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Skin Disorders of Dogs
Skin disease in Westie
Sebaceous Adenitis possible in Weimaraner
Epidermal Dysplasia and Malassezia Infection
Vasculitis, folliculitis, hepatocutaneous syndrome are possibilities in German Shepherd
Scabs and bumps on older dog after Grooming
Bacterial Skin infection possible
Skin problems, allergies
Skin problem in Boston Terrier
Chihuahua puppy with dry, itchy skin
Hyperemia (extreme redness) and alopecia on puppy
Discoloration on Daisy's head
Skin problems in older West African Bush Dog
Pressure sores
Chronic skin problems - long term treatment
Odd skin problem in Golden
Hair loss - oozy skin
Skin problems in Golden
Skin problems in Boxer
Skin Tags
Familial Canine Dermatomyositis in a Schipperke
Sebaceous adenitis
Skin conditions
Hepatocutaneous Syndrome
Skin problem in Bull Mastiff
Necrolytic Dermatitis
Skin Problem - possible demodex - Great Dane
Skin Problems - AmStaffs
Skin problems - Bull Terriers
Hygromas
Metatarsal Fistulation
Acanthosis Nigricans
Acanthosis Nigricans part 2
Pruritis
Canine Acne
Psoriasis
also see Allergy Problems
also see Demodex Mange
also see Haircoat problems
also see Hairloss Problems
also see Itching Problems and Control
also see Inherited Disorders and Problems
also see Juvenile Cellulitis
also see Lick Granulomas
also see Parasites
also see Pyoderma
also see Sarcoptic Mange
also see Ringworm
Skin disease in Westie
Question: Hi Dr Richards
I have an 8 year old West Highland white terrier who is suffering skin problems. When he sweats his skin secretes a yellowy fluid which crust and causes him great distress and irritation. . If left untreated he will attempt to chew the scabs and ends up pulling his hair out in the process. Along his back he also has tiny scabs that come off like dandruff – some are light skin colour, but some are quite black; there are also 5-6 inter-dispersed lumps which look like boils or warps (their presence and size fluctuate with the condition of his skin - at one point they disappeared completely). I have to brush him every day and wash him every second day using a soft brush to remove the scabs. His skin can become sticky, particularly under his armpit, where is has been quite mucusy, more recently though this has all but disappeared under his arms, but the yellowy secretion still happens on his chest, lower legs and bottom (it is more pronounced in the folds and cracks of his skin).
He has been treated for a number of years for allergies and problems with his immune system. 3 years ago he began a program whereby he was injected with allergens to trigger his immune system to function correctly. This appeared to be successful, his skin improved greatly and his fur grew back. Unfortunately, he was then placed in kennels for 2 weeks and his skin deteriorated drastically; he contracted a bacterial skin infection whilst he was there which was mistakenly attributed to his immune problem, so went untreated for about a month during which time his skin deteriorated further. Following antibiotic treatment for the infection, his skin slowly started to recover but never made it back to where it was before he went into kennels.
In January this year, a second opinion was sought from another vet who, after examining his skin, prescribed a course antibiotics and nizoral (ketoconazolo), followed by the continued (reduced) use of nizoral coupled with a Atoplus (ciclosporina), an animal auto-immune equivalent drug of sandimum - the cover of the box describes its use as for chronic dermatitis . At the same time a blood test (Jan 2005) was carried out which produced the following anomalies (expected reading in brackets):
BILT0.11(0.1-0.6) ALTP534(0-90) PT9.3(5.3-7.6) ALB2.6(3.0-4.7) Na+158.7(145-155)
Following the exam, it was suspected that he may be suffering from copper-toxicosis; a biopsy was performed which, whilst identifying some liver degradation, came up negative for copper-toxicosis. But for over a week following the biopsy, his skin improved dramatically; his skin was in the best condition it had been for about a year (all his hard skin became soft, there was no skin seepage and no skin flaking) and he was only taking post-op antibiotics
About a week before the second opinion (before the biopsy), Major started to eat excessively (about twice his normal intake), but was loosing weight. Over the next month he lost about 3rd of his body weight (thankfully he has appeared to have stabilized at around 9kg).
He has been on the nizoral and autoplus for one month now and whilst there does not appear to be a worsening of his condition, there has been no significant improvement. I should point out, that I have been varying my washing routine over that time which has now steadied at one wash every 2 days with an antiseptic shampoo (more frequently causes his skin to become red and irritated) cleaning the scabs off with a soft brush.
The latest blood tests (March 2005) show the following changes:
BILT0.23(0.1-0.6) in rangeALTP339(0-90) reductionPT9.2(5.3-7.6)ALB2.8(3.0-4.7)Na+147.3(145-155) reduction.
A number of symptoms which I feel have not been adequately explained, are:
the sudden weight loss coupled with his increased appetite
his dramatically improved skin condition following his biopsy
I have spoken to my vet and she is happy for me to approach you for an alternative opinion on what you think may be the problem with Major. I look forward to hearing your thoughts on subject.
Regards, Tracy
Answer: Tracy-
I think that your vets have been doing the right things in working towards a diagnosis and you are doing the right things, too, so I guess the best thing to do is simply to explain what skin diseases West Highland White Terriers are prone to that might be impacting on this case and o make one small cautionary statement -- it is possible that there are two more more causes of the skin disease and that the skin disease may be an entirely separate issue from the rises in liver enzyme levels, as well.
I do have a small problem with the blood test reports -- the abbreviations do not match those most commonly used in the U.S. and it is possible that ALTP could mean either alanine transferase (generally called ALT in the U.S.) or serum alkaline phosphatase (generally abbreviated ALKP here). There is a difference in the meaning of rises in either of these enyzmes individually which I'll try to explain as I go along.
These are the inherited skin diseases and skin diseases that might not be inherited but that appear to be more common in Westies than in other breeds:
primary seborrhea -- this is a defect in the way that the skin produces keratin. Most dogs affected by this condition develop signs when they are young but sometimes the disease is mild in its primary form but becomes severe when it also becomes a secondary condition to another disorder such as food allergies, atopy, Malassezia (yeast) infection or bacterial pyoderma. Since primary seborrhea can't be cured the skin has to be maintained with frequent bathing and the use of anti-seborrheic shampoos, conditioners, etc.
epidermal dysplasia -- This is a very severe skin disease in which a defect in the skin seems to be coupled with a tendency to get secondary yeast infections. Generally it shows up by the time the dog is a year of age, doesn't respond well to any type of treatment (except getting rid of the yeast can be helpful) and can be diagnosed by skin biopsy
ichthyosis (lamellar ichthyosis?) -- another congenital disease that usually shows up in young westies and doesn't respond well to treatment. This disease produces scaling, which you seem to be seeing, so it may be a consideration if his original problems started when he was young. This can also be diagnosed by a skin biopsy but it is really important to ensure that the pathologist who examines the slide is very interested in skin disease (dermatohistopathologist). In the U.S. the most reliable lab for diagnosing this condition is probably Texas A&M's lab. If skin biopsies are done it would be a good idea to ensure that the pathologist is contacted first for advice about taking samples and preserving them.
atopy (allergy to pollens and other environmental irritants)
food allergies
Malassezia infection (see this web link: http://www.dermapet.com/articles/art-20.html )
The thing that you have to do with lists like this is try to think back to the very first time you were aware he had skin disease. How old was he? If he was less than a year old then primary seborrhea, ichthyosis, epidermal dysplasia and food allergies are most likely. If he was over a year of age then atopy, malassezia infection (perhaps secondary) and secondary seborrhea (can occur in any breed) become more likely.
If the problems started when he was young and he has not had skin biopsies then it would be a good idea to consider doing these to try to rule out epidermal dysplasia and ichthyosis. If these have been ruled out this is obviously not necessary.
I can't explain why his skin would get better after surgery with certainty but I suspect that this favors a diagnosis of primary seborrhea for the simple reason that this disease is characterized by very rapid growth of skin cells and big stresses like surgery could slow that growth. In addition primary seborrhea can be altered by hormonal influence, especially changes in thyroid hormone levels and these drop in times of major stress, as well. But that's just a guess -- I really don't know for sure what to make of that particular symptom.
I am thinking that the liver enzyme rise is actually in alanine transferase (ALT). If this is the case it is an indication of damage to liver cells (ALT is released when liver cells are severely damaged or die). Rises don't always indicate a severe problem but continued rises are worrisome. Ketaconazole can cause liver damage so this has to be kept in mind, even though I think its use is definitely justified. If the rise is in alkaline phosphatase (ALP or ALKP) then this is more likely to be an indication of other problems such as Cushing's disease. I think that your vet wouldn't have pushed for a liver biopsy with a rise in alkaline phosphatase alone, though -- so it makes more sense that the rise was in ALT. My thinking is that this is likely to be a separate problem that will have to be sorted out over time but since the values are improving it seems unlikely that ketaconazole is causing problems and that the situation may also continue improve, in which case a diagnosis may not be necessary.
Weight loss with an increase appetite always worries me. The most common cause of that in dogs in our practice is early diabetes. Once in a while we don't get much blood sugar rise (usually stays high normal or just above normal) for a few months even after other clinical signs like drinking a lot and urinating a lot or weight loss occur. Diabetes probably isn't present since you don't report unusual blood sugar levels from the lab work -- but I'd still keep it in the back of my mind. Unfortunately the other common cause for unexplained weight loss in middle aged or older dogs in our practice is cancer. This can be very hard to detect early on but keeping a watchful eye for any continued signs of cancer like continued weight loss, unusual lumps, lethargy, coughing, etc. would be a good idea. Hopefully cancer isn't present. Sometimes itchy dogs lose weight rapidly due to restlessness. Dogs with liver disease and heart disease can lose weight very rapidly but most dogs with these problems have a decrease in appetite. All I can really suggest is keeping an eye out for problems and periodically checking urine or blood for increases in sugar indicative of diabetes.
I am not sure if this information will help or not. Dr. Hnilca ( one author of the study I sent the link for above) also maintains a web site utskinvet.org, that can be helpful for veterinarians who need information on skin diseases.
Good luck with this. I am happy to answer further questions if something I wrote isn't clear or generates further questions.
Michael Richards, DVM
3/16/2005
Sebaceous Adenitis possible in Weimaraner
Question: Hi,
Thanks for a great site, I've learned a lot.
I saw in your Weimaraner section that a common disorder is "color mutant dermatitis", but there was no further information on it that I could find.
I live in Northern Baja California and am using a Mexican vet. He's okay, but tends to oversimplify everything.
Daisy is almost 5 years old, a purebred, but definitely non-AKC quality, Weimaraner born in Colima, Mexico. I have a male 3 months her senior with no skin problems. We took her home at only 6 weeks of age because the vet said that the breeder was mistreating her. She hid food in her cheeks for several weeks and had very weak rear leg muscles, but recovered quickly and has always been a jumper and very energetic.
She is about normal weight (a couple of pounds overweight), spayed before the first heat, and has been remarkably healthy up until recently. She suffers from severe incontinence, which had its onset as a puppy, with a "break" of about 4 years before it returned in spades. She has been taking 25 mg per day of Proin for the last two weeks and it's worked amazingly well.
About 6-8 months ago she suddenly started growing a coarse, wavy coat from the neck to the tailbone which became itchy, flakey and then hair started falling. The vet said "dermatitis" (Uh yeah, it's ALL dermatitis) and gave her an anti-histimine and a rank-smelling tar shampoo, prescribing 4x weekly- then semi-weekly baths and the pills 2x day. It got better, though her hair never grew back in smooth again. It's quite thick and noticeably a different texture from the coat she used to have.
We eventually wound down to once a month baths and after about 4 months, the itchiness and hair loss started again. Took her back again, same treatment. Gave her the pills for about a week, until she stopped the scratching and am now back to bathing her only once a week.
In this last month, I noticed a light spot growing in her fur near the neck and now it's 4-5 shades lighter than the rest of her coat and about 2 inches by 3 inches, sort of an irregular rectangle in shape. That's what made me notice the "color mutant" dermatitis note.
We live near the ocean, she does get walked on the beach, though neither dog is allowed in the water anymorem due to suspected pollution in the ocean here.
Daisy is a "roller", but she is never out alone and not allowed to roll in anything, so it's rare that she actually gets into anything. We do not have a yard, she is taken to the empty lot next door several times a day, which has little to no vegetation. She is walked in a grassy park twice a day and once a day takes a 90 minute walk on the beach.
In the 4 years we've lived here, neither dog had even a hint of a flea or tick, but I recently found a tick on Daisy and a flea in my bed, so they were treated with Frontline Plus a couple of days ago. The vet said the heavy rains here this year probably increased the pest population.
About 4 months ago, both of them suddenly came down with diarrhea and vomiting, the vet took them off kibble altogether for a couple of months, both recovered quickly. Only Ziggy had a recurrance about 2 months ago, which we again treated with antibiotics and removal of kibble from the diet. The second time, no pork products were involved, so I have no idea where he got it.
Daisy is taking a supplement twice a day for her liver (honestly, no idea what it is, they are reddish/pink capsules). She's been on the supplement for about 2 months.
The vet had taken blood samples the first time the dogs were ill and said he was concerned about the liver enzymes in both. We repeated the tests in 6 weeks, Ziggy was normal, Daisy remained slightly elevated, which is when he put her on the supplements.
I'm feeding both dogs a small amount of Iam's Reduced Fat (my male was grossly porcine), with some rice, de-fatted homemade chicken broth and a bit of home-cooked chicken (a holdover from their illness). Both dogs have lost quite a bit of weight on this diet. They are given almost no table scraps.
Daisy is very close to normal weight now, Ziggy is about 5lbs to go. They are continuing to slowly lose weight. They are given cookies/biscuits I get from a friend who makes them at home that contain no eggs or additives. No more pig ears or other treats that made them so fat before. The vet claimed that the dogs got ill from pork skin products, so they were discontinued completely. I occasionally give them a Dentabone, but it's rare. The biscuits they get every time they go out are about 1/2 in diameter, just cavity-fillers. Turns out they can't tell the difference between them and a pig ear...it's the "thought" that counts. Who knew?
Daisy's dermatitis didn't coincide with any particular changes in diet or lifestyle, she had it when fat, eating pork products, and got it again after losing weight and being on the new diet.
Ziggy seemed to have ear/allergy problems with Hill's, Eukanuba and Royal Canin foods, they both seem to do well with the IAM's.
Ziggy has a gorgeous coat, but I'm starting to notice some slightly dry-seeming spots on his rear flanks. Could be my imagination.
Sorry for the long letter, but I wanted to give as much history as possible.
Is this color mutant dermatitis? Is there anything else we can do for her? Any hope to recover a smooth coat?
Thanks in advance for your time.
Regards,
DeannaAnswer: Deanna-
I am not sure why we have a subject line for color mutant alopecia in the Weimaraner section of the breed problems listing. Color mutant alopecia is usually called color dilution alopecia now. It is a problem in dog breeds that have "blue" and "fawn" variations in hair coloring. It affects most Dobermans that are blue or fawn and it occurs in a number of other breeds to a lesser extent but it is not a problem in Weimaraners. This is just a mistake on our part. I have notified Michal and we'll get it fixed soon.
I do think that there are some other things to consider in Daisy's case that might be helpful, though.
There is a condition, sebaceous adenitis (sometimes called granulometous sebaceous adenitis) that could cause changes in the hair color. It usually causes hair loss over time, though. It can start as scaling or look just like a skin infection. The only really good way to diagnose this condition is by skin biopsy. This may be a good idea if the affected area goes on to lose hair or if it starts to grow in size or if new similar areas appear elsewhere in the hair coat. I have not heard of changes in the hair coat resulting in changes in hair texture from this disease, at least not associated with a coarse or wavy hair coat appearing.
I am not sure what bearing this might have on Daisy's condition but there are long haired Weimaraners. This would usually be a trait that showed up within the first two or three months of life but I'm not sure if an underlying tendency towards long hair could surface later in life if things like hormonal changes occurred.
The onset of the itchiness falls within the normal range for onset of atopy (allergies to pollens, etc.) in dogs but it is late. Most dogs with atopy will show signs when they are between 1 and 5 years of ages so she does fall within this "norm". The pattern of the itchiness and skin disease isn't highly suggestive of atopy, which often causes itchy feet, itchy ears and hair loss on the front half of the body. Unfortunately there is a lot of variation in this so it is not possible to rule out atopy just based on when it occurs and where it causes itchiness. You could have Daisy allergy tested if you wanted to know more about this possibility, though. Antihistamines are often prescribed as a first line of treatment for atopy.
The early onset of incontinence (presumably after spaying) may have been due to a decrease in estrogen levels. If so there is a small chance that this could also cause skin or hair coat changes. This would be pretty hard to confirm, though.
There are tests for two enzyme levels associated with the liver included in most general lab panels. The first is ALT or alanine transferase. The second is alkaline phophatase (SAP, alk phos, other names). Rises in ALT are more closely restricted to liver damage. Rises in SAP can be associated with administration of prednisone or other glucocorticoids, hyperadrenocorticism (Cushing's disease) and with liver disorders. If Daisy had a rise in SAP but not a rise in ALT then it would be reasonable to test her for hyperadrenocorticism with the changes in hair coat and lab work. Five years of age would be a young onset for this disease but again it falls within the normal range. Most dogs with Cushing's disease are 9 years of age or older but it has been reported in much younger dogs. If the rise in liver enzyme levels is for ALT alone, then a liver disorder of some sort is more likely. It would be good to review these findings to see if you can get a hint about what is going on.
If it seems like liver disease is unlikely it may be best to consider testing for hypoadrenocortcism to see if is present and even to think about testing for hypothyroidism, another hormonal skin disease. Lastly, there would be a small chance of excessive growth hormone with the changes seen. I think that the University of Tennessee has a blood test for growth hormone but I am not sure of it. Growth hormone excess (acromegaly) has been associated with greasy haircoats, scaling and can eventually contribute to the development of diabetes. It would be rare for this condition to be present but is is possible.
If follow-up lab work does reveal a bigger problem with the liver or persistent elevations in alkaline phosphatase it would be best to figure out what is causing the rises. If there is no way to prove or disprove liver damage then it would make sense to concentrate on the skin disease hoping it will improve. If it doesn't happen you might consider asking your vet about the possibility a skin biopsy (or several) to try to sort through this problem.
Mike Richards, DVM
5/2/2005Michal Input: It's fixed. Its mentioned as a problem in my older Genetic Aspects of Pure breed dogs but all other sources I looked at since then do not list it. It is not listed in George Pagett's Canine Genetic diseases or Kirks.
Epidermal Dysplasia and Malassezia Infection
Question: I have a WHWT (Westie) that was born with the genetic disorder Westie Seborrhea also known as Epidermal Dysplasia. My little girl Krissy is going on five (5) months of age and symptoms are already predominate. The only information that I have been able to obtain to date is that Westie's with this problem have been euthanized in the past, not a very promissing future I might ad. It is heart breaking to see my little girl going through such an ordeal.
I would like to know if there has been any advances in this area of subject matter? I have heard of a
medication called chlorosporine (sorry about the spelling) a.k.a. NEORL. Apparently this is an immune
suppressant. How would this medication benefit Krissy? Any information you can provide is greatly
appreciated. If you do not have any information on this disease can you direct me to a site that can
provide me with additional information in this area? Your time and consideration is appreciated.Jennifer
Answer: Jennifer-There is some disagreement among veterinary dermatologists about the origins and treatment of
epidermal dysplasia, especially in Westies. This reference "Epidermal Dysplasia and Malassezia
Infection in Two West Highland White Terrier Siblings: An Inherited Skin Disorder or Reaction
to Severe Malassezia Infection?" by CS Nett, et al, Vet Dermatology Oct 01, is an example of
the controversy. In this article the authors question whether this an actual congenital condition or
a secondary response to atopy (allergies) and malassezia (yeast) infection. Their conclusion is
that the condition developed as a response to these underlying conditions in the two patients
they examined. I have also seen a similar article written about the same skin condition in other
breeds, suggesting that it may be a secondary response to hormonal diseases (CB Chastain, et
al, Small Animal Clinical Endocrinology, 1999).Atopy usually occurs in dogs that are a little older than five months of age but it can occur in
West Highland White Terriers and other breeds at a younger age. Secondary yeast infections
apparently occur quite readily in this breed and the combination appears to cause pathologic
changes in the skin that either are, or resemble, epidermal dysplasia.I do not know how this diagnosis was made, other than skin biopsy. If testing for atopy and/or
food allergies was not done it would be best to do these tests. In addition, it would be a really
good idea to try to rule out a secondary yeast infection through impression smears of the skin or
possibly even treatment, if there is sufficient reason to suspect it based on clinical appearance. It
may be best to consider asking for referral to a board certified veterinary dermatologist, if it was
not a dermatologist who made the diagnosis. These things would help to rule out a primary
cause that was leading to the pathologic changes in the skin.I could not find information on treating epidermal dysplasia with cyclosporin but it makes sense
that this might work. Cyclosporin seems to help patients with atopy and it can stop
self-destruction of tissue because it interferes with the immune response, which is the reason that
it works as a drug to help prevent rejection of kidney or other organ transplants. This may not
be necessary to use if it did turn out that atopy and yeast infection were present, since treatment
for the yeast and for the atopy with less expensive and easier to regulate medications might be
equally or more effective.I have seen photographs of a Westie at a recent dermatology seminar which had atopy and
secondary Malassezia infection at a very early age and was able to live a normal life with
appropriate therapy, although it sounded like it did take a really intensive effort on the part of
the owners and the veterinary dermatologist to keep things under control.Good luck with this.
Mike Richards, DVM
2/7/2002
Vasculitis, folliculitis, hepatocutaneous syndrome are possibilities in German Shepherd
I discovered your site today and was very impressed and signed up
immediately.My question concerns my dog, Lucy, a german shepherd mix who is about
11 years old. We rescued her about 4 years ago from a very bad
environment.Last year she started showing signs of arthritis and was put on 100 mg
Rimadyl daily. Everything was fine for about a year.This March, I took her for her annual exam and routine
vacination--Distemper (DHLPP). My regular vet was not in but an
associate examined Lucy and gave her Duramune Max 5/4L DA2P+Pv/LCI-GP.About a month after the visit, Lucy's arthritis worsened and the
medicine no longer helped. She also developed a lump near one of her nipples.
She was put on antibiotics, but the lump continued to grow, become very
painful, and runny (blood and pus).She then had a mastectomy and things seemed to be improving. Within a
few weeks, however, the area began to develop similar symptoms as before,
but even more intense.All blood tests and biopsies were normal.
She was put on a different antibiotic, but the problem persists and
begins to worsen. She now has developed open, running lesions on the inside
of her front and back legs.The vet is puzzled and said that Lucy's skin seems to be breaking
down, but with no signs of infection (fever, loss of appetite, etc.) other
than the sores and pain. He sent new samples off for biopsy once again but
is concerned that in 25 years of practice, he's never seen a skin
infection like this. If the biopsy comes back negative again, he said he will
send it to his veterinary college.Since March, Lucy has lost about 7 pounds--going from 58 to 51 pounds.
I love the vet, and I have confidence in him. I'm looking for any
information that can lead us to a cure for Lucy.Could there be a connection to the new vaccine? Have you heard of such
a skin problem? Do you have any recommendations? I would appreciate any
information you can provide.Thank you so much for your help.
Answer: Mary-
There are several possible problems that might fit what Lucy is
experiencing. The skin biopsies are a good idea and I hope that they
are helpful in providing a more definite diagnosis.The first thing that came to mind reading your note is a disorder in
German shepherds in which they develop deep skin infections (folliculitis,
furunculosis and/or cellulitis) that are more severe than those seen in
most dog breeds. These infections can come on quickly and seem to occur
after a stressful situation in some affected dogs. This is not a really
common problem. I can't remember with certainty how often we have seen
it, but I am pretty sure it is no more than three or four times in the
twenty-two years I have been in practice. This disease usually occurs
in middle-age German shepherds but could have a later onset in some cases.
This condition is a bacterial infection and long term use of
appropriate antibiotics (cephalosporins, fluoroquinolones, sulfa/trimethoprim (not
long term), some others) is necessary to cure it. In some cases it is
necessary to use antibiotics continuously to suppress the infections and in other
cases intermittent use is satisfactory. It is really tempting to use
corticosteroids due to the severe inflammation that is sometimes
present but this is probably not a good idea. Pentoxyfylline (Trental Rx) is
supposed to be helpful in some cases. The skin infection is usually
precipitated by some disorder. It may be allergies, hypothyroidism,
hyperadrenocorticism, demodecosis and probably a number of other
disorders. This disease syndrome can be really frightening at first due to the
severity of the sores but it can be kept under control in most dogs
affected by it. Sometimes it takes a long time to get the sore areas to
look better, though.Another problem that sometimes occurs in German shepherds but is not as
closely associated with the breed is cutaneous vasculitis. There is a
form of this that occurs in German shepherd puppies as an inherited disorder
but that obviously wouldn't count in Lucy's case. Some dogs with vasculitis
develop subcutaneous lumps before skin sores develop, so this makes
this disorder seem possible, as well. Often, dogs have hives when this
condition is present. In other cases, there just seem to be skin sores that may
be mild to pretty severe. This condition might respond to pentoxyfylline,
too --- but usually responds better to corticosteroids. This makes for a
bad situation in Lucy's case because treatment for the first condition
would be complicated by corticosteroids and treatment for vasculitis may require
it and it may be difficult to differentiate which condition is causing the
problem, although the skin biopsies might make that possible. Vaccines
have been implicated in some cases of vasculitis but this is usually a
reaction at the injection site rather than a generalized problem. I tend to
discount the possibility that the vaccine is involved but could not totally rule
out the possibility.There is a third condition, hepatocutaneous syndrome, in which liver
disease or pancreatic disease (or both) leads to secondary skin
lesions. I don't know why that happens. Most of the time the sores affect the face
but they can be found on the legs as well. The sores are usually less
severe than those seen with the deep skin infections of German shepherds (at
least that is my impression) but might be harder to distinguish from the
cutaneous vasculitis lesions. Since this disorder is associated with
liver disease most of the time it is a good idea to be sure that there are no
discernible liver problems.There are other conditions that seem possible, such as cutaneous
lymphoma (cancer affecting the skin), sporotrichosis, phemphigus or discoid
lupus but these conditions don't fit the signs really well. They just seem
remotely possible. Since there are a lot of unusual possibilities
whenever skin disease is present it might be a good idea to think about asking
for a referral to a veterinary dermatologist -- so taking Lucy to the
veterinary school rather than just sending the skin biopsy samples there for
review.
It is sometimes the quickest way to a diagnosis in a difficult case of
skin disease because the dermatologist gets everyone's difficult cases,
making it more likely that he or she will have seen the problem before.I think I'd want to stick with the antibiotics, just like your vet is
doing, at least until I had the skin biopsy reports. I might add
pentoxyfylline if you didn't mind the cost and I was getting concerned
while waiting. It may be worthwhile to check for the hormonal diseases
and liver disease through blood work while you're waiting, too. Those are
just my thoughts -- your vet can actually see the sores and may know from
the appearance or from the testing so far that any or all of these
conditions are unlikely.Good luck with this.
Mike Richards, DVM
10/20/2001
Scabs and bumps on older dogs back after grooming
Question: Dr Mike,
Tinker is a coyote/german shepherd mix, she is EIGHTEEN years old, and in
INCREDIBLE shape, all things considered. I'm fortunate to be writing to you
with something as minor as this, really. But I have a question about her skin.About a week after her app't with the groomer, I was brushing Tinker and
noticed a whole bunch of bumps ...... more like scabs, really, on her back - in
the areas of her neck, between her shoulder blades and down her back
about halfway. This is right where her fur is the thickest. I didn't see any
anywhere else.I wonder if this could have anything to do with the grooming. Is the skin on
older dogs more fragile, and could vigorous combing or brushing cause little
tears or lesions? Tinker sheds just horribly, all the time - worse than any dog
I've ever seen in my life - and the groomer was trying to comb her out really
well. I realize that I have noticed this before, and it seems to be after she has
been groomed. I'm not sure if this is coincidence or not. In the past I've
chalked it up to an allergy to some preparation they used, and we've changed
products - avoided lanolin - whatever I could think of that might be the
culprit. It didn't occur to me that the groomer might be a little too rough.
What do you think?Thank you for your help!
PC
Answer: PC-
We see skin irritation and skin infections, which this might be, fairly often after grooming in
dogs. I think that sometimes it probably is due to a problem during grooming, like clipping too
close, the clippers getting hot, or irritation from the shampoos or other grooming products used.
Flea sprays containing alcohol are very irritating to some pets, for instance. However, I think
that a lot of dogs are just irritated by the clipping process because they are sensitive to it. So I
think it is worthwhile to think about whether your dog might be sensitive to something that is
being used during the grooming but I think that you have to accept that skin irritation is just a
fairly common problem after grooming, otherwise.Skin infections occur secondary to irritation in some dogs. This can happen when dogs have
allergies, hormonal diseases or after events like grooming or hunting. Skin infections can show
up as scabs scattered in the hair coat, as excessive dander, as areas of hair loss - especially if
there is scaling around the edges and through the presence of pustules or red blotches in the
skin. They often will clear up on their own if they are due to an irritation that doesn't stick
around. As dogs age, it is a little harder for them to clear up a skin infection on their own and
you may find at some point that these irritations have to be treated with antibiotics even though
your dog has been able to cure herself in the past.As long as the scabs clear up on their own within a week or so, there is probably no need to
worry about this problem. If the scabs are still present in 7 to 10 days then it would be a good
idea to let your vet take a look at them to see if antibiotics are necessary.Mike Richards, DVM
10/20/2001
Bacterial skin infection possible
Question: Dear Dr. Mike,
First I would like to say that I think vetinfo.com is
very informative and helpful to people like myself who
have concerns about their pets. I am writing to you
regarding my English Bulldog who will be two years old
in October. At the end of April I took him to the vet
because he was scratching around his left eye which
caused some hair loss. He was also missing a spot of
hair on his side which was not caused by scratching.
The vet wanted to scrape the two spots to check for
mange. When the tech came in to scrape she only did
the spot on his side because the other spot is so
close to his eyeball. Anyway, he did not have mange.
The vet told me to just put vitamin E on the spots and
see if they get better. After about a week the spot
on his side was a little bit better but he continued
to scratch all around his left eye which caused more
hair loss and some bleeding; basically it looked raw.
I took him back to the vet on May 7th and he wanted it
scraped again. I told him that the girl never scraped
around his eye the last time only his side even though
he had asked her to do both spots. Well they scraped
around his eye and again it was negative for mange.
he vet gave me Neo-Poly-Dex Ophthalmic Ointment to
put in and around his eye for 10 days and also put him
on Cephalexin 500mg 2x daily. His eye got better but
about two weeks later (around June 10th) it came back
again so I called the vet and he had me use the
ointment again. It got better but never really went
away because he would still scratch at it. I took him
to the vet again on July 6th for his eye and for what
I call a skin infection (they are little scabs and
bumps that he gets on his skin pretty often but they
do not seem to bother him). He saw another vet this
time (there are 4 vets where he goes) because the one
I normally see was booked. He gave him an Azium
injection for the scratching and put him on Cephalexin
500mg 2x a day and Prednisone 20mg 1 tablet 2x a day
for three days, then 1 tablet a day for five days
(which only ended up being for three days because he
was urinating too much) and then 1 tablet every other
day for five doses. He stopped scratching around his
eye while on the medication and everything cleared up.
His eye was better again. A week after finishing the
medication he once again started scratching at his
eye. Now he is also scratching around his other eye
and also in the creases near his nose. All around his
left eye looks awful, it is raw and bleeds and he is
starting to do the same thing to the area around his
other eye and nose. So basically everything they have
put him on so far only works temporarily. I am taking
him to the vet again this Wednesday, August 8th.
Something is obviously making him itch around his eyes
and nose or he would not be scratching at it so bad
that he loses hair and makes it bleed. I appreciate
your help with this matter. Thank You.
Sincerely,
FrancescaAnswer: Francesca-
We have seen this sort of problem around eyelids from bacterial
infections in a number of dogs. Usually they are older Labradors in our practice
but the problem may be similar in your younger bulldog. We have found that
we have to use antibiotics (we usually use cephalexin, too) for about 8
weeks to clear these up and prevent them from recurring. We have had to
retreat a couple of patients more than once but there is usually at least a few
months to a year or more between episodes when we use antibiotics long
enough.We also see skin problems like this from allergies and in those cases
it is usually necessary to use corticosteroids like prednisone to keep the
pet from damaging the eyelid further. However, we try hard to contain the
problem with long term antibiotic therapy first, when we can. If we can
get by with a corticosteroid eye drop and the antibiotics, we like that
better than using corticosteroids (prednisone is a corticosteroid) orally.Scraping for the mites is a good idea and I wouldn't rule that out in
the future just because no mites were found on the first two attempts, if
this problem proves to be persistent.Bulldogs and other short coated breeds are pretty prone to primary
bacterial infections of the skin. They can be itchy from this but
usually antibiotics will help with the itchiness pretty quickly if the problem
is just a bacterial infection.It can take persistence to figure out skin disease. Give your vets a
chance to get this under control but if you reach a point where you feel
strongly that you need to do something more, you could ask for referral to a
veterinary dermatologist.Good luck with this.
Mike Richards, DVM
8/24/2001
Question: Cowboy, my Frenchie, has skin problems again. Last year it was on
his head, this year on his tummy and back above his tail. The area
is dry and flaky and bumpy.He has been sort of on a maintenance of generic chlortrimetron.....I
am very stingy with it...maybe too stingy. He is on no other
medication.( 1/2 tab once a day.)I feed him Solid Gold, the gold bag, and snacks of carrots, fruit,
some broccoli, cabbage occasionally, romaine lettuce. He loves
salad!! I supplement, i.e., mix the solid gold with a homemade mix
I found in a Natural Health for Animals (not exact title) at health
food store. Also a bit of olive oil. His hair is pretty and shiny and
he has never been sick much at all in his 7 years.I am beginning to think that he may have grass allergy, contact
and digestive. He loves to eat grass. Also on his tummy are the
worst red spots....the part of his body most in contact with grass,
etc.The vet and I have talked about this. She suggested that he be
taken off beef products. Shampoo with oatmeal baths (just started
that for total body); prior to this, I bathed the affected areas only.
She is very helpful. I have found, though, that I am ultimately
responsible for his well being as I know him best.Do you have suggestions? I really do not want to do the steroid
route. I think it shortens their lives. He has high pain tolerance
and he does not complain much at all. It makes it a little hard to
know when something is bothering him.I value your input.
Thanks,
JeanAnswer: Jean-
Food allergies are not especially common, but they are among the most treatable of allergies, so
it is always reasonable to try to rule them out. The best way to do that is to feed a diet that
contains no proteins that a pet has previously been exposed to. Diets formulated for this include
diets such as egg/rice, lamb/rice, duck/potato and combinations similar to these. Recently, there
are new diets that include proteins that have been hydrolyzed to make them small enough that
they can not be allergenic. The two that I know of are Hill's z/d (tm) and Purina's HA diets.
These should be a more reliable test diet but we sometimes have trouble getting pets to eat
these diets. Keeping beef out of the diet will eliminate the possibility of a beef allergy but if that
doesn't work you'd have to go through all other possible allergens one by one. Of course, if the
food trial does work and you want to know what Cowboy is allergic to, you would have to add
foods back into his diet one by one until he reacted badly to one of the foods, which would be
the likely food allergen.Whichever method of food trial you pick, it takes at least 8 weeks to be sure that a food allergy
is not present and it is very important that no other foods or treats by given during the food trial.
Vegetables aren't too likely to provoke food allergies but it is best to discontinue them, too.The dosage of chlorpheniramine is very low. The usual dosage for dogs is 2 to 8mg/kg every 8
to 12 hours. Chlorpheniramine is usually a 4mg tablet, so this is roughly 1 tablet per 2 to 5 lbs
every 8 hours. The dose is lower for cats, about 1 to 2mg/kg, which makes it a more practical
medication for use in cats. Some pets do respond to lower dosages, so if this has been working
at the low dose you may want to see if increasing the frequency of administration to 2 or 3 times
a day provides enough relief to control Cowboy's symptoms.Supplementation with essential fatty acids can be helpful for pets with allergies. These are
available under several brand names for pets (OmegaDerm tm, DermCaps tm, 3V Capsules tm,
EFA-Z tm) and are also available in human formulations.I saw something recently that suggested that pollen allergies in dogs may have a much larger
contact allergy component than was previously thought. The theory is that pollens stick to skin
when it is wet and are irritating on the skin surface, just as they would be if inhaled. This could
explain why so many dogs do seem worse after they are in contact with wet grass in the
mornings. I am not sure that knowing this helps much, since it probably would require bathing
on a daily basis to get the allergens off the skin and that is not practical in many situations.Some dogs have bacterial pyoderma that looks like allergic skin disease. It can take several
weeks of antibiotics to get a response to treatment in these dogs, so I think that they are easily
missed when working with itchy dogs. It is sometimes helpful to stop other medications and
continue with an antibiotic to see if will successfully control the bacterial infection and resulting
itchiness and scabbiness but it is hard to be patient the first two or three weeks while waiting for
positive effects to show up.If the allergy season is short and Cowboy isn't too bothered by the skin sores, it probably is
OK just to wait it out and see what happens, although that does sometimes allow secondary
infections to develop or to become worse.I hope that this helps some.
Mike Richards, DVM
8/21/2001
Skin problems in Boston TerrierQuestion: Dr. Richards,
I live in Fairbanks, Alaska and none of our local vets have been able to help my
little Boston Terrier, Buddy.When Buddy was 8 months old, he has a severe corneal ulcer. It required
suturing the lids together and he had to wear the lampshade collar for 3
weeks. He was always a very timid little guy and this was very hard for
him to adjust to. He acted like he was being punished and was upset the
entire time. 3 weeks after the treatment ended, he developed hair loss
over that same eye that was also itchy, red and a little scaly. The hair
loss is not complete, but serious thinning. Over the past 2 years that
hair loss has moved slowly in the following pattern. Over rt eye, over
left eye, behind his ears, down to his throat, down from his throat over
his chest, groin, and it is now moving up the outside of his thighs. It
is moderatly itchy, very smelly, and his skin is intermittently
reddened. I can control the itching and odor somewhat with oatmeal
shampoo frequent baths - 2-3 per week, and I rub cortisone ointment into
the worst spots after the baths. However the hair loss is continuing
and he still scratches quite a lot. He has seen 3 vets and the
following treatments have been tried:1. Dipping for demodex - they never could see the mite under a scope. He
was dipped twice and was so sedated after, I asked them not to continue.
This is when he was 10 - 11 months old.
2. Skin biopsies - they lost the first set and had to repeat. This
showed nothing.
3. Allergy testing - serum, (not skin) - showed many allergies - 4 or 5
grasses, several trees, lamb, corn, milk, dust, etc. I understand the
the serum testing is not that reliable.
4. Allergy shots - I only gave him the test doses and 2 of the actual
shots because the itching got much worse after the injections.
5. Food challenges - he has lived on rice and moose meat for a month
with no success - lots of non allergic food - even the new super
processed food without much improvement. He seems to do best on
turkey/barley.
6. Acupuncture, oils, and vitamins.
7. Thyroid checks x 3.
8. Several courses of antibiotics and anti-fungalsI am most confused by the slow moving pattern of the skin condition. It
makes it hard for me to accept allergies as the sole cause. Do you have
any ideas?Answer: Linda-
I am not familiar with any particular skin disorder that produces the
clinical signs that you have described, so I can't give you a simple answer
to your question. I am hoping that I can provide you with enough
information to be helpful, though.There is a pattern baldness problem that sometimes occurs in Boston
terriers. This usually occurs in female dogs, usually starts around the
ears and moves down to the underside of the neck, then the underside of the
truck and finally down the inside of the rear legs. It usually starts at
about six months of age. The skin underlying the areas of hairloss is
usually normal and does not have the signs of secondary infection that you
are describing. So even though this condition exists in Bostons it doesn't
seem too likely to be the problem given Buddy's sex, the presence of
secondary skin disease signs and the spread to the outside of the thighs
rather than the inside and rear of the thighs.Allergies are definitely a possible underlying cause for hairloss and
secondary skin infections. Boston terriers are listed among the breeds that
are prone to atopy (inhalant allergies). Most dogs with atopy have an onset
of clinical signs when they are between one and three years of age but some
dogs show signs as early as two to three months of age. I am in the process
of rethinking the comparison between skin testing and serum testing for
allergies, especially with the currently available serum tests. While there
still seems to be a little better correlation between skin testing and
serum testing, the gap is narrowing and if a practitioner is good at
recognizing the most likely allergens in the practice area and can take the
time to correlate the peak times of itchiness to likely allergens present
at that time, it is possible to develop a good antigen mixture for
hyposensitization (allergy shots) for a particular patient using either
technique. It may be worth reconsidering the hyposensitization if nothing
else seems likely after considering the rest of this note.In chronically itchy skin diseases it is important to rule out the
possibility of sensitivity to internal parasite migration and sarcoptic
mange, even if these problems can't be identified on lab testing. Deworming
a couple of times with a fenbendazole (Panacur Rx) or other dewormers
capable of killing larval migrating stages of roundworms is a good idea. We
usually treat for sarcoptic mange using ivermectin but there are several
treatments for this condition. Some dogs seem to have long term itchiness
from sarcoptic mange, or something else that responds to ivermectin, even
though we can't find the mites on skin scrapings or biopsies.It is critically important to use a good flea killing product such as
fipronil (Frontline Rx), imidocloprid (Advantage Rx) or selamectin
(Revolution Rx) if there is any problem with fleas where you are. Even if
flea allergy is not the problem, fleas make almost any other skin disease
worse. Flea allergy dermatitis is more common that atopy in most areas of
the country. The hairloss associated with this can be different from one
dog to another but there usually isn't as much facial pruritis with flea
allergy as with atopy.The really hard part of cases like Buddy's is trying to differentiate the
problems that are causing the initial itchiness from the problems that
occur due to the itchiness. This is particularly difficult for bacterial
skin infections and Malassezia yeast skin infections. In most cases, these
problems occur as a secondary problem but the bacterial skin infections, in
particular, can be the source of the original itchiness and then can
self-perpetuate as the dog scratches, damaging the skin and making it even
easier for bacteria to grow in the skin. We have the best success ruling
out bacterial skin infections by using long term antibiotic therapy while
withholding corticosteroids, if it is possible to do that. The best hint
that bacteria could be the underlying problem would be the reaction to the
previous use of antibiotics. If there was improvement in the condition when
on antibiotics but then the problem recurred when antibiotics were
withdrawn it is highly likely that bacteria are playing a significant role
in the itchiness. When we think this is happening we usually prescribe two
months worth of antibiotics. That is usually long enough to figure out if
they antibiotics are going to work, but may not be long enough to resolve
the problem. Our last patient with a primary bacterial skin infection took
six months of continuous antibiotic use to be completely itch free and has
been able to be without antibiotics for about five months at this time. It
is unusual to get a lifelong cure in a dog prone to itchy bacterial skin
infections. Some dogs require nearly lifelong antibiotic use and other dogs
have recurrent infections that can be treated successfully each time with
antibiotics. I like cephalexin as my first choice antibiotic for long term
use but some vets favor other antibiotics.Malassezia is harder for us to diagnose and to treat, although we have had
some luck lately using chlorhexidine shampoo and vinegar/water rinses (1:1
water to vinegar). We usually do an impression smear of the skin (pressing
a microscope slide to the skin, heat fixing the sample and staining it) and
examine it for the yeast organisms or a skin scraping with the same
staining procedure. If we get a lot of yeast on the smear we go ahead and
treat for Malassezia. If not, we do skin biopsies and hope that there will
be some evidence of it on the biopsies. Since Buddy had biopsies and yeast
organisms weren't found that makes it a little less likely but does not
rule it out, unfortunately. Oral anti-fungal medications such as
ketaconazole and itraconazole will usually eliminate the yeast with three
to four weeks of therapy. These are a little expensive to use without good
evidence that yeast is the problem but I would do this if antibiotic
therapy didn't help and especially if antibiotic therapy makes the
situation worse. Malessezia has a strong tendency to recur, just like
bacterial skin infections. So if there has been improvement when on
anti-fungal medications and then recurrence of the problems it may be
necessary to use some sort of long term maintenance therapy. Hopefully,
shampoos would work in that case. It can take several tries to find the
right anti-fungal therapy for a specific patient.The food allergy test is a good idea. Contact allergies have to be
considered, too. If Buddy has a cedar bed or a wool blanket or something
else that might be causing a contact allergy it might be a good idea to
change that situation long enough to see if the skin problems clear up.When I am not getting a good response to my diagnostic and treatment
efforts in a case like Buddy's there are a couple of things things that I
try to think about. The first one is whether or not I have used antibiotics
or antifungal agents long enough at any one time to be certain that they
are not going to be effective. The next thing is to be sure that we have
achieved good flea control (maybe this should be the first thing).
Sometimes, if we carefully review what we have done, we can see where there
were short periods of good response to particular therapies and that can be
helpful in figuring out where we should concentrate our diagnostic or
treatment efforts.I am not sure whether this is a possible option in Fairbanks, but we have a
veterinary dermatologist who practices reasonably close to our clinic and
when we just don't seem to be making progress on a case we refer our
patients to the dermatologist. This is a good option for any chronic case
of skin disease that is not responding to treatment and for which diagnosis
has not been possible despite a good effort at testing as in Buddy's case.I hope that this helps some.
Mike Richards, DVM
5/1/2001
Chihuahua puppy with dry, itchy skin
Question: My question concerns Patties dandruff and itchy skin. She doesn't
have any rashes and just seems to have dry flaky puppy skin. As I recall, my
other two dogs had it as well but it cleared up after being on good food for
a couple of weeks. I changed her from Science Diet dry puppy food to the
Nutro at the suggestion of a PetSmart employee who I discussed her itchy skin
problem with. She's been on the Nutro now for an entire month and it doesn't
seem to make a difference. I use an expensive Essential Fatty Acid Shampoo
for dry sensitive skin and have only shampooed her 3 times in 2 months and
still no improvement.Answer: There is no advantage that I know of to using essential fatty acids
topically. They can be very helpful when given orally, though. There are a
number of fatty acid supplements available, such as DermCaps (tm),
OmegaDerm (tm), EFA-Z (tm) and 3V Capsules (tm) --- and probably at least a
dozen more. In short haired dog breeds dander can be a sign of a primary
bacterial skin infection. In dogs with this problem, antibiotic therapy
usually works well to stop the problem, although it has a tendency to
become an intermittent problem for the life of the dog. Usually it will
continue to be responsive to antibiotics, though. In dogs that just have
dry skin due to the low humidity in many homes in the winter, using a
conditioner after bathing often helps. It is necessary to bathe dogs once
or twice a week for this to help a lot, though. The only time that dietary
changes seem to help a lot are when a dog has food allergies and the switch
lessens the allergy or when a dog is on a food that has a deficiency, which
is really a pretty rare event for any of the brand name dog foods.Mike Richards, DVM
2/27/2001
Hyperemia (extreme redness) and alopecia on puppy
Question: Dr. Michael Richards,
My friend has a 3 months old dog. She had her from a kennel. She had a
kennel cough but cured by her doctor. But we don't know why since 2 weeks
hyperemia and alopecia started from her left cheek which is very near to
her eye. The doctor made skin examination (ectoparasite) sarcoptes and
fungal spores was not seen. The unususal think is the legs of the dog are
also red. But she has no itch. The doctor said she has never met such red
legs before.If you give us advice we will be very happy.
Thanks a lotAnswer: Isin-
The first thing I would do in this case is to recheck the skin scrapings.
Sometimes it is hard to find mites, especially in certain breeds (shar peis
being the hardest for me). I would do this two or three times before
giving up on the idea of mites, since demodecosis (infection with Demodex
canis mites) is an extremely common cause of very red skin in puppies in
this age range.We have seen this type of extreme redness from contact allergies to cedar
chips and to walnut chips. If the puppy has access to these materials it
would be a good idea to stop allowing this. We have also seen really
hyperemic skin after bathing in pennyroyal shampoos, so if that has been
done, stopping it would be a good idea, too.Without itchiness it is hard to figure out where to go next. Food allergies
would be something to consider with the extreme redness. That has been our
most common problem with really red, really itchy puppies who didn't have
demodectic mange. I can't recall a puppy that didn't itch when it had food
allergies, though.Some puppies do develop primary bacterial or yeast skin infections. If
nothing else seems evident to your vet on examination it might be worth
trying antibiotics for three or four weeks to see if they help.A skin biopsy can be a very useful test for unusual skin disease problems.
Having a biopsy sample examined by a pathologist with an interest in skin
disease can sometimes provide an answer when nothing else does.I hope your neighbor is able to find a solution to this problem.
Mike Richards, DVM
2/14/2001
Question: Dear Mike
A quickie about Daisy's head.
For more than two months she has had a largish discolouration on her head. It looks like a
stain - as if something had been spilled on her skull! It even has a slightly darker outline
characteristic of a stain.Our vet in Italy thought it was sunburn (she is part Shar Pei, part Golden Lab, so her skin is, of
course, very sensitive and susceptible, as you may recall, to allergic rashes of various kinds).It doesn't seem to bother her at all, but, though I have applied topical creams (antibiotic,
ant-histamine) it does not seem to be going. The skin itself is a little rough, but not raw (despite
its appearing so).Any thoughts?
Kind regards.
Raymond
Answer: Raymond-
I can't think of many reasons for this kind of staining. We have caused distinctly purple stains on
a Weimaraner that had a drug reaction to a medication we were using. It looked just like
something purple had been spilled in her hair coat but there were a number of these lesions.Golden retrievers are prone to areas of moist pyoderma on their heads and these can cause
discoloration of the hair coat but usually it is matted together with thick exudate at the same time.
Usually these occur just below the ears on the side of the face.We have seen hemangiomas that looked like discoloration of the skin but these usually have
hairloss over the affected area and often also have at least somewhat of a "blood blister" look to
them.I can't think of anything else at this time that might cause this problem. I'll try to keep thinking
about it, though.Mike Richards, DVM
11/28/2000
Skin problems in older West African Bush Dog
Question: Dear Michael Richards,
Hamlet is an West African "bush dog" from Ghana. He is fifteen and a half
years old and we have had him since he was a puppy. He has lived with us in
Ghana, Italy, France, Costa Rica and now Nicaragua. His health has been
excellent and he has shown great resistance against disease.Now Hamlet has a problem.
DESCRIPTION
He develops black scabs on the back of his neck. They start small and then
extend outwards. If the scab is removed, the skin under it shows red 'pimples'
or clusters of 'pimples'. The affected skin itches when rubbed.
He also has 'boils' that come up on his neck, but they do not contain puss.
When they burst, a small quantity of bright red, clean blood is released. The
'boil' heals leaving the skin with a black scar.
He has shown the need to drink much more often than was normal, also he is
frequently hungry, but picky. Prior to these troubles he drank very sparsely
(once or twice in 24hrs) and never asked for 'extra' food.
HISTORY
The symptoms first showed up a few days after we collected Hamlet from a six week
stay in local kennels. We have tried to get it sorted here in Nicaragua at the
University Veterinary Service with some degree of success, but the symptoms
re-occur every month or so.TREATMENT
Prescription 28/06/2000
Norfloxacina 400mg
One tablet every twelve hours for ten days
Acar gen
Put three drops on each infected area for seven days
Hidro Rex Vital
5cc per day
Rimadyl
One per day for ten days
Dermoxil shampoo
Wash once per week and leave shampoo on skin for ten minutes prior to rinse
Gerodiog
Injection once per day for three days
03/08/2000 blood test
Hematocrito 45%
Hemoglobina -
Globulos blancos 12.600/mm3
Globulos Rojos 5,620,000/mm3Segmentados 77
Linfocitos 11
Monocitos 1
Eosinofilos 11 (0-3%)
Basofilos -
En band
TOTAL 100%Prescription 07/08/2000
Histaclor 4mg
One tablet per day for ten days
Cefalexina 500mg
One tablet every twelve hours for seven days
Vitamins A and E
One capsule per day for fifteen days
Prescription date?
Ciprofloxacina 500mg
One tablet every 12hrs for three days followed by one tablet per day for three days.Prescription date 02/09/2000
Ketogina
Apply three times a day for two weeks
Pet-Tabs Plus
One tablet per day for fifteen days
Linconicina 600mgs
Three doses, one per day for three days
Total-antiparasitaris
Two tablets per day for two daysPrescription date?
Anavimir
one spoon full per day in food
Jabon Projiderune
Antiseptic soap to use for shampoo, leave on affected skin for some minutes prior to
rinse.
Hamlet show allergic reaction to this and came covered in big swollen spots and
suffered from terrible itching. The spots left small dark lumpy scars which seem to be
permanent.Culture test date 11/10/2000
Isolated Difteroide sp
Sensitive to: Ciprofloxacina, Cloranfenicol
Less sensitive to: Penicilina, Teraciclina
Resistant to: Ampicilina, Doxiciclina, Trimetropin
Prescription date (monthly since first week September)
Dipsospan 1ml
InjectionDipsospan 1ml Injection This seems to be able to control the symptoms and the
infection 'dies down' with the skin getting back to a healthy state. (see photos) Hair
regrows and Hamlet shows a normal interest in life and looks well and is happy.
So Doctor, what do you think?
In advance thank-you, Simon
Answer: Simon-
I am hampered in my reply to you by an inability to identify some of the medications and also the
organism cultured. I can not find Difteroide in the databases available to me.However, it is reasonable to assume that if antibiotics clear up the symptoms, but they recur, that
there is a bacterial infection and that antibiotics haven't been used long enough -- or it may be
necessary to use them continuously in the future.One of the more common causes of bacterial infections that do not respond well to antibiotic therapy
in older dogs is hyperadrenocorticism (Cushing's disease). This would also cause the increased
drinking and urinating. Anything that lowers immune resistance can contribute to this problem,
including diabetes, kidney failure, liver failure, cancer or any severe illness. Cushing's disease can also
cause skin sores that can be very itchy, so I do think it is a strong possibility.Your description of the sores made me think of hemangioma, which is a skin cancer that produces
small blood blisters on the skin in some patients. It should not respond to antibiotics, though.I am sorry that I can not provide specific information on the organism cultured.
Mike Richards, DVM
11/22/2000
Question: Mike,
I just want to be sure I am communicating correctly the location of the tiny hairless
patches on Terry's "elbows". If you are standing, holding your arm straight against your side,
palm against the thigh, in back of you is what I would call the back of the elbow, and parallel
to your side are the inside and the outside of the elbow.The reason I am making a point of this is that when Buddy's elbows got puffy from lying
on concrete, the puffiness seemed to be in back of the elbow joint. I am visualizing the boys
lying on their stomachs on a hard surface which would aggravate that area. Although they do
seem to lie mostly on their sides, I am thinking the width of the shoulders would take most of
the weight, rather than where the little hairless patches are, but hoping that I am wrong, that
this *is* just from lying on hard surfaces, rather than something that needs treatment.On the other hand, closer examination reveals that most of the boys have this condition
to some degree, whereas the girls (lighter in weight) do not, which would support the idea that
it is due to lying on hard surfaces.
HelenAnswer: Helen-
The outside of the elbow and the outside of the hock (ankle of the rear leg) are the sites we
most commonly see pressure sores from lying on hard surfaces. Sometimes there are also sores
on the outside of the hip and the outside of the carpus (wrist of the front leg). If hairloss is the
only sign seen there may be no need to worry over this, but if the skin starts to look inflamed it
would be a good idea to try to find some softer materials for the dogs to lay on.
Mike Richards, DVM
11/22/2000
Chronic skin problems - long term treatments
Question: Hello Dr. Mike
Hope this is the right way to write to you and that you can help with
information regarding my dog.
I live in Bali and have two local dogs, I am not able to describe the type
of dogs they are, they are so called "bali dogs", one they say originates
from dalmatians, but it is smaller.The one male dog has suffered from various skin problems since he was
borne, which is very common down here. He was cured with cortisones and
antibiotics for the first 4 months I had him. On January 13th (he was
about 7 months then) he was neutered and approx. 2 weeks after that his
problems became very severe, he got rashes all over his back part and had
high fever. The vet treated him for skin problems giving him the usual
(which I do not know what is) with cortisones and antibiotics. I assumed
the antibiotics were not good for him and requested that the vet stopped
that and she continued with only cortisones and prednisone tablets for a
while. The dog was so sick his temperature had risen to a high degree and
he could not move. I contacted another doctor and she decided to try to
find out what was wrong. At the time I had found your site on the Internet
and I believed he had hormonal problems. The vet agreed looking at the
pictures and we decided to put him on hormones, but could not get any
locally. We had to wait until end of April before he got his testosterone
medicine, Supertest from Australia. In the meantime he was treated with
prednisone tablets and injections to keep him going. If you need to know
what kind of treatment he got I will revert with this. Just now I need to
know why the Supertest was not very successful and how he should have been
treated with that. The vet put him on 0,6-0,8 ml injections every three
days for 4 weeks (12 injections) and then stopped. She did not give him
any other treatment during these injections, but the last week I requested
that we put him on Prednisone again because he definitely had infections
all over his body. After the first 3 to 4 injections the skin problems
disappeared and his fur started to grove, he had lost 90 percent of it
during his sickness. He has received vitamin injections along with the
hormonal treatment. He also recovered fast in his muscular structure and
was able to move and run again after the first injections. He received his
last injection with Supertest on the 31 of May. After approx. 10 days his
problems begun again, he got rashes, his skin is flaking and dry, not
itching, looks like he has dandruff like before and he looses his hair
again. I requested that the doctor started treating him with hormones
again, and after one injection the condition improves. My question is:
when treating dogs for hormonal problems and subsequent hair loss/skin
problems is it recommended to stop after 4 weeks of treatment or can we now
put him on 1 time a week injection until he is fully recovered? I think he
is only 40 percent recovered and got approx. 40 percent hair back.
Do you have any general information about hormonal treatment? He is now on
prednisolon 2 times 0,5 mg a day, but I want to reduce that to every other
day.Hoping you can give both me and the vet some information about this.
Thanks and best regards
SisselAnswer: Sissel-
I am a lot more comfortable using antibiotics long term than
corticosteroids, especially in puppies and young adult dogs.When dogs have skin conditions from birth, or close to birth, the most
likely problems are mange infestations, bacterial skin infections and
fungal skin infections. Other possibilities include food allergies and
immune system deficiencies or disorders. Hormonal skin disease is uncommon
in very young dogs. In some areas inhalant allergies are very very common
and some dogs will develop skin disease associated with these allergies as
early as three or four months of age, although normally these allergies
develop after a year of age.Identification of mange infestations can usually be done by making a skin
scraping and examining it under the microscope. This works very well for
finding demodectic mange but not always as well for sarcoptic
mange. Sometimes it is necessary just to treat for sarcoptic mange in
order to be sure that it isn't present. Sarcoptic mange causes hair loss,
itchiness and secondary bacterial skin infections. If the ear margins are
rubbed on a dog with sarcoptic mange they often react by scratching
frantically with the rear leg on that side.Demodectic mange is somewhat difficult to treat and is less common.
Sarcoptic mange is very common but relatively easy to treat. We currently
like to treat this with ivermectin because it works quickly but there are a
lot of other treatments that work. This form of mange often appears to
improve when corticosteroids are administered.Bacterial skin infections will respond to antibiotics in most cases,
although it is necessary to use one the bacteria are susceptible to. If the
first choices in antibiotics don't work it is sometimes possible to get a
culture sample from a pustule in the infected area of the skin and then do
sensitivity testing to see which antibiotics will kill the bacteria that
grew in the culture sample.It is not possible to make a diagnosis of skin disease over the computer
and it is sometimes really hard to make a diagnosis in person, too. If
possible, it would be a good idea to ask your vet to do skin scrapings and
look for mange mites. If this isn't possible, it is reasonable to treat for
sarcoptic mange in order to be sure it isn't present. Then treating for a
reasonable amount of time, such as 3 to 4 weeks, with an antibiotic likely
to work for skin disease (cephalexin or sulfa-trimethoprim combinations are
good starting medications) is a good second step. If there is not
significant improvement during this period it may be necessary to use
corticosteroids to control the itchiness, in conjunction with the other
treatments. It really is better, if possible, to treat for these conditions
one at a time, though.If you need more specific information on any of these conditions or
treatments, please feel free to write back.Mike Richards, DVM
6/19/2000
Question: Dear Dr. Richards:
I have owned, shown and bred Golden Retrievers for approximately 20 years and
have never encountered anything like what my friend's Golden bitch has come
down with. This bitch is a normal, healthy, active three year old. About a
year ago the owner noticed a patch of black skin about the size of a quarter
on the bitch's flank. The hair in that area was normal in color but sparse
and rather wiry. The blackened skin is now spreading along the flank and up
towards the shoulder.The veterinarians in her area are puzzled as to what this could be. The
bitch has been tested for fungus, mange and two thyroid tests. The results
of both thyroid tests showed the bitch to be normal. They are now running
tests for Cushing's but have not received the reports as of this time. I did
own a bitch with Cushing's who died several years ago. She carried on quite
well with Cushing's for two to three years but she did not exhibit any of the
above symptoms. Although it probably does not have any bearing on this
bitch's condition, I might also mention that the owner lives in a semi-rural
area and does have several cows. Also in the past she did own two horses on
that property. There are 3 other Golden bitches living there and they appear
to have no problem.I would appreciate any thoughts or suggestions concerning the above. This
owner is willing to take the bitch anywhere to solve this situation.Irene
Answer: Irene-
There are probably a lot of things this could be. If this dog is itchy, the
list is very long, because itching from any cause that goes on long enough
can cause hairloss, darkened skin in the itchy area. The most common causes
of this degree of itchiness are sarcoptic mange mites, atopy (inhalant
allergies), bacterial and yeast (Malassezia) infections. There are some
uncommon disorders involving sex hormones or growth hormones that can
produce darkened skin and hair coat changes.Malassezia is not always itchy and hyperadrenocorticism (Cushing's) and the
other hormonal problems are not usually itchy, either.I think that the best approach would probably be to seek referral to a
veterinary dermatologist, since they see the odd skin cases. If that isn't
possible, skin biopsies can be very helpful in sorting through these kinds
of problems, at least at giving some direction for further testing. It is
best to have the skin biopsy specimens examined by a pathologist with an
interest in skin diseases, if possible. Veterinary schools and larger
referral centers are good choices for this sort of case, since they often
have the capability of doing the exam and lab work, both, which can be helpful.Good luck with this.
Mike Richards, DVM
5/5/2000
Question: Dr. Mike, I have just faxed my subscription, am up late worrying about my
little dog. Buttons is a 13 yr.old shih tzu that has always been in perfect
health. about 2 mths ago we noticed a loss of hair on his back paws with
yellowish discharge. we took him to the vet and was told he had an
infection, started on Cephalexin bid for 30 days with washing of the feet
daily. In a short while he was not improving and having some tremors. We
took him back and they checked his Thyroid and then was started on Solozine. He
was not improving at all so back we went.This time they scraped a foot and
said he had mange mites, he was not himself and we were very worried. we had
to bathe him 3xw with Dermazole and Temaril-p was added to his meds with
another round of abx. He improved until we finished the Temaril-p, then it all came
back.Another trip to the vet, checked the Thyroid again, anther round of
Temaril-p plus Revolution q3w x 3.We are now up to the present, he was
coming along wonderfully until the Temaril-p was about done and here we are again
with the discharge, itching, licking, and I'm ready to pull my hair out, I love
this little dog so much and working so hard to get him well. Do want to
mention that the vet said if this doesn't do it we will have to think about
taking a biopsy or seeing a Dermatologist. Also, his skin can be seen
through the hair on his belly, neck and above his eyes. Forgot to mention on the
last visit we found that his tail is also affected. I am calling the vet in the
morning and would really like to know what you think about this before I
take him in again. I guess I need to hear another opinion.
.Thank you in advance, JoanAnswer: Joan-
I am hoping that you found out what type of mite is present on Buttons. If
this is demodectic mange there is a problem with using Temaril-P when
demodecosis is present, since Temaril-P contains prednisone. If this is
sarcoptic mange then is it OK to use a corticosteroid like prednisone to
relieve itching while using anti-mite medications. Since Revolution will
kill sarcoptic mange mites but probably doesn't kill demodex mites I am
thinking the sarcoptic mange might be the problem your vet is seeing.On the other hand, demodectic mange is more likely to suddenly appear on an
older dog than sarcoptic mange. This usually happens when there is some
sort of systemic illness that is depressing the immune system of the dog
and allowing the mite to prosper. It is critically important in this
situation to try as hard as possible to find the underlying cause and treat
it, so that the pressure on the immune system is relieved and the patient
has a chance to fight off the mite.Prednisone will make most skin conditions improve, at least temporarily. In
some cases it is almost the only medication that will work. However, it is
still really important to know whether or not this is a case of demodectic
mange before committing to long term use of corticosteroids and if there is
demodecosis to make a really concerted effort to look for an underlying
cause. General blood panels, X-rays of the chest and abdomen, thorough
physical examination and other more specialized testing may be necessary to
identify or rule out an underlying illness.It is probably a good idea to consider getting an opinion from a veterinary
dermatologist, if that is possible for your vet to arrange for you. They
see these sort of complicated cases more often then general practitioners
and sometimes are able to help with conflicts such as a skin disease that
responds well to cortisones when it isn't a good idea to use them because
of the presence of Demodex mites.The general depiction of his appearance is suggestive of hormonal disease
but hyperadrenocorticism would be more likely to cause a secondary problem
with demodecosis than hypothyroidism. It may be a good idea to check for
this, too. Unfortunately, it is more accurate to do this testing when
corticosteroids haven't been used for several weeks. That is another
situation where the dermatologist may be a little better at sorting out the
difficulties of concurrent problems than a general practitioner.It is going to take some effort to get to the bottom of Button's problem.
There is a chance of finding a major underlying problem, such as cancer or
liver disease. Despite this, it is best to make the effort. Lots of times
there is a treatable problem, like hyperadrenocorticism, that is the
primary problem and treating it will allow a patient to handle the
remaining complicating factors.Good luck with this. Please consider taking the advice from your vet to
seek an opinion from a veterinary dermatologist.Mike Richards, DVM
3/24/2000
Question: Dear Dr. Mike,
My family and I own a Golden Retriever. She has some skin disorder all
around her body. I don't know the best way to explain what she has. So I
will do my very best. Wherever she has this skin disorder she no longer
grows hair. And it has affected most of her body. All over her skin are
soars, crusty skin, moist red areas on her eyes and face. And has eaten
rarely. We try to give anti-biotics in which a local veterinarian had
prescribed to her and it seemed to work for her but then it would just
get worse. She looks terribly bad, and her eyes and face are disfigured.
And she has a very strong terrible odor. And just recently she has
started to breathe heavily. I know that she is in terrible pain so I ask
of you if you know any treatment that could help her. I love this dog
and it would hurt me terribly for she is one of my family.
I thank you graciously for any help you can provide for her.Timmy
Answer: Timmy-
The best advice that I can give you is to ask your vet to refer your Golden
to a veterinary dermatologist. Your vet can do this. In some cases finding
a dermatologist involves traveling some distance but it is usually worth
doing that for cases of skin disease that have not been responsive to
treatment. If you can not do that it would at least be a good idea to get a
second opinion from another local vet.There are a number of possible problems, including skin parasites
(demodectic or sarcoptic mange), food allergy, flea bite hypersensitivity,
inhalant allergies (atopy), immune deficiency or immune mediated diseases,
bacterial and fungal skin infections.If your Golden is young (less than a year of age) it is very important to
make sure that skin scrapings have been checked for demodectic mange. If
this has not been done, that would be one step to take prior to considering
making a long trip to a veterinary dermatologist (if a long trip is
necessary).Good luck with this.
Mike Richards, DVM
4/12/99
Question: Hello Dr. Mike,
You may remember me from last year. I'm an American living in Bosnia with
two Boxers.I'm having a problem with my 7 year old female. She has three skin
conditions which concern me. One is a small lump the size of a pea with a
sore on it that has not healed in 8 months. It is next to another small lump
without a sore on it.The next condition is a lump the size of a small walnut behind her left
shoulder that appeared 4 months ago.The third condition, started 3 months ago as 12 dark gray patches on her
back and sides. Each patch was about 1/2 long and 1/4 wide. They were a
little flaky but she did not act as if they itched. These patches have now
turned into a slightly flaky mask like large dark gray area on her skin,
covering her back and sides. The rest of her unaffected skin is white. The
hair has thinned as is not growing back. She does not itch. When I put
Vitamin E on the skin, the slight flakiness disappears. A week before the 12 patches
appeared, she had eaten a bar of soap and the vet thought maybe it was a
reaction from that.She gets a good quality dog food and vitamin, mineral and amino acid
supplements. She is about 5 lbs overweight but has been dieting slowly since
November and is slimming down nicely even though she's always been pudgy.
She likes water but I would not say she drinks or urinates excessively.
She's active, happy, and has normal stools. Her son, eats the same diet and
has none of these symptoms.I have cc'd this email to her vet here as we have a good relationship and I
feel confident he would appreciate being included in your feedback.She has not undergone any tests or biopsies. Can you please recommend some
theories of what this might be or some tests that could bring us closer to a
diagnosis? I am concerned about cancer and diabetes.Thanks so much, Laura
Answer: Laura-
Boxers are very prone to mast cell tumors in the skin and I usually remove
suspicious looking lumps and have them examined by a pathologist. Lots of
times they are benign lesions when we do this but it is important enough to
find the mast cell tumors that surgery to remove other tumors is warranted.I think that the skin condition could be one of several things. The two
most likely problems are probably seasonal flank alopecia, a condition that
occurs for unknown reasons and seems to be very prevalent in boxers and
hypothyroidism, which occurs in many dog breeds.Seasonal flank alopecia usually causes hairloss, dark pigmentation of the
skin, flakiness and is not pruritic (doesn't itch). It usually starts in
the winter and gets better in the late spring or summer when the days get
longer. I have heard other reports of Vitamin E being a little bit helpful
for this condition and some vets recommend trying melatonin -- but I am not
aware of any scientific studies that support the use of this medication at
the present time. The good thing about this is that most dogs recover. And
when the problem returns the next winter you already know what it is.Hypothyroidism can cause hairloss, flakiness, a tendency towards obesity,
heat-seeking behavior, interference in estrus cycles, increased
susceptibility to skin infections and many other clinical signs. Due to the
large number of clinical signs that can be associated with this condition
it is usually easiest just to run labwork to rule the condition out. That
might be hard to do from Bosnia but thyroid levels are stable enough in
serum that you probably could ship the blood to a testing lab anywhere in
the world and get reliable results.There are a number of other possible problems, including primary bacterial
pyoderma, atopy (allergies), and Cushing's disease (hyperadrenocorticism).
If you elect to have the skin tumors removed it would be pretty easy to do
a skin biopsy at the same time in the affected area, which is another good
test to start with to rule out the other conditions.Hope this helps.
Mike Richards, DVM
3/17/99
Question: My Doberman Natasha is developing little skin tags all over her nose, and
on her legs: tiny bits of white/light grey skin that stick out a
little. (She's a black dobie and her skin is generally pretty dark.)
She also has what seems to be a small raised black mole on the inside
of her thigh.The vet says she has no idea why Natasha gets these "tags," but not to
worry unless they are pink.Answer: Skin tags are really common in Dobermans and I can't provide any more
insight into them than your vet. They do not seem to cause problems (except
maybe when they are mistaken for ticks and pulled off, causing bleeding).
Once in a while one will get large enough to be irritating to the dog but
they are easy to remove.Mike Richards, DVM
2/5/99
Familial Canine Dermatomyositis in a Schipperke
Question: I noticed the Schipperke graphic on this site. I have had Schips for
nearly 23 years. A couple of years ago I came across a Schipperke with
familial canine dermatomyositis. The vet college where she was diagnosed
was quite excited about this as it was the first case they had ever seen
in a Schipperke. The bitch was spayed prior to 6 months of age. The
breeders deny ever having seen this condition in any of their Schips
prior to this. Comments?KATHLEEN
Answer: Kathleen-
I am not an expert on dermatology but I have seen a post on the Veterinary
Information Network concerning dermatomyositis in a Schipperke (from 1996).
This condition has not been reported in this breed in the literature to the
best of my knowledge as an hereditary condition as occurs in shelties and
collies. The conventional wisdom appears to be that dermatomyositis can
occur in any dog breed but that it may not or is not hereditary in breeds
other than collies and shelties. Because of that I have no problem at all
in accepting the likelihood that the breeder really hasn't seen this
condition in their puppies before.Mike Richards, DVM
1/99
Question: I have raised Standard Poodles for 30 years and have just found your web
site. Although I have many questions/comments based on my past experience
with poodles, my first note is that you do not seem to have any information
on Subasious Addinitis which is very prevelent in several breeds of dog.
Having purchased a foundation bitch from a well known breeder and finished
her in confirmation, I then found out that she had SA. The breeder
replaced her and we did the same thing. Again, she turned out to be a
carrier. Needless to say, one was put down and the other was spayed.
This disease is often misdiagnosed as a thyroid condition and we had to
educate our vet with material. It seems to me that with any major hair
loss in a breed prone to SA that a skin punch would be in order. We
learned the hard way. I would be nice if this were addressed on your site.Thanks for listening,
Janet
Answer: Janet-
We elected to start our web page with a question and answer format on the
theory that the information people needed most would get on the web site
faster that way. It has been a reasonably good theory but it hasn't been
perfect. As you point out, there are lots of conditions we still need to
cover!Sebaceous adenitis (granulometous sebaceous adenitis) is a skin condition
that can affect any breed of dog and even cats, although it is much less
common in cats. Despite the fact that any breed may have sebaceous adenitis
certain breeds do have more problems with this disorder than others. At
present, according to Dr. Morgan's "Handbook of Small Animal Practice", the
breeds most likely to be affected are Akitas, vizslas, Samoyeds and
standard poodles (black and apricot colors).Sebaceous adenitis is an inflammatory disease affecting the sebaceous
glands. It may start out as skin flaking in affected areas or as hairloss.
In some cases the hairloss can be pretty extensive. Secondary bacterial
infections are common. When the disease starts it is usually not itchy but
this may change as secondary problems develop. The only way to diagnose
this problem with certainty is a skin biopsy, as you suggest.At present the working theory is that this is a genetic disorder with an
autosomal recessive mode of inheritance (Dunstan and Hargis, as reported in
Dr. Morgan's text).A couple of years ago there were reports that this condition may respond to
the retinoid medications such as isotretinoin but these medications are
really expensive and I think that the long-term results didn't really
justify the price. Antiseborrheic shampoos and creme rinses sometimes help
with clinical signs but there is no really successful cure or treatment for
this condition that I am aware of. Fortunately, affected dogs do not
usually seem to be too bothered by the sebaceous adenitis and the disorder
is not thought to be fatal even when it is present long term. They do
sometimes need a lot of maintenance with bathing and antibiotics for
secondary infections, though.Due to the strong possibility of a genetic factor in this disorder it
probably is best to avoid breeding affected individuals.Mike Richards, DVM
Skin conditions
:
Question: Thank you once again for your help with OCD and Glasha. She had another
operation on Monday for her other shoulder, but hopefully that will end the
matter.We have another problem. One of our other dogs, Tilly, has a history of
flaky skin and mild hairloss on her chest, under 'arms' and thighs a few
weeks prior to coming into season. She was, however, spayed in April 98.
Had she not been spayed her next season would have been due in September.
For a couple of days (since 23/11) she has been manifesting her 'normal'
flaky coat, but it has now spread to the outside of her thighs and down
her back legs. It resembles dandruff and is not causing any itchiness.Possibly, or possibly not, connected with this is that Glasha has had skin
problems which were diagnosed as hookworm. She has been throughly wormed
and is on a course of anti-mite injections. Her skin is itchy, and forms
small round patches on her elbows, hocks and one on a front paw. Her ears
also show signs of earlier patches. Has she passed something on to Tilly?Thanks once again for all your help.
Elizabeth-
Answer: I am pretty surprised that hookworm dermatitis occurs in Colorado. I have
seen a few cases here in Virginia (mostly prior to the use of the monthly
heartworm preventatives which kill hookworms) and have always heard it is
more of a problem further South. I have seen a couple of cases of rhabditic
dermatitis, which is caused by a worm that invades the skin and is
associated with straw bedding. It responds to treatment for mange so it
should clear up if it is present. One of the difficulties of providing the
VetInfo service is the difference in diseases that occur simply due to
geography. Sometimes my frame of reference isn't wide enough.Even though the skin conditions that Glasha and Tilly have sound different,
in that Glasha is itchy and Tilly is not, a contagious cause is always a
concern when more than one dog has skin disease in a family. There is a
mite, Cheyletiella, that is said to look like "walking dandruff" and to
cause relatively mild skin disease. It is not a common problem here in
Virginia and I can't even remember if we have seen it in our practice or
not. It might be a good idea to look carefully to be sure that there isn't
movement in the skin flakes.Bacterial skin infections don't always itch. Hormonal skin conditions don't
usually itch, either. Spaying may cause skin problems, apparently due to
the changes in estrogen levels, in a very small number of dogs so it can't
be ruled out as a possible problem but it would be very very unusual.If Glasha's problems continue it might be a good idea to do fungal cultures
and to consider skin biopsy to try to get a diagnosis. If Tilly's problems
get worse the first thing to do is let your vet take a look to make sure
that there aren't more similarities to Glasha's condition than there seem
to be and to start ruling out other problems as well.I realize this hasn't been much help but skin disease is particularly hard
to give differential diagnoses for without seeing the patient. You'll just
have to keep working with your vet to get both dog's skin problems resolved.Sorry I can't help more.
Mike Richards, DVM
Necrolytic dermatitis, hepatocutaneous syndrome
and necrolytic migratory erythema.Question: My 11 year old Westie has just been diagnosed with this syndrome and I
can't find any information on it. Can you possibly give me the info or direct me
to a site about it. He has just been diagnosed with diabetes also..
Thanks for your help.
Carole
Answer: Carole-
Skin crusting and ulcerative skin lesions (especially on the face, legs and feet) that
occur due to underlying liver disease, pancreatic tumors and possibly diabetes is
known as necrolytic dermatitis, hepatocutaneous syndrome and necrolytic migratory
erythema.There is at least one case reported in a West Highland White Terrier due to liver
disease with copper toxicosis
(Veterinary Medicine, Dec. 1997).The prognosis for this condition is usually poor because the underlying liver and
pancreas disorders are often difficult to treat and that makes resolving the skin disease
difficult as well. Corticosteroids may be helpful if they are not contra-indicated due to
the underlying disorder.Mike Richards, DVM
Skin problem in Bull Mastiff
Q: Dear Sir, have a problem with a Bull Mastiff and I am unable to get
a long term answer from a couple of vets. The problem is a skin problem
which starts as similiar to small pimples. These get much bigger and
spread quickly and seem to get infected. They open and leave quite a large
hole. They develop predominantly around the head. "" and gave a cortisone
injection and prescribed antibiotics. This cleared the problem but it
redevelops about every month. We can't afford to keep getting this
treatment. Have you any ideas or alternatives ? Regards
A: Graham
There are several conditions which can lead to skin infections similar to
those you describe. Allergies can lead to secondary bacterial infections or
fungal infections. Immune deficiency problems can lead to secondary
bacterial infections. Both of these conditions would be responsive to
cortisones and antibiotics. Long term control of allergies is best
accomplished with hyposensitization (allergy shots) but these are
expensive, too. If the allergy is food related it may be possible to do
food trials and find the problem. Then eliminating that food ingredient
from the diet will control the problem. We have information on our website
about food trials -- search for "food and trial" or "food and allergy".It is expensive to care for a pet with chronic skin disease in many
instances for precisely the reason you are dealing with. Finding
medications that will control the problem is often possible but they often
can not be discontinued without return of the problem. This is particularly
difficult in big dogs since the medications are given according to size and
cost more for larger dogs.Mike Richards, DVM
Question: Please let me know what the treatment my vet should use for necrolytic
dermatitis. I think that my four year old shepherd has it. He gets this
hard small, dark bump on his leg and he licks at it until it breaks
open. In the beginning it looks like a dark hard mole. After he licks it
off a wound develops, it heals , goes away for a while, and then the
hard dard mole reappears. This usually takes a couple of months.
Thanks for the info.Nanette
Answer: Nanette-
While it is impossible to be sure without seeing your dog, I think it is
unlikely that the lesion you are describing is a case of necrolytic
dermatitis. This is usually seen in conjunction with liver disease,
diabetes or glucagon producing pancreatic tumors.In the case of a solitary lesion I think I'd be most tempted do a biopsy
and explore the area a little while I was doing it to rule out a foreign
body trapped under the skin but your vet has the advantage of being able to
see this lesion and is in a better position to recommend diagnostic and
treatment alternatives.Mike Richards, DVM
Question: Dear Dr. Mike,
I have a 2.5 year old male Great Dane, Ike, who was born in Australia in a farm. No need to say he is very important for me. I work with an American women's group in Istanbul to help stray dogs. 3 months ago I adopted 2 puppies from different litters. One was very healthy and the other was about to die when I found him and his siblings which we couldn't save. The puppy was diagnosed with distemper and parvo and he also had mange. Thanks to our vet's efforts he recovered after a long treatment. His mange treatment started after his recovery from both diseases as the vet didn't prefer to put too much work on his immune system. Once the vaccinactions of the other puppy were completed, I had to bring him home and we tried to keep him separated from my Great Dane and the puppy. Unfortunately they both contracted mange from him. The healthy puppy had localized demodectic mange with only one patch on her front leg and the other one had generalized demodicosis with several patches all over his body. They had ivomec injections and mitaban dips whilst Ike who weighs 55 kgs was orally given 3cc ivomec daily and had two mit