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Chronic Dermatitis

by ROBINSON - June 4, 2009

I have been trying to treat a dog with suspected allergic dermatitis. I first saw Maceo in February 2009 after a severe hot spot encompassing the right lateral shoulder. He originally was treated by rdvm with c-roids and antibiotics, which resolved the acute condition but there is still a focal lesion on point of shoulder and right lateral shoulder is still pruritic. When I first saw him I diagnosed him with blood deficiency because he had a needy/slightly anxious personality, a slightly pale tongue and wiry/tense pulses. I started him on si wu xiao feng yin. Two weeks later, the owner reported slight improvement in pruritis and size of lesion. Another two weeks later, owner reports that condition getting worse again - increased pruritis and wound increasing in size. Now, his tongue appears light pink/lavendar and pulse was soft and slippery?? Two weeks later, he developed a hot spot in inguinal region as well. He was started on a 3 week course of antibiotic with only mimimal improvement. He just had an excisional biopsy of the focal, nonhealing wound and surrounding tissue. The biopsy result was superficial ulcerative dermatitis with secondary granulation tissue, dermal fibrosis and adnexal hyperplasia = chronic allergic dermatitis. There is no evidence of neoplasia, fungal or parasitic disease.
Help, the owner( and myself) are very frustrated.

Thanks Wendy

by naturevet

June 6, 2009

Hi Wendy,

An initial response to a Blood tonic in a skin case, followed by a worsening again, suggests the next formula needs to address the Spleen. Once the deficiency in Blood was 'topped up', continued use of it rehydrated Damp. The only way we can explain both as present in the same animal is if they were Spleen deficient. Spleen deficiency is the common origin of both problems.

There are several Spleen formulas to choose from for the skin patient. When the inflammation is fairly significant (creating ulceration) and the pulse is superficial and slippery, then Si Miao San is not a bad thing to try next. To avoid drying the patient out again, you could try adding about 20g of Dang Gui to SMS. To start with, though, you could just get going with the formula with no additions, and confirm the thinking is correct. If we're on the right track, you'll see some improvements over the next couple of weeks.

Hope that helps!

Steve

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