I am needing some advice on a dog that I am seeing. Kingston is a 2 year old, male neutered, blonde and white, pit bull mix, rescue. I have been seeing him for a little over a year. When he initially presented, he had very mild and very few papules and pustules he would get on his ventral abdomen and inner thighs. Gentomycin and betamethasone spray helped as did pred, but his owners were concerned with long term use of these. He also had a history of releasing his anal glands. They are never infected or impacted, but they seem to be more "active" at times.
On presentation, he is very bouncy, but can be nervous. His tongue was pink and his pulse is moderate. Maybe a little thin, but not totally off for what I'd expect of a young dog. He had no PU/PD on prednisone, great appetite, no vomiting and no diarrhea. My initial diagnosis was blood deficiency and possibly some dampness, so I started him on Chu shi wei ling tang (Kan Dispel Dampness and Nourish the Skin 1 tablet twice daily). I also advised to add in blood nourishing foods like liver and beef.
He did not improve and actually got a bit worse. It was winter and we had a pretty heavy snow fall (For Ohio) and he was out in it playing quite a bit. His timidity was worse, his anal glands were worse, and his papules were worse. I increased the DDNS to 2 twice daily and rechecked in 2 weeks. The liver made his anal glands worse, but his spots cleared up except for the days following a snow fall. He was dreaming less and his timidity was better.
No changes were made for 2 months and he improved until spring came. I added in 1/2 tablet of Si Miao san (Kan Four Marvels) twice daily. This made the skin worse, made him feel cold and very clingy to the owner. However, the anal glands were better! I had the owner use the FM as needed on rainy days, but he still seemed clingy and sort of anxious on the days he got it, so we eventually discontinued it.
He was not great, but not awful through the summer until November, then his anal glands got much worse- seeping at night. And he now had excoriations on the inner thighs near SP10. I added xian fang huo ming yin and the anal glands improved greatly! However, the skin lesions turned to large, bruised, blistery dermal lesions.
He just had a skin biopsy at his traditional vet that come back as actinic comedone formation and solar dermatitis.
His tongue remains a good pink and his pulse is mostly normal! Any ideas??
Thanks!