Aloha! You're speaking with Dr. Michael SalkinI'm sorry that your question wasn't answered in a timely manner. Skin scraping is important and presumptive antibiotic therapy is reasonable but there's so much more that can be done.I’m sorry to hear of this with Scooby. Pruritic (itchy) dogs are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmentals such as pollens, molds, dust and dust mites, and foods should be considered. In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be responsible.Scooby's vet can check a sample of Scooby's skin surface (a cytology) for abnormal numbers of bacteria and yeast. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) and yeast is addressed with ketoconazole for at least a month.Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advocate - as you've done - or a fipronil-containing product such as Frontline, FiproGuard or PetArmor 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, egg hatches are common. In severe cases, an anti-allergenic prescription corticosteroid such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas as well but may not be allergic to the flea’s saliva.Environmental allergies 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 chlorpheniramine (Piriton) dosed at 2mg twice daily may be effective. Antihistamines, however, aren’t reliable as you've seen. Adding fish oil to the diet at a dose of 40mg/kg 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. (Oclacitinib - a cytokine antagonist - has been released for use in dogs suffering from allergic dermatitis. It's likely going to revolutionize how we address dogs such as Scooby. Unfortunately, it's difficult to obtain because the manufacturer underestimated the demand for this drug. Please speak to Scooby's vet about Apoquel (oclacitinib).)In addition, has allergy testing been discussed with you? We can identify which allergens offend Scooby and then produce a desensitizing serum ("allergy shots") designed just for him. This testing is only appropriate for environmental allergens - not foods - which is discussed next...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 Scooby's 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 Scooby's vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. 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.Please respond with further questions or concerns if you wish.
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