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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.

by CorinneC

October 16, 2023

O sent email update: "For the first 2 weeks he seemed to be doing better, with more energy and a decrease in the number of skin lesions. Then in the last 2 to 3 weeks he's got progressively worse with plaques of lesions on his back and flanks and a bad infection on his peri anal area and tail. Also the lesion on his anterior paw, where he had hair loss has flared up again and he has another similar lesion further down. His abdomen has several smaller lesions but overall isn't too bad.
Diet wise I added in gluten free oats, chia seeds, black beans, peas and cucumber all of which he loves, plus I started probiotics a week ago. I also stopped the Omega 3 ten days ago just in case this was causing him problems. Everything else has stayed the same, he remains on Carnivore raw duck, raw beef offal and small amounts of cooked extra lean ground beef and beef liver as treats. The Qing Ying Tang is still at 3 tablets twice a day. He seems hungrier but hasn't gained weight, if anything he's lost weight which is a surprise because his carbohydrate intake is significantly higher.

As an addendum I was wondering whether I should increase his soluble fibre/ fermentable carbs to approx a 1/4 of his diet, probably at an 1/8 right now. Also the probiotics haven’t had much time to kick in. Lastly my intuition says to decrease the QYT to 2 tablets twice a day, which may be totally wrong however. "

I was going to add XCHT with SWT as you suggested but I had given XCHT alone to him in June and his skin really flared up on it. Now I am really confused with this case as the QYT seemed like such a great fit!

by naturevet

October 19, 2023

Hi Corinne,

I find dogs don't respond very often to XCHT alone, so a lack of response really isn't a test. I would go ahead and try the XCHT + SWT. QYT can work much better when XCHT + SWT is in use.

The other possibility besides QYT that can work with XCHT + SWT is Bu Zhong Yi Qi Tang. The dog may have worsened due to a secondary skin infection because of Wei Qi declines as you move into fall. If you saw the dog in person. You could try it alone or with XCHT + SWT for a more comprehensive effect. It's more likely to work all by itself if there is a floating pulse that responds to SP 4 or GV 20. You could pair it with Cephalexin for a faster response.

I agree that the diet should be 20% plant protein, so she should make that change. The weight loss suggests the carb levels are not yet enough to support the dog. Since they are also fodder for the species in the microbiome that regulate the immune system, those carb and fiber levels do need to be increased. If she is not using a Lactobacillus probiotic, then that might be part of the problem, too, since it's that genus that uses the plant material to produce compounds which modulate immune function.

The omega 3s should be added back in for their anti-inflammatory effects, given the dog is most likely not Damp due to the persistence of problems on a real food diet.

Hopefully this helps you out! Thanks for the follow up!

Steve

by CorinneC

October 23, 2023

Once again, THANK YOU SO MUCH!!!! I have relayed all of this to the owner tonight and we will try the XCHT + SWT first with dietary changes and see how it goes. If no response then I've asked her to come back in to test his pulses and see about BZYQT.

All the best!
Corinne

P.S. You and Karen gave amazing lectures! I am so pumped with all the great info - I've been relaying it all week since I got back from glorious SD!!!

by naturevet

October 24, 2023

So glad we were helpful! Have a great week!

S

by CorinneC

April 9, 2024

Rt ear still erythematous and has thick golden yellow wax coating down to tympanic mb, and both ears smell yeasty. He only gets rare skin lesions now, the ones on his dorsum are minor, the ventral ones are more moist and red but also appear to resolve quickly with a bit of Viaderm. But the perianeum and tail can really flare up on occas - last time Mar 28th - treats with Viaderm and clears up, but comes up so quickly! Has had 2 bouts of blood in his stools, starts with loose stools that follow with blood - blood and mucoid coating. O switched from chia to ground chia and none since. Rt ear has been bad, have had to treat 5 times, roughly q 3 weeks, use Surolan and resolves but comes back again, Mar 20th last bout. Added in a multivitamin - Nutrify brand - 5mg Zinc, 50IU Vit E, 50mg Vit C. Still on probiotics - Lovebugs initially but switched to AlphaOmega

I wonder what I am missing with the AD and perineum? I've now switched him to Cessorex for simplicity sake. Wondering if Quercetin? Nettles? Hoxsey? could help with this elusive flaring inflammation? Your thoughts Steve?? And thank you in advance for all you do!

by naturevet

April 27, 2024

Hi Corinne,

If the dog has improved the point that it is quickly and completely responsive to antibiotics, then I'd wonder if there is now an immune deficiency component. Once the dog is subdued in its inflammatory responses by antibiotics or ear meds, try adding in Bu Zhong Yi QI Tang. I also combine Qing Ying Tang and Nettles with Cessorex

Hope that helps!

Steve

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