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Chronic Skin And Allergies In A Dog

by lvanharen - September 1, 2017 View Case Report

Linna is a 3.5yr old Presa Canario that has been on 2.5mg pred daily for chronic pruritis/suspected atopy (sometimes increases to BID during bad spells). She has flare ups every 1-2 months that last a week or two. Without pred she will scratch till she bleeds. Owner feels the low dose of pred resolves her itch about 90%. She is worse first thing in the morning and when she gets excited/happy. Although I did not see her when she was off pred, pictures of her without pred showed alopecia, papular rashes in the armpits, craniomedial thighs, around neck and behind the ears. Currently she chews at her feet between her toes and pads and scratches at her muzzle. Recurrent otitis with thick brown-black discharge also occurs.

Linna was adopted at 3.5 months and O described her as emaciated, very pruritic and was alopecic around her eyes. She started prednisone at about 4 months of age as well as a raw diet. She tried various homeopathics with no success but was well managed on herbs (SWXFY + Yin Chiao) when she lived in British Columbia for a period of 3 months. Since moving to Ontario, there has been very little success with herbal management. She has tried Si Wu Xiao Feng Yin + Yin Chiao. Xiao Yao San, Qing Ying Tang and Wind Toxin, Si Wu Tang, Long Dan Xie Gan Tang, Body Sore and Si Miao San with no success.

Owner describes her as a bossy, hot dog that seeks heat and softness. She is a very reactive dog that barks a lot. She was spayed last year when she became unpredictably aggressive during her heat cycle (she does have aggressive tendencies). It was only her second heat cycle as she has not had regular heat cycles. Post spay, she had an infection that was treated with antibiotics. She developed a fever and went off all food while on antibiotics. She tends to wake up each night around 2am to scratch. She snores and sounds very congested when she lays down.

Since I started to see her this spring, we have tried Long Dan Er Miao San by itself and San Ren Tang + Dang Gui Yin Zi. With each formula Linna becomes more itchy. When her owner reduces the dose to 1/8tsp she improves significantly for a few days before becoming itchy again. She does have mild infections with bacteria and yeast on her feet and muzzle which we are attempting to treat topically with Dermoscent Pyoclean shampoo for now as owner reports that Linna has tolerated antibiotics very poorly in the past.

At her last recheck, when we did the cytology, her pulse was rapid, a little deep, a little wiry and slippery and weak. Her tongue was dark pink with purple center and very moist. She is gaining weight steadily with a BCS of 4.5/5 and her coat has become greasy. Her paws and ears are very warm to touch and she has mild to moderate erythema between her pads and some toes. She is still waking in the night but it seems to have shifted to between 4 and 5am. We just started SMS to see what kind of effect it will have at this time of year. Any thoughts or suggestions?

Thanks for your help!

Lori

by naturevet

September 5, 2017

Hi Lori,

Since you used SMS, I'm guessing you feel this dog has Damp Heat, and I agree. The morning aggravation, weight gains, reliance on pred, pulse, worsening with excitement, and ear discharge all dovetail with that formula or diagnosis.

Itch acquired when so young can signal a food allergy, unless vaccine-induced. Food allergies are often Damp conditions, but on rare occasion, improvements will only be seen when the offending protein is identified and avoided. I wouldn't resort to kibble for that. I'd choose another raw and see whether that helps.

As well, I'd roll in Chu Shi Wei Ling Tang. It's often needed in Damp Heat dogs to resolve Damp Heat, when the pulse is deep like that. If this combination of SMS, CSWLT and a novel protein takes the dog further than it has been, the way is clear to at least reduce pred to EOD therapy.

Hope that helps you out!

Steve

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