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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 33244
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My ***** ***** is constantly scratching we have put spot on,

Customer Question

My ***** ***** is constantly scratching we have put spot on, flea tablets and showered her with flea shampoo, but still she scratches, she has also started biting her paw relentlessly drawing blood I have looked but can't see anything out of the ordinary, I put some sudacream on it to try and deter her from biting it, any advice please, I am retired and live in a small village in North Wales so find it difficult to get to a vets.
Submitted: 2 years ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking to Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner. ***** *****s are overrepresented as a breed for atopy - an allergic dermatitis caused by a hypersensitivity to environmental allergens such as pollens, molds, dust, and dust mites. Her pruritis (itchiness) - particularly on her paw(s) - is pathognomonic (specifically indicative) of atopy. Food intolerance can mimic the signs of atopy but is less commonly found.
You're limited to what you can do for Ruby without a vet's assistance. You can bathe her twice weekly in a hypoallergenic shampoo such as Allergroom in an attempt to lessen the number of allergens on her skin. You can administer an over the counter antihistamine such as chlorphenamine (Piriton) at a dose of 2-8 mg/dog 2-3 times daily but antihistamines aren't reliably effective in atopic dogs. You can administer fish oil to her at a dose of 40 mg/kg daily of the EPA in the fish oil. EPA is the most anti-inflammatory of the omega-3 fatty acids. You can see if food intolerance is present.
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 Ruby'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 her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (my preference). 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.
Ideally, Ruby should see a vet who is likely to treat her with either a corticosteroid such as the antihistaminic prednisone or, preferably, with the new cytokine antagonist oclacitinib (Apoquel) which works as well as a corticosteroid but without its adverse effects. One of these drugs is going to be necessary to stop Ruby from mutilating her paw. For now you can apply an over the counter hydrocortisone cream to her paw but I don't believe it will be potent enough to keep her away from the paw.
I understand your logistical constraints but we need to get Ruby under control before she causes chronic and irreversible changes to her skin. Please respond with further questions or concerns if you wish.