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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24410
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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She scrat scratches her whole body all the time and it's the

Customer Question

She scrat scratches her whole body all the time and it's the worst right after she goes to the groomers
JA: I'm sorry to hear that. Using the wrong medication for fleas can be dangerous. You should definitely talk to the Veterinarian. What is the dog's name and age?
Customer: Her name is ***** ***** a Shih Tzu and she does not have fleas I have two other Shih Tzus besides her and I can't no one has fleas at my house for sure
JA: How old is Honey?
Customer: 7
JA: Is there anything else the Veterinarian should be aware of about Honey?
Customer: She's got an all black coat which is rare I've heard for Shih Tzus and her hair is like heavy so her ears are constantly getting yeast infections because of the moisture even if I clean them and put medicine in them it never goes away
JA: OK. To minimize me, please click the down arrow at the top right corner of this box.
Customer: K
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Veterinarian about your situation and then connect you two.
Submitted: 6 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 6 months ago.

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer.

Customer: replied 6 months ago.
Hi I'm sorry it's my first time on here so I'm not exactly sure how to how did do everything in where the talk to people and how to get answers and where to get them
Expert:  Dr. Michael Salkin replied 6 months ago.

I’m sorry to hear of this with Honey. Pruritic (itchy) dogs are suffering from an allergic dermatitis in the great majority of cases. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw and extremity licking indicates both atopy and a food intolerance and so it behooves vets to distinguish one from another.) In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be contributory.

Honey's vet can check a sample of Honey's skin surface microscopically (a “cytology”) for abnormal numbers of bacteria and yeast and skin scrapings can be taken in an attempt to find mites. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) and yeast is addressed with ketoconazole for at least a month. We know that her ears are yeasty. We musn't overlook that the rest of her skin may be yeasty as well.

Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage/Advocate, a fipronil-containing product such as Frontline or one of the newer prescription products available from Honey's vet even if fleas aren’t seen. Dogs can be such effective groomers so as to eliminate all evidence of flea infestation. Dogs who remain primarily indoors can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. As the weather warms at this time of year, egg hatches are common. If the area between the edge of Honey's rib cage and tail (the “saddle” area) is particularly excoriated, a flea saliva allergy should be the most important differential diagnosis. In severe cases, an anti-allergenic prescription glucocorticoid such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas too but may not be allergic to the flea’s saliva. Of course, I hope you're correct that we don't have to consider fleas.

Environmental allergies (atopy) are usually initially addressed with prednisone as well. In some dogs an over the counter antihistamine such as clemastine (Tavist) at a dose of 0.025 - 0.75mg/lb twice daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily may be effective. Antihistamines, however, aren’t reliably effective. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are antiinflammatory but may take 8-12 weeks to kick in. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with Honey's vet. Oclacitinib works as well as a steroid without a steroid's adverse effects. Please note that atopy, at least initially, should have a seasonality to it while a food intolerance should cause pruritis regardless of the season. Chronically atopic dogs may be pruritic year round.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Honey's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. (I prefer the hydrolyzed protein diets because it avoids the possibility of my patient being intolerant to even a novel protein.) A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

We need to consider seborrhea in such a patient as well. This is skin disorder of keratinization and maturation. It's a diagnosis of exclusion of the above mentioned skin disorders and can be suggested by skin biopsy.

You also have the option of having a specialist veterinary dermatologist (please see here: www.acvd.org) attend to Honey You can expect some combination of skin scrapings, cytology, bacterial culture and sensitivity, fungal culture, skin biopsy, intradermal or blood allergy testing, or presumptive hypoallergenic diet trials to be performed.

Please respond with further questions or concerns if you wish.

Customer: replied 6 months ago.
Ok was only looking to see how Mark Benadryl I could give my dog and something popped up and I was talking to the first lady and before I know it she doesn't need to use a bunch of other people that answer me and basically you're telling me nothing except ever go see if they have their skin test it will thank you but do you have already thought of that years ago and I know she doesn't have fleas because she was just at the vet for her ears and she goes to a groomer that would definitely notice if she had three and the other two Shih Tzus don't scratch it off it doesn't scratch at all so you're telling me she's got fleas butt I know it's most likely a food allergy but I can't get her to eat the right kind of food so I wanted to give her Benadryl and now I've spent over $20 on all these answers telling me what I already know and can't do anything like prescribe medication for me so I basically wasted my money thank you sorry for being blunt but