How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 26157
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
55012488
Type Your Dog Question Here...
Dr. Michael Salkin is online now

My shih hu has red itchy skin ive been many vets about this

Resolved Question:

my shih hu has red itchy skin ive been many vets about this nothing as worked, she does not have fleas but shes always scratching. what do u suggest?
Submitted: 6 months ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 6 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.

Expert:  Dr. Michael Salkin replied 6 months ago.

I'm sorry to hear of this with your Shih Tzu. If many vets haven't been able to diagnose her properly, please consider having a specialist veterinary dermatologist attend to her as can be found here: rvc.ac.uk/small-animal-referrals/dermatology

I'm going to post my synopsis of the pruritic (itchy) dog for you so you have a broad overview of all the conditions we need to consider in such a dog as yours. Please take your time perusing it and then return to our conversation with additional questions or concerns.

Pruritic (itchy) dogs are suffering from an allergic dermatitis in the great majority of cases. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw and extremity licking indicates both atopy and a food intolerance and so it behooves vets to distinguish one from another.) In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be contributory.

Your Shih Tzu's vet can check a sample of her skin surface microscopically (a “cytology”) for abnormal numbers of bacteria and yeast and skin scrapings can be taken in an attempt to find mites. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) plus antimicrobial shampoos containing either chlorhexidine or benzoyl peroxide and yeast is addressed with ketoconazole plus shampoos containing either ketoconazole, miconazole, or clotrimazole for at least a month.

Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage/Advocate, a fipronil-containing product such as Frontline or one of the newer prescription products available from her vet even if fleas aren’t seen. Dogs can be such effective groomers so as to eliminate all evidence of flea infestation. Dogs who remain primarily indoors can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. As the weather warms or you turn on heaters at this time of year, egg hatches are common. If the area between the edge of her rib cage and tail (the “saddle” area) is particularly excoriated, a flea saliva allergy should be the most important differential diagnosis. In severe cases, an anti-allergenic prescription glucocorticoid such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas too but may not be allergic to the flea’s saliva.

Environmental allergies (atopy) are usually initially addressed with prednisone as well. In some dogs an over the counter antihistamine such as clemastine (Tavist) at a dose of 0.025 - 0.75mg/lb twice daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily (maximum dose of 50 mg at any one time) may be effective. Antihistamines, however, aren’t reliably effective. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are antiinflammatory but may take 8-12 weeks to kick in. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with her vet. Oclacitinib works as well as a steroid without a steroid's adverse effects. Please note that atopy, at least initially, should have a seasonality to it while a food intolerance should cause pruritis regardless of the season. Chronically atopic dogs may be pruritic year round.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that her immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. (I prefer the hydrolyzed protein diets because it avoids the possibility of my patient being intolerant to even a novel protein.) A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

We need to consider seborrhea in such a patient as well. This is skin disorder of keratinization and maturation. It's a diagnosis of exclusion of the above mentioned skin disorders and can be suggested by skin biopsy.

As mentioned above, you also have the option of having a specialist veterinary dermatologist attend to her. You can expect some combination of skin scrapings, cytology, bacterial culture and sensitivity, fungal culture, skin biopsy, intradermal or blood allergy testing, or presumptive hypoallergenic diet trials to be performed.

Please respond with further questions or concerns if you wish.

Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 26157
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Dog Specialists are ready to help you
Customer: replied 6 months ago.
il try the diet thank you
Expert:  Dr. Michael Salkin replied 6 months ago.

You're quite welcome. Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

What Customers are Saying:

 
 
 
  • It was so professional, so personally concerned (as we were) and you answered all of our questions. George and I are so happy that I found ""JustAnswer"" on my Google search -- you are now in my ""Favorites"" list! And, yes we do love our kitty - she makes our life complete! Bev & George
< Previous | Next >
  • It was so professional, so personally concerned (as we were) and you answered all of our questions. George and I are so happy that I found ""JustAnswer"" on my Google search -- you are now in my ""Favorites"" list! And, yes we do love our kitty - she makes our life complete! Bev & George
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
 
 
 

Meet The Experts:

 
 
 
  • Rebecca

    Rebecca

    Dog Veterinarian

    Satisfied Customers:

    297
    Veterinarian for more than 30 years
< Previous | Next >
  • http://ww2.justanswer.com/uploads/TO/tomasicvet/2011-3-15_20483_RTI.64x64.jpg Rebecca's Avatar

    Rebecca

    Dog Veterinarian

    Satisfied Customers:

    297
    Veterinarian for more than 30 years
  • http://ww2.justanswer.com/uploads/MS/msb13sm/2011-3-7_52612_Dr.B.64x64.JPG Dr. Matt's Avatar

    Dr. Matt

    Veterinarian

    Satisfied Customers:

    2355
    DVM - 13 years experience in canine medicine and surgery.
  • http://ww2.justanswer.com/uploads/DR/Dr. Gene/2012-6-29_2247_20120223174645649.64x64.jpg Dr. Gene's Avatar

    Dr. Gene

    Veterinarian

    Satisfied Customers:

    1049
    DVM degree from Ontario Veterinary College
  • http://ww2.justanswer.com/uploads/VE/Vet help/2012-11-3_20182_Avatar2.64x64.png Vet help's Avatar

    Vet help

    Veterinarian

    Satisfied Customers:

    963
    12 yrs experience as a small animal veterinarian; 21 yrs exp. in the animal care field
  • http://ww2.justanswer.com/uploads/DE/debkatreyn/2011-11-28_33650_682e.64x64.jpg Dr. Debbie's Avatar

    Dr. Debbie

    Dog Veterinarian

    Satisfied Customers:

    902
    Companion animal veterinarian practicing for over 10 years.
  • http://ww2.justanswer.com/uploads/KR/kritrdr/2014-3-26_152042_Dr.Gray1.64x64.jpg Dr. Dan's Avatar

    Dr. Dan

    Dog Veterinarian

    Satisfied Customers:

    2143
    12 years of experience with domestic and exotic dogs, PLEASE rate my service when satisfied.
  • http://ww2.justanswer.com/uploads/DJ/djan2000/djan2000_avatar.64x64.jpg Dr. Dave's Avatar

    Dr. Dave

    Veterinarian

    Satisfied Customers:

    2053
    21 years small animal general and emergency practice