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Chronic Dermatitis In A Dog

by drwells - July 25, 2021 View Case Report

Hi All:

I love some help with sweet, gentle Bruno, a 12 year MC German Shepard. His owners have fed him raw and cooked fresh food his entire life...lucky boy.
We live in the Northeast, particularly damp (to be honest, always damp). About 8 months ago, he started to have anal gland issues: very full, not impacted, very loose: more damp with occasional heat.
He presented to me as owner wanted another opinion on anal gland issue and his increasing skin itching.
On initial exam: He is certainly Earth. I think his TCM dx is blood and kidney yin deficiency with low grade damp ( a little heat: some blood in the anal gland material).
Physical exam: He has a "baboon" perianal area: thick and lichenified and black. His flanks are also lichenified, dry with low grade itch. He licks these areas often, sometimes scratches. He feels yeasty as well as dry. His pads are dry. He also has mild nasal dermatitis (ulcerated lesion). He does have palpable mild hepatomegaly. His blood work from previous dvm was normal with mild ALP elevation (I don't have the exact numbers). He does prefer to be cool, but not especially thirsty. Pretty mellow guy.
Pulses: weaker on left than right, a little stronger than I expected.
Tongue: Lavender/dark brick red (stagnation)
So I started with the excess using acupuncture to dispel wind, damp as well as tonify the kidney yin and blood. Gave B12 at BL23 and GV20.
Started Dispel Damp and Nourish the skin at 3 tabs twice daily (He is about 80 lbs). We added a probiotic (proviable). After about 2-3 treatments he started to grow a little perianal hair and the skin was noticeably softer, itching was less. Then we hit some major environmental allergy junk which affected everyone. So he started itching again, dorsal epidermal collarettes with moist big flakes, anal glands full again. We were back to square one. I added Qi Bai Mai Ran Dan by Evergreen (don't recall my logic honestly): did OK but still itching. Finally had to give in and give him 2 days of low dose pred to give him some relief which it did for about 2 weeks.....but of course we are still itching.
So I am thinking about still conitnuing dispel damp and nourish the skin, adding Si Wu Xiao Feng yin and possibly at kidney yin or spleen qi tonic.
Any thoughts on if my logic is sound ?
If so, how to make that formula and have it be balanced and not too cloying, support the spleen, tonify and move blood and get rid of the low grade irritating itch...
I started with acupuncture to dispel wind, tonify Kidney yin

by naturevet

July 29, 2021

Hi Hannah

My temptation would be to try a 2:1 mix of Xiao Chai Hu Tang and Si Wu Tang, on the suspicion that he has a Shao Yang disharmony, which is often attended by Blood deficiency. I see why you went the Dampness route, but a dog that is on real food and has skin lesions recur generally does not have Damp Heat or Dampness as the primary problem, since in western terms Dampness is inflammation arising from the metabolic consequences of a processed diet, which he isn't on.

Animals that do worse despite a real food diet often have a Shao Yang disharmony - a problem with systemic immune regulation rather than just an unregulated inflammatory response (which equates to Damp Heat).

Shao Yang patients likely have a leaky gut priming the oversensitivity of their immune system. The leakiness appears to come from too low (that's right, low) fermentable carbohydrate in their diet. This causes flora shifts in the gut away from those species that produce propionate. Propionate regulates the immune system. The probiotic you used may have been what produced the benefits you saw, rather than the CSWLT.

Other hallmark features of Shao Yang disharmony:

worsening in spring and late summer to fall at first, then later just bad all year round

immune mediated issues, like the nasal dermatitis

irritation along the sides of the body, where the GB channel runs

deficiency of the dorsum, making the animal prone to Wind invasions, leading to collarettes

often what appear to be Damp Heat lesions

improvement from immune suppressants

lesion occurrence even while on raw, or especially when on raw

stasis and heat in the tongue

a surprisingly strong pulse, although it can feel amazingly weak if Blood deficiency is very pronounced

Regarding the anal glands, I know they are often considered a lower burner structure (and thus prone to Damp), but the Nan Jing noted anything on the outside of the body is potentially an upper burner issue. I have noted this to be true in most anal gland cases.

So, hopefully this helps you out. Naturally XCHT offers some GI support, and you have the Blood and Kidney support in the Si Wu Tang, so in a way, it fits your criteria, but I'm sure this wasn't the analysis you were expecting. Hopefully it helps anyway!

Steve

by drwells

July 30, 2021

Hi Steve
I appreciate your in depth answer. I think I went straight from damp ( inflammatory issue) to endothelial stage missing the Shao yang disharmony. My only concern with the blend you suggested is that this guy needs something for external wind. He is licking his flanks quite a bit which is just causing more damage to the skin. I originally ordered si wu xiao feng but unfortunately back ordered. I do have dry derma relief but not sure how to dose that if making the 2:1 of the xcht and si wu without being too cloying.
Thoughts on how to handle the current wind component? I understand correcting the Shao yang disharmony will eventually correct this but I think he is going to create a more swipes pyoderna in the meantime.
Maybe nettles ?
Use acupuncture to treat the external wind ?
Thanks so much again
Always learn so much with these posts.
That darn Shao yang disharmony. Seems to be everywhere.
Thanks again.
Hannah

by drwells

July 30, 2021

Hi Steve
I appreciate your in depth answer. I think I went straight from damp ( inflammatory issue) to endothelial stage missing the Shao yang disharmony. My only concern with the blend you suggested is that this guy needs something for external wind. He is licking his flanks quite a bit which is just causing more damage to the skin. I originally ordered si wu xiao feng but unfortunately back ordered. I do have dry derma relief but not sure how to dose that if making the 2:1 of the xcht and si wu without being too cloying.
Thoughts on how to handle the current wind component? I understand correcting the Shao yang disharmony will eventually correct this but I think he is going to create a more swipes pyoderna in the meantime.
Maybe nettles ?
Use acupuncture to treat the external wind ?
Thanks so much again
Always learn so much with these posts.
That darn Shao yang disharmony. Seems to be everywhere.
Thanks again.
Hannah

by naturevet

July 30, 2021

Hi Hannah,

It's probably fine to use SWXFY instead for the Wind. It won't be as tonifying, and I don't usually feel it is necessary, but I don't see a problem with your plan, if that is your instinct

Good luck!

Steve

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