Issue 1: December 08
Dear Dr. Schelling,

Our one-year-old English Bulldog, Fergie, has developed a number of scabby sores and dry patches across the back of her neck, in the folds of her skin, and all around her nose. She scratches and licks at them endlessly, and they do not appear to be healing at all. Several have started to bleed, especially the ones close to her collar, and others are oozing some sort of pus. I am hoping you can tell me what the cause may be and what we can do to help heal the sores.

- Burning Concern

Dear Burning Concern,

Skin diseases are one of the most common reasons owners bring their dogs to a veterinarian, and you have already gathered some important information your vet will need to begin the diagnosis of Fergie's problem. Breed, age, gender, overall health and any behavioral or environmental changes are important facts that can assist your vet in the proper diagnosis.

It is important to understand that if a dog has a skin disease, there is often an underlying cause that has nothing to do with the skin. The skin is acting as a sentinel to signal that something else is wrong.

It is important to take Fergie to your veterinarian for treatment of the symptoms...i.e. the sores, and even more important, to determine and treat the underlying cause so the sores do not recur. I would like nothing better than to give you a magic remedy to make Fergie feel better, but without knowing the cause, the remedy likely will not work. Fergie's skin is telling us that there probably is an abnormality in her body that needs to be treated. And if we do not know the cause, some treatments might make things worse.

This is an extremely important concept, which I hope will help you understand Fergie's problem much better. Let's talk about a few of the things that can cause skin lesions. The skin, which is the largest organ of the body, has only a few limited responses to a wide variety of causes. For example, a dog with hypothyroidism—low thyroid levels—may have skin problems very similar to those of a dog with diabetes or hyperadrenocorticism—big word for another hormonal imbalance in dogs. This drives home the point that if we don't know the cause, we can't treat the disease effectively.

If there are no underlying metabolic or hormonal problems, the most common cause of skin irritation in dogs is external parasites, most commonly, fleas. I know, I have heard it before—"My Dog does not have fleas!" But did you know there are many, many dogs who have a condition called Flea Allergy Dermatitis—FAD. These dogs are extra sensitive to fleas and exhibit an exaggerated response to flea bites. One flea bite can cause an allergic reaction in an FAD dog. So even if you don't see fleas, there is a possibility that fleas are the cause.Common symptoms of flea allergies include itching over the hips and tail area, the abdomen and inside the rear legs and armpits.

The flea injects saliva when it bites the dog. Flea saliva is an anticoagulant as well as a protein. The problem is the protein from the saliva remains in the dog's system for two weeks and, if the dog is allergic to this protein, intense itching results. With FAD, the first line of defense is to be sure a high quality flea preventative is used monthly, following manufacturer's directions. Note that if a dog's skin is broken, more medication will be absorbed than would be through the skin of a healthy dog. This can lead to toxicity, especially with medications containing permethrins or pyrethrins. Again, this emphasizes the need to consult your veterinarian before starting any treatment.

You are likely to hear from anyone you ask that if your dog has bad skin, it is a food allergy. This is a common misconception, and although food allergies definitely do occur, we find a food allergy component in only about 10 to 40 percent of dogs with allergies. Common symptoms of food allergies include facial itching, feet licking and chewing, and chronic ear infections.

There are many pet food manufacturers that claim to offer a hypoallergenic diet. Dogs, like people, can be allergic to a variety of allergens, usually carbohydrates, proteins, and sometimes, preservatives. Unless a food trial is performed, feeding one protein, one carbohydrate at a time, it is not possible to determine which of the ingredients are triggering allergies. There is no "one size fits all" diet for dogs with allergies. Additionally, if you do not implement a proper food allergy feeding trial designed by your veterinarian, you may end up making Fergie allergic to even more types of food. This is a complicated subject which we will delve into further in subsequent issues. In short, don't just go out and buy a hypoallergenic diet as your version of a feeding trial.

Another type of allergy is Atopy, a heritable allergy to environmental allergens, molds, pollens, grasses, weeds and trees, usually inhaled through the respiratory tract. Atopic dogs generally show symptoms beginning around the age of two. At first the symptoms seem to be seasonal, but recur with longer and more severe episodes. Diagnosis can be made with blood work and allergy testing. Owners should know that these dogs are never cured, but can be very well controlled with life-long therapy. Since this is a condition that can be passed on to offspring, these pets should be spayed or neutered.

Regardless of cause, skin irritations have a high potential for secondary bacterial and/or yeast infection. Any secondary infections will need to be treated as well as the cause. Your vet may very well be treating two separate conditions. One treatment for the cause of the lesions - sores, and the second treatment, a palliative and therapeutic treatment to soothe the lesions resulting from the primary cause.

Medications to control itching can help improve Fergie's (and your) quality of life. Gentle hypoallergenic shampoos help to reduce the allergen load and improve overall skin health. Omega 3 fatty acids have proved to be vital to pets' overall health, especially with regard to the skin.

I realize that this is a long answer that didn't really give you a cure, but I hope it will help you understand that Fergie's skin can act as a sentinel organ to tell you and your veterinarian that something internal may be out of balance. The sooner the cause is diagnosed, the better for all concerned.

-Dr. Schelling
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