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My dog has an offensive odor, I have given her Ketoconazole…

Customer Question
My dog has an...

My dog has an offensive odor, I have given her Ketoconazole 200 mg 1/4 of a pill and when she took her last was on Friday and yesterday the odor started coming back. Now what do I do???

Veterinarian's Assistant: I'll do all I can to help. What is the dog's name and age?

Khloe and she is 10 years old.

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Khloe?

This odor has only come in the last year

Submitted: 5 months ago.Category: Dog Veterinary
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Answered in 14 minutes by:
12/17/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 5 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 33,795
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 5 months ago

I'm sorry to hear of this with Khloe. Has she been diagnosed with a skin infection with yeast (Malassezia)? If so, when addressing this infection any underlying cause (allergies, endocrinopathy (hormonal disorder such as hypothyroidism), or keratinization defect (as seen with seborrhea)) must be identified and corrected.

For mild cases, topical therapy alone is often effective. Khloe should be bathed every 2-3 days with shampoo that contains 2% ketoconazole, 1% ketoconazole/2% chlorhexidine, 2% miconazole, 2% to 4% chlorhexidine, or 1% selenium disulfide. Shampoos that have two active ingredients provide better efficacy. Treatment should be continued until the lesions resolve and follow-up skin cytology (microscopic exam of a small sample of Khloe's skin surface) reveals no organisms (~4 weeks).

The treatment of choice for moderate to severe cases is ketoconazole or fluconazole at 10 mg/kg orally with food every 24 hours. Treatment should be continued as stated above.

Alternatively, treatment with terbinafine at 5-10 mg/kg orally daily or itraconazole (Sporanox) at 5-10 mg/kg daily for a month may be effective.

The prognosis is good if the underlying cause can be identified and corrected. Otherwise, regular once- or twice-weekly antiyeast shampoo baths may be needed to prevent relapse.

If Khloe has been diagnosed with seborrhea and yeast is a secondary infection. You'll need to know the following:

Clinical signs of seborrhea may include a dull, dry, lusterless hair coat, excessive scaling (dandruff), follicular casts, scaly and crusty seborrheic patches and plaques, and greasy, malodorous (often described as the odor of dirty gym socks) skin. Most of the body is involved to some degree, with interdigital areas, perineum, face, axillae, ventral neck, abdomen, and skin folds usually most severely affected. Pruritis (itchiness) is mild to intense, and ceruminous otitis externa (oily external ear canal inflammation) is common. Secondary skin and ear infections with bacteria and Malassezia (yeast) are often present.

I can appreciate how frustrating Khloe's care must be for you. I don't know everything you've tried so I'll list a primer for treatment and prognosis for you to peruse.

1) Ensure good nutrition. A commercially balanced dog food that meets AAFCO requirements should be fed. You should find the AAFCO statement on the food label.

2) Any secondary bacterial and Malassezia skin and ear infection should be treated with appropriate topical and systemic therapies. Periodic treatments or long-term, low-dose maintenance therapy may be needed because these dogs are susceptible to recurring infection.

3) For symptomatic control of ceruminous otitis, long-term maintenance ear care is necessary. Ear treatments with a multimodal therapy (consult with Khloe's vet) or ear cleaner should be administered to both ears every 1-7 days to control cerumen (wax) accumulation.

4) For symptomatic control of seborrhea, antiseborrheic shampoos and emollients may be used every 2-7 days until the skin condition is improved (~2-3 weeks), then, bathing frequency should be decreased to every 1-2 weeks or as needed for maintenance. Antiseborrheic shampoos contain some combination of sulfur, salicyclic acid, tar, benzoyl peroxide, and phytosphingosine.

5) Daily oral fatty acid supplementation may be helpful as an adjunct therapy (180mg EPA/10lbs). EPA is thought to be the most antiinflammatory of the essential omega-3 fatty acids. It's plentiful in fish oil supplements.

6) Vitamin A 8000-10,000 IU per 20lbs orally administered with a fatty meal every 24 hours. Improvement should be seen within 4-6 weeks.

7) For dogs with severe, greasy, malodorous, pruritic seborrhea, treatment with systemic corticosteroids may be helpful. Acitretin (a retinoid) may be helpful in some dogs. Calcitriol (vitamin D) may be helpful in some cases.

The prognosis is variable, depending on the severity of the seborrhea. This is an incurable condition that requires lifelong therapy for control. Please respond with further questions or concerns if you wish.

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Customer reply replied 5 months ago
Thank you so much for your help. I am worn out because this was not a problem years ago. Khloe is one of the sweetest little girl you would ever have and I have to get this resolved. Thank you again, respectfully ***** *****
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 5 months ago

You're welcome, Diana. There a lot of information there so you might print it out and peruse it at your convenience. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 5 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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