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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 24454
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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HI I HAVE BEEN TO MY LOCAL VET TWICE WITH MY DOG HE IS SCRATCHING

Customer Question

HI I HAVE BEEN TO MY LOCAL VET TWICE WITH MY DOG HE IS SCRATCHING A LOT OF THE TIME AND GNAWING AT THE PARTS HE CANT SCRATCH THEY GAVE HIM A STEROID INJECTION WE HAVE GIVE HIM PIRITON BUT NOTHING SEEMS TO WORK HE IS A SHIH TZU MANY THANKS
Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
I’m sorry to hear of this with Scruffy. Pruritic (itchy) dogs are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmentals (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. Paw 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 responsible.
Scruffy's vet can check a sample of Scruffy's skin surface (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) 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 Advantage or a fipronil-containing product such as Frontline, even if fleas aren’t seen. Scruffy's vet is likely to have newer prescription flea products which might be even more effective. 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 diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily may be effective. Antihistamines (Piriton, e.g.), however, aren’t reliable. 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. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs but it’s currently poorly available due to the manufacturer’s mistaken assessment of its demand. Specialist veterinary dermatologists in the UK may have it in stock, however.
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 Scruffy'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 Scruffy'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 note that food intolerance is poorly responsive to steroid therapy - as seems to be the case with Scruffy.
Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 2 years ago.
I have to leave my computer for a few hours but promise to reply as soon as I return if need be.

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