Derm case suggestions?

Re: Derm case suggestions?

Evelyn Barbour-Hill — Tue, 07 Aug 2012 02:55:43 GMT

Well obviously it needs garlic.

Re: Derm case suggestions?

Kathryn Burton — Mon, 06 Aug 2012 21:15:21 GMT

Thanks everyone for the advice. I will give the owner a ring tomorrow and see how the dog's getting on, and if she wants to persue things further. Glad I'm not missing anything obvious! :-)

Re: Derm case suggestions?

Jo Cobbett — Mon, 06 Aug 2012 16:54:49 GMT

[quote user="Kate Richardson"]

Also, a lot of daxys seem to develop pinnal and tail tip alopecia- I don't know why, but I see a lot with bald ears and tail and are happy little dogs and the owners don't seem bothered and the dogs certainly aren't. Maybe there is a dermatologist lurking somewhere who can shed some light?

[/quote]

Glad it's not just me! I've seen a lot with bald and slightly scaly ears, but not painful/pruritic, and having ruled out the obvious, I tend to end up advising just monitoring it, possibly with some omega 3/6 supplementation if the owners feel that they want to do something!

Re: Derm case suggestions?

Rajat — Mon, 06 Aug 2012 16:32:16 GMT

[quote user="Kate Richardson"]why not just sit back and monitor? [/quote]

I second this whole heartedly, meant to include this, but totally forgot to include it in my mini essay on management!!

Re: Derm case suggestions?

Kate Richardson — Mon, 06 Aug 2012 16:16:03 GMT

Is there a friendly practice near by with a microscope you could use? I don't believe it's cheaper to trial different treatments- ultimately the most cost effective approach is to treat a diagnosis. Skin scrapes and cytology- a scalpel blade, some sellotape, a few slides, some liquid paraffin plus your time shouldn't break the bank.

Equally if the lesion isn't bothering the dog and isn't progressing and there are no other skin lesions whatsoever (If I am understanding it correctly you simple have alopecia and some crusting on the tail tip only?) why not just sit back and monitor? Poss put a buster collar on the dog to rule out self trauma? If you feel you have to use something or the owner really wants to, then I would use a moisturising shampoo designed for dry seborrhea/crusting/scaling- speak to Virbac as to which shampoo best indicated.

Re: Derm case suggestions?

Rajat — Mon, 06 Aug 2012 16:03:45 GMT

Derm cases always tough when there is no money

Trying to sift through info provided my summary is :

Dog has had a 'skin problem' since a pup. At various times this has presented differently, with Otitis, impetigo, pustules and scaly lesions.

He has had various treatment trials but not much diagnostics.

He currently has a 'skin issue' with his tail

He is currently non pruritic.

I'd suggest using a diagnostic algorithm to try and sort this out. Others have made good suggestions.

So scaly alopecic lesions with no pruritus aloine make me think ringworm and demodex- as you mentioned this was negative.

Dachschunds are also prone to vasculitis (usually ear tip) and this can present similarly tho often painful with necrosis and crusting of skin.

But overall, this dog 'smells' of an allergy. the age of presentation, and the ventral pyoderma with an episode of Otitis externa makes me think allergy only thing that doesn't fit is he is not pruritic, might be worth checking this again with owner?

If owner ties your hands re costings, its so difficult to do anythign properly.

In my hands I would:

1. Use stronghold/advocate every 3 weeks- breaking life cycle of parasites. ensure flea negative and spray the house with indorex( twice at 3 week intervals) aiming to kill dust mites as well as immature flea lifestages. I have used Promeris quite a bit and not had any problems. Heard about the issue re pemphigus in US but rep assured me it was quite rare and had been withdrawn for commercial reasons (too many spot ons available commercially) and not because of the few reactions noted.

2.Tapestrip impression smears of tailtip-inhouse exam

3. Malasseb/chlorhex bathe tailtip daily, +/- apply aloe vera or similar to soothe if sore

4.3 week course rilexine or antirobe (supposed to be better for skin than amoxy clav)

5.Dietary trial with novel protein and carb source. Need to check with O exactly what he has eaten in the past- including treats. I'm currently liking pork and potato from burns and salmon and potato from barking heads for commercially available novel protein trial foods which arent too expensive. if affordable z/d or RCW hypoallergenic may be a good way to go.

To be blunt, practising dermatology without a microscope is like going sailing without a sail. Tough and I'd be unlikely to get very far personally.

Add in limited funds and its a frustrating exercise and probably a guessing game every consult I imagine!

hope it goes well

Raj

Re: Derm case suggestions?

Kathryn Burton — Mon, 06 Aug 2012 14:18:33 GMT

We only have his Hx as of 2010 as was elsewhere prior to this and no Hx ever sent so don't know when the skin problems started.

When we first saw the dog he was on malaseb. Vet in 2010 started him on rilexine initially for impetigo (non-pruritic) , improved but didn't resolve so started on Aludex but no skin scrapes done, continued rilexine too. Skin seemed to improve on this in a couple of months (but no skin scrapes to show cure if was demodex). Since then the dog has had otitis in early 2011 and had aludex applied to it's ears but skin seems ok otherwise. no diet trial as far as I'm aware.

Tail doesn't seem to be bothering the dog - not painful or pruritic. The skin is really dry and scaly rather than there being any pustules etc. Had to send skin scrape to lab as we don't have microscope and they'd only let me send one :-(

So a bit stumped on where to best spend the owner's money with this one! Would be nice to do more scrapes to rule demodex and try to get them to another branch with a scope. Or try aludex again as worked in past but never been actually Dx with demodex. Pro-meris duo may be cheaper but I've read that if it's used regularly enough to sort out demodex it can cause pemphigus, which is why it's been withdrawn for this in USA...

Re: Derm case suggestions?

Mark Hedberg — Sun, 05 Aug 2012 15:26:45 GMT

I really think you need a t4 here to rule out an underlying cause. Finances are always an issue, especially if you use up all the money and the dog doesn't get better. A T4 is reasonably cheap. Skin infections always need at least 3 weeks antibiotic cover. Also, if you have facilities to do a culture and sensitivity on contents of a pustule, that's cheap too. Cephalexin is a big broad AB but it's nice to make sure the actual bug is susceptible.

Chlorhexidine containing shampoo, or even dilute hibiscrub soap is very good for drying out a good purulent skin.

also, just because the dog was or wasn't cured of mites before doesn't rule out mites being the cause this time. Advocate is licensed against mites when administered every 2 weeks. Off license: ivermectin works too.

finally, have you ever considered a food trial? A month of d/d, z/d, anallergenic, or the hypoallergenic food of your choice may help.

good luck!

Re: Derm case suggestions?

Lorna McHardy — Sun, 05 Aug 2012 13:22:59 GMT

I don't think you can rule out demodex or sarcoptes unless you take multiple scrapes, and even then, I'd be wary of "definitely negative" pronouncements; so I'd treat him... I can never remember which spot-on does the mites, have to check every time - is it Advocate? Anyway, that one.

Atopy/hypersensitivity reaction seems less likely in a dog that's had the problem from the start (when you say 'puppy', just how young was he when it started?)

I also don't think clavaseptin is necessarily the best choice for the kind of thing you describe; and I wouldn't have thought a week would be enough... even if you've successfully treated for any underlying mange, this has been going on so long it'll take a while to get rid of all the secondary changes.

So if that was me, I'd do a full work up if possible; but if finances forbid proper investigation, use the spot-on, start whichever shampoo seems most appropriate, and put him on cephalexin for 3-6 weeks. If they can't afford treatment either... preds! But not without making sure you've treated adequately for mites.

Re: Derm case suggestions?

James Laidlaw — Sun, 05 Aug 2012 12:41:52 GMT

How many scrapes did you send off? I'd probably biopsy over blood test, but depends on how financially limited you are. Is it causing the dog any problems currently?