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Dr. Joey
Dr. Joey, Board Certified
Category: Dog Veterinary
Satisfied Customers: 4723
Experience:  15 yrs in practice, specialist canine/feline medicine
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I have a Maltese who keeps breaking out in this rash all

Customer Question

Hi I have a Maltese who keeps breaking out in this rash all over his body. I have changed his food and got him An allergy test and avoiding everything he is allergic to but he keeps breaking out. I'm tired of putting him on steroids and an antibiotic it's only a temp fix
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Dr. Joey replied 2 years ago.

Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 15 years of experience. I look forward to working with you.

This is a tough situation, and unfortunately common. In a dog like Link with documented atopic dermatitis (environmental allergies) plus possible food allergies, there are some longer term solutions that you should discuss with your veterinarian (or veterinary dermatologist). One is to put him on Atopica daily. This medication is remarkably successful and many dogs after the initial 6 weeks loading dose can do to an every other day dosing. The drug is sometimes expensive, and there are ways to mitigate this such as combining administration with ketoconazole, which potentiates the drug (or makes it stronger). You can have your vet price it out. IT does require some long-term blood monitoring (done 4 weeks after start and then every 6 months or as directed by your veterinarian) as there are possible side effects, but most dogs do great on this. Let me mention the generic formulations of this medication (cyclosporine) do NOT work in dogs; they are not absorbed well out of the digestive tract, and it is cost prohibitive to do blood testing to see what his blood level is of the drug and then determine how high we can go, if a generic formulation is tried.

Another possible treatment is to do immunotherapy or allergy shots, which can be specifically formulated based on the submitted allergy test. This takes about 9 months to work and must be used for at least 9-12 months before we can say it didn't work. There is an 80% success rate with this therapy. OF course, during the initial 9 months there is a high chance he will continue to have relapses of skin infection.

Finally, another long term solution is Apoquel. However, this drug is on backorder and unless your vet is one of the special vets that can actually get the drug from the company, you probably do not have this as an option for another 6-12 months, but it is a daily drug that works like the steroid without the side effects. We're very excited to have this on the horizon but frustrated it's been on backorder for 2 years.

In the shorter term you should continue your routine bathing (at least every 7 days) in a medicated shampoo (like Malaseb or Douxo Chlorhex), and daily antihistamines and daily omega-3 fatty acid supplement. These all help reduce itching long term, and if not using any then ask your vet and get on them.

I agree the antibiotic or antifungals are short-term fixes in dogs with severe chronic allergies, but they are necessary any time he has sores. So, if he is again broken out, then you need to call his vet and get back on the drug while discussing a next step. If your vet seems stumped by him and not offering these solutions I mentioned, then please please please ask for a referral to see a dermatologist ASAP.

I am at a point I need to know what questions you have. We can continue our dialogue in this setting.

I hope that the information I provided has been helpful.

Please remember to select REPLY TO EXPERT if for any reason you need further clarification, have more questions, or were expecting a different type of answer.

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Expert:  Dr. Joey replied 2 years ago.
Hi Stef,
I'm just following up on our conversation about Link. How is everything going?
Dr. Joey