Aloha! You're speaking to Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner and I regret that I'm not allowed to correspond with customers by phone. It's difficult for me to ascertain the etiology of Molly's pruritis (itching) from here and so I'm going to post my entire synopsis for the pruritic dog which also includes a section on food intolerance. Please review the synopsis and then return to our conversation with additional information and further questions or concerns if you wish...
I’m sorry to hear of this with Molly. 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 which might be causing those pieces of hair to come off), yeast infection
(Malassezia), or mange mite (Demodex or Sarcoptes) might be contributory.
Molly's vet can check a sample of Molly'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.
Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage, a fipronil-containing product such as Frontline or one of the newer prescription products available from Molly'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. 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 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 reliable. 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 Molly's vet.
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 Molly'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.) 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.