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Chronic Dermatitis In A Dog

by CorinneC - August 24, 2023 View Case Report

Theo is a 6yo MN Golden Retreiver who I started seeing back in Jan 2020 for atopic dermatitis. He had had panosteitis (along with 4 other pups in his litter!) as a pup. With his previous Vet, he had, IMO, been heavily vaccinated in his young years (had DAP, Lepto, Rabies, Bord annually). By May of 2018 he was constantly itchy, prone to recurrent ear infections, and hotspots. The O had taken it upon herself to switch him to a raw diet in Sept 2018 after her original Vet tried various meds and z/d with no improvement.

When I saw him in Jan 2020, he had a bilateral ear infection (erythema, dark brown yeasty debris), coat was dry and dull, pulses were deficient, tongue was lavender with vertical fissures, dry. I assumed Liver Blood deficiency and Wind Invasion and put him on SWXFY, but he got worse so I ended up trying CSWLT instead. Only mild improvement with O applying Viaderm to soothe the occas minor hotspot. I didn't see much of Theo until the following Spring and O cont'd CSWLT throughout. He was only mildly itchy, rare hotpsot if swimming and O slowly weaned of CSWLT.

In April of 2022 I removed a benign apocrine ductular mass off his back (shiny purple hairless = Blood Stasis), has never returned. By Sept 2022 she was back with Theo due to ear infections, occas hotspots, and pruritus. This all seemed to ramp up after O chose to give him Nexgard all summer?? He had LF interdigital erythema with papules, dorsal midline and right chestwall had patchy erythema with crusty yellow scabs - O requested Viaderm, no herbs.

Once again revisited skin in Jan 2023 - all about the same wrt skin. Pulses toned, still on raw diet, lesions all over back, ventral abdomen, perianal, periorbital, periaural, perioral. Likes to scratch his face the most. Viaderm really helps 2-5 days in a row, skin will settle down quickly. His tongue was still lavender-pink, moist, normal sized, and a toned pulse. I realize my mistake now, but I assumed Wei Qi deficiency and ShaoYang disharmony and put him on BZYQT and XCHT. These both also only helped minimally but he was worse off. TOday he was in again and I think I now realize this is a deep-seated pathogen and Blood Heat/Stasis with Wind Heat Invasion so have started him on Qing Ying Tang. I never saw his lesions as particularly alarming, red, and hot. Maybe because the owner kept applying Viaderm like a body lotion! His tongue and pulse never seemed all that intense either. The tongue rarely went anywhere from lavender. Looking back the panosteitis in the history should have alluded me to Blood Heat? Can you guide me here? Am I on the right track? Owner is getting frustrated.

Grateful for your help as always!
Corinne

by naturevet

September 3, 2023

I think you're on the right track, Corinne. Unless the dog has markedly improved already, I would also add Xiao Chai Hu Tang mixed with Si Wu Tang in a 2:1 ratio. Both Qing Ying Tang and Chai Hu Si Wu Tang address Shao Yang skin disorders.

The diet is likely a contributing factor here. Raw diets kill off the species in the gut most responsible for producing metabolites (like propionate) that modulate the immune system. They also use fiber to improve bowel wall integrity to allow excess systemic immune stimulation to wind down. To fix the diet, she must add soluble fiber and fermentable carbs (to make up about 1/4 of the diet) and repopulate with probiotics containing Lactobacillus or Bacteroides.

With these steps and a little bit of time, I think you can wind up with this dog in the Win column. She can use the ointment prn to maintain her sanity. If she finds herself using it less and less over the next few weeks, that will be proof the dog is finally healing itself (with a lot of help from you!)

Steve

by CorinneC

September 12, 2023

Thanks so much Steve, as always! Great Immune talk too! Wow, always learn so much from you! She is continuing for now with just the QYT, but has added soluble fibre and fermentable carbs. I hope to see this boy improve over the next month.

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