to occur after a stressful situation in some affected dogs. This is not a really common problem. I can't remember with certainty how often we have seen it, but I am pretty sure it is no more than three or four times in the twenty-two years I have been in practice. This disease usually occurs in middle-age German shepherds but could have a later onset in some cases. This condition is a bacterial infection and long term use of appropriate antibiotics (cephalosporins, fluoroquinolones, sulfa/trimethoprim (not long term), some others) is necessary to cure it. In some cases it is necessary to use antibiotics continuously to suppress the infections and in other cases intermittent use is satisfactory. It is really tempting to use corticosteroids due to the severe inflammation that is sometimes present but this is probably not a good idea. Pentoxyfylline (Trental Rx) is supposed to be helpful in some cases. The skin infection is usually precipitated by some disorder. It may be allergies, hypothyroidism, hyperadrenocorticism, demodecosis and probably a number of other disorders. This disease syndrome can be really frightening at first due to the severity of the sores but it can be kept under control in most dogs affected by it. Sometimes it takes a long time to get the sore areas to look better, though. Another problem that sometimes occurs in German shepherds but is not as closely associated with the breed is cutaneous vasculitis. There is a form of this that occurs in German shepherd puppies as an inherited disorder but that obviously wouldn't count in Lucy's case. Some dogs with vasculitis develop subcutaneous lumps before skin sores develop, so this makes this disorder seem possible, as well. Often, dogs have hives when this condition is present. In other cases, there just seem to be skin sores that may be mild to pretty severe. This condition might respond to pentoxyfylline, too --- but usually responds better to corticosteroids. This makes for a bad situation in Lucy's case because treatment for the first condition would be complicated by corticosteroids and treatment for vasculitis may require it and it may be difficult to differentiate which condition is causing the problem, although the skin biopsies might make that possible. Vaccines have been implicated in some cases of vasculitis but this is usually a reaction at the injection site rather than a generalized problem. I tend to discount the possibility that the vaccine is involved but could not totally rule out the possibility. There is a third condition, hepatocutaneous syndrome, in which liver disease or pancreatic disease (or both) leads to secondary skin lesions. I don't know why that happens. Most of the time the sores affect the face but they can be found on the legs as well. The sores are usually less severe than those seen with the deep skin infections of German shepherds (at least that is my impression) but might be harder to distinguish from the cutaneous vasculitis lesions. Since this disorder is associated with liver disease most of the time it is a good idea to be sure that there are no discernible liver problems. There are other conditions that seem possible, such as cutaneous lymphoma (cancer affecting the skin), sporotrichosis, phemphigus or discoid lupus but these conditions don't fit the signs really well. They just seem remotely possible. Since there are a lot of unusual possibilities whenever skin disease is present it might be a good idea to think about asking for a referral to a veterinary dermatologist -- so taking Lucy to the veterinary school rather than just sending the skin biopsy samples there for review. It is sometimes the quickest way to a diagnosis in a difficult case of skin disease because the dermatologist gets everyone's difficult cases, making it more likely that he or she will have seen the problem before. I think I'd want to stick with the antibiotics, just like your vet is doing, at least until I had the skin biopsy reports. I might add pentoxyfylline if you didn't mind the cost and I was getting concerned while waiting. It may be worthwhile to check for the hormonal diseases liver disease through blood work while you're waiting, too. Those are just my thoughts -- your vet can actually see the sores and may know from the appearance or from the testing so far that any or all of these conditions are unlikely. Good luck with this. Mike Richards, DVM 10/20/2001
Scabs and Bumps after Grooming
Q: Dr Mike, Tinker is a coyote/german shepherd mix, EIGHTEEN years old, and in INCREDIBLE shape, all things considered. I'm fortunate to be writing to you with something as minor as this, really. But I have a question about her skin. About a week after her app't with the groomer, I was brushing Tinker and noticed a whole bunch of bumps ...... more like scabs, really, on her back - in the areas of her neck, between her shoulder blades and down her back about halfway. This is right where her fur is the thickest. I didn't see any. I wonder if this could have anything to do with the grooming. Is the skin on older dogs more fragile, and could vigorous combing or brushing cause little tears or lesions? Tinker sheds just horribly, all the time - worse than any dog I've ever seen in my life - and the groomer was trying to comb her out really well. I realize that I have noticed this before, and it seems to be after she has been groomed. I'm not sure if this is coincidence or not. In the past I've chalked it up to an allergy to some preparation they used, and we've changed products - avoided lanolin - whatever I could think of that might be the culprit. It didn't occur to me that the groomer might be a little too rough. What do you think? Thank you for your help! PC A: PC- We see skin irritation and skin infections, which this might be, fairly often after grooming in dogs. I think that sometimes it probably is due to a problem during grooming, like clipping too close, the clippers getting hot, or irritation from the shampoos or other grooming products used. Flea sprays containing alcohol are very irritating to some pets, for instance. However, I think that a lot of dogs are just irritated by the clipping process because they are sensitive to it. So I think it is worthwhile to think about whether your dog might be sensitive to something that is being used during the grooming but I think that you have to accept that skin irritation is just a fairly common problem after grooming, otherwise. Skin infections occur secondary to irritation in some dogs. This can happen when dogs have allergies, hormonal diseases or after events like grooming or hunting. Skin infections can show up as scabs scattered in the hair coat, as excessive dander, as areas of hair loss - especially if there is scaling around the edges and through the presence of pustules or red blotches in the skin. They often will clear up on their own if they are due to an irritation that doesn't stick around. As dogs age, it is a little harder for them to clear up a skin infection on their own and you may find at some point that these irritations have to be treated with antibiotics even though your dog has been able to cure herself in the past. As long as the scabs clear up on their own within a week or so, there is probably no need to worry about this problem. If the scabs are still present in 7 to 10 days then it would be a good idea to let your vet take a look at them to see if antibiotics are necessary. Mike Richards, DVM 10/20/2001
Constant Scractching Near Eyelids - Bacterial Skin Infection Possible
Q: Dear Dr. Mike, First I would like to say that I think vetinfo.com is very informative and helpful to people like myself who have concerns about their pets. I am writing to you regarding my English Bulldog who will be two years old October. At the end of April I took him to the vet because he was scratching around his left eye which caused some hair loss. He was also missing a spot of hair on his side which was not caused by scratching. The vet wanted to scrape the two spots to check for mange. When the tech came in to scrape she only did the spot on his side because the other spot is so close to his eyeball. Anyway, he did not have mange. The vet told me to just put vitamin E on the spots and see if they get better. After about a week the spot on his side was a little bit better but he continued to scratch all around his left eye which caused more hair loss and some bleeding; basically it looked raw. I took him back to the vet on May 7th and he wanted it scraped again. I told him that the girl never scraped around his eye the last time only his side even though he had asked her to do both spots. Well they scraped around his eye and again it was negative for mange. he vet gave me Neo-Poly-Dex Ophthalmic Ointment to put in and around his eye for 10 days and also put him on Cephalexin 500mg 2x daily. His eye got better but about two weeks later (around June 10th) it came back again so I called the vet and he had me use the ointment again. It got better but never really went away because he would still scratch at it. I took him to the vet again on July 6th for his eye and for what I call a skin infection (they are little scabs and bumps that he gets on his skin pretty often but they do not seem to bother him). He saw another vet this time (there are 4 vets where he goes) because the one I normally see was booked. He gave him an Azium injection for the scratching and put him on Cephalexin 500mg 2x a day and Prednisone 20mg 1 tablet 2x a day for three days, then 1 tablet a day for five days (which only ended up being for three days because he was urinating too much) and then 1 tablet every other day for five doses. He stopped scratching around his eye while on the medication and everything cleared up. His eye was better again. A week after finishing the medication he once again started scratching at his eye. Now he is also scratching around his other eye and also in the creases near his nose. All around his left eye looks awful, it is raw and bleeds and he is starting to do the same thing to the area around his other eye and nose. So basically everything they have put him on so far only works temporarily. I am taking him to the vet again this Wednesday, August 8th. Something is obviously making him itch around his eyes and nose or he would not be scratching at it so bad that he loses hair and makes it bleed. I appreciate your help with this matter. Thank You. Sincerely, Francesca A: Francesca- We have seen this sort of problem around eyelids from bacterial infections in a number of dogs. Usually they are older Labradors in our practice but the problem may be similar in your younger bulldog. We have found that we have to use antibiotics (we usually use cephalexin, too) for about 8 weeks to clear these up and prevent them from recurring. We have had to retreat a couple of patients more than once but there is usually at least a few months to a year or more between episodes when we use antibiotics long enough. We also see skin problems like this from allergies and in those cases it is usually necessary to use corticosteroids like prednisone to keep the pet from damaging the eyelid further. However, we try hard to contain the problem with long term antibiotic therapy first, when we can. If we can get by with a corticosteroid eye drop and the antibiotics, we like that better than using corticosteroids (prednisone is a corticosteroid) orally. Scraping for the mites is a good idea and I wouldn't rule that out in the future just because no mites were found on the first two attempts, if this problem proves to be persistent. Bulldogs and other short coated breeds are pretty prone to primary bacterial infections of the skin. They can be itchy from this but usually antibiotics will help with the itchiness pretty quickly if the problem is just a bacterial infection. It can take persistence to figure out skin disease. Give your vets a chance to get this under control but if you reach a point where you feel strongly that you need to do something more, you could ask for referral to a veterinary dermatologist. Good luck with this. Mike Richards, DVM 8/24/2001
Dry, Flaky, Bumpy Skin - Potential Food or Pollen Allergy
Q: Cowboy, my Frenchie, has skin problems again. Last year it was on his head, this year on his tummy and back above his tail. The area is dry and flaky and bumpy. He has been sort of on a maintenance of generic chlortrimetron.....I am very stingy with it...maybe too stingy. He is on no other medication.( 1/2 tab once a day.) I feed him Solid Gold, the gold bag, and snacks of carrots, fruit, some broccoli, cabbage occasionally, romaine lettuce. He loves salad!! I supplement, i.e., mix the solid gold with a homemade mix I found in a Natural Health for Animals (not exact title) at health food store. Also a bit of olive oil. His hair is pretty and shiny and he has never been sick much at all in his 7 years. I am beginning to think that he may have grass allergy, contact and digestive. He loves to eat grass. Also on his tummy are the worst red spots....the part of his body most in contact with grass, etc. The vet and I have talked about this. She suggested that he be taken off beef products. Shampoo with oatmeal baths (just started that for total body); prior to this, I bathed the affected areas only. She is very helpful. I have found, though, that I am ultimately responsible for his well being as I know him best. Do you have suggestions? I really do not want to do the steroid route. I think it shortens their lives. He has high pain tolerance and he does not complain much at all. It makes it a little hard to know when something is bothering him. I value your input. Thanks, Jean A: Jean- Food allergies are not especially common, but they are among the most treatable of allergies, so it is always reasonable to try to rule them out. The best way to do that is to feed a diet that contains no proteins that a pet has previously been exposed to. Diets formulated for this include diets such as egg/rice, lamb/rice, duck/potato and combinations similar to these. Recently, there are new diets that include proteins that have been hydrolyzed to make them small enough that they can not be allergenic. The two that I know of are Hill's z/d (tm) and Purina's HA diets. These should be a more reliable test diet but we sometimes have trouble getting pets to eat these diets. Keeping beef out of the diet will eliminate the possibility of a beef allergy but if that doesn't work you'd have to go through all other possible allergens one by one. Of course, if the food trial does work and you want to know what Cowboy is allergic to, you would have to add foods back into his diet one by one until he reacted badly to one of the foods, which would be the likely food allergen. Whichever method of food trial you pick, it takes at least 8 weeks to be sure that a food allergy is not present and it is very important that no other foods or treats by given during the food trial. Vegetables aren't too likely to provoke food allergies but it is best to discontinue them, too. The dosage of chlorpheniramine is very low. The usual dosage for dogs is 2 to 8mg/kg every 8 to 12 hours. Chlorpheniramine is usually a 4mg tablet, so this is roughly 1 tablet per 2 to 5 lbs every 8 hours. The dose is lower for cats, about 1 to 2mg/kg, which makes it a more practical medication for use in cats. Some pets do respond to lower dosages, so if this has been working at the low dose you may want to see if increasing the frequency of administration to 2 or 3 times a day provides enough relief to control Cowboy's symptoms. Supplementation with essential fatty acids can be helpful for pets with allergies. These are available under several brand names for pets (OmegaDerm tm, DermCaps tm, 3V Capsules tm, EFA-Z tm) and are also available in human formulations. I saw something recently that suggested that pollen allergies in dogs may have a much larger contact allergy component than was previously thought. The theory is that pollens stick to skin when it is wet and are irritating on the skin surface, just as they would be if inhaled. This could explain why so many dogs do seem worse after they are in contact with wet grass in the mornings. I am not sure that knowing this helps much, since it probably would require bathing on a daily basis to get the allergens off the skin and that is not practical in many situations. Some dogs have bacterial pyoderma that looks like allergic skin disease. It can take several weeks of antibiotics to get a response to treatment in these dogs, so I think that they are easily missed when working with itchy dogs. It is sometimes helpful to stop other medications and continue with an antibiotic to see if will successfully control the bacterial infection and resulting itchiness and scabbiness but it is hard to be patient the first two or three weeks while waiting for positive effects to show up. If the allergy season is short and Cowboy isn't too bothered by the skin sores, it probably is OK just to wait it out and see what happens, although that does sometimes allow secondary infections to develop or to become worse. I hope that this helps some. Mike Richards, DVM 8/21/2001
Pattern Baldness or Allergies in Boston Terrier
Q: Dr. Richards, I live in Fairbanks, Alaska and none of our local vets have been able to help my little Boston Terrier, Buddy. When Buddy was 8 months old, he has a severe corneal ulcer. It required suturing the lids together and he had to wear the lampshade collar for 3 weeks. He was always a very timid little guy and this was very hard for him to adjust to. He acted like he was being punished and was upset the entire time. 3 weeks after the treatment ended, he developed hair loss over that same eye that was also itchy, red and a little scaly. The hair loss is not complete, but serious thinning. Over the past 2 years that hair loss has moved slowly in the following pattern. Over rt eye, over left eye, behind his ears, down to his throat, down from his throat over his chest, groin, and it is now moving up the outside of his thighs. It is moderatly itchy, very smelly, and his skin is intermittently reddened. I can control the itching and odor somewhat with oatmeal shampoo frequent baths - 2-3 per week, and I rub cortisone ointment into the worst spots after the baths. However the hair loss is continuing and he still scratches quite a lot. He has seen 3 vets and the following treatments have been tried: 1. Dipping for demodex - they never could see the mite under a scope. He was dipped twice and was so sedated after, I asked them not to continue. This is when he was 10 - 11 months old. 2. Skin biopsies - they lost the first set and had to repeat. This showed nothing. 3. Allergy testing - serum, (not skin) - showed many allergies - 4 or 5 grasses, several trees, lamb, corn, milk, dust, etc. I understand the serum testing is not that reliable. 4. Allergy shots - I only gave him the test doses and 2 of the actual shots because the itching got much worse after the injections. 5. Food challenges - he has lived on rice and moose meat for a month with no success - lots of non allergic food - even the new super processed food without much improvement. He seems to do best on turkey/barley. 6. Acupuncture, oils, and vitamins. 7. Thyroid checks x 3. 8. Several courses of antibiotics and anti-fungals I am most confused by the slow moving pattern of the skin condition. It makes it hard for me to accept allergies as the sole cause. Do you have any ideas? A: Linda- I am not familiar with any particular skin disorder that produces the clinical signs that you have described, so I can't give you a simple answer to your question. I am hoping that I can provide you with enough information to be helpful, though. There is a pattern baldness problem that sometimes occurs in Boston terriers. This usually occurs in female dogs, usually starts around the ears and moves down to the underside of the neck, then the underside of the truck and finally down the inside of the rear legs. It usually starts at about six months of age. The skin underlying the areas of hairloss is usually normal and does not have the signs of secondary infection that you are describing. So even though this condition exists in Bostons it doesn't seem too likely to be the problem given Buddy's sex, the presence of secondary skin disease signs and the spread to the outside of the thighs rather than the inside and rear of the thighs. Allergies are definitely a possible underlying cause for hairloss and secondary skin infections. Boston terriers are listed among the breeds that are prone to atopy (inhalant allergies). Most dogs with atopy have an onset of clinical signs when they are between one and three years of age but some dogs show signs as early as two to three months of age. I am in the process of rethinking the comparison between skin testing and serum testing for allergies, especially with the currently available serum tests. While there still seems to be a little better correlation between skin testing and serum testing, the gap is narrowing and if a practitioner is good at recognizing the most likely allergens in the practice area and can take the time to correlate the peak times of itchiness to likely allergens present at that time, it is possible to develop a good antigen mixture for hyposensitization (allergy shots) for a particular patient using either technique. It may be worth reconsidering the hyposensitization if nothing else seems likely after considering the rest of this note. In chronically itchy skin diseases it is important to rule out the possibility of sensitivity to internal parasite migration and sarcoptic mange, even if these problems can't be identified on lab testing. Deworming a couple of times with a fenbendazole (Panacur Rx) or other dewormers capable of killing larval migrating stages of roundworms is a good idea. We usually treat for sarcoptic mange using ivermectin but there are several treatments for this condition. Some dogs seem to have long term itchiness from sarcoptic mange, or something else that responds to ivermectin, even though we can't find the mites on skin scrapings or biopsies. It is critically important to use a good flea killing product such as fipronil (Frontline Rx), imidocloprid (Advantage Rx) or selamectin (Revolution Rx) if there is any problem with fleas where you are. Even if flea allergy is not the problem, fleas make almost any other skin disease worse. Flea allergy dermatitis is more common that atopy in most areas of the country. The hairloss associated with this can be different from one dog to another but there usually isn't as much facial pruritis with flea allergy as with atopy. The really hard part of cases like Buddy's is trying to differentiate the problems that are causing the initial itchiness from the problems that occur due to the itchiness. This is particularly difficult for bacterial skin infections and Malassezia yeast skin infections. In most cases, these problems occur as a secondary problem but the bacterial skin infections, in particular, can be the source of the original itchiness and then can self-perpetuate as the dog scratches, damaging the skin and making it even easier for bacteria to grow in the skin. We have the best success ruling out bacterial skin infections by using long term antibiotic therapy while withholding corticosteroids, if it is possible to do that. The best hint that bacteria could be the underlying problem would be the reaction to the previous use of antibiotics. If there was improvement in the condition when on antibiotics but then the problem recurred when antibiotics were withdrawn it is highly likely that bacteria are playing a significant role in the itchiness. When we think this is happening we usually prescribe two months worth of antibiotics. That is usually long enough to figure out if they antibiotics are going to work, but may not be long enough to resolve the problem. Our last patient with a primary bacterial skin infection took six months of continuous antibiotic use to be completely itch free and has been able to be without antibiotics for about five months at this time. It is unusual to get a lifelong cure in a dog prone to itchy bacterial skin infections. Some dogs require nearly lifelong antibiotic use and other dogs have recurrent infections that can be treated successfully each time with antibiotics. I like cephalexin as my first choice antibiotic for long term use but some vets favor other antibiotics. Malassezia is harder for us to diagnose and to treat, although we have had some luck lately using chlorhexidine shampoo and vinegar/water rinses (1:1 water to vinegar). We usually do an impression smear of the skin (pressing a microscope slide to the skin, heat fixing the sample and staining it) and examine it for the yeast organisms or a skin scraping with the same staining procedure. If we get a lot of yeast on the smear we go ahead and treat for Malassezia. If not, we do skin biopsies and hope that there will be some evidence of it on the biopsies. Since Buddy had biopsies and yeast organisms weren't found that makes it a little less likely but does not rule it out, unfortunately. Oral anti-fungal medications such as ketaconazole and itraconazole will usually eliminate the yeast with three to four weeks of therapy. These are a little expensive to use without good evidence that yeast is the problem but I would do this if antibiotic therapy didn't help and especially if antibiotic therapy makes the situation worse. Malessezia has a strong tendency to recur, just like bacterial skin infections. So if there has been improvement when on anti-fungal medications and then recurrence of the problems it may be necessary to use some sort of long term maintenance therapy. Hopefully, shampoos would work in that case. It can take several tries to find the right anti-fungal therapy for a specific patient. The food allergy test is a good idea. Contact allergies have to be considered, too. If Buddy has a cedar bed or a wool blanket or something else that might be causing a contact allergy it might be a good idea to change that situation long enough to see if the skin problems clear up. When I am not getting a good response to my diagnostic and treatment efforts in a case like Buddy's there are a couple of things things that I try to think about. The first one is whether or not I have used antibiotics or antifungal agents long enough at any one time to be certain that they are not going to be effective. The next thing is to be sure that we have achieved good flea control (maybe this should be the first thing). Sometimes, if we carefully review what we have done, we can see where there were short periods of good response to particular therapies and that can be helpful in figuring out where we should concentrate our diagnostic or treatment efforts. I am not sure whether this is a possible option in Fairbanks, but we have a veterinary dermatologist who practices reasonably close to our clinic and when we just don't seem to be making progress on a case we refer our patients to the dermatologist. This is a good option for any chronic case of skin disease that is not responding to treatment and for which diagnosis has not been possible despite a good effort at testing as in Buddy's case. I hope that this helps some. Mike Richards, DVM 5/1/2001
Chihuahua Puppy with Dry, Flaky Skin- Bacterial Skin Infection Possibility
Q: My question concerns Patties dandruff and itchy skin. She doesn't have any rashes and just seems to have dry, flaky puppy skin. As I recall, my other two dogs had it as well but it cleared up after being on good food for a couple of weeks. I changed her from Science Diet dry puppy food to the Nutro at the suggestion of a PetSmart employee who I discussed her itchy skin problem with. She's been on the Nutro now for an entire month and it doesn't Acid Shampoo for dry sensitive skin and have only shampooed her 3 times in 2 months and still no improvement. A: There is no advantage that I know of to using essential fatty acids topically. They can be very helpful when given orally, though. There are a number of fatty acid supplements available, such as DermCaps (tm), OmegaDerm (tm), EFA-Z (tm) and 3V Capsules (tm) --- and probably at least a dozen more. In short haired dog breeds dander can be a sign of a primary bacterial skin infection. In dogs with this problem, antibiotic therapy usually works well to stop the problem, although it has a tendency to become an intermittent problem for the life of the dog. Usually it will continue to be responsive to antibiotics, though. In dogs that just have dry skin due to the low humidity in many homes in the winter, using a conditioner after bathing often helps. It is necessary to bathe dogs once or twice a week for this to help a lot, though. The only time that dietary changes seem to help a lot are when a dog has food allergies and the switch lessens the allergy or when a dog is on a food that has a deficiency, which is really a pretty rare event for any of the brand name dog foods. Mike Richards, DVM 2/27/2001
Hyperemia (Extreme Redness) and Alopecia
Q: Dr. Michael Richards, My friend has a 3 months old dog. She had her from a kennel. She had a kennel cough but cured by her doctor. But we don't know why since 2 weeks hyperemia and alopecia started from her left cheek which is very near to her eye. The doctor made skin examination (ectoparasite) sarcoptes and fungal spores was not seen. The unususal think is the legs of the dog are also red. But she has no itch. The doctor said she has never met such red legs before. If you give us advice we will be very happy. Thanks a lot A: Isin- The first thing I would do in this case is to recheck the skin scrapings. Sometimes it is hard to find mites, especially in certain breeds (shar peis being the hardest for me). I would do this two or three times before giving up on the idea of mites, since demodecosis (infection with Demodex canis mites) is an extremely common cause of very red skin in puppies in this age range. We have seen this type of extreme redness from contact allergies to cedar chips and to walnut chips. If the puppy has access to these materials it would be a good idea to stop allowing this. We have also seen really hyperemic skin after bathing in pennyroyal shampoos, so if that has been done, stopping it would be a good idea, too. Without itchiness it is hard to figure out where to go next. Food allergies would be something to consider with the extreme redness. That has been our most common problem with really red, really itchy puppies who didn't have demodectic mange. I can't recall a puppy that didn't itch when it had food allergies, though. Some puppies do develop primary bacterial or yeast skin infections. If nothing else seems evident to your vet on examination it might be worth trying antibiotics for three or four weeks to see if they help. A skin biopsy can be a very useful test for unusual skin disease problems. Having a biopsy sample examined by a pathologist with an interest in skin disease can sometimes provide an answer when nothing else does. I hope your neighbor is able to find a solution to this problem. Mike Richards, DVM 2/14/2001
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...