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15 yr old Golden has pulled almost all of her hair off her…

Customer Question
15 yr old Golden...

15 yr old Golden has pulled almost all of her hair off her lower half of her body

Veterinarian's Assistant: I'll do all I can to help. What is wrong with the dog?

She is always scratching too

Veterinarian's Assistant: Where does the dog seem to hurt?

Very bad rear hips also, having more and more difficulty walking

Veterinarian's Assistant: Have you looked to see if there is a wound on their foot?

She is constantly pulling her hair out o her skin

Veterinarian's Assistant: What is the dog's name?

Roxxy

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Roxxy?

Not really, other than her old age this hair pulling-out has been going on for several months

Submitted: 8 months ago.Category: Dog Veterinary
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Answered in 9 hours by:
12/6/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,474
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago

I'm sorry that your question wasn't answered in a timely manner. I'm going to post my entire synopsis of the itchy dog for you. Please pay particular attention to a flea saliva allergy which usually manifests on the lower half of the body...

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.

Roxxy's vet can check a sample of Roxxy'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. Mites are addressed topically, orally, and by injection.

Our dermatologists tell us to apply an over the counter flea spot-on such as Advantage/Advocate, a fipronil-containing product such as Frontline or, preferably, one of the newer prescription products available from Roxxy's vet to which fleas are less likely to have become resistant 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. If the area between the edge of herrib 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 (steroid) 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 Roxxy's vet. Oclacitinib works as well as a steroid without a steroid's adverse effects. The new injectable immunomodulary drug IL-31 (Cytopoint) should also be considered. 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 Roxxy'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 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.

Please respond with further questions or concerns if you wish.

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Customer reply replied 8 months ago
The primary issue is not the scratching, but rather the fact she has pulled all the hair out of the lower 2/3 of her body
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago

The primary issue is that she's pruritic (itchy) which is prompting her to pull out her hair. We also see this behavior when there's a painful area underneath the skin but that would be an unlikely scenario when such a large area of skin is affected. Please continue our conversation if you wish.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin
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