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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 33254
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Airedale terrier, 12 year old bitch. Vet has said it is a yeast

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Airedale terrier, 12 year old bitch. Vet has said it is a yeast condition. It does seem to have responded in the past to Malaseb medicated shampoo, but not this time. This time the Malabeb doesn't seem to be having any effect. it has now been four or five months of treatment with Malaseb, Anti-bacterial tablets, and now anti fungal tablets (cant remember
exactly what they are called but I think that it is something like flucazole 150mg) One a day for a month. We are about twenty days into that treatment and it doesn't seem to be having any effect. Even a few days after a thorough was with Malabeb the smell returns.
The main symptems are a very strong smell a bit like smelly feet, flaky waxy skin, lumps and spot - they seem to be all over but are mainly concentrated around the neck, shoulders and chest area. What can it possible be? Thank you, ***** *****
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry to hear of this with your Airedale. You've described a seborrhea - a disorder of skin maturation and keratinization - which has developed secondary to her chronic yeast infection or the yeast infection has arisen secondary to her seborrhea. The distinction may not be important at this time.
Clinical signs may include a dull, dry, lusterless hair coat, excessive scaling (dandruff), follicular casts, scaly and crusty seborrheic patches and plaques, and greasy, malodorous skin. Most of the body is involved to some degree, with interdigital areas, perineum, face, axillae, ventral neck, abdomen, and skin folds usually most severely affected. Pruritis (itchiness) is mild to intense, and ceruminous otitis externa (oily external ear canal inflammation) is common. Secondary skin and ear infections with bacteria and Malassezia (yeast) are often present.
I can appreciate how frustrating her care must be for you. I don't know everything you've tried so I'll list a primer for treatment and prognosis for you to peruse...
1) Ensure good nutrition. A commercially balanced dog food that meets AAFCO requirements should be fed. You should find the AAFCO statement on the food label.
2) Any secondary bacterial and Malassezia skin and ear infection should be treated with appropriate topical and systemic therapies. Periodic treatments or long-term, low-dose maintenance therapy may be needed because these dogs are susceptible to recurring infection.
3) For symptomatic control of ceruminous otitis, long-term maintenance ear care is necessary. Ear treatments with a multimodal therapy (consult with her vet) or ear cleaner should be administered to both ears every 1-7 days to control cerumen (wax) accumulation.
4) For symptomatic control of seborrhea, antiseborrheic shampoos and emollients may be used every 2-7 days until the skin condition is improved (~2-3 weeks), then, bathing frequency should be decreased to every 1-2 weeks or as needed for maintenance. Antiseborrheic shampoos contain some combination of sulfur, salicyclic acid, tar, benzoyl peroxide, and phytosphingosine.
5) Daily oral fatty acid supplementation may be helpful as an adjunct therapy (40mg of EPA/kg/daily). EPA is thought to be the most antiinflammatory of the essential omega-3 fatty acids. It's plentiful in fish oil supplements.
6) Vitamin A 8000-10,000 IU per 10kg orally administered with a fatty meal every 24 hours. Improvement should be seen within 4-6 weeks.
7) For dogs with severe, greasy, malodorous, pruritic seborrhea, treatment with systemic corticosteroids may be helpful. Acitretin (a retinoid) may be helpful in some dogs. Calcitriol (vitamin D) may be helpful in some cases.
The prognosis is variable, depending on the severity of the seborrhea. This may be an incurable condition that requires lifelong therapy for control. Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.

Have tried Malaseb with no real success

Can you please recommend something other than Malaseb -by name please.

Malaseb isn't antiseborrheic. You'll need one of the following and if one isn't effective enough, try another...
Sebalyt Shampoo (DVM)
NuSal T Shampoo (DVM)
Micropearls Sebahex Shampoo (Vetoquinol)
Sebolux Shampoo (Virbac)
Keratolux Shampoo (Virbac)
DermaSebS Shampoo (Virbac)
Universal Medicated Shampoo (Vet's Solution)
Duoxo Seborrhea Shampoo (Sogeval)
Please continue our conversation if you wish.
Dr. Michael Salkin and other Vet Specialists are ready to help you
Customer: replied 3 years ago.

Is there a specific treatment, having already tried Malaseb. Thanks

Perhaps my thorough review didn't post correctly. I discussed therapy for seborrhea in your Airedale in my initial response to you. Please look above and let me know if you don't see the numbered treatments I posted.
In addition to one of those antiseborrheic shampoos, I would address her yeast with the inexpensive ketoconazole at 5mg/kg daily for a minimum of 3 weeks. Fluconazole at 10mg/kg with food daily is a more costly alternative and should be continued until lesions resolve and follow-up skin cytology reveals no organisms - approximately 3-4 weeks. Alternatively, treatment with terbinafine at 5-40mg/kg daily or itraconazole at 5-10mg/kg daily for 3-4 weeks may be necessary. The prognosis is good if the underlying cause can be identified and corrected. This may not be possible because seborrheic skin changes have already appeared. You may need to continue to bathe with an antiseborrheic shampoo and treat with an antiyeast drug indefinitely. Your vet may suggest pulse therapy - an antiyeast drug administered one week on, one week off, e.g. in order to control rather than cure your Airedale.
Please continue our conversation if you wish.
Thank you for your kind accept. I appreciate it.

I'm going to check back with you in a few weeks for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.

Please disregard the info request.
Customer: replied 3 years ago.

Yes, I don't think I received all your message. Got it all now though - those other medication have given us some hope. Many thanks Doc

You're quite welcome. Yes, we're having a few problems with the site. Glad you got all the info. I set a follow up for October 2. Speak to you soon.

Please disregard the info request.