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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15596
Experience:  Over 20 years of experience as a veterinarian.
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My dog continually stratches behind her ears, above her eyes

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My dog continually stratches behind her ears, above her eyes and top of her head until she bleeds. The vet doesn't know what this is causing this. She's been on antibiotics three times for a month with each med course. We have no idea how to go forward as she's continually either bleeding or on medication. Please help as she looks like we abuse her.
Submitted: 1 year ago.
Category: Vet
Expert:  Dr. Kara replied 1 year ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian. I'm sorry to hear that your girl Belle continually scratches behind her ears, above her eyes and on the top of her head and has hairloss and bleeding due to her scratching.
Given the location, especially as she continues to get lesions as soon as she if off medication I highly recommend that she have a skin scraping done to look for sarcoptic or demodex mange mites. The location and her repeated problems would fit with either one. Even if she has had previous skin scrapings I would repeat them now, as she continues to suffer.
If her skin scraping is clear then I would be concerned that she is developing a food allergy. Young dogs with allergic tendencies, and very itchy skin, often have food allergies. Dogs can develop allergies to any protein or carbohydrate so even if she is only fed one thing that can be what she is allergic to. Dogs with food allergies tend to lick and scratch their face, ears and the area around their ears, as well as lick their paws the most, but any of the "allergy reactive areas" can be affected.
If you choose to try to treat her for a food allergy make sure that the food that you put her on is a true hypoallergenic diet. The trouble with "limited ingredient" or "low allergy" pet store brands is that the same machinery is used on multiple lots of food without sterilization cleaning in between. So for example even if a food says it has salmon and rice if the previous batch had beef and corn then you will get traces of those ingredients in your bag of food. Not a big deal if your dog isn't allergic but a waste of money thinking that the food was hypoallergenic and not good for your dog if those happen to be allergens for your dog.
The veterinary brand true hypoallergenic foods are more expensive because it isn't cheap to thoroughly remove all traces of a previous food mixture from the machines used to process food.
Generally what I recommend is trying to clear the skin first with a true hypoallergenic diet and then adding one food item (chicken, beef, corn wheat etc) every month to see what they react to.
Then we can find a regular food that doesn't have the ingredients that he is allergic to in it to try. As far as permanent diets I do tend to stick with Purina Pro Plan brands or Nature's Recipe as I find those rarely if ever have cross contamination. Purina Pro Plan Turkey and Barley or Nature's Recipe Vegetarian or Venison are pretty good products. I know that this isn't easy from personal experience (my dog is allergic to wheat) and it is time consuming, but worth it.
If you choose to try testing/treating her for a food allergy I recommend that you try a true hypoallergenic diet like Hills z/d or Purina Veterinary Diets HA. No treats, flavored medication or bones while on the diet and it must be used for a least 12 to 16 weeks to see the full effects. You should see some improvement in 6 to 8 weeks.
If her itchiness seems to worsen with the changes in seasons then inhaled allergies (atopy) are also possible.
You can use a combination of antihistamines and high doses of omega-3 fatty acids to help with those (they also help with the symptoms of flea allergy). In combination fatty acids and antihistamines work synergistically, much better than either one alone.
You can try:
1)Benadryl (diphenhydramine only don't use the combination products with acetaminophen or decongestants as they can be toxic for dogs) at 2mg to 4mg per kilogram of body weight or one 25mg capsule per 6 to 12 kilograms of body weight orally every 8 hours.
OR 2)Claritin (loratidine) at 5mg per 12 kilograms of body weight once or twice daily.
OR 3)Hydroxyzine at 2mg per kilogram of body weight orally every 8 hours.
OR 4) Chlorpheniramine at 4mg to 8mg per dog once or twice daily.
Some dogs do better on one antihistamine rather than another. Give the one you pick a week trial and if it isn't working try another. Be aware antihistamines can cause sleepiness or hyperactivity in some dogs. These side effects do wear off with repeated use.
Omega-3 fatty acids are fish oil products. 3V by DVM or Derm Caps ES are good brand name products. Use the high end of the dosing schedule for your pup's weight. I recommend a dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give her 40mg of EPA per kilogram of body weight per day. For example an 8 kilogram dog could take 320mg of EPA per day.
Another option if the antihistamines and omega 3's aren't enough is a product called Atopica. It suppresses the immune system a bit so it decreases allergic symptoms but it doesn't have as many harmful side effects as systemic steroids.
Another option is a brand new drug called Apoquel (generic name oclacitinib) which interferes with the allergic pathway. It works very quickly to stop the symptoms of an inhaled allergy, but it won't help with food allergies. Most dogs are reported to be much more comfortable in a day or so. Unfortunately it is on backorder now due to overwhelming demand, but it is something to keep in mind for the future if she continues to have trouble.
If you are interested discuss these medications with your veterinarian as they are prescription products.
Another option if you are interested, is trying immunotherapy. Your girl would need to be tested to determine exactly what she is allergic to, and then she is given small amounts of the allergen to build up her tolerance to it, increasing the amount of allergen in the injection incrementally so that her immune system no longer responds to it. This isn't a quick fix, it takes time to slowly build up their tolerance and as she develops new allergens things may need to be added, but it is an option.
Best of luck with your girl, please let me know if you have any further questions.
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15596
Experience: Over 20 years of experience as a veterinarian.
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