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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 27398
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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She's a Pomeranian and she constantly itches and scratches

Customer Question

She's a Pomeranian and she constantly itches and scratches and always hiding under the bed when I try to calm her down she doesn't know how to relax. It was my Sister's dog and she was always crated. She has anxiety and she licks uncontrollably
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: She doesn't have fleas and I think she's 2 or 3 yrs. old. Her name is Halo
JA: Is there anything else important you think the Veterinarian should know about Halo?
Customer: No. Other than that she is highly hyper and anxiety
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: 10 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 10 months ago.

It sounds as if she suffers from both a behavioral and medical problem. It's important that a medical problem be satisfactorily addressed before behavioral retraining/reconditioning is attempted.

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.

Her vet can check a sample of your Pom'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) plus antimicrobial shampoos containing either chlorhexidine or benzoyl peroxide and yeast is addressed with ketoconazole plus shampoos containing either ketoconazole, miconazole, or clotrimazole for at least a month.

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 her 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 egg hatches are common. If the area between the edge of her 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.

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 (maximum dose of 50 mg at any one time) 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 her 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 her 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 her. 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.