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Doc Sara
Doc Sara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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Maltese dog, age 4, three of s four feet are red and

Customer Question

Maltese dog, age 4, three of his four feet are red and swollen, been to the vet. EVERY week, tests and shots, ALLERGY, but not a thing helps, used foot soaks etc. But they are getting redder ??? Vet suggest I TAKE him to a vet school, I CAN'T do that because of my age and condition. Any suggestions
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Doc Sara replied 2 years ago.

Good afternoon - I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with dogs and cats. I'm sorry to hear that your pup has been having such a rough time with his feet. Chronic issues like allergies can be quite frustrating, as I can tell you're already feeling. There is a pretty straight forward way that most of us approach these types of cases - so I'll give you how I usually handle these. There will be a delay of 5-15 minutes while I type out your response. You can reply at any time with additional questions and we can talk until I've covered them all.

Thanks :)

~Dr. Sara

Expert:  Doc Sara replied 2 years ago.

It's important in a young dog with very severe skin signs to rule out a microscopic mange mite called sarcoptes. A sarcoptic mange infection can look exactly like skin allergies, but it usually doesn't respond well to allergy treatments. Sarcoptes mite infections cause severe itching, redness, and sometimes hair loss and raw spots. upwards of 70% of the time when we do a skin scraping on a dog with sarcoptes we will get no mites, even though they are there. Since it's so hard to detect, I recommend treatment for all of my severely itchy patients or dogs who aren't responding as expected to allergy treatments so far. A common way to treat for sarcoptes is with a prescription called Revolution, which is a spot-on flea and heartworm medication. It does a good job of eliminating sarcoptes mites when dosed every 2 weeks for three doses. I always do this when I have a pet with severe signs who isn't responding as expected to allergy treatments.

The vast majority of itching and paw licking in dogs is caused by allergy. I will start out by saying that allergic skin disease is a life-long condition that can be managed but not cured. It also requires patience and lots and lots of recheck appointments. There is no magic cure for skin diseases - he's going to need to be seen by a vet to tweak his treatment plan and keep him itch free every so often. Often in the beginning the allergy is steroid responsive (ie: gets better with steroid treatment) and they may only flare up once or twice a year, but they get worse as they get older, flaring up more often.

Allergies can cause dogs to lick their paws and scratch in many places on their body. They can also lead them to get secondary infections with bacteria and/or yeast. Any secondary infections that may be going on, as these can make them much much more uncomfortable. Sometimes the majority of their symptoms are actually caused by the infections themselves. Treatment is often accomplished by topical treatments, oral antibiotics, and sometimes oral antifungals. It’s important to realize that it takes 3-4 weeks and maybe longer for bacterial and yeast infections to resolve with appropriate treatment. Beyond that, It’s very difficult to say what a dog is allergic to without a lot of testing.

There are three broad 'flavors' of allergy: flea allergy, food allergy and atopy (allergy to things in the environment like grasses, trees, or pollens).

With flea allergy, the itching and hair loss is centered on the caudal dorsum (the top of the lower part of the back), thighs, rear legs, and hind end. It's accompanied by the presence of at least one flea, usually many. Just one bite can cause an allergic pet to become intensely itchy and develop secondary infections that can perpetuate the itching even after the fleas are gone. Obviously flea allergy doesn't improve until the fleas are controlled. If you'd like more information about flea control, just ask and I'll be happy to provide it.

As for food allergy, pets can become allergic to a diet at any time their lives just like we develop allergies as we age. In order to check for/treat for food allergy, we do what is called a 'food trial'. This is where the pet is fed nothing but a strict hypoallergenic diet. I use Iams Response KO, Royal Canin novel protein or Anallergenic diets in my practice however there are a lot of good diets out there. A pet must be on this strict food trial for 3 months to determine if it's really food allergy. I really recommend a food trial for dogs when I suspect allergy because if you get a good response from the hypoallergenic food, then you can give your pet less drugs in the long run. It’s important to be consistent and not give any treats that aren’t in the diet plan. Anything that goes into his mouth could cause an allergic reaction, so if he eats it and begins to itch it will mask any positive response you will see from the diet trial.

There are a number of treatments for atopy (or environmental allergy). Usually a food trial is performed first before these. A dermatologist or a vet with experience in allergy vaccines can test the pet to find out exactly what they are allergic to and make an allergy vaccine, just like they do in people. This is called allergen-specific immunotherapy. There is also a product called RESPIT, which is an allergy vaccine that combines the most common allergens in a geographic region into a vaccine. In this case we don't test the pet, we use the RESPIT vaccine that has the most common allergens for our location. Some pets can be managed with antihistamines (like benadryl) when all of their secondary infections have cleared up. Some veterinarians (myself included) have had a lot of success with a drug called Atopica. Atopica is a maintenance drug to help prevent allergy flare ups, however it can be very expensive. Another allergy maintenance medication that has great potential is Apoquel, but it is very new to the market and so far extremely difficult to come by.

If trips to the dermatologist and pricey drugs like Atopica aren't an option, many pets do respond positively to treatment with steroids. Steroids are potent anti-itch medicines but they do have long-term side effects. Steroids are great because they are very effective but if used too frequently can predispose your dog to developing life-threatening problems like diabetes. Typically I will use a course of steroids for a first time offender - in the hopes that it was a contact or seasonal allergen that will be out of the air by the time the steroids wear off. I encourage you to discuss the treatment plan with your vet. It’s also never wrong to seek a second opinion if you’re unhappy with your pet’s progress but be prepared that another vet may (or may not) recommend the same course of treatment. There are only so many things that we can do for allergies, so you might hear the same story multiple times. Please let me know what items I can give you more information about an what other questions I can answer for you!

~Dr. Sara

Expert:  Doc Sara replied 2 years ago.
I'm just following up on our conversation about Phillip Marlow. How is everything going?
Doc Sara
Customer: replied 2 years ago.
Expert:  Doc Sara replied 2 years ago.

It's great that you're seeking expert opinions. It's even better that not one but two experts have given you the exact same advice - this should help you decide what to do next. Definitely make sure sarcoptic mange has been ruled out by way of treatment (either with Revolution as I described or by ivermectin injections). Have you tried allergen specific immunotherapy (allergy vaccine)? Have you tried Atopica or Apoquel? If not, I'd talk about trying those next. If you have tried these things and your regular veterinarian doesn't know what to do next, it's absolutely time to see a board certified dermatologist to find out what to do next. Some cases, unfortunately, are so severe that a general practitioner is going to need to call in a specialist for help. What other questions can I answer for you?

~Dr. Sara