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Cushing's and Skin Disease in Dogs
Possible Cushing's and itching
Cushing's treatment
Cushing's disease in Westie
also see Treating cushing's with Lysodren
also see Treating with Anipryl
also see Hormonal Disorders
also see Cushing's page 2
also see Cushing's and liver enzymes
also see Cushing's and renal disease
Possible Cushing's and itchingQ: Dear mike
Furher to my report on kiki with her supposed cushing.
After testing her urine for a second time it was diagnosed by prof.
Rijnberg in utrecht As non cushing.He advised me also to go to dermatology to try to findout what the real
Problems were.in the meantime no cortisol injections for kiki,
It has been exactly 30 days since her last shot,, and we all suffered,
Kiki and we too, because of the contious scratching from kiki and
Unable to sleepYesterday we went to dermatologu, they are going to take some skin tests
And we have to come in 3 weeks.in the mean time we got antibiotics
For the infections kiki had all over her body. We got cefa-cure
200 mg 2 x daily. But no cortisol, because if we want to complete
the test period we shpuld not take cortisol.Do you know will the sefa cure the itching ? we are hesitating what to
do, and not sure if the antobiotics will cure the itching.If we will not follow the complete testing program and decide to go to
Cortisol the doctor advised us to take pills instead of in jections.Thank you for your attention
Kees
A: Kees-
Cefalothin antibiotics do not have a direct effect on itching. They do
often decrease the itchiness in skin disease, though. This happens because
skin infections are itchy and if the antibiotic can suppress the skin
infection there will be less itchiness. In many instances control of the
infection is sufficient to stop the itching, but not always.It is generally better to use corticosteroids such as prednisone in the
oral form rather than by injection. It is easier to control the dose with
oral medications.It is hard to make it through the time periods necessary to ensure accurate
test results when dealing with itchy skin conditions but it is worthwhile
if you can stand it.I sure hope that the antibiotics are helping and that Kiki is feeling
better by now.Mike Richards, DVM
7/12/99
Cushing's treatmentQ: thank you for your earlier reply regarding kiki.as you mentioned in your
email, besides lysodren there are no approved medicine here available.our vet suggested to wait and see what happens with kiki
she has been getting an injection for the scratching etc.
but from injections once a month we are goiing to every 2 to 3 weeks.
she is scratching very badly and develops bad spots all over her body.since our vet does not give us a concrete plan how to proceed
I am contacting you again.can we continue with the injections(cortisones) on shorter periods ?
the injections help well but the time period in between gets shorter
and shorter.what is the other alternative ? we are getting desperate what to do.
kiki is scratching constantly and does not sleep very much at night
and keeps us awake too.we would appreciate if you could advise us what the best way is
to continuebest regards
kees
A: Kees-
I am somewhat confused by the use of corticosteroid injections in a dog
that has Cushing's disease. This is a disorder in which the body's natural
cortisone levels are too high --- so it would seem to be counterproductive
to give additional cortisone.I do understand one situation in which the use of cortisones is
occasionally very tempting, though. There is a condition known as
calcinosis cutis. It is associated with Cushing's disease. It is sometimes
VERY itchy. Since cortisones reduce itchiness in most dogs, there is a
strong temptation to use them for this condition, especially if the
Cushing's disease diagnosis has not been made or is questionable. However,
when a dog on corticosteroids continues to be itchy in the face of the
medications and especially when this dog may have naturally occurring
Cushing's disease or even artificially produced Cushing's disease signs due
to the administration of cortisones, the best course of action is usually
to stop the injections and try treating for the Cushing's disease. It is
very easy to get into a cycle of giving more and more cortisone instead of
looking for a reason why it isn't working very well.I have made that mistake in my practice. I have done this when a dog had
been responding well to cortisone injections on a periodic basis for
allergic dermatitis. When the injections had to be given more frequently I
just did it. When they stopped working entirely I did skin biopsies and the
pathologist found calcinosis cutis. Stopping the injections did not resolve
the problem but eventually we were able to diagnose naturally occurring
Cushing's disease and treat the problem.I really think you need to get a second opinion from another vet or discuss
this carefully with your vet and ask about the possibility that the
cortisones are actually making the problem worse in this case.Mike Richards, DVM
6/10/99
Q: Hello
We have a westhighland terrier called KIKI , she is almost 10
Years old.We have had problems with her for years that she is scratching
Her back , her behind , her leggs etc.she developes sore spots
On her body and scratches badly.at night she also pants heavey
And does not sleep much.We always thought this was caused by fleas and have treated her
Occasiously with frontline.furthermore she has received a small shot of
somekind of medecin from the vet in her back.
This releaved her for a while, but the vet did not want to give this to
her to oftenSeveral weeks ago we had her blood and urine tested through
Our vet at a vet university.the diagnosis came back as cushing
Decease in her hipofisis - pitietary glands.We have read dr mike's email letters through my daughter
From boston.but I have several questions.Our vet tells us that in holland the general treatment for cushing is to
have the hipofisis stop working completely and give the dog
Additional medicin to compensate.they use lysodren for this
And I think probably so much to stop the hipofisis .But our vet tells us,that the cure maybe worse than the disease,
Because it is a chemo treatment and the site effects will be
considerable.When I asked him for alternatives, he said there were none, he did not
know about other medicins for this disease and felt that they are very
advanced with this disease in the netherlands.One alternative there was he said, lately the university has gone back
o operate the dogs with cushing and to remove the
Hipofisis or part of this.We don't want to consider this alternative at all.
Our question to you now is : is there an alternative to this
Method of having to stop the hipofisis completely, can a medicin
Be used in smaller doses and are there alternatives to lysodren ?We sure would like to help our dog, but our vet clearly does not
Know how, and we don't know either.Some suggestions from you would be appreciated.
Regards
Kees
A: Dear Kees-
There are three medical treatments used for Cushing's disease in the
United States.The first is Lysodren (mitotane). In the United States it is most commonly
used on a continuous basis to control Cushing's disease. By checking
cortisol levels in the blood stream on a regular basis it is possible to
give enough Lysodren to control Cushing's disease but not enough to totally
wipe out the adrenal gland. Some veterinarians here, and in other
countries, recommend going ahead and using Lysodren to completely destroy
the adrenal gland. This causes the opposite condition, known as Addison's
disease. Then the vets just regulate the Addison's disease. Their reasoning
is that Addison's disease is easier to treat and to monitor. There are
potential complications with either method of treatment but many vets are
familiar with this medication and continue to use it as a first choice for
Cushing's disease.The second treatment is to use l-deprenyl (Anipryl Rx in the United
States). This medication is available in other countries and may be
approved for use in the Netherlands. It is recommended here in the United
States for uncomplicated cases of Cushing's disease. We have used it a
couple of times and it seems to work well, after a couple of months of
administration. It is a relatively new medication, so we do not have a lot
of experience with it. This medication has less side effects than Lysodren
and there is much less monitoring of labwork associated with its use. It is
fairly expensive here in the United States, though.The third medication that is sometimes used for treatment of Cushing's
disease is ketaconazole. This is an antifungal medication that inhibits
release of adrenal hormone as a side effect. Since this is a useful side
effect in this case, some vets use this medication when the others won't
work or when Lysodren seems dangerous for a particular patient.About 80% of Cushing's disease patients have the pituitary dependent form,
in which the brain is producing too much of the hormone that stimulates the
adrenal glands. The other 20% have adrenal gland cancer. In the dogs with
cancer, removal of the adrenal gland can be curative, although it is
considered to be a high risk surgery.I have seen a small amount of research material on surgery to remove a
portion of the pituitary gland in the brain as a treatment but it was from
Utrecht in the Netherlands (I copied it below). To the best of my
knowledge, this has not become a standard treatment in the United States.These are the options for treatment that I know of. If you don't want to
have surgery done (and I can understand not wanting to) it would be worth
trying one of the medical options since this disease is causing discomfort
for your dog. We like the l-deprenyl treatment based on very limited
experience with it. I wish that I had a list of where medications were
available and where they are not, but I don't. You'll just have to ask your
vet to research that one a little.Good luck with this. Thank-you for subscribing to the VetInfo Digest. It
helps us maintain the website and hopefully will be interesting reading, too.Mike Richards, DVM
4/17/99
Last edited 01/30/05
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