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In reviewing the image, yes it appears the hair coat is thinner. Many times when Apoquel does not work to stop the itch we are concerned that there is an underlying condition. You may want to have the thyroid level checked. Low thyroid very commonly makes the hair grow slower and shed more, it also weakens the skin and immune system such that these dogs keep having more skin problems. To try to help with the clinical signs now, you can use a medicated shampoo with chlorhexidine and miconzole or ketoconazole. These are over the counter shampoos that will kill the opportunistic yeast and bacteria very well. My concern is that if Apoquel did not help much, then the hypothyroid is a very high differential diagnosis. Your veterinarian can draw blood to assess this level. If it is low, they can put on a thyroid supplement and then a new and healthy skin an hair coat will grow in.
There is a topical hot spot spray with lidocaine and hydrocortisone that you can spray on the affected areas 2-4 times a day also. In reviewing the skin, as red as it is, it appears infected also. Did they give you any antibiotics for skin infection at the last visit?
Piriton is only an antihistamine. I was one of the first clinics to recieve Apoquel when it first was released by Zoetis. It is a fantastic medication. It works much better than an antihistamine like Piriton. In my experience when Apoquel did not work many times we had internal hormonal alterations. Also checking levels like a thyroid are more economical than skin biopsies. The only other alternatives for the skin would be an injectable called Cytopoint also made by Zoetis. This is a once a month injectable that will help to alter the immune system to decrease allergies. Steroids like prednisone can help, however they have a lot of side effects. In looking at the skin, as red and possibly infected it looks. I feel that a course of antibiotics would help a lot to eradicate any complicating skin infection. If I could give any other ideas for over the counter relief ideas I would, Are we on current flea and tick products?
Do you know what the active ingredient in the shampoo you have?
That is a very good shampoo, however I feel that more needs t be done to get the red skin under control now. I wish I would have another over the counter idea. Did they discuss using an oral antibiotic to help with skin infections? Also many allergy dogs will also have more of the itch just start on the paws first, are the paws and lower legs affected much?
I really feel that you will need to discuss this case more with your veterinarian to stop the itfching before we chew and damage the skin even more by chewing. Ask them about cytopoint and also to get the skin under control, some prednisone as a steroid and some antibiotics I feel will be needed now due the severity and extend of how much of the body is affected.
You are more than welcome. I just want you to be able to get to the bottom of this case such that our little one will feel better soon. Best of success. Have a good evening. Dr Mike
Happy to help always.