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I would like to help you and your dog but need a bit more information in order to better assist you.
Where on his body are these hot spots?
What was the name of the medicated bath?
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You have described to me a 6yr old Anatolian Shepherd with a few "hot spots." A hot spot is the common name for "acute moist pyoderma" which is a type of skin infection.
Let me explain more about how this happens...
There are commonly yeast and bacteria living in small numbers on the skin surface. When a dog starts chewing or scratching at one spot, she opens up little scratches in the skin surface, and the yeast and bacteria invade there. The fur stays wet from oozing serum from the scratches, and this keeps the area moist and warm - just the kind of place that bacteria like to grow!
As the bacterial numbers increase, the scratches get infected and ITCHY! The dog scratches more... and soon a large area of red, raw, weeping infection can occur.
More about hot spots:
And here is a photo of a dog with a hot spot:
Treatment involves shaving all the hair in the affected area (as shown in the above photo) - which is often quite large. This allows the skin to dry out.
Antibacterial washes are usually used on the skin and antibiotics (usually for 2-4 weeks) may be given by mouth. If it is very inflamed and itchy, a short course of corticosteroids would likely be used to give the dog relief and stop him from scratching and thus exacerbating the problem.
You may be able to treat this by washing the area with an antibacterial soap. One example would be chlorhexidine scrub (which you can get at pharmacies off the shelf in Canada and the USA). Your pharmacist would be able to suggest an antibacterial soap if you don't see this one. It is often called Hibitane.
I suggest people wash small areas of pyoderma 3 times daily for 3 days. Scrub hard to get that scaley, scabby material off it. Rinse well. Pat dry. You can apply corn starch to keep it dry. Then continue to wash twice daily for 4 more days. Watch VERY closely that there are no more patches coming up.
If your dog is very itchy, then when I have clients phone me after hours about this, for patients that I have seen, I advise the people that they may be able to give their dogs BENADRYL (diphenhydramine). This should not be given if the dog has glaucoma.
I ADVISE OWNERS TO MAKE SURE IT IS PLAIN DIPHENHYDRAMINE WITH NO OTHER INGREDIENTS.
The dose that one generally gives is 1mg/lb.
It comes as 25 mg tablets, and if he is 85lbs, his dose should you choose to use it would be THREE and a HALF TABLETS. This can be repeated every 8 hours for 24-36h.
Here is more about Benadryl:
You should see improvement (less itchy and a bit sleepy) within 30 minutes.
If this is not improving, then you may need to see a vet to get a prescription for antibiotics for your boy!
Now, in terms of WHY your boy is developing hot spots, when I see dogs with these happening repeatedly, I do start to wonder about underlying allergies.
If your boy has allergies, it could be to something in his food (eg corn, beef or OTHER things), to insects biting him, or most commonly to atopy, which is an inhalant allergy.
Dogs with allergic dermatitis can be VERY itchy and often need long term corticosteroids or immuno-suppressants like prednisone or Atopica in order to relieve the itch.
Here are some links to further information about allergic skin diseases in dogs:
http://www.petplace.com/dogs/allergic-dermatitis-in-dogs/page1.aspx Dogs with atopy can be allergic to not only dust mites, but also to various plants that may be pollinating at various times. It is often very useful to keep a diary with an "itchy" rating in it to be able to determine what times of year it is worse. I'm not sure what plants you have pollinating now where you are, but it is really helpful to keep a journal. Here are some links to further information about atopy: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=597 http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=599 http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1535 http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=652 So, when I diagnose a patient with atopy, I always start by warning people that we CANNOT CURE this! The best we can ever hope for is to control it. Anything that can be done to decrease his allergic tendencies should be done, and lots of little things may start to have a big effect. What I suggest for dogs with atopy: 1. Bathing It can be soothing to give your boy a *cool* bath in the tub, and apply a soothing colloidal oatmeal conditioner (I used Aveeno colloidal oatmeal treatment on myself and was suprised how much relief I got from it) Here is one example of a Conditioner:
http://www.calvetsupply.com/index.asp?PageAction=VIEWPROD&ProdID=373 After bathing, towel dry gently, and then keep him in a warm room snuggled in the towel so that you don't need to blow dry him at all.
2 Antihistamines If your boy were my patient, I would evaluate him for being a candidate for being on antihistamines year round. They are safe in the majority of patients, and although they don't stop the itching the way prednisone, temaril-P or Atopica does, they do "take the edge" off and make future flare-ups less severe.
As with humans, some dogs do better on one type of antihistamine, and not on others. Often, we have to try a few different ones, giving each a trial of several weeks before knowing whether it helps, and before moving on to another. Common anti-histamines we use in veterinary medicine are Diphenhydramine (Benadryl here in Canada), chlorpheniramine and hydroxyzine. Here is more about each, including dose: http://www.petplace.com/drug-library/diphenhydramine-benadryl/page1.aspx http://www.petplace.com/drug-library/chlorpheniramine-maleate-chlor-trimeton/page1.aspx http://www.petplace.com/drug-library/hydroxyzine-atarax-anxanil-vistaril/page1.aspx With anti-histamine use it is really important to use them at the recommended frequency as they help PREVENT itchiness, but don't do as much at stopping it once it has started.
3. Essential Fatty Acids Again, if he were my patient, I would put him on a dietary source of essential fatty acids (Omega 3 and Omega 6 fatty acids) daily added to the food. Your vet would be able to provide these for you - some brands are DermCaps and EFA-Z.
You could use a combination of evening primrose oil (for Omega 6 fatty acids) and fish oil (for Omega 3's). Extra strength fish oil is most useful - it provides approximately 600mg of combined EPA and DHA per capsule. You can find a listing of companies that make such a thing here: www.nasc.cc. The omega-6/omega-3 ratio should be 5 to 10. Here are some examples of combined Omega 3 and 6 fatty acids: http://www.1800petmeds.com/Derm+Caps-prod10062.html http://www.vetrxdirect.com/product/view/ALLERDERM-EFA-Z-PLUS
4 Air filter I would also consider getting a HEPA filter for your house. In Canada, you can get these at hardware stores. For $100 - $300 (depending on the amount of space you want to have filtered) it removes tiny dust particles from the air, which is another thing to help your dog a bit. Make sure that there are no pollutants in his environment. Avoid cigarette smoke, fireplaces, incense, hair sprays, air fresheners and other things with small particles that can be inhaled.
5. Quercetin This homeopathic remedy works to inhibit mast cell's participation in the manifestation of allergy signs. This is similar to the way antihistamines work in Western medicine.
I have not used this myself, but my colleagues have used it and recommend it to "take the edge off" and allow you to reduce the Temaril-P. The vets I know who use it give 400mg three times daily in medium to large dogs that have severe signs.
6. Vitamin E This can also be helpful when added in. The dose I use is about 5-10 IU per lb daily. So, in an 85lb dog, that would work out to 425 to 850 IU per day. You can purchase this at any pharmacy.
7. Probiotics If your dog were my patient, I would put him on a probiotic. They are very safe and help a lot of dogs! It just helps to promote the growth of "good" bacteria and reduce the "bad" bacteria in a natural and safe way. This can help to decrease stimulation to the immune system.
You can use FortiFlora products which are available from your veterinarian, or you can use Culturelle which is available at pharmacies in the USA. For the Culturelle, an 85lb dog would get 1-2 capsules daily sprinkled on the food. Here are links: http://www.dogbuffs.com/purina-fortiflora-probiotics-dogs-cats www.culturelle.com
8. Limited antigen diet Your dog may be allergic to things he is EATING as well as things he is inhaling. Because it is hard to know WHAT he may be allergic to, you may wish to discuss with your vet changing the food so he is on some different protein sources. If he has been eating beef, then switching to something that does NOT contain beef is a good idea. This could be fish, seafood, or anything else novel (rabbit, venison, duck, etc). ***In order to know that he cannot be allergic to it, the protein has to be one that he has never had before!*** There is nothing magical about any one protein source, it just has to be something that he has not had before. So, you have to check ALL the foods he has previously eaten and make a list of all the proteins he has been exposed to. Then you have to find a food that has NONE of those in it. Also, he can have no other sources of food or treats (rawhides, chew toys, not even PB) while he is on the elimination diet – which is for 8 – 12 weeks! I strongly recommend a home-made diet so you know exactly what it going in to it. The site, www.balanceit.com , has a section where you can get custom balanced recipes easily for your adult pets. You can put in the promotional code HOMEMADE at checkout and the recipe will be free. Just choose a recipe with a meat that your boy has never had before (goat? rabbit? venison?) and use that to make the food. When you get to the payment/invoice type window, zero out the bottles of supplements (if you're going to buy them elsewhere), put the promo code in, and hit the "apply" button next to it. Then your invoice will recalculate and go down to zero if you only have one recipe there. You can continue on through the process without entering any payment info from there, and it will take you to the recipe for the pet you entered. Finally, all home recipes for dogs need supplementation with essential fatty acids, calcium, phosphorus, potassium, vitamins, and minerals. The amounts of these are totally dependent on the animal and the base diet. There is no universal "supplement" that covers everything appropriately. If you do not feel up to making a home-made food, then another option would be a "hydrolyzed" protein food. These are available only through a vet. The idea with this is that the protein is broken down so that the immune system can no longer recognize it. So, to the immune system it is no longer a protein, and (theoretically) the body cannot become allergic to it. These are fairly new in veterinary medicine (just a few years old) and so far, I have not had dogs become allergic to it, so I am crossing my fingers! Your vet would have a number of different brands of prescription foods that have these “hypoallergenic” diets containing hydrolyzed protein. You could contact your veterinarian to try one. There are prescription foods that your vet could provide that serve this purpose.
One of these is Royal Canin HP food:
9. Acupuncture This has been reported to improve immune function in dogs. Your vet could refer you to a veterinarian trained in this modality. 10. Traditional Chinese Medicine (TCM) My colleagues trained in this area use Tri Snake subsitute from Mayway. **Use the Plum Flower Brand.** Hua She Jie Yang Wan is the Chinese name of the formula from Plum Flower. Here is a link: http://www.chineseherbsdirect.com/hua-she-jie-yang-wan-p-179.html and the company's phone number is(NNN) NNN-NNNNfor the company that makes them. The dose is 6 pills given THREE times daily for a dog that weighs 60lbs or more. Give them a week to work.
11. Herbs There are veterinarian trained in alternative medicine and the herbs that they recommend are yellow dock, sarsaparilla, Xiao Feng San. These are dosed based on size - so an 85lb dog would get roughly 1/2 the dose of a human, I hope that these things will help!
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The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.
Good luck with your dog!