Treatment for Westies with Severe Skin Issues 4/18/19

Our vet is Dr. Brad Theodoroff at Animal Medical Center of Troy

248-852-9800 Amctroy.com

Generally, when a dog comes into Rescue and is having allergy/skin issues, we take him to see Dr. Theodoroff.  Following is a general description of the things that are usually done to help the dog.  When these procedures are followed, we have a very high success rate.  

Dr. T. checks the dog over.   He checks for fleas; if present, he treats for adult fleas with Capstar, and/or Effitix (topical).  Simparica (oral) might be used in place of the Effitix since Simparica will kill fleas, ticks, sarcoptic and demodectic mange mites.  Both ear canals are tested for yeast, bacteria and mites – tape prep of skin sores and feet for bacteria and yeast  – skin scraping to check for mites – blood panel, heartworm testing, fecal testing – all dogs are started on Sentinel Spectrum for flea and heartworm prevention, and hookworm, whipworm, round worm and tapeworm treatment and prevention.  A Thyroid panel, sent to the lab at Michigan State, may be done at the 1 month follow up visit if the dog is not responding as expected.  It is rare that the Thyroid is tested.

Most Recues with skin disease or itch are suffering from Atopic Dermatitis.  In human medicine, the common name for Atopic Dermatitis is eczema.   Recently, there is emerging evidence that the inflammation in Atopic Dermatitis results primarily from inherited abnormalities in the skin – a skin “barrier defect”. This barrier failure causes increased permeability of the skin and reduces its antimicrobial function.  Additionally, the “barrier defect” means that Water is lost; Irritants (soap, detergent, solvents, dirt) and Allergens (pollens, dust-mite antigen, microbes) may penetrate through the skin “barrier defect”.

Dr. T. usually recommends the itchy dog start on Hill’s J/D food which has lots of Omega 3 fatty acids and can often provide enough support for the mildly allergic dog without going into the steps below.  Additionally, the Omega 3’s are powerful antioxidants and have anti-inflammatory functions that aid in skin health and healing.  The Omega 3’s are thought to help restore or improve the disrupted skin barrier and do help the skin retain moisture.  J/D has more Omega 3’s than the skin and allergy diets.  Every cup of J/D is the equivalent of a cup of DermCaps and has more Omega 3’s than any other supplement.  (No, this isn’t a typo…..Yes, J/D is a joint disease food, but it is what we use for the skin/allergy issues.)

Dr. T. may give Simparica to dogs suspected of having sarcoptic and demodectic mange mites.  If so, a 2nd dose is given 1 month later

He will often give us antibiotics if he feels they are appropriate and always if steroids are used.  The skin cytology will let us know the type of bacteria or the presence of Yeast, Cocci or Rods, Cocci is almost always part of the problem. Bacteria cultures are very rarely done on the 1st visit.   Convenia antibiotic injection is most often used for Cocci bacteria.  It is very effective, and a single injection works for 2-3 weeks.  Sometimes a 2nd injection is required.  Other oral medications (Simplicef, Clavamox, Zeniquin or Baytril are the typical antibiotics used) can be used in place of the Convenia, but oral meds may be needed for 8 to 12 weeks.   If Rod bacteria is present on the skin or in the ear canals, Zeniquin or Baytril may be given along with the Convenia.   If yeast is an issue, oral ketoconazole is used to 2 to 10 weeks.  Almost all dogs with skin infections will be bathed every few days with a medicated shampoo to kill surface yeast and bacteria.  After rinses may also be needed. 

Apoquel will be used to stop the itch (regardless of the cause of the itch).  It will work better and be safer than the Dexamethasone Sodium Phosphate (Dex SP- is a short-term steroid shot that lasts around 1 week) that we used in the past.   Steroids have profound effects on the immune system and long-term health for our Rescues, so we like to avoid them if possible. 

Apoquel (Oclacitinib Maleate), provides onset of relief within 4 hours and effectively controls itch in 24 hours.  It works as fast as steroids with none of the side effects we see with short- or long-term use of steroids.  Side effects are very, very rare.  Some recues will need Apoquel just during their allergy season, or just during the infection clearing time.  Some rescues dogs may need it daily year-round, depending on what they are allergic to.

Apoquel will stop all skin itch and irritation.  Cytopoint is a newer medication given as an injection that is very effective but only works for allergic or atopic dermatitis.  It is a fine choice for long-term care and can replace Apoquel for dogs that itch from allergic or atopic dermatitis.  Cytopoint injects will last 4 to 10 weeks, 6 weeks is the average.  If the injection lasts 5 weeks, an injection is given every 5 weeks during the allergic times for the dog.

CYTOPOINT works like the dog’s own immune system.  It is specifically designed to target and neutralize one of the main proteins that send itch signals to the dog’s brain that triggers scratching, licking, and chewing.  CYTOPOINT blocks signals that trigger itch so the constant scratching can stop, and red, irritated skin can heal.  In fact, in a study, CYTOPOINT helped damaged skin begin to heal within 7 days.  (www.cytopoint4dogs.com)

Note:  Dogs that have ear infections, treatment depends on what is found on the cytology.  Medication is selected based on what is seen on the ear canal testing.

When able, Dr T will apply a treatment of a long-acting treatment into the canal so that the drops are not needed.  If daily or twice/day drops are needed, medications like Mometamax or Baytril are used.   ALL dogs with ear infection must have an exam 2-3 weeks after treatment.  All medications make the ears “look better” but we need to know what the deep canal looks like and if the ear drum can be seen.