exceptionally pruritic dog - but not allergic it seems ?!

RE: exceptionally pruritic dog - but not allergic it seems ?!

Aine Seavers — Mon, 19 Oct 2015 11:58:23 GMT

The case certainly has some issues and hence I would reallylike to see a video - pseudoepilepsy caused by malessia will show as intense paddling of fore legs esp just often around and in front of nose so not always contact and syringomelia does the air scratch-Cushing a possibility but after this long would you not expect skin fragility and tearing at least? I am constantly amazed with videos as to what clients tell me the dog is doing compared to what the dog is actually doing-often so far apart as to make one wonder how 2 humans can look at an event and come up with such divergent thoughts-but equally long term occult scabies has only shown as a very hot dog- hence I always rule it out for sure-cutaneous heartworm can cause waxing and waning pruritus and lesions- not a concern in UK unless dog went abroad -y once saw a dog in London- 4th vet to see it-no lesions but was crawling with lice- so itch from parasitic infestation is so high up the list it needs to be ruled out before paraneoplastic and other oddities explored.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Aine Seavers — Mon, 19 Oct 2015 11:56:52 GMT

RE: exceptionally pruritic dog - but not allergic it seems ?!

Tracey Kernaghan — Mon, 19 Oct 2015 11:25:28 GMT

My thinking is that if this dog had a large amount of endogenous steroids, there may not be the usual signs of inflammation that we would expect with a pyoderma - a bit like those allergy dogs that have had repeated courses of antibiotics and steroids. It would be the pyoderma that's bothering the dog, not the cushings.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Sun, 18 Oct 2015 16:01:14 GMT

[quote user="Tracey Kernaghan"]I've seen a number of very pruritic dogs with no visible skin lesions [/quote]

This is the thing I can't go with at all. There's got to be some sign in a pyoderma surely??

Even if we scratch ourselves once, the skin goes red for a while, let alone scratching for weeks on end.

I've seen some dogs with psychogenic polydipsia; the old boiled water trick eliminates many of them.

This dog sounds like a candidate for every psycho manifestation going....

Not sure we know just how much the dog drinks either.

Not sure Cushings dogs are itchy either; about the only skin sign not coupled with itch, IMHO?? [sorry hypothyroid dogs [except greyhounds, in case I get into more doo-doo]

RE: exceptionally pruritic dog - but not allergic it seems ?!

Tracey Kernaghan — Sun, 18 Oct 2015 15:17:53 GMT

There's a couple of things that would bother me about this case:

1/ why are there no redness or skin lesions if the dog had been licking constantly for this period of time?

2/ is the polydypsia signficant?

You should be able to prove if the dog is indeed licking/chewing by a hair pluck/sellotape impression I would expect to see broken hairs and possibly Simonsiella (a bacteria found in saliva) if he is so you don't have to take the owner's word for it.

I've seen a number of very pruritic dogs with no visible skin lesions respond to an appropriate course of antibiotics and having had impetigo myself, I know how itchy skin infections can be so I'd definitely want to look for Malassezia and if not found, give an appropriate course of antibiotics to rule out pyoderma.

Going back to 1/. What if this dog had cushings? He's a predisposed breed and the right age and had PD. A negative ACTH stimulation test isn't a complete rule out for cushings (some adrenal tumours don't have ACTH receptors) and even a normal ALKP is only a 90% rule out. Cushings might be why a dog that is doing so much damage to himself isn't showing the expected signs of inflammation. If anyone in your practice is good at scanning adrenals, I think it's worth a shot.

Anyway, just some suggestions. It would be great if they help.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Sat, 17 Oct 2015 11:17:27 GMT

[quote user="Andrew Mellor"]a very anzious dog[/quote]

What about a "suitable" dose of Acp or Valium, as needed and at night for the owner's benefit, at least

I can't see how we can even consider sarcoptes or demodex or bacteria with absolutely no changes in the skin.

I have a vague memory of demodex being totally asymptomatic in some animals, although present, bit like E.coli in the gut.

It was thought that it was the reaction to demodex and not it's actual presence that caused the signs.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Aine Seavers — Sat, 17 Oct 2015 06:01:44 GMT

can you post a video of him doing his thing so we can see first hand what he does?

Does it stop when you kennel him at clinic?

Bravecto should sort out scabies given recent work-unless they don't give it with good meal of food in which case absortion really reduced so one has to ? efficacy then

- is it possible for you to apply advocate 2 weeks apart on 3 occassions? If + scabies they get worse peri-treatment so I preemptively dose the dogs with preds and antihistamine to address some of the suffering induced when mites dying off- and at that point scabies does seem to respond to glucocortiocoids.

Gapapentin is good for neuropathic pain but would like to see a video.

Some times putting the dog in a white sun shirt or baby t-shirt can reduce the itch- here its recommended to put a warm wet wrap on when allergy flares up- often we use a wet vinegar/water soaked t-shirt here in the summer as both a barrier and adjunct treatment for itch(not at same time as advocate application), Equally a dry white t-shirt or rash vest can be a source of information- the white shows up if dog lying on irritant plants, ants, contacts etc and is a barrier if the human owners have hand creams or medicated creams which irritated the dog- easier than making owners wear gloves during a trial. The oddest results we had was an owner on methotrexate who had creams for all sorts of fungal and bacteria nail/hand infections-her cats driven mad with itch- stopped when she wore white cotton gloves around the house and so wearing them whenever she patted the cats- equally a landscape gardener whose dog rolled over for a belly rub when owner appeared home- constant ventral itch of some years- stopped when owner learnt to wash his hands well before he greeted the dog first thing after work.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Simo — Fri, 16 Oct 2015 19:19:39 GMT

I second A.Todd on the compulsive behaviour. Complete lack of secondary lesions after such a long time is not consistent with true itch in my opinion.

EDIT: The fact that the dog is anxious and licks/sucks at skin are two more points in favour of the OCD rather then pruritus. Licking and sucking the skin is a quite common self comforting behaviour in many species (think thumb sucking in children, for exemple)

RE: exceptionally pruritic dog - but not allergic it seems ?!

Andrew Mellor — Fri, 16 Oct 2015 17:03:41 GMT

[quote user="Anthony Dennison"]

Could it be a weird presentation of syringiomyelia?

[/quote]i did wonder that but thise dogs that i jave seen tend tl scratch the air rather than actually contacting the skin and in this case licking and sucking the skin happens more that itching. The owners say they do not smoke. Do not use any air fresheners etc etc . The dog never smells perfumed or of anything but general dog smell - normal not wet labrador! Plucks and scrapes were normal. Biopsies were not performed as owner did not want to go that far. I struggle with them because they come in exausted because dog has had them up all night pleading with me to fix the dog but will not let me refer. It is as an aside a very anzious dog with raised basal cortisol and hct after very relaxed uneventful blood sampling if that gives any other clues.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Fri, 16 Oct 2015 11:31:56 GMT

[quote user="Martin Atkinson"]I can't think of another explanation of generalised licking and scratching other than some weird psycogenic/behavioural problem,[/quote]

https://www.aspca.org/pet-care/virtual-pet-behaviorist/dog-behavior/compulsive-behavior-dogs

This may help, I'm not allowed to "cherry-pick" but others can, most of it could fit.

My solution of shouting at the dog is a complete no-no, they say......

RE: exceptionally pruritic dog - but not allergic it seems ?!

Martin Atkinson — Fri, 16 Oct 2015 10:54:29 GMT

[quote user="Thomas Johnson"]I've got a vague memory that someone once told me that the trouble with the food allergy panels is the number of false positives. [/quote]The one and only one I've done came back being allergic to anything and everything. It was of no use whatsoever and with that and the universal opinion of dermatologists (apart from those who are in the pay of the labs that promote the tests) I have not bothered again.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Dennison — Fri, 16 Oct 2015 10:53:28 GMT

Could it be a weird presentation of syringiomyelia?

RE: exceptionally pruritic dog - but not allergic it seems ?!

Richard Carter — Fri, 16 Oct 2015 10:11:48 GMT

or it could be the owner smokes, is into aromatherapy and never vacuums the house and the dog is living in this environment.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Thomas Johnson — Fri, 16 Oct 2015 10:08:48 GMT

[quote user="Andrew Mellor"]

I have to say i have done ige bllods for food for ages and seem tk have had good results / success with the nationwide test. I started after using hills z/d ultra for loads of dogs food trials and having no success and they were all on ige rice allergic. Only the chicken is hydrolysed not the carb component.

[/quote]

I've got a vague memory that someone once told me that the trouble with the food allergy panels is the number of false positives. So if the dog is genuinely food allergic they can be useful as they will pick up what the dog is allergic to, as well as several things it is not, so you will be over-restrictive but your exclusion diet should work. But for a dog that doesn't have food allergies you will still get positive responses and this may lead you to do a food trial that won't work and delay further investigations.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Kate Richardson — Fri, 16 Oct 2015 10:07:57 GMT

You don't mention skin scrapes or hair plucks anywhere? have had a few itchy dogs with demodex, negative on skin scrapes, diagnosed on biopsy

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Fri, 16 Oct 2015 09:57:22 GMT

[quote user="Martin Atkinson"] "2 year history now of licking and scratching itself constantly 24-7" tends to be suggestive. [/quote]

Yes thanks for the heads up.

As some of us rely sometimes on the history, and not on tests straight away, it occurred to me that it may be the owners' just stating "the dog is itchy", possible, with the total lack of physical signs.

We usually take the owners word for it when they say the dog has bitten their child and, knowing how weird some owners can be, it seemed a reasonable question to ask.

I wonder how the dog acts when the owners aren't around? What happens if someone shouts at it to stop?

Will it start limping.....

RE: exceptionally pruritic dog - but not allergic it seems ?!

Andrew Mellor — Fri, 16 Oct 2015 09:22:24 GMT

Thank you all for your replies. I too struggle with the lack of lesions etc . I have done all the things suggested except skin biopsy as owner does not want to go thst far ! The apoquel dose was top end of range. The dog has apparently been washed twice weekly with malaseb for 1 month. Then twice daily with an oatmeal shampoo for 1 month then as no difference with either tried no bathing for 3 mth and no difference. The dog ckmes in to consult room and unless on table is sat in a corner suvking himself or itching but not really hard enough to damage skkn. Or rolling on back on consult room floor. I did think about diabetes but bloods and urine normal. The only other thing that has been noted over many consults is he seems hot . Totally well but core temp never seems to be less that 38.9 and this has been since a pup. I have started him on amitriptyline a week ago in case neuropathic or ocd . Early days yet i suppose but he is still sucking himself through the night. - legs flank folds feet etc.

Perhaps i am kidding myself / my clients and should look elsewhere. Owners have ruled out referral to detmatologist or neurologist on cost grounds.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Martin Atkinson — Fri, 16 Oct 2015 09:01:23 GMT

[quote user="Anthony Todd"]

How do we know the dog has an "itchy skin"?

[/quote]The opening gambit: "2 year history now of licking and scratching itself constantly 24-7" tends to be suggestive.

I can't think of another explanation of generalised licking and scratching other than some weird psycogenic/behavioural problem, which I know you have intimated, every other cause is likely to be localised.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Thu, 15 Oct 2015 21:20:43 GMT

How do we know the dog has an "itchy skin"?

RE: exceptionally pruritic dog - but not allergic it seems ?!

Richard Carter — Thu, 15 Oct 2015 20:48:16 GMT

exclusion diet, air fresheners, carpet cleaners, have vacuum cleaner at home (and use it), non-bio soap for bedding; EFA/Zn/Vit B supplementation, what soap used by poodle parlour, how often bathed/ clipped, worse after clipping, trial bath in soothing type shampoo, sarcops serology?

Think I would also ban all processed / coloured treats, stick to simplified identifiable food source and use non-processed treats if cannot get away from giving treats if not already done.

And then go insane because abnormal brain pressures, systemic MCT and other histamine releasing syndromes and other zebras are also DDs .

RE: exceptionally pruritic dog - but not allergic it seems ?!

Martin Atkinson — Thu, 15 Oct 2015 19:28:31 GMT

[quote user="robloxley"]Interesting[/quote]Indeed. But all dermalogists I've listened to would still not rely on Ige serological tests alone. This may give an indicator but they would still like an intradermal test if someone is going to spend money on a vaccine. Of course there are plenty of labs who are happy to take your money and make up a vaccine from just the results of Ige serology as there are still plenty of vets who will do serology for food allergy when we've both agreed this is useless. That tells you what you want it to tell you!

I guess you pays your money and you takes your chance.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Rob Loxley — Thu, 15 Oct 2015 19:01:16 GMT

[quote user="Martin Atkinson"]If you're going to spend money on a blood test and considering serology (otherwise it is a waste of money) IMO you'd be better spending it on patch testing which is more reliable.[/quote]

Interesting: the WSAVA 2010 clinical practice guidelines say "As written above, veterinarians can use either allergenspecific intradermal or IgE serological tests to identify hypersensitivity to common environmental allergens as there is no clear evidence that the response to ASIT is superior using allergens selected by IDT or serology"

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Thu, 15 Oct 2015 19:00:55 GMT

[quote user="Martin Atkinson"]patch testing which is more reliable.[/quote]

I say again: a dog with a really itchy skin for two years with no changes in the skin or fur!

Come on, the dog has sussed that if he scratches or chews he gets a doggy treat!

Unless it's Munchausen By Proxy syndrome ?

RE: exceptionally pruritic dog - but not allergic it seems ?!

Martin Atkinson — Thu, 15 Oct 2015 18:04:06 GMT

[quote user="robloxley"]

[quote user="Martin Atkinson"]Blood test for allergies are waste of time and money[/quote]

Really? Agreed for food but for environmental allergies? Must say a number of the last ones I've referred have had allergy serology?

[/quote]Not quite so unequivocally for skin as food but I would still take them with a large pinch of salt. If you're going to spend money on a blood test and considering serology (otherwise it is a waste of money) IMO you'd be better spending it on patch testing which is more reliable.

RE: exceptionally pruritic dog - but not allergic it seems ?!

Anthony Todd — Thu, 15 Oct 2015 17:51:54 GMT

[quote user="Martin Atkinson"]Sarcoptes [/quote]

1. Has anyone ever seen a 2 year infestation with sarcoptes, or even 2 days without lesions?

2. Has anyone ever seen a 2 year pruritic dog without changes in fur or skin]

3. Referral will only start where you have been already, but at much greater cost including biopsies of normal skin.

5 or 10. Have the dog in, distract it, play with it, walk it and see if it still itches [not concurrently with other treatments]

[I remember a corgi that would limp if you shouted at it! so a "two-and-two" response to whatever is a possibility]

60. Are the owners bathing it daily with something irritant or sensitising?

7. Is the dog given a treat when it starts to scratch?

You will have tried these things I'm sure, [says he, on egg-shells,so as not to offend!]

My bets are pending the results of the above.

8. But if I had to, I'd bet, it'd be a smart dog, that can ring the owner's bell, and an adoring owner....

25. Try one jab at a decent dose of dex.; response should be dramatic if it is "allergic" Tell the owner it should will last for a month. But do that as a last resort, just to please me in case it works.

PS Better check the urine though, don't diabetic people itch?