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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 38543
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My brother's pug ( he's based in Dubai) is having a skin

Customer Question

Hi,My brother's pug ( he's based in Dubai) is having a skin infection for a few months now. He has taken the pug to several doctors now but the skin infection is getting worse. Some say its food allergy, some say its skin infection and they simply give him allergy injections or advice to stop feeding him certain kinds of food. The most recent advice is to stop feeding chicken. Our pug is going through a lot of distress and we are really concerned that the suggested treatments are not working. I can send pictures for your reference. Any idea what this is and could you suggest any medication? I will be travelling to the UAE soon, so perhaps can go with some recommendation. Please help. Thanks
Submitted: 6 months ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 6 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 6 months ago.

I would be pleased to look at photos. You can upload photos by using the paperclip or add file icon in the toolbar above your message box (if you can see those icons on your particular device) or you can use an external app such as Please check that the photo(s) is in focus prior to uploading it.

How old is the pug and is he pruritic (itchy)?

Customer: replied 6 months ago.
Hello thanks for getting back to me. He is 6 years old and yes very itchy. Sending the pictures now.
Expert:  Dr. Michael Salkin replied 6 months ago.

I'll watch for your next post.

Customer: replied 6 months ago.
Here are pictures
Expert:  Dr. Michael Salkin replied 6 months ago.

Give me a moment to take a look, please...

Expert:  Dr. Michael Salkin replied 6 months ago.

I see minorly affected skin overall. There appears to an erythema (redness) around his neck and axillae (armpits). I don't see obvious evidence of bacterial or yeast infection but, then again, he's been treated with antibiotics and most likely steroids such as prednisone. I'm going to post my entire synopsis of the itchy dog that you can send to your brother who can share with his vet...

Pruritic (itchy) dogs are suffering from an allergic dermatitis in the great majority of cases. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw and extremity licking indicate 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 contributory.

His vet can check a sample of his skin surface microscopically (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. Mites are addressed topically, orally, and by injection.

Our dermatologists tell us to apply an over the counter flea spot-on such as Advantage/Advocate, a fipronil-containing product such as Frontline or, preferably, one of the newer prescription products available from his vet to which fleas are less likely to have become resistant 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 or you turn on heaters at this time of year, egg hatches are common. If the area between the edge of his rib cage and tail (the “saddle” area) is particularly excoriated (it doesn't appear so), a flea saliva allergy should be the most important differential diagnosis. In severe cases, an anti-allergenic prescription glucocorticoid (steroid) such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas too but may not be allergic to the flea’s saliva.

Environmental allergies (atopy) 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 (maximum dose of 50 mg at any one time) may be effective. Antihistamines, however, aren’t reliably effective. Adding fish oil to the diet at a dose of 20mg/lb 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 anti-inflammatory but may take 8-12 weeks to kick in. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with his vet. Oclacitinib works as well as a steroid without a steroid's adverse effects. The new injectable immunomodulary drug IL-31 (Cytopoint) should also be considered. Please note that atopy, at least initially, should have a seasonality to it while a food intolerance should cause pruritis regardless of the season. Chronically atopic dogs may be pruritic year round.

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 his 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 his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. (I prefer the hydrolyzed protein diets because it avoids the possibility of my patient being intolerant to even a novel protein.) 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.

Customer: replied 6 months ago.
Many thanks for your detailed response. This is really helpful. Can I get back to you tomorrow for further questions?
Expert:  Dr. Michael Salkin replied 6 months ago.

Certainly. Please stay in this conversation rather than opening up a new one.

Customer: replied 6 months ago.
Hello Dr. Michael, many thanks for a detailed review. My brother's pug is definitely very itchy ( and a lot of paw licking); is there any suggestions on the type of food we can feed him. At this stage, we are confused as every vet has offered a different opinion on what to feed him. Is chicken an issue for pugs suffering from any kind of skin infection? On the other hand, I am travelling to the UAE next week, can you suggest what tests can I request the vet to conduct based on some of your earlier comments? Thanks
Expert:  Dr. Michael Salkin replied 6 months ago.

Please review the paragraph concerning food intolerance/allergy posted 5 Aug 2018, 4:04 PM (my time). Chicken wouldn't be a good choice as the most common offending food allergens are beef, chicken, corn, wheat, eggs, rice, and soy. The only reliable testing for food intolerance consists of prescription hypoallergenic diet trials. There is both blood and skin scratch testing for atopy, however. This is done when a desensitizing serum is going to be made and then used for "allergy shots". Please continue our conversation if you wish.