That looks pretty uncomfortable. When I see a dog with skin disease like that, I always warn them it may take a bit to work through to figure out what it is and what works. That it can be frustrating for all involved. So many of the skin diseases can look the same and often, and likely in Wallace's case, they have a secondary skin bacterial infection from the scratching. The bacterial infection is itchy by itself, which compounds the whole issue. There are many different potential causes, I will discuss several of the most common, but it won't be an all inclusive list. A recheck with your vet is definitely warranted at this time. Antibiotics for the secondary infection are needed. My typical initial work up involves things like a skin/scrape pluck- to look for mites. I check for both demodex mites and sarcoptic mites. It isn't common to see demodex in a dog that old, but if I find them, there is likely an underlying immunosuppression issue ongoing. Sarcoptic mange can be spread from animal to animal and sometimes to us. I also look for topical yeast infections with an impression smear. Yeast infections are very itchy and treated with anti-fungal medications. After I've ruled those out, I start to think about environmental allergy. There is a newer drug out for allergies in dogs called Apoquel. It works very well. I'll often combine that with an antibiotic initially. Antihistamines often help in allergy dogs, but in many it isn't enough to use them by themselves. Like I said, there are other skin diseases that can look like this, I've hit on some of the more common things we see. I'd recommend doing a recheck exam with your vet to start to work through the different things it could be and get Wallace more comfortable. On occasion, we'll even need to do something like a skin biopsy to figure out what is going on. While it doesn't look like a classic flea issue, making sure he is covered with a flea product that kills the flea before it bites him is also important.
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