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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 14581
Experience:  Over 20 years of experience as a veterinarian.
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Compulsive scratching of ears, biting front and rear feet,

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Compulsive scratching of ears, biting front and rear feet, and licking lower abdomen and perineum. The external ears are inflamed. The skin of the abdomen is inflamed and excoriated. She is 2 1/2 year old Tibetan terrier. Has professional groom every six weeks and occasional bath in between. Has daily walk with dog walker. Is regularly treated for fleas with medicine between shoulders.
Submitted: 2 months ago.
Category: Vet
Expert:  Dr. Kara replied 2 months ago.

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

Expert:  Dr. Kara replied 2 months ago.

I am sorry to hear that your pup Jessie is miserably itchy even with using flea control medication.

Allergies are the most common cause of itchy skin and can give her a skin crawling, all over itchy type effect which many dogs find irritating. I'll give you an allergy rundown of likely causes for skin troubles. She may have more than one allergy given how symptomatic she is now. Dogs that have one allergy often develop several with time. The effect of multiple allergies aren't additive, they actually compound one another.

Even if you don't see fleas I do recommend using protection, so I am glad that you have started with flea control. Flea bite allergy is the most common allergen and it only takes one bite a month to make an allergic dog scratch so I recommend using flea prevention even if you never see one again. Frontline Plus, Advantage II or Advantix are excellent as is the new Seresto Flea collar. I don't normally recommend flea collars, but this one really works and lasts for at least 6-8 months. Don’t use over the counter products, especially Hartz or Sargents, as most are ineffective if not toxic. Unfortunately even after the fleas are gone the allergic reaction can continue for weeks and I will discuss controlling that reaction below.

Other allergens can be inhaled (like grass pollen, dust mites or molds).

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. If her symptoms worsen seasonally I would think that inhaled allergens are a part of her problem.

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 a dose of 1mg to 2mg per pound of body weight or one 25mg capsule per 15 to 25 pounds of body weight orally every 8 hours.

OR 2)Claritin (loratidine) at 5mg per 25 pounds of body weight once or twice daily.

OR 3)Hydroxyzine at 1mg per pound of body weight orally every 8 hours.

OR 4) Chlorpheniramine at 4mg to 8mg per dog once or twice daily.

OR 5) Zyrtec (Cetirizine hydrochloride) at 1/2 mg per pound of body weight orally every 24 hours. That would be one 10mg tablet per 20 pounds of body weight. Make sure it is NOT the formulation with a decongestant (such as Zyrtec-D) because dogs cannot tolerate decongestants.

Some dogs do better on one antihistamine rather than another, and many seem to respond best to cetirizine. But each dog is different so I've given several options. 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 20mg of EPA per pound of body weight per day. For example an 18 pound dog could take 360mg of EPA per day.

Cool water baths with an oatmeal shampoo or chlorhexiderm shampoo (which is antibacterial and antifungal) and a conditioner with an antihistamine may help. The water rinses off allergens and the cool temperature soothes itchy skin. Do not bathe Jessie for 2 to 3 days before or after applying flea control products or the bath will interfere with the product's efficacy.

It may be helpful to wipe her feet with a damp cloth to remove allergens when she comes in from outside.

Food allergy is very possible with her given the areas where she is most itchy and especially if she seems to be itchy all year round. 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 paws, perineum, face and ears the most, but any of the "allergy reactive areas" can be affected.

Make sure that the food that you put her on is a true hypoallergenic diet if you choose to try to treat her for possible food allergies. 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 with a true hypoallergenic diet and then once her skin is cleared adding one food item (chicken, beef, corn wheat etc) every month to see what she reacts to. Then we can find a regular food without any of the food ingredient she reacts 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.

Cortisone ointment applied to the very itchy places (as long as they aren't raw) twice daily may help as well if needed. Some sprays have alcohol which can be painful on raw skin and lead to more inflammation. I don't like oral steroids but sometimes we need to use a short course to break the cycle. For now a topical directed at the problem areas can be very helpful and are less likely to cause side effects.

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 allergy. Most dogs are reported to be much more comfortable in a day or so.

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 pup 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.

If it's been a while since her last exam parasites like cheyletiella, demodex or sarcoptes mites or evidence of a secondary bacterial or fungal infection should be looked for by your veterinarian as well if she isn't improving as they can lead to very itchy skin.

Please let me know if you have any further questions.

Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 14581
Experience: Over 20 years of experience as a veterinarian.
Dr. Kara and 3 other Vet Specialists are ready to help you
Customer: replied 2 months ago.
Hi, so you think it's allergic rather than say Sarcoptic or Demodex mange or even Ear mites?
She's never had a problem before part from a tick and occasional fleas?
Expert:  Dr. Kara replied 2 months ago.

I'm sorry I missed your follow up question.

With her pattern of itchiness I do believe it is much more likely that she is suffering from allergies rather than mange or ear mites. Of course it is possible that she has multiple allergies, or even more than one problem. But I would bet that allergies are at least part of her troubles given her symptoms.

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