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Severe Painful Prurituc Dermatitis In A Dog

by CorinneC - September 20, 2017 View Case Report

This dog was rescued and adopted at 3 years and has had chronic skin issues since - all responsive to Cephalexin and Prednisone, and on Apoquel daily. Many chinese herbs tried with past Vets - Xia Yao San, Chu Shi WLT, QYT, and Long Dan Xie Gan Tang, SMS- none helped but always on Apoquel at same time (with Pred and/or Ceph for 3 weeks at a time).

His dorsal midline breaks out in open scabs and sores and he will not allow his owner to touch him as he is so uncomfortable. Skin actually twitches in discomfort.

I have given him 2 fecal transplants since meeting him 1 mth ago. We have been able to decrease his Apoquel from 4 tabs to 2, but no further. The owner spends close to $700/month on meds and Vet visits. She is willing to do whatever she can to heal him. He is raw fed - I recommended bison or elk for now. He uses Zymox on occasion as his ears flare up as well. Presently he has a swollen raised sore on his right lip that appears to be progressing, now sore to touch.

From a TCVM perspective, he has moderately toned pulses (not taut, nor slippery), his tongue is lavendar pink, flabby. He is such a sweet boy! A true gentleman and easy to work with. He is not good with other dogs however, just great with people (he's intact). His coat at present is healthy, no dander, but he does have a generalized yeasty odour suggesting Damp Heat (yet SMS and CSWLT did not help him).

I am at my wits end as I want to help this poor boy! Any thoughts would be SO APPRECIATED!!!

by naturevet

September 22, 2017

Hi Corinne,

There are two basic differentials for a dorsal midline outbreak - Wind Invasion, and severe Yang excess. Given the pain, it would have to be a Wind Invasion causing Blood stasis, which Qing Ying Tang theoretically addresses. If the lesions are furuncles or are raised and rounded, however, and not just ulcers, then Xian Fang Huo Ming Yin may be a better choice.

Otherwise, if you're seeing ulceration, I would suggest Hoxsey-like Combination as the next step. Perhaps this is an autoimmune process, in which case Hoxsey would for sure be the go-to formula. The lip lesion sounds like something Hoxsey can address, too. For example, it's our main choice for rodent ulcer (eosinophilic granuloma) in cats.

Hopefully one of these suggestions work. I know how hard these cases can be on both you and the owner (as well as the dog). I guess my last idea is Xiao Chai Hu Tang, in which case I would look for the pulse 'becoming even more moderate' when GB points are needled.

Hopefully this helps you out!

Steve

by CorinneC

September 28, 2017

Thank you Steve! Since my entry (I had to re-enter as I put my initial entry in wrong) I have done skin biopsies, histo, and cytology as he was getting much worse. He has Demodex and a MRSI. I had to start him on Nexguard and Doxycyline with Cytopoint in lieu of Apoquel. This made me feel ill but I was lost as to what else I could do TCVM-wise. He became very finicky with food 3 days later, as well as very lethargic. I stopped his Doxy for a couple days and then restarted at 50%. I have added Nux Vomica 30C prn and plan to run bloods tomorrow as he is pu/pd the last 48 hours as well. I will keep you posted.

As an aside, do you still allow people to shadow you? I started into TCVM 3 years before my daughter was born and took a great deal of time off to focus on her. With the time away, I feel like my TCVM is weak and I would really love to "soak up" some skills again from my most favourite teacher :)

Corinne

by naturevet

September 29, 2017

Hi Corinne,

I'm traveling a lot through the end of November, and have to split my clinic time between people and animals. So that's just a couple of days a week. One of the other vets may be up for having you shadow them on my human days. We'd just need to ask and see...

Let me know when you're thinking of

Steve

by CorinneC

April 10, 2018

Update on Moose: After so many visits, Moose is doing extraordinarily well and I plan to use his case in my Graduate course in CHM! He really struggled through all of the Western medicine and I managed to support him and get him off most of those meds ASAP. He literally looked like he was dying with Nexgard so was only given this once and started on low doses of Ivermectin. At the same time I put him on Qing Qing Tang and he has been on that with Xiao Chai Hu Tang on and off. His last visit in March he was more Liver Blood deficient (dry dorsal skin, powdery dander, toned pulses, lavender tongue, dry scales ear tips) so I added Si Wu Xiao Feng Yin. I am so pleased with him! This owner is the most dedicated woman I have ever met and really worked hard on his diet with me as well. THANK YOU SO MUCH FOR YOUR HELP!!!!!

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