Chronic Unknown Skin Condition - Desperate

[Champs Dad]

I wouldn't bath him in any medicated shampoos, his skin needs to be soothed.

I would make sure he does not have any coulour, flavours or preservatives in his diet.

Check his bedding, remove any hession and wool bedding. If you aren't already using cotton, I'd switch to that and also make sure you washing powder is for sensitive people.

If he's scratching that crazily, put cotton socks on his back feet and bandage them up, so he at least can't use his claws to further damage his skin.

Thanks for replying. This might be upsetting to some people, but Oscar has been sleeping on our bed. It is not his habitual sleeping place - but we feel very sorry for his and he loves sleeping on the bed. Cotton sheets. I will make sure I cover the couches in cotton too. Thanks also for the sock tip. I hadn't thought of that. I'll need to put it on his front and back leg as he uses both. He doesn't scratch all the often but tends to rub his face in whatever he can find with the occasional foot scratch

I have tried all sorts of diets of late but am thinking of trying vets all natural complete mix next. I don't know whether I should use chicken or roo. I have heard red meats are not great for sensitive dogs.

I have read that people use calendula tea to soothe itchy or inflamed skin. I am interested in trying this but don't want to aggravate his skin anymore than it is.

Poor Oscar, sounds awful for him Heaps of good suggestions so far. My dog Champ had bad allergies too. As mentioned, cut out the shampoos and medications and try the calendua bath. No preservatives, artificial colours, etc in food, I'd advise cutting out dry food all together for the moment. Do not start him on the vets all natural mix!

Hope you get some answers soon, good luck.

[espinay2]

Agree with a lot of what is being said here. I would back right off and go back to simple basics. If a dog like this were coming to me I would do the following:

Feed only chicken (mince and/or wings etc) and nothing else at all for a few weeks at least.

To this however I would add Vit C, Vit E and fish oil.

Bathe only in a very mild no soap shampoo. If he is not dirty, refrain from bathing too much.

Rinse with a mix of vinegar and water (as strong as he can stand - if the skin is broken mix 50/50 with water - if not got as close to 100% as possible) Vinegar is anti bacterial and fungal and will help with any infection (or stop it developing). You can use this in a spray bottle to spritz on the skin between washes too.

Then rinse with a a little alpha keri oil in some warm water - this will help sooth dry and broken skin. Alpha Keri Oil is available at the chemist.

Also investigate what you are using in the house and yard. things that may be suspect include your washing powder, fabric softener, anything you use on the carpet or floor etc etc. Try removing or changing these things.

[pixandpug]

Oscar had his visit with the emergency vet today. It is very disheartening when you can tell they don't know what to say to you and can't help. He advised to keep on the antibiotics and cortisone until he sees the dermatologist.

I agree with all the suggestions here to keep things as simple as possible. Tomorrow (when the shops open again), I will pick up some calendula tea and see if this will offer him some relief.

I think I will try oscar on a chicken only diet. Would it be better to feed this to him raw or cooked? I noticed some people suggest adding rice and others don't.

On a positive note - we took Oscar for a walk after his visit to the vet and he appeared in good spirits. Very busy sniffing and marking every 3 meters. He appears to be maintaining his bottomless pit of an appetite too.

There were lots of naughty doggies at the emergency hospital today. I heard many mentions of easter eggs!

[dogbesotted]

ok i will be the one to suggest a complete thyroid panel( not just T4) ... the whole shebang. It is not expensive and is frequently overlooked.

preferably sending the sample off to Dr Jean Dodds.

I know of several cases of dogs being treated for skin problems which after 3 years of treatment with cortisone ,antibiotics, medicated washes etc etc turned out to have a thyroid issue. so it is well worth pursuing.

have a read here for starters:

http://www.newmanveterinary.com/Hypothyroid.html

good luck

PS what wrong with a dog on the bed???????

Edited April 25, 2011 by dogbesotted

[pixandpug]

PS what wrong with a dog on the bed???????

I don't have an issue with it - though some might be put off by the little patches of blood and other mysterious substances he leaves all over the place at the moment. Thank god for the washing machine!

[poodlefan]

P&P, what do you feed your dog now?

[Erny]

ok i will be the one to suggest a complete thyroid panel( not just T4) ... the whole shebang. It is not expensive and is frequently overlooked.

preferably sending the sample off to Dr Jean Dodds.

I know of several cases of dogs being treated for skin problems which after 3 years of treatment with cortisone ,antibiotics, medicated washes etc etc turned out to have a thyroid issue. so it is well worth pursuing.

Yay!!! I've become relunctant to mention this as I can't help people just passing it over because I mention it so much (same goes for the Calendula Tea) lol.

Yes! Yes! A thyroid test via Dr Jean Dodds .

[pixandpug]

P&P, what do you feed your dog now?

He is currently on Science Diet Z/D Allergen Free. Before this I was making him a homemade diet of veges, roo meat and wholegrain rice for approx 3 months and before that he has always eaten Science Diet dry food with raw bones about once a week.

I'd like to change his diet when/if we get to the bottom of what the problem is but have been having a hard time navigating through all the conflicting ideas on diet.

[RuralPug]

Pugs are notorious for grain allergies and reacting to starches. Of animal proteins, the fattier ones like chicken and lamb are often the culprits, but once the immune system has become unbalanced, they can react to any protein they have been eating for a while.

Given what you have been feeding him and his worsening condition I would remove all grains from his diet immediately. It's elimination time, so start with a single protein (roo or rabbit mince (raw) or canned sardines/mackerel - pick one only) with pureed steamed leafy green vegies and an immune system booster such as Missing Link. I would also add a little powdered kelp just in case his thyroid levels are off. This will do until you have had your consult with the dermatologist. In fact, for the short time until you do see the dermatologist you can omit the booster powder.

Meanwhile, the calendula tea wash is very soothing and if you can, keep him off the carpet in case he's reacting to the floor coverings. PM me if you want more information on allergy pugs - there is a lot of experience across the globe, unfortunately.

[espinay2]

Yes!! Agree on the thyroid panel!! Just re-read the thread and was thinking a full blood panel would be in order, but especially thyroid.

If I were feeding this dog it would be raw and no grains (which includes no rice). Stick to one simple protein. I have no problem starting with chicken on the whole - it is amazing how many dogs considered allergic to it (because they react to 'chicken based' commerical foods - which of course include lots of other things and present protiens which are not in their natural state) are actually not when you feed it plain and raw with no further processing.

[Andisa]

Contact http://www.pugrescue.org.au/ they have dealt with all sorts of issues and would be a wealth of information.

Another vote for Calendula Tea, I am treating a girl with skin issues at the moment and this has been very soothing for her. I have a spare bag if your unable to find it locally.

Good luck.

[rotts4ever]

I have a 9 year old pug that has been suffering from an unknown skin condition for quite some time. The first sign appeared around a year ago with a small patch of missing fur that gradually moved from one spot to another over the course of around 9 months (and several different vets later).

Sorry to hear about your little ones suffering, when I read your post it made me think about this article I read and if one product could cause such problems that maybe other products could be causing problems to others dogs and that vets may not always link the use of certain products to the illness.

Sorry I haven't read all the post but I just found this interesting that the use of a product isn't always linked to symptoms in the 1st instance especially if the occurance of problems with the product isn't common.

The article is below, a bit long Sorry

Cheers Lee

By Jessica Tremayne

Contributing Editor

A recent groundbreaking study of clinical, histological and immunological data of 22 cases of Pemphigus foliaceus, or PF, shows evidence that it can occur as an adverse drug reaction to the canine flea and tick preventive ProMeris.

PF is the most common spontaneously occurring autoimmune skin disease of dogs and typically displays as lesions on the face, nasal planum and ears. The reaction is rare but serious, says the study’s lead author, Thierry Olivry, DrVet, PhD, Dipl. ACVD, of North Carolina State University.

Ultimately, ProMeris Duo (Metaflumizone–amitraz ), which is also used for treating demodicosis, will be discontinued. The product, marketed by Pfizer Animal Health, will be available while supplies last or until mid-September. ProMeris Duo is called ProMeris for Dogs in the US. It is a novel topical ectoparasiticide.

“ProMeris was one of the many products that Pfizer brought into its portfolio when we acquired Wyeth/Fort Dodge Animal Health,” says Jim Brick, director and team leader of U.S. marketing for Pfizer Inc.

“We have completed a thorough review and evaluation of the strategic fit into the Pfizer Animal Health portfolio, and have made the decision to discontinue the manufacture and sale of Promeris flea and tick control for dogs and cats.

“We notified our current customers of this decision in early April and will continue to fill their orders until Sept. 20, 2011, or while supplies last. We look forward to continuing to meet the needs of our customers with our evolving parasiticide portfolio.”

The study that gathered and presented the ProMeris findings was conducted by Dr. Olivry; Ursula Oberkirchner, resident; and pathologist Keith Linder, DVM, PhD, all of North Carolina State University.

Since ProMeris’ introduction to U.S. and European markets in 2007, veterinarians have reported this adverse reaction, but previous case studies failed to use a drug-reaction probability scale and therefore an ADR couldn’t be definitively identified.

Olivry says this examination of all parameters studied suggests that this ADR might represent the first instance of contact drug-triggered PF to be published in Veterinary Dermatology. The article was published in the March issue of the joural.

Spontaneously occurring PF, thought to develop through genetic and environmental triggers, has a higher prevalence in chow chows and Akita Inus, whereas ProMeris-triggered PF has a higher occurrence in Labrador retrievers and other large-breed dogs, Olivry says.

The study found that ProMeris Duo-associated PF not only had a reaction to the same drug, but also shared many of the same phenotypes. Lesions in PD-triggered PF were found to be both localized and at distant locations from the point of application.

“We contacted specialists who had diagnosed these cases in the U.S. and Europe,” Olivry says. “Dogs were selected if they had a history of skin lesions that first arose at the PD application site, but dogs with a known history of autoimmune disease were omitted.”

Skin biopsies from said PD-associated lesions had to reveal microscopic characteristics similar to those of PF, which means the presence of superficial keratinocyte acantholysis.

“Referring veterinarians from cases used completed questionnaires providing information on the patient’s lesions and drug application history. Within the 22 dogs included in this study, two groups of affected animals were distinguished: dogs with localized signs or those who also exhibited distant skin lesions.”

Olivry’s goal in revealing his study findings is to provide veterinarians with information on the prognosis and management of this disease. In addition to skin lesions, more severe reactions can occur and can be long-lasting.

“Signs of systemic illness were reported in three dogs in the study, and four required immunosuppressive treatment,” Olivry says. “After ADR PD lesions occur and are then treated, they could recur at a later time without reapplying ProMeris Duo.”

Olivry says the study is referenced in Pubmed as:

Metaflumizone-amitraz (Promeris)-associated pustular acantholytic dermatitis in 22 dogs: evidence suggests contact drug-triggered pemphigus foliaceus.

An NCSU Case study

Olivry recommends that veterinarians use alternatives to ProMeris in animals known to have autoimmune disease, Labradors and other large-breed dogs, as well as in dogs that previously developed lesions.

“Dogs developed lesions in a draping pattern or along the dorsal side after having ProMeris Duo applied,” Olivry says. “Some dogs showed systemic signs that included lethargy, generalized pain and anorexia. In the case of a 7-year-old (spayed) female Labrador, a two-week history of skin lesions and lameness was presented.

“Ten months prior to referral, the dog’s monthly flea and tick prevention was changed from Frontline to PD. The patient received a total of three PD applications, three and five months separating them. One month after the third application of PD, the owner noticed extensive crusting on the application site between the shoulder blades as well as lameness in the left front leg. The dog was examined by the primary care veterinarian, who suspected a tick-borne disease as the cause of this dog’s lameness. Doxycycline was then prescribed.”

One of Olivry’s concerns with lesions occurring after ProMeris application is that primary care practitioners may not be able to identify or connect the product as a cause of the lesions and misdiagnose the patient, as in the case of the 7-year-old female Labrador.

“Skin biopsies were taken from interscapular crusts and histopathology revealed an acantholytic dermatosis of unknown origin in the female Labrador,” Olivry says.

“The patient’s health worsened dramatically over the following days. The dog appeared in pain, she showed lameness of the left front paw and skin lesions had progressed. The veterinarian prescribed prednisone (1 mg/kg twice daily) and tramadol, while a fentanyl patch was applied and doxycycline was continued.

“Only minimal improvement of the lameness and skin lesions was seen with this regimen, and the patient was referred to North Carolina State University. Skin cytology was performed on pus obtained from a crusted lesion in the shoulder, and microscopic examination revealed neutrophils and acantholytic keratinocytes suggestive of PF. Serum was collected for detection of circulating antikeratinocyte autoantibody by indirect immunofluorescence (IF) in our laboratory.”

Based on the strong suspicion of the diagnosis of ProMeris-triggered pemphigus foliaceus (PTPF), Olivry says the dosage of prednisolone was increased to 1.5 mg/kg twice daily, and tramadol was to be given as needed to relieve pain.

“On histopathology, the presence of a superficial epidermal neutrophilic pustular dermatitis with keratinocyte acantholysis was confirmed, and bacteria or dermatophytes were not seen in the stratum corneum by special stains,” Olivry says.

“Direct IF performed on paraffin-embedded skin sections revealed the intercellular deposition of IgG and IgM in both lesional and perilesional epidermis. Circulating antikeratinocyte autoantibodies were not detected at 1:20 serum dilution.”

Olivry and his team concluded this case with a diagnosis of PTPF.

“The dog returned for a re-evaluation visit the following week,” Olivry says. “At that time, skin lesions had improved, as there was only minor crusting left in the interscapular region and pinnae. The dog no longer exhibited signs of lameness, and tramadol was discontinued. The dose of prednisolone was tapered progressively over the following 11 days. The disease has remained in remission without any relapse for more than two years.”

Efficacy

Before ProMeris became available for veterinary purchase and distribution, studies evaluating its safety and efficacy reported the development of skin lesions at the site of drug application in some treated animals, Olivry says. In one clinical trial enrolling dogs with flea or tick infestation, six of 293 subjects (2 percent) exhibited skin hyperpigmentation, hair matting or scales at application sites.

In another experimental study of dogs infested with either fleas or ticks, one dog treated with ProMeris developed dorsal skin lesions that required treatment with an anti-inflammatory drug for seven days.

“Specific information on the frequency of these severe adverse drug reactions isn’t available, but it is important that veterinarians are aware of the product’s potential to cause the patient harm,” Olivry says. “Caution needs to be exercised if a vet decides to use this drug.”

dogs: case reports and recommendations for diagnosis and treatment. Veterinary Medicine, submitted March 2011. Not yet published).

How to diagnose generalized PTPF

• History of ProMeris application. This may have begun months before the onset of clinical signs.

• Development of skin lesions (e.g. crusting, alopecia, erythema) at the site of PD application.

• Later development of skin lesions at sites distant from the PD application area.

• Systemic signs (lethargy, fever, pain, anorexia, lameness) may be present in most dogs.

• Perform cytological examination of visible pus and look for acantholytic epidermal cells typical of pemphigus foliaceus (PF).

• Take several biopsies from recent skin lesions, preferably from intact pustules, and submit them for routine histopathology. Microscopic lesions are identical to those of typical autoimmune PF.

How to treat generalized PTPF

• Do not reapply PD.

• Use a mid-potency topical glucocorticoid at the site of skin lesions if feasible.

• Use oral glucocorticoids at immunosuppressive dosages (e.g. prednisone or similar, 2-4 mg/kg/day)

• If signs do not undergo clinical remission within one month, or if they recur after dose tapering, add another immunosuppressive drug such as azathioprine (2 mg/kg/day) or cyclosporine (7-10 mg/kg/day)

• Treat until clinical remission of lesions and taper drug doses progressively until withdrawal, if at all possible.

• Prognosis is generally good. Most dogs with generalized PTPF are likely to achieve complete disease remission and complete drug withdrawal. Oral immunosuppression may be prolonged in some patients

[Erny]

Whilst it is worth noting, especially for OS readers, my understanding is that we don't permit the sale of ProMeris in Australia.

[cavNrott]

Where are you Pixandpug? You must be fairly close to me in Mt Waverley since you're seeing the Emerg. vets in Glen Waverley and the Specialist Centre there.

If you haven't been able to get the Calendula tea I have some here you are welcome to. If you are local, shoot me a pm so we can get it to you today.

ef multiple spelling errors.

Edited April 26, 2011 by cavNrott

[pixandpug]

Where are you Pixandpug? You must be fairly close to me in Mt Waverley since you're seeing the Emerg. vets in Glen Waverley and the Specialist Centre there.

If you haven'e been able to get the Calemdula tea I have some here you are welcome to. If your are local, shoot me a pm so we can get it to you today.

Thanks everyone for all the offers of calendula tea. I managed to find some today and am getting it ready at the moment (looking for instructions on this forum actually). Poor little boy hates a bath - but at least he won't have to stand there with chemicals all over him for 10 minutes whilst they penetrate his skin.

We are located in Ivanhoe for all those that asked. One of the things I will mention to the specialist is that Oscar's problems began when we moved to the north side of the city. We used to live in the south east. It could be coincidental but you never know.

[Erny]

Thanks everyone for all the offers of calendula tea. I managed to find some today and am getting it ready at the moment (looking for instructions on this forum actually). Poor little boy hates a bath - but at least he won't have to stand there with chemicals all over him for 10 minutes whilst they penetrate his skin.

We are located in Ivanhoe for all those that asked. One of the things I will mention to the specialist is that Oscar's problems began when we moved to the north side of the city. We used to live in the south east. It could be coincidental but you never know.

Brew up about 2 tablespoons worth into a cup, as though you are making a cup of tea (which in essence, you are). I use one of these :

Before I thought of using the plunger (much easier), I used the toe of a cut off stocking and put the Calendula tea in that, and hung it over the side of the cup as you would a tea bag. Someone else here has simply brewed as they would for a cup of tea from a tea pot, and used a strainer when pouring.

Leave the tea brewing until the water (which was initially boiling) has completely cooled.

You can spray on, but many dogs don't like this. I have a big dog and used a flannel which I saturated in the brewed tea and rubbed/dabbed through the coat to the skin. This was the method I used when I was only treating certain areas and not the full body.

As things have been pretty bad, you could do the bath. For that, about 2 inches of the hottest water from the tap. Take a lump (fist full) of Calendula and put it in the toe of a cut off stocking. Tie the open end of the stocking off and let it float/bob around in the hot water. When the water has completely cooled it is ready to use. Pop your dog in (have a non-slip base for your dog) and use the Calendula in the stocking like you would a sponge, to wet him all over.

Don't rinse it off - leave it to dry. Give a gentle towel dry just to remove the excess water, but not to mop it all off.

Edited April 26, 2011 by Erny

[rotts4ever]

Whilst it is worth noting, especially for OS readers, my understanding is that we don't permit the sale of ProMeris in Australia.

I agree Erny, I wasn't meaning this product as such but was thinking more along the lines that any product/ enviromental factor could potentially cause the same sort of issues and if it was not a common thing vets may not link the two. Maybe even if the symptoms are similar then treatment might be as well. Especially when sometimes the same companies might be involved with products that are used in Australia.

Another thing I was thinking about, I've seen while grooming, is dogs with skin problems that didn't have the complaint until they moved to a new property. Many dogs have a reaction to any type of wondering or ground covering plants even when it isn't in their yard and they only had very quick contact with the plant on a walk or toilet break. In these cases though the skin problem normally started on the feet & belly where as when I've seen a reaction to say frontline it started at the site the product was applied.

Skin problems can be so hard to treat because there can be so many causes, dogs with cushings can have skin issues.

If the problem started after moving I would check yard as it could be something as simple as a plant, try the Calendula tea and make sure the diet is easy to process. I would try the sardines & vegies as mentioned, dogs usually love sardines and they are good for skin and coat and since it has been an ongoing problem talking to your vet about checking the thyroid as suggested wouldn't hurt and would at least rule it out.

Good luck, I hope to hear some good news about your pug soon

Cheers Lee

[Staff'n'Toller]

The consultant at Lort Smith is very good. Hold your fire until you see him tomorrow. Good luck.

[Champs Dad]

P&P, what do you feed your dog now?

He is currently on Science Diet Z/D Allergen Free. Before this I was making him a homemade diet of veges, roo meat and wholegrain rice for approx 3 months and before that he has always eaten Science Diet dry food with raw bones about once a week.

I'd like to change his diet when/if we get to the bottom of what the problem is but have been having a hard time navigating through all the conflicting ideas on diet.

Take him off the Science Diet! I had Champ on the same thing and he started to get better once he was off it. I went back to basics with chicken and rice, cooked and drained the chicken so it was a bit gentler on his system.

I would NOT be putting vinegar on your dog, that would sting! Calendula would be the best way to go at the moment. Thanks for posting the instructions Erny, I was going to look for them

[Mason_Gibbs]

My allergy dog also cannot tolerate the hills allergy food. My dog who is allergic to all grains, chicken, beef, turkey, wheat gets raw meat, bones and pumpkin, sweet potato, sardines and some other veg. I would feed 1 meat like goat that he has not had before and pumpkin. Add primrose oil to diet too. All this we were told to do by our derm.