This is one of my tricky chronic skin cases that I would love some advice on.
Annie – 7 year old FN Doberman
History;
Had a litter 13 pups September 2023. Prior to this no health issues noted. Mastitis when pups 4 weeks old, treated with antibiotics.
Feb 2024 given Nexguard for tick prevention and had diarrhoea for 2 days.
NQR since litter – started getting itchy Spring 2024 (itch 5/10). Reasonable response to antihistamines.
Booked in for desexing December 2025 but NQR, lethargic, weight shifting on front legs. RV couldn’t find anything wrong but started on antibiotics pre-op. Next day very lethargic, hard to walk. Was treated with 4-6 weeks of prednisolone and doxycycline (suspected dx idiopathic neurological episode – MUO?) – very quick and good response to this treatment but dropped her coat entirely.
Desexed January 2026. Mild post spey incontinence. 3/10 itchy at this stage.
Removed chicken from diet, on different brand of kibble and fed some fresh food (rice, turkey, pumpkin, veg, blueberries, slippery elm bark).
This Spring 2025 became 9/10 itchy. Responds well to shampoo followed by Pine Tarsal soak (without this she still seems itchy). Gets very greasy if bathing less than every 3 weeks.
Owner added Antinol, an oil to coat and sardines to diet – feels this has improved things.
Exam #1 December 2025;
- Thinning fur coat ears and midway along dorsum at sides, and ventral neck
- coat is coarse but dorsum also greasy
- hot to touch all over
- rash with red pimples (not pustules) lateral lower limbs, ventral abdomen along midline, perivulvar area to top of back of thighs
- erythema ventral abdomen, groin, axilla
- dry patches of fur loss lateral toes
- redness ventral interdigital area especially front feet – not moist / no secondary infection
- hot to touch on ear pinnae
- deep set eyes with yellow mucoid discharge R eye
- personality – not overbearing, likes pats and cuddles but in a gentle way, quite muted
T – pale, wet, flabby
P – full, toned, palpable at deep level.
AP – BL 25, GB 27
My diagnosis included;
Blood Deficiency – hair loss, scurf, dry pimples, pale tongue
Shao Yang disharmony – pulse, heat, sensitive at GB 27, previous immune mediated disease, itch since gut damage with antibiotics +/- nexguard
Damp – greasy 3 weeks after washing, larger scale, oily coat, mucoid discharge, previous mastitis
Stomach Yin Deficiency and Heat – ventral distribution of lesions
So I was confused! I started QYT, moved to fresh food diet – ensure 15-30% green veg, added LGG Probiotic and Colostrum for immune modulation
Exam #2 – January 2026;
Very good response 3 weeks later with good itch reduction.
- rash on hindlimbs, ears, and feet resolved
- not obviously itchy when touching/examining
- coat coarse and dry, not greasy as previously (dry despite barrier oils being applied day before)
- scurf+++ medium size flakes, yellowish
- thin fur lateral right flank and lateral toes
T – very pale, flabby, pale pink mucus membranes
P – toned, full, improved with GB 34
TCVM dx - Qi Deficiency (pale flabby tongue)
- Blood Deficiency (pale gums, coarse coat, scurf, fur loss, dry skin)
- Shao yang Disharmony (immune mediated disease, microbiome, pulse)
- Secondary Stomach yin Deficiency (fur loss ventral neck)
Treatment
- Continue QYT 1tspn/d
- Add Cessorex 1 tspn/d
- Recommend fresh food diet but owner reports she won’t eat the veg and added back in dry kibble as well as the home cooked mix
Exam #3 – March 2026;
Response 1 month later – fairly good until owner ran out of QYT and continued Cessorex only. Back on fresh food diet only. Feels she is more itchy since QYT stopped.
- coat now is greasy++ on dorsum with slight corn chip smell, no scale
- moth eaten appearance on chest walls
- skin on base of back of ear is alopecic, thickened almost wrinkled skin
- mild erythema only axilla / groin / abdomen
- skin on thighs now not inflamed but has papules (look like burst pimples)
T – big, flabby, pale blue-lavender, hangs over edge of teeth
(tongue has been like this the whole time - not sure how this fits with any of the patterns?)
P – superficial – mid, broad, toneless, quite fast, can compress at deep level but it doesn’t disappear
So my assessment so far – good response to QYT indicating end stage chronic skin issues leading to Blood Heat. Cleared Heat but preserved Yin, so not exacerbating underlying Blood Deficiency signs. Worse off the QYT - maybe because Cessorex is bringing too much blood to the skin and reigniting inflammation? OR maybe she is now Damp / Damp Heat and Cessorex wasn’t appropriate?
Signs above confused me (again!) as she seemed a mix of Damp and Dry again. Pulse ?fitted more with Damp vs Shao Yang Disharmony this time.
I put her back on to QYT for now as such a good response initially, but not sure where to go next.
My questions are;
- Should I have stayed on QYT for longer if a response before adding in another formula (in this case Cessoriex). Do you use for example for 1 month, 3 months or ongoing until signs say a change of formula is needed. For some reason I thought this formula was only a short term formula?
- Is QYT a Shao yang Formula – ie good response to this means Cessorex / Halscion would be a next good step? Or can any long standing issue eventually end in Blood Heat? (ie chronic Damp Heat can lead to this too)
- She seems to fit more now with Damp (not even that much Heat) – should I trial SMS next? Or Xian Feng San to address Damp and Blood Deficiency?
- Does Cessorex address Dampness at all, or only Shao Yang Disharmony?
Thank you for your help!
Sophie