A taste of my own medicine: Adopting Cindy, a dog with atopic dermatitis, has been a great learning experience for me as
a dermatologist.(PHOTOS: COURTESY OF DR. ALICE JEROMIN)
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After years of giving advice all day long to pet owners with allergic dogs, I now have a fresh perspective on the subject—that
is after adopting Cindy, an allergic 11-year-old Golden Retriever, a few years ago. Surprisingly, I took on the challenge
of owning an atopic dog with confidence, believing that now I could finally practice what I preached. The real question was,
could I?
When I first saw Cindy, I didn't have much to go on, as her history was requested but denied to me from her veterinarian.
From the look of her skin, however, she had probably been pruritic for 10 of her 11 years. On a scale of 1 to 10, Cindy is
still at times about an 8 in terms of itch factor, but she's happy, playful and a delight to us. Most of all, she is enjoying
her life, despite her condition. Do I frequently tell her to stop scratching? Absolutely! Does that bother her? Not in the
least.
I wrote this article l½ years ago, after a few months of owning Cindy. I've added a recent status update that includes the
highs and lows of the last two years of owning Cindy (who is now 13 years old), what I've done to help her, and an overview
of her progress so far.
Cindy's storyWhen I adopted Cindy, she had ventral abdominal, periocular, perineal and dorsal lumbar alopecia; erythema; lichenification;
hyperpigmentation; a "rat tail"; an odor; and otitis. Blood work and urinalysis showed a normocytic/normochromic anemia, but
all other results were normal. An ELISA test for inhalant allergy was negative. (I tested her skin later). I immediately started
feeding her Iams Veterinary Formulas Skin and Coat Response FP and within two months the anemia resolved. She began to grow
hair on the dorsal lumbar area and tail.
Despite this progress, Cindy still had a significant amount of pruritus and seborrhea oleosa. At this point, I was bathing
her every other day. After using several different shampoos, I kept coming back to DVM Tearless. Hesitant to be too aggressive
with meds and considering her advanced age, I tried to rely on topical treatments and diet. However, after eight to 10 weeks
of this approach, it was evident I needed to add something else for the pruritus.
Antibiotics and ketoconazole for the secondary yeast and bacterial pyoderma did not help, so I decided to perform intradermal
allergy testing. After Cindy tested positive to some grasses and weeds, I began treating her with a low dose of cyclosporine
(25 mg daily) to prevent gastrointestinal upset. Again, not knowing Cindy's history—and whether she was sensitive to medications
or had a past history of malignancy—was important in my treatment plan. Although the low amount of cyclosporine was helpful,
I had to increase the dose to 50 mg/day, which caused a foul mouth odor after two dosages. Thinking back, I remembered having
clients complain of the same signs in their dogs receiving cyclosporine, which was usually followed by gum erythema and eventually
gingival hyperplasia. Therefore, I discontinued the cyclosporine with plans of starting allergen-specific immunotherapy in
the fall, after our Ohio grass and weed season had passed.
In addition, the entire time she also had a waxy yeast otitis that changed into a yeast/rod bacterial otitis accompanied by
a foul odor. I cultured and began treatment with Cerulytic (Virbac) as a wax dissolver, oral Baytril (Bayer) and Baytril Otic
(Bayer). The ear pruritus refused to subside no matter which topicals I chose (some with steroids and some without). Toward
the end of the summer, the ear problem lessened. Although she still had otitis, the odor and ear rubbing greatly decreased.
I did not opt for systemic steroids because she had some urinary leakage and a mild urinary tract infection when I adopted
her. My goal was to try and keep her comfortable without them.
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