Any of you beagle folks got a clue….

[Goldeneagle]

You two are stuck like Chuck

Steve

[Brannon74]

DERMATOLOGY
By Carol S. Foil, DVM, MS, Diplomate A.C.V.D.
Board-certified specialist through the American College of Veterinary Dermatology



Canine Atopic Dermatitis


Canine atopic dermatitis (allergic dermatitis, canine atopy) is an inherited predisposition to develop allergic symptoms following repeated exposure to some otherwise harmless substance, an "allergen," such as dust mites or pollen. Most dogs begin to show their allergic signs between 1 and 3 years of age. Due to the hereditary nature of the disease, several breeds, including golden retrievers, most terriers, Irish setters, Lhasa apsos, Dalmatians, bulldogs and Old English sheep dogs are more commonly atopic, but many dogs, including mixed breed dogs can have atopic dermatitis. The incidence is increasing both in man and animals.

Atopic animals will usually rub, lick, chew, bite or scratch at their feet, muzzle, ears, armpits or groin, causing hair loss, and reddening and thickening of the skin. In some cases several skin problems can "add" together to cause an animal to itch where just the allergy alone would not be enough to cause itching. These problems include air borne-allergens (pollens, etc.), allergens in food, and allergens from parasites (fleas, etc.) and also bacterial or yeast infections of the skin. Eliminating some but not all of the problems may allow a patient's itchiness to go away. Therefore it is important to treat any other problems that could be making your pet itch while dealing with allergy.

Diagnosis

Specific diagnosis of atopic dermatitis is based upon the results of intradermal testing and/or in vitro (blood) testing. Many medications can interfere with our ability to properly skin test your pet. Length of time that a medication's effect remain in an animal's body is highly variable; however, basic guidelines for withdrawal of medications are: At least 4 weeks off oral prednisone; 10 weeks after triamcinolone acetonide injection; 14 weeks after methylprednisolone acetate injection; 10 to 14 days off antihistamines; 10 to 14 days off topical steroids (ear drops, ear drops or medication for skin); 2 days off tranquilizers.

Treatment

1) Antihistamines: This medication works in 20% of atopic patients. Your pet can take antihistamines for life. The only side effect usually seen is drowsiness. Several types may be tried to find the one best for your pet. Topical antihistamines for the eyes can be helpful in patients with eye allergy (itchy conjunctivitis). Visine A® is one over-the-counter product that can be helpful.

2) Avoidance of the allergens: This can be helpful for house dust mite allergies. Pollen exposure can be reduced by using air-conditioning and air filters, avoiding the outside early morning and late afternoon, wiping down with moist cloths after going outside and frequent bathing.

3) Oral Steroids (prednisone, cortisone, triamcinolone, etc.): These drugs have many potential side effects and are reserved for adult animals, those with short seasonal problems or where other therapy is not possible or is ineffective. Typically, treatment is started at one dose and then tapered off to every other day usage.

4) Topical Steroids: Topical usage is safer than oral usage. It can be very helpful if itching is localized (e.g., eyes, ears). It can be used for more widespread disease in the form of leave-on rinses or lotions (ResiCORT®) or a triamcinolone spray (Genesis®).

5) Cyclosporine (Neoral®): This immunosuppressive agent can be used at low doses to treat allergy successfully in about 60% of patients. It can also be used to lower needed dosages of steroids. The major short-term side effect is gastrointestinal upset. The long-term safety is not completely known. The dosage can often be lowered after a few weeks of successful treatment.

6) Tacrolimus (Protopic® ointment): This drug is related to cyclosporine. It can be very useful for treating localized itchy areas in atopic dermatitis. It is applied once or twice a day at first, and then frequency is reduced.

7) Fatty acid supplements: Certain types of oils can reduce allergic symptoms in some patients. We can give fish oil capsules in conjunction with a low-fat diet or prescribe special prescription diets with the fish oil content raised. This therapy can help improve response to antihistamine therapy.

8) Allergen Specific Immunotherapy: This involves giving an allergy vaccine injection that is made up specifically for your pet, usually for the lifetime of the animal. After an initial series of injections, periodic boosters will be needed (every 1-3 weeks). 60% to 80% of animals will improve with the vaccine. Results may not be seen for 3 to 6 months. When results are not seen in 9 to 12 months, a re-evaluation is necessary.

9) Bathing: Atopic skin is sensitive and subject to drying. Only specially designed hypoallergenic shampoos should be used on your allergic dog. Rinsing should be thorough. Generally it is best to follow with a hypoallergenic cream rinse or spray to remoisturize the skin after every bath. Virbac's Allermyl® comes as a shampoo or a spray and contains 1-rhamnose, which may reduce itch and inflammation.

Instructions For Your Pet

1. Topical Therapy:


A. Locally __________________________________________________ __________
B. Whole body __________________________________________________ _______
2. Bathing Protocol:


Bath at least once a week with _________________.
Lather 5 minutes, rinse very well.
Follow with a spray or cream rinse (_______________) to rehydrate as indicated.
3. Systemic Therapy:


A. - Steroid therapy:
Give ____ mg once a day for _____ days,
then ______ mg once a day for ________,
then _______ mg every other day for _______days.

B. - Antihistamine therapy:

Give ______________, _____ mg once ____ or twice ____ a day, indefinitely.

C. - Cyclosporine therapy:

Give Atopica, ___ mg or ml, once ____ or twice ____ a day, with food.

4. Fatty Acid Therapy:


Give ______ capsules, daily with food or use _________ prescription diet.
By Dr. Carol S. Foil, DVM, Diplomate A.C.V.D., and

[Brannon74]

THE PET HEALTH LIBRARY
By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com



Itch Relief






The Itching Pet: Alternatives to Steroids


Excessive licking, chewing, and scratching can make a pet’s life miserable for month after month, even year after year. For rapid relief of itch and inflammation, nothing matches the corticosteroid hormones such as cortisone, hydrocortisone, prednisone, dexamethasone, and others.) There are some animals that seem unable to live with any degree of comfort without these medications. Unfortunately, these hormones have widespread and potentially dangerous actions throughout the body when they are used for inappropriately long periods and it is generally desirable to minimize the use of these hormones when possible to do so. Ideally, corticosteroids are used for a few really tough itch weeks and other forms of itch management are used for general itch maintenance.

See more detail on long-term corticosteroid use.

This is, of course, easier to write about than to actually do. When one's pet is scratching and chewing raw spots on his or her skin, practical advice is called for. The following list includes assorted non-steroidal methods for relieving itch and reducing the amount of corticosteroid hormones needed.

Oral Medications

Antihistamine Trials
Histamine, a biological chemical, is the chief mediator of inflammation in humans hence the proliferation of antihistamines available for people both by prescription and over the counter. Histamine is not the major mediator of inflammation in the dog, thus these medications are not as reliable for dogs as they are for us.

The protocol recommended by this hospital is helpful to approximately 40% of dogs who try it. Four different antihistamines are used, one at a time, at least 2 weeks each, in hope of finding one that is acceptably effective. While the chance that an individual antihistamine will be helpful is small (about 15%), trying several antihistamines greatly increases the chance of finding one that works.

Antihistamines are not free of side effects; they are notorious for drowsiness in some individuals. Still, this is vastly preferable to the systemic disruption caused by the corticosteroid group.

Our hospital uses the following antihistamines in a typical antihistamine trial (click for more information):

Diphenhydramine (Benadryl)

Clemastine fumarate (Tavist)

Hydroxyzine (Atarax)

Chlorpheniramine (Chlor-Trimeton)
In cats, antihistamines are substantially more reliable than in dogs so that the chances of a given antihistamine working are usually pretty good. For both cats and dogs, using antihistamines together with a corticosteroid hormone will decrease the amount of corticosteroid hormone needed to control the itching (i.e., less hormone is needed to get the job done if it is given with an antihistamine).






Fatty Acid Supplementation
The discovery of anti-inflammatory properties of evening primrose oils and fish oils in humans has led to similar products on the market for our pets. These products are not analogous to the oil supplements that are recommended as food supplements to make a pet's coat shiny; instead; these are true anti-inflammatory drugs capable of relieving joint pain, cramps, and itchy skin.

The supplement alone is helpful in 10% to 25% of itchy dogs; we often recommend its use in combination with antihistamines to boost the efficacy of the protocol described above.

Cyclosporine (Atopica)

Cyclosporine is an immune system modulating drug originally developed for use in organ transplant patients, but which is also useful in other immune-mediated diseases. Since allergy is an immune-mediated condition, cyclosporine was investigated as an alternative to corticosteroids and found effective for most patients. Currently this medication is being marketed only for dogs and one dog in three will develop an upset stomach when starting the drug (though this resolves or is manageable with dose modification).


Topicals to Try


When using any dip on inflamed skin one should be aware that the use of cool water is considered much more soothing than warm water.


Colloidal Oatmeal Shampoos and Creme Rinse - At first, these products were only available for human use, as powdered soaks to pour into bath water.



Once their value in itch management was determined, their use quickly spread to the veterinary field. Colloidal oatmeal actually pulls inflammatory toxis out of the skin, generally yielding 1 to 3 days of relief. The creme rinses are meant to yield longer acting relief. They are available plain or combined with local anesthetic forumlas to soothe itch.



Lime Sulfur Dip - This product kills parasites, ringworm fungi, and bacteria.



It also dries moist, weeping skin lesions and helps dissolve surface skin proteins that are involved in itchiness. Many veterinary dermatologists recommend it regularly to control itch; however, it has several disadvantages. It smells terrible. The sulfur ingredient smells like rotten eggs and this is how your bathroom or bathing area will smell during the pet's bath. This dip can stain jewelry and clothing and will temporarily turn white fur yellow.

Other Shampoos
Itchy skin can be the result of skin infection, excess oil accumulation, yeast infection, even parasitic infection. The list goes on. The shampoo products listed above can be used against any itchy skin disease but it should be noted that there are many other shampoo and creme rinse products that can be used against the specific skin diseases listed. If some other type of shampoo product has been prescribed to you for an itchy skin disease, it is important that you use it allowing at least a good 10 minutes of skin contact time before rinsing.

TEN MINUTES OF SKIN CONTACT IS THE MINIMUM REQUIREMENT FOR ANY MEDICATED SHAMPOO. PREMATURE RINSING WILL NOT ALLOW FOR THE THERAPEUTIC BENEFIT TO BE REALIZED.

Other Topical Products


Colloidal Oatmeal Sprays and Lotions - Same principle as above. These products pull inflammatory toxins out of the skin. Oatmeal products have become very popular and are available as shampoos, creme rinses, soaks, sprays, and lotions.

Humilac Spray - This moisturizer may be applied as a spray or mixed in water as a dip. It is helpful for dry skin but can also be used in combination with lime sulfur as lime sulfur is naturally drying to the skin.

Witch Hazel - This product has a cooling effect on the skin that is soothing for both animals and for people with sun burn. It is available as a spray or lotion.

Aloe Vera Gel - If possible, obtain 100% aloe vera gel from a health food store. Products containing aloe are much more available but are generally not as effective and not meant to be licked away by a pet. Aloe vera gel comes from the aloe vera succulent and contains enzymes which break down inflammatory proteins and enhance healing. Pure aloe vera gel is not harmful for pets who want to lick it off.


Topical Steroids? - It seems clear that taking steroids orally may be harmful to the body with chronic use but are topical cremes safe for long term use? We now know that topical steroids (cortisone cremes and related products) are absorbed through the skin and into the bloodstream but the hormonal side effects with topical use do seem blunted. For small irritated areas (hot spots), topicals can provide excellent relief without the systemic effects of hormones.

Respect the Steroid


Severe itching amounts to a reduction in life quality. It is important not to develop the mindset that corticosteroids should be avoided at all costs. This would not be fair to the itching pet. Steroids are valuable tools in the relief of pain and suffering and have an important place the therapy of the itchy pet. The goal is not to avoid steroid use if possible but to avoid long term dependence on steroids if possible. Despite all of the above management tricks, some pets will still require long term steroid use to achieve any reasonable comfort. There are monitoring protocols in place for such cases. It should also not be forgotten that underlying allergies and recurring skin infections can be addressed specifically and that as these conditions are managed, the itch is also managed.

Steroid hormones have many side effects and, as helpful as they are for allergic skin diseases, it is best to reserve them for only the most itchy episodes.

It is our policy not to give dosing information over the Internet.

Date Published: 1/1/2001

[Bones]

The whole idea behind a food trial is to rule out proteins like beef, chicken, and lamb which are the most common one in canine diets. Thats why you will see diets like venison and rabbit.

That makes so much sense that its scary..... To rule out a protein allergy, you would want to use variable protein sources. I'm glad that you cleared that up because I really have asked other vets who didn't have a good explanation.

On another note, I am sending you a PM...

[Brannon74]

pm returned.

[lil'murdock]

Change the dog food to a food with no bi products and has sunflower oil seed in it and bath him with dawn dish soap

[Landrover]

That is still much more common than you might think. I know of several people who use if for mange, ringworm etc.

I figured as much Bones but I know how folks get shook up on these dog threads.

The **** test cost me $600 !!!!! Almost cost me a divorce cause I wanted to just shoot the thing and get another dog!

LOL!!! "Honey, sorry but the dog ran away!"
Hopefully some of the ideas suggested get that nasty stuff cleared up for you.

[Goldeneagle]

I figured as much Bones but I know how folks get shook up on these dog threads.

LOL!!! "Honey, sorry but the dog ran away!"
Hopefully some of the ideas suggested get that nasty stuff cleared up for you.

They're pretty sure the injections will clear him up. We just started them a couple of weeks ago and he seems to not be scratching as much. They also have him on some kind of pills too. I've never been known to get so attached to a dog that I would spend this kind of money on, but I've gotten pretty attached to this lap warmer too. And the sorry the dog ran away, i's funny that when we we're kids and moved from Dallas to Plano, the day before our dog just happened to run away.