Ask Dr. Amy for June 10

Dear Dr. Amy,
I have read skin problems are common in the Westie breed. My Westie is 12 yrs old and has chronic skin problems since about the age of 6. The problems first appeared after she was in a kennel for a few days. My veterinarian and I have tried numerous treatments without any permanent success. Is there a cure or treatment that will last more than a few days?
Talmadge Indian Trail

Dear Talmadge,

My sympathy is with you, as chronic skin problems tend to be a condition that requires strong follow up and patience from an owner to tailor a therapy with the least side effects.

Westies are a top breed for food and environmental allergies. My approach would be step by step to rule out complicating factors slowing down a complete response. First, identifying any underlying parasitic/contagious issue never treated via a skin scrape for the mites or a therapeutic trial with meds such as ivermectin injections or topical flea/tick products labeled for treatment of mange. Even dermatologists only find these hair follicle mites less than 20 percent of the time, so often response to treatment is the way to diagnose. Also, flea allergies will mask any improvement of the original problem; year round prevention guaranteed to last a full month, of a vet approved product such as Frontline, Advantix, Advantage Multi, Vectra, Revolution, is an essential part of the plan.

Secondly, rule out any secondary skin infections that are complicating the issue with a quick and simple cytology with double-sided sticky tape microscope slide pressed against skin lesions, stained and viewed in-house for yeast, bacterial cocci, or more resistant bacterial infections such as rods. If the population is heavily bacteria, and the medical history includes chronic use of multiple classes of antibiotics, perhaps a culture and sensitivity will be a financial and medical smart choice to determine which antibiotics are effective- then proceeding with up to 6 to 8 weeks continuously to treat deep skin infections. Without culture, my best success antibiotic class is usually related to cephalexin or a once a day drug called Simplicef that is a newer related class of drug. Dermatologists have determined that superficial skin infections take 14 to 21 days to shed and clear to healthy underlying skin, so most moderate infections will be treated with a minimum of 21 days to avoid immediate relapse.

Thirdly, rule out underlying issues that impede the immune system- i.e. hormone imbalances such as a low thyroid level (send a panel to Michigan or an outside lab that includes a T4, fT4 and TSH to avoid false positives). Other concurrent diseases and illnesses can falsely lower a regular T4 screen test, and I rarely trust this number alone for diagnosis. If thyroid tests are positive, simple supplementation with thyroxine pills daily can greatly improve the response to treating chronic and repetitive skin and ear infections.

As I mentioned last month, Westies are a top breed for food allergies, perhaps a new food was fed at the kennel that triggered the skin changes? A novel protein trial with a hypoallergenic diet (i.e. Royal Canin Venison and Pea or Duck and Potato, as well as other grain-free and novel protein diets) for 6-8 weeks is a good approach as well.

Some folks in a hurry for a cure will often do simultaneous blood testing for thyroid and environmental allergies, via a blood test for allergy testing to the laboratories with low false positives such as VARL or Spectrum that measures antibody levels to 30+ environmental factors such as grasses, trees, mold, insects, cat/human dander , wool, while initiating a food trial and treating any secondary infections present with oral and topical therapies.

Lastly, other supportive treatments I have found include antihistamines to reduce itching (i.e. Benadryl, Zyrtec, Hydroxyzine, Chlorpheniramine), daily oral supplementation with essential fatty acids (omegas) that improve the health of the skin’s immune system, weekly topical therapy with essential fatty acid products and therapeutic shampoos once or twice weekly during an skin outbreak that follicle flush, exfoliate, remove surface allergens, and treat present yeast or bacterial infections with targeted ingredients.

Even allergy injections created from the results of the either blood allergy testing or intradermal skin testing with a board-certified veterinary dermatologist can be formulated for owners to administer at home. The goal is to hyposensitize the immune system to tiny amounts of the same things the pet is allergic to, and then gradually build the immune system’s resistance.

Steroids may be necessary in some cases, but carry heavy side effects including increased appetite, thirst, urination, as well as decreased immune system and greater changes of other issues such as high blood pressure and diabetes.

An alternative on the market called cyclosporine (also known as Atopica) has been fantastic as another way to reduce the immune reaction from allergies without the negative side effects of steroids. Even cats are finding good results from cyclosporine, especially from a specific type called Neoral that can be compounded into liquid to be given orally daily. Be prepared for the cost to be considerably higher than steroids, but it can be a great choice.

Many different skin conditions can look and present the same. Only with a thorough history, an orderly step by step diagnostic approach, and good owner compliance and follow up communication can the challenge of a chronic skin problem be successfully met. If a regular vet prefers, referral to a board-certified dermatologist is an option as well. Best of luck to you!

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