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Itchy Skin And Bad Odour In A Dog

by CorinneC - January 12, 2023 View Case Report

Geno is a 10yo MN Soft coated Wheaton terrier who was rescued in 2016 after being abandoned without food or water and in despicable conditions. When I started seeing Geno in June 2019 he looked pretty awful. His mom had been battling a bad skin issue for 3 yrs. He had ventral lichenification, was mostly hairless and greasy, and smelled like a "yeast bucket". Hi pulses were toned and deep, tongue lavender-pink, moist, sl swollen. His ears were the same but with a thin yellow exudate. He was itchy all over and constantly licked or chewed at himself, esp his feet. The owner, 1 week prior, had switched from kibble to a. homemade diet of fish and squash out of desperation which had made him less itchy. His nails were very overgrown from previous neglect, but I also noticed that his nailbeds were dry as were his pads. The skin around his eyes was hairless and there was a yellowish exudate OU that made his lids stick together. I was in the middle of my CIVT graduate course in herbal medicine, but hadn't reached the skin part yet, so I thought Damp Heat and out him on San Ren Tang. Somewhat better but not substantial. Eventually I switched to Chu She Wei Ling Tang and then lost touch. I realized later that he had been slowly losing wt too, from 21.4kg down to 18.9kg in 3-4 mth on these herbs. I realize now he was Yin deficient because of my choices.

Flash forward 2 years Dec 2021. Covid, O moved far away but decided to return to me, she had had Geno on several rounds of abx (Clavaseptin, Baytril, Cephalexin for skin + Surolan, Mometamax, & Claro for ears), Cytopoint, Bravecto, and Ketoconazole through another Vet but it wasn't working longer than 2 weeks at a time. With abx the skin odour never went away which I thought remarkable. He was terrified of loud noises (new). His fur had mostly come back in, but he had a dorsal strip of hairloss and the tops of all his feet were lichenified and hairless. He still reeked of yeast, was greasy, ears were yeasty but clear other than mild lichenification, and was itchy. His tongue was dark pink-purple, swollen, and moist and his pulses seems slippery to me so I put him on SMS & Nettles. I kick myself now! He came back 2 weeks later and had chewed his paws raw and the owner could no longer bear to be in the same room as him for the horrible skin odour. Sadly, I thought I had dried him out too much and put I'm on Dry Derma Relief + Clavaseptin (+ Cytopoint cont'd by local Vet). By Feb 2022 I finally came to my senses. The poor owner was bathing him almost daily due to his horrible odour! I put him on XCHT & Aventi GI and he started to improve little by little - by March he had these weird red flakes of dander? but was less itchy and hair was growing in very slowly. I had also taken the CIVT Nutrition course so I made Geno a new homecooked diet which seemed to really help as well.

However, by Sept 2022 his horrible odour was back and he seemed to literally give off heat (I couldn't help but think think was Damp Heat but now I wonder if it was Empty Heat???) so I added a bit of SMS in with the XCHT. Odour didn't change and he again seemed to get a bit worse. His tongue was now dark pink, moist, normal size and pulses were toned. As of last month I put him on CHJLGMLT.

What is this odour?!?!?! I feel like such a failure with Geno! I've had so much success with TCM and he has continued to elude me. I'm embarrassed to send this but I lost my ego long ago with Vet med and I'd rather see others learn from my mistakes and you lead me in a better direction!

Corinne

by naturevet

January 14, 2023

Well, Corinne, I've certainly been humiliated by my fair share of skin cases, probably more than you, given my advancing age! So don't beat yourself up too harshly. I doubt anyone using Curedcases feels cocksure about every case they treat. I have some ideas, but I don't know that they will be any more successful than what you've come up with. Your treatment results yield what I think are valuable clues, though, so let's go through them:

A lack of resolution of skin odor even on antibiotics and minimal benefits of immune suppressants makes me think of immune deficiency. XCHT partially helps with local skin immunity even as it calms systemic hypersensitivities so you saw more from it.

The strip of lingering hairloss down the dorsum may be because, from a Chinese medical point of view, that zone is the hardest to reach with circulation. It is the penultimate Tai Yang location, with Tai Yang probably being more accurately interpreted as 'extremity of Yang' rather than 'extreme Yang'. It's the furthest out Yang (and Blood) can go, so when circulation is at all compromised, it's the hardest to reach. So, too, are the extremities, and of course the dorsum of the extremities.

The deep toned pulse and lavender tongue further corroborates the notion that this dog needs a dispersing mobilizing therapy, some of which you used, the most powerful of which was XCHT. SMS and CHJLGMLT are internalizing, so they would move the blood supply inward, making it harder for the body to 'police it's borders' and kill off any pathogens. The worsening of the itch on SMS confirms that it's icepack like effect on skin circulation is not what we need.

The lack of resolution on a healthy diet is another clue. There are three strategies I most associate with that. Qing Ying Tang fits the deep toned pulse, heat billowing off the skin, and profound itch. It clears Heat even as it moves Blood and tonifies Yin to support normal skin circulation. It pairs well with XCHT.

Another thing that pairs well XCHT is BZYQT. If the dog is severely inflamed, that might give you pause, so try it at a low dose, but the incomplete response to antimicrobials suggests immune competence might be weak. The weight loss on the real food diet might suggest Spleen deficiency, which BZYQT addresses.

My third idea is just to add in Si Wu Tang. It's rare for XCHT to fully succeed in a skin case without it, and it addresses your sense that the dog might be Blood or Yin deficient.

Of the three, Qing Ying Tang is the safest to try first. I do think you're almost there with this case, so you've done really good work to date. The tragedy in medicine is not making a mistake, but not learning from them. Conventional medicine doesn't teach us much when we are not effective with it, making it a lesser pursuit just for that reason. Holistic medical outcomes do teach us, though, and all your hard work seems like it should pay off because you've paid careful attention even when things aren't going well for you, which is truly a sign of a brave and devoted doctor

Hope that helps

Steve

by CorinneC

January 15, 2023

You're so kind Dr. Marsden! I think the QYT makes a lot of sense and I will start there for sure. I guess I should stop the CHLJGMLT then? I will update once I have some success!! Fingers crossed!
Corinne

by naturevet

January 16, 2023

Yes, unless he has improved on it.

Good luck!

S

by CorinneC

June 21, 2023

Ok, so QYT didn't help! Skin still smells horrific. I then switched to XCHT and SWT alone for awhile but he actually seemed to get worse. I tested him with a full thyroid panel in February and he was off the charts hypothyroid so put onto levothyroxine. I thought I had finally figured out his issue (I had thought the original Vet had run a full thyroid panel awhile back but it turns out they just checked a T4). Unfortunately, he didn't improve much. The O was convinced he did the best on CHJLGMLT so I put him on that as well as DGSYS to support the thyroid. Presently he continues to lose weight on his homemade diet. His most recent T4 was 15nmol/L (N 13-51) - I was kinda hoping he might be veering towards hyperthyroid, but nope. I am just so lost as to where to go with this boy. He has good energy and mobility, decent stools, great appetite. Just itchy, bald and lichenified on his ventral half, smells awful, and I can't keep wt on him??? Any more amazing thoughts???

by CorinneC

June 21, 2023

Sorry, I just reread above and I'm wondering if I should switch to XCHT and BZYQT as you originally suggested?

by naturevet

June 27, 2023

Hi Corinne,

It's very odd to see a worsening on those formulas unless the dog is Damp (which you seem to have ruled out). Is the dog on a zero carb diet? If so, that is likely the cause for the weight loss and the continued skin struggles. A small amount of vegetables, fruits, beans or even cooked whole grains is needed (1/6 of what is in the dish) to normalize immune function and to maintain weight. If it's in there, she needs to feed way more. Weight loss can aggravate inflammatory tendencies as fat deposits are mobilized, releasing inflammatory mediators stored there in the process.

While you're exploring that, go back to CHJLGMLT. Maybe double the dose, and consider adding in a small amount of Yi Guan Jian, which might help the ventrum in particular (even if it looks Damp).

Hopefully those two moves bear fruit!

Steve

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