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My cavalier is 11 years old. Over the last year or so he has

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My cavalier king Charles is...
My cavalier king Charles is 11 years old. Over the last year or so he has been scratching and biting himself to the point where he is losing fur and has scabs and red skin. We have tried prescription shampoo flea treatments ( he did have fleas but they have been gone for months now and we treat him regularly). The vet gave him a tablet but once the course of tablets finished he just started up again. It's driving me and him to distraction and I have no idea what is wrong. The vet said it isn't mange and probably just allergies. I feed him dry food for sensitive skin (vets kitchen) and I just want it to stop. I'm embarrassed to take him places as I must look like a bad owner. Please help!
Submitted: 2 years ago.Category: Dog Veterinary
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Answered in 44 minutes by:
11/27/2015
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 years ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 31,799
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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I'm sorry to hear of this with your CKC. Can you tell me, please, which medication was in that tablet? I suspect that is was a steroid such as prednisone which usually addresses skin allergies well but if a secondary bacterial or yeast infection has arisen, your dog's itching will return as soon as the prednisone wears off. Can you upload a photo of representative skin to our conversation? You can use the paperclip icon in the toolbar above your message box (if that icon is visible) or you can use an external app such as imgur.com or dropbox.com. I can be more accurate for you if I can see what you're seeing. I'm going to post my synopsis of the itchy dog for you. Please peruse it and then return to our conversation with additional information, questions and concerns if you wish.

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.

Your dog's vet can check a sample of your dog'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 your dog'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 or you turn on heaters 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. I'm pleased to hear that fleas no longer appear to be a problem.

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 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 your dog's vet. Oclacitinib works as well as a steroid without a steroid's adverse effects.

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 your dog'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 his 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.

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. I understand your frustration but a thorough and methodical approach to such a dog should be very helpful. If your vet isn't wiling to properly "work up " your CKC, please consider having a specialist veterinary dermatologist (please see here: www.acvd.org) take a look at him.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 years ago

Thank you! When the ventrum (underneath) is so affected, atopy is most likely. There appears to be a secondary pyoderma in the abdominal skin which would explain why he starts scratching as soon as a steroid wears off. If I'm correct, 3-4 weeks and 1 week past clinical signs of an antibiotic in the cephalosporin class such as cephalexin should be helpful. Bathing in an antimicrobial shampoo twice weekly containing either chlorhexidine or benzoyl peroxide should hasten resolution of any infection.

I have to leave my computer for a few hours but promise to reply as soon as I return if need be.

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Customer reply replied 2 years ago
Thank you. I'm not sure if you are in the states or UK but I'm UK. Is there anything I can get over the counter to help?
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 years ago

The shampoos should be able to be found in pet/agricultural merchant stores or at your vet hospital but the antibiotic is by prescription only. Please continue our conversation if you wish.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 2 years ago
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
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