Forty-four years (since 1974) of observing, pondering and treating dogs with skin problems have led me to think that I have a good concept of the issues.

Skin Issues in Dogs

Skin problems are common and very often put down to an “allergy” to a grass, food etc. Skin tests and blood tests reveal reactions to mostly dozens of allergens and only once in my career did a blood test reveal a reaction to a single element which was a plastic in a food dish and once removed the reaction disappeared.

Standard Skin Treatments for Dogs

The standard treatment is cortisones given orally or by injection, which do stop the skin reaction symptoms, but then have side issues affecting health and eventually stop working because the immune system is compromised, and the skin becomes thinner.

There is one area of investigation that I agree with and that I now direct my treatments to: viz the skin of these dogs is not healthy with a defective barrier that allows various infecting organisms like malazzezia yeast and bacteria such as staplococci to penetrate and infect, this skin type is thin too, and the combination allows allergens to contact the immune system and cause allergies as a secondary effect rather than primary.

My principles are:

1. Eliminate systemic diseases such as diabetes, pemphigus, hypothyroid, and cancers which are more of a consideration in old dogs.
   
   
2. Fleas must be eliminated totally! Other biting insects like mosquitoes and midges also

2. Need a good quality shampoo like Malaseb or Austrazole to be massaged onto the skin at a ratio for both of 1 part to 50 warm water eg 10mls/500mls in a container with a sponge and massage vigorously all over paying more attention to problem areas. Do more often initially and gauge the periodicity as when the itch returns, e.g. initially wash daily and then extend to every few days depending on result. Chlorhexidine leave on conditioner (Pyohex Lotion) has been proven to have effective skin levels for a week after. Bleach bathes are  very effective: 1ml of 4% hypochlorite bleach solution readily available in supermarkets, check label, 1ml into 400–500 mls water. 1ml in 400 mls water = 0.01% hypochlorite and this can be sprayed on and left for ten minutes then rinsed off and dried. (qt Robert Hilton BVSc (hons) MANZCVS Cert VD MRCVS Dermatology Update 2016 Jan “The Veterinarian”) 

3. Rinse well with ½ cup vinegar to a ½ bucket water. Dry well and finish with a hair drier. Coconut oil can be rubbed in afterwards too. Robert’s choices for moisturizer/barrier repair after are Pyohex Lotion or Paws Nutriderm Conditioner as a spray. 

4. Turmeric as in Golden paste is a very good anti-inflammatory effect on skin as well as growing a thick healthy skin and coat. As well as the reducing the prostaglandin inflammatory mediators, it also reduces the other major mediators, the cytokines.  Make a paste of turmeric by simmering ½ cup T powder to cup water for 5/10 mins and then adding 2 or 3 teaspoons fresh cracked black pepper at the end and mix well. Keep this in fridge and feed out ½ to 2 teaspoons with food 2 or 3 times a day. 

5. The new drug released by Zoetis, Oclacitinib (Apoquel) also reduces cytokines and one interleukin-31 has been identified as the major cause of pruritus in dogs. Apoquel is going to be very useful. And the target kinase is also the one that curcumin targets, and the two will work together.
   
   
6. Cytopoint has now been released by Zoetis and is an injection that controls chronic dog itch for 4 to 8 weeks. Cytopoint is not a drug but a monoclonal antibody (a protein) that neutralises the major itch cytokine and cannot produce toxic effects and the only potential is the very rare possibility of an allergic reaction. It is a safe, effective, long-lasting treatment for chronic itch due to allergic or atopic dermatitis. It is an injection that is given by your veterinarian that targets the itch at its source.Cytopoint works like your dog’s own immune system. It is specifically designed to target and neutralize one of the main proteins that send itch signals to your dog’s brain that triggers scratching, licking, and chewing. Cytopoint blocks signals that trigger itch, so the constant scratching can stop, and red, irritated skin can heal. In fact, in a study, Cytopoint helped damaged skin begin to heal within 7 days. Just one Cytopoint injection starts controlling itch within one day and provides relief that lasts for 4 to 8 weeks. That means your dog may be able to go as long as 8 weeks between injections.

7. Sometimes the skin is bad enough with an entrenched infection that a course of antibiotics is needed as well as topical wash, and the course should be at least 2 weeks and preferably a month or even longer. My favorite antibiotic for long term use is doxycycline at 5mg/kg up to 30kg and over, may reduce to 2.5mg/kg after a priming dose for 2 days. Cephalexins are also good. I have used doxycycline successfully on some intractable cases for years when after cutting it out regression of the problem occurs. 

8. Antihistamines generally give very inconsistent cures, but if you successfully are able to use one, they have few side issues. http://www.melbvet.com.au/files/NNBML3FCLS/Antihistamines.pdf 

9. Feed a good quality grain free diet with correct ratio of omega 3 oils to omega 6 eg 1:3 out to 1:7 at the outside. Coconut oil which is not an omega oil but is mostly lauric acid which is a mid-chain triglyceride added at a dessert spoon per 10 kgs . Coconut oil which is mainly lauric acid does not stir up the pancreas like some other inflammatory oils. 

10. Quite often along with poor skin immunity comes an infection of Demodectic mange. Evidenced by not itchy hairless patches. This can now be controlled easily with the new oral drugs Bravetco and Nexgard as well as the old standby of Dectomax injections. 

11. I do not like cortisones such as prednisolone or dexamethasone, because of side effects, and it also depresses skin immunity, but I will use it short term to give the dog relief from intense itching. They do have a place.

12. Cyclosporin (Atopica) is useful in about 80% of dogs with Atopy and can be used instead of cortisone because it has fewer side effects. It is expensive and some cannot tolerate it and vomit excessively. My opinion is that this is now superseded by Cytopoint or Apoquel