Frantic scratching at face

RE: Frantic scratching at face

Carolyn — Thu, 18 May 2017 15:25:44 GMT

Thank you everyone for the replies here- very helpful!

I agree the hypothyroidism diagnosis is very questionable. I haven't broached the subject with the clients yet but certainly will. The pruritus began prior to thyroxine supplementation.

Skin scrapes were negative but I did take a skin biopsy 'just in case' when I did the dental, so I will send this forhisto as advised - probably wise to be sure we have no demodex as well as checking full haem/biochem prior to an apoquel trial given that interesting paper.

if no response perhaps phenobarbital is the next one to try!

Thank you all, I'll keep you posted

RE: Frantic scratching at face

Andrew Henfrey — Wed, 17 May 2017 21:18:20 GMT

Demodex injai reported by Forsythe, Auxilia and Jackson to cause intense facial pruritus. Diagnosed by biopsy rather than scrape. IIRC it was mainly Shih thus but signs sound similar. It was presented at a BVDSG meeting a few years ago. The only paper I can find is: Forsythe PJ, Auxilia ST, Jackson HA: Intense facial pruritus associated with Demodex injai infestation: a report of ten cases. Proc 24th N Am Vet Dermatol Forum 20:248, 2009

RE: Frantic scratching at face

Beats — Wed, 17 May 2017 21:14:40 GMT

+1 for apoquel as next trial.

I think I remember someone claiming accidental success after a cerenia trial too, but I may be about to start an urban myth...

How high did you go with the gabapentin dosing?

RE: Frantic scratching at face

Stephen Courtney — Wed, 17 May 2017 19:55:22 GMT

[quote user="Nicola Lawlor"]

I had a dog present almost identically a few months ago as a second opinion and whilst I tried to read up and learn more from colleagues before formulating a sensible workup plan, I trialled the dog on apoquel. After 12 months of intense facial pruritis the dog was perfect within 24hrs! It had been given steroids by the previous vet which hadn't made any difference apparently.

The major differential I had at the time based on previous history and tests already done was some form of trigeminal neuralgia with a sensory bias. This particular dog seemed to have significantly more issues on one side of the face than the other so I was pleasantly surprised when the apoquel worked.

[/quote]

2 weeks trial on apoquel is a lot cheaper than a CT/MRI referral....and less troublesome than phenobarb too!

RE: Frantic scratching at face

Nicola Lawlor — Wed, 17 May 2017 19:50:59 GMT

RE: Frantic scratching at face

Stephen Courtney — Wed, 17 May 2017 15:44:11 GMT

You cannot diagnose hypothyroidism on a single low total T4. Thats bad medicine. Stop the supplementation. Seems some poor dental work was done initially as well, which can't have helped, but it seems unlikely that it is a dental problem. good analgesia makes no difference, so if you can rule out itching, then that leaves some sort of neurological issue.....

Might be worth a phenobarbitone trial? Failing a more in depth work up, and that would depend on the owners appetite for expensive imaging / specialist referral.

RE: Frantic scratching at face

Thomas Johnson — Wed, 17 May 2017 12:27:42 GMT

[quote user="Martin Atkinson"]

[quote user="David Mills"]Thyroxine supplementation in humans is associated with facial skin rashes some of which are pruritic. Never seen it in a dog but haven't treated that many (it's a bugbear of mine as an overdiagnosis). [/quote]Equally it is often missed as a diagnosis. Given that this dog was diagnosed as hypothyroid only on a 'slightly low T4' it is probably a good idea to stop treatment.

[/quote]

I agree, I wouldn't be happy with a diagnosis of hypthyroidism based just on a slightly low T4. Even if it's unrelated to the facial pruritis I would consider stopping the supplementation and checking T4 and TSH in a few weeks.

RE: Frantic scratching at face

Bob Russell — Wed, 17 May 2017 10:47:35 GMT

It has always concerned me that so many 'hypothyroid' cases seem to occur in other practices but we have very few!

Not sure if I am under diagnosing them or whether it is not as common as rumoured. I also find that only rarely is hypothyroidism confirmed by tests other than T4!

Perhaps a subject for a clinical discussion or even a clinical audit of my diagnostic skills!

RE: Frantic scratching at face

Martin Atkinson — Wed, 17 May 2017 10:25:04 GMT

RE: Frantic scratching at face

David Mills — Wed, 17 May 2017 10:07:05 GMT

Thyroxine supplementation in humans is associated with facial skin rashes some of which are pruritic. Never seen it in a dog but haven't treated that many (it's a bugbear of mine as an overdiagnosis).

Limbic epilepsy also a consideration. Depending on owner, phenobarb trial may be worthwhile Esp if no skin changes.

RE: Frantic scratching at face

Richard Carter — Wed, 17 May 2017 09:51:16 GMT

Calcium levels? Hypercalcaemia can cause facial irritation.

Or is he wirehaired with lots of hair & constantly wet face/ malasezzia overgrowth? Dilute iodine wash for lips, chin??

Or trial phenobarb / apoquel for 2-3 weeks to allow things a chance to heal over?