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My 6.5 year old German Shepherd is constantly itchy. Part of…

My 6.5 year old...

My 6.5 year old German Shepherd is constantly itchy. Part of the problem, I think, is that he generates static everywhere he goes in the house as it's winter here in Northern Ontario and is very dry. This usually occurs during the winter months, but this year is different. I noticed a bald spot on his left hind leg where he is constantly biting. I also discovered today that he has crust on the inside of his left ear and that ear is very sensitive.

Veterinarian's Assistant: I'll do all I can to help. Strange behavior is often perplexing. I'm sure the Veterinarian can help you. What is the dog's name?

Zeus

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

He is allergic to beef/pork/chicken. He was diagnosed by trial and error of individual protein foods as a puppy

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Answered in 1 minute by:
3/28/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,800
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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I'm sorry to hear of this with Zeus. I believe that he's causing a pyotraumatic dermatitis ("hot spot") by incessant biting at his left hind leg and that the inside of his sensitive ear indicates a reactive ear - one that has inflamed and likely is secondarily infected due to a more systemic allergy such as the food intolerance you mentioned. The hot spot can be addressed both topically by cleansing the skin with an over the counter antimicrobial shampoo containing chlorhexidine and then sprayed with an over the counter product containing an analgesic (benzocaine, lidocaine) and glococorticoid (steroid) such as hydrocortisone. Zeus's vet has more potent products for your puproses. The ear needs to be checked by his vet. A cytology (microscopic exam of a small sample of affected ear surface) is checked for abnormal numbers of both bacteria and yeast and then treatment is predicated upon findings in the cytlogy.

I'm going to post my entire synopsis of the itchy dog for you. There are quite a few consideration in dogs such as Zeus so please take your time perusing the synopsis and then return to our conversation with additional questions or 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.

Zeus's vet can check a sample of his 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 his 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 Zeus's rib 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 Zeus'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 Zeus'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 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. Dryness does predispose to pruritis. Static electricity is unlikely to cause pruritis.

You also have the option of having a specialist veterinary dermatologist (please see here: www.acvd.org) attend to Zeus. You can expect some combination of skin scrapings, cytology, bacterial culture and sensitivity, fungal culture, skin biopsy, intradermal or blood allergy testing, or presumptive hypoallergenic diet trials to be performed.

Please respond with further questions or concerns if you wish.

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Customer reply replied 3 months ago
Thank you for your time and response. I will consult his vet for further information.

You're quite welcome. 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.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,800
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Thank you for your kind accept. I appreciate it.

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Hi,

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

Dr. Michael Salkin
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