Dog scratching face-Vet stumped

[duster]

My 8yr old Vizsla has been scratching his face raw for the last 8+ weeks and the vet is stumped. First vet visit they send me home with antibiotics. Second visit, they suggest x-rays of his head and teeth to make sure there are no issues. Everything was perfect, no growths anywhere, teeth looked great etc. No fleas, mites or any other skin issue that would show up under a microscope. Vet said to give it some more time to see if it gets better or if something starts to look different but poor guy is itchy. He has never been allergic to anything in the 8yrs I have owned him but we went ahead and eliminated treats and changed his food. No environmental changes.

Benadryl does help.

Any ideas?

[Simkie]

I remember something, deep within the cobwebs of my brain, about out of whack blood values causing facial itching? I think it was calcium? Have you run any bloodwork?

Otherwise, perhaps it’s environmental? Any weird pollens or molds spiking in your area? http://www.pollen.com/allergy-weather-forecast.asp Did you have a live Christmas tree, or pull out dusty stuff from last year?

[duster]

Blood work was all normal. Scratching started before the holiday stuff came out of the attic. Nothing in our environment has changed, no mold etc.

It is a fairly localized area on one side of his muzzle, that is why the vet thought there might be a growth or a problem with one of his teeth.

She did mention that it could be nerve damage but she was not overly convinced of that because he was responsive to stimuli all along his muzzle.

I guess we will just have to wait and see:-(

[Simkie]

Hmmm. Herpes can cause nerve damage that causes itching without making the nerve unresponsive. Perhaps give lysine a try?

(And for a truly horrifying run down of what herpes can do, there’s this)

[idlemoon]

Did she do a skin cytology to check for Malassezia (yeast) as well? Can you post /send a picture?

It is very common to have a yeast infection on the face, and yes, it would most likely be secondary to something else. Are the ears ok? I would also do an ear cytology as well even if they look normal. Amazing what could be hiding in there.

How long were the antibiotics given for?

Idlemoon
Who loves a good derm challenge.

[duster]

I’m not sure if they did a skin cytology, I would think that they would have. They sent me home with 42 500mg of Cephalexin to be given every 8 hrs. We completed the course and it did seem to help but I also started giving him Benadryl at the same time.

His ears have always been great. No issues, but I’m starting to think another round of anibiotics might be in order. It’s starting to look too much like a yeast infection since its more around his lips and under his chin(where the wrinkles are).

I think this link will work.

http://s209.photobucket.com/albums/bb228/krisbhow/Face/

Oh, and the reason they went straight to x-rays after the first visit was that she put a mirror up to his nose to see if he was breathing out of both nostrils, he was but it seemed like less so on the side of the scratching. She did not mention it again after the x-rays were done.

[duster]

OMG! Just read the artical linked above, scratching all the way to your brain! That’s crazy! I hope he doesn’t have herpes. How do they get it?

[JackSprats_Mom]

I know you said you’ve changed food but have you gone to a non grain food?

My Rottie got allergies at about 6-7 yrs old, vet said fleas, in fact it was to grain in his food and as soon as I changed food within weeks he was fine.

GL with it, nothing more frustrating then not having a diagnosis.

[duster]

He’s on grain free now:-( that’s what we switched to.

Thank you so much for all of the suggestions. I think I’ll wait another week and go back to the vet with a list of all your ideas.

[Kachina]

My Lab scratched her face until she created a horrible, superating lesion. Turned out to be mange. Easily fixed with a short course of antibiotic, steroids and ivermectin. Easily prevented with monthly topical Revolution. Nothing turned up on the skin biopsy, which I guess is not unusual. I hope you find an answer soon for your pup!

[chaltagor]

[QUOTE=Kachina;6062523]
Nothing turned up on the skin biopsy, which I guess is not unusual. [/QUOTE]

That’s because the mites live on the hair follicle. No use scraping the skin at all unless the vet gets some hair scraping too.

OP, it doesn’t matter if he’s never been allergic to anything before, I don’t know why people say this, sorry. I’ve never broken my leg before, does that mean I won’t ever?

Don’t wait at all if he’s still miserable. He needs relief to help him heal and stop irritating the area, even if was the food.

[jetsmom]

What kind of bowls does he eat out of?/Drink out of?

[duster]

The vet told me to wait a week and see if anything changed, so far it hasn’t. He will go back to the vet next week like the vet recommended unless things get worse and in that case he will go in ASAP.

He eats and drinks out of stainless steel.

[Horsegal984]

Unless you’re leaving out a lot of meds that didn’t work I would try some steroids and a different antihistamine. Go with hydroxazine/pred or try temaril-p, and see how much relief that gets you. I’m still thinking allergies, because it’s the most common, and facial itching is one of the biggies for them.

I dunno, but even with it being localized to one side I am still a little suprised the vet jumped to radiographs before either topicals or oral steroids, esp if the benadryl/abx are helping.

Katherine
Vet Tech

[Bluey]

If antihistamines helped, the chances of being an/some allergies is great.
What the dog is allergic to, that will take some investigating, as you are doing.

Being localized, I would assume contact dermatitis may be what you have there, once other has been ruled out.

How about a referral for a second opinion from a specialist vet in dermatology?

[Romany]

Looong shot, but what’s the climate like where you live? It’s been frigginfreezin here recently, and our normally non-scratching dog has been scratching her face with some irritation when she comes back indoors; I reckon it’s because it’s itchy as it thaws out - could that be your dog’s problem?

Did you try an antihistamine, or some other calming meds such as - and I am NOT a vet/expert - Valium-type meds, under vitnery supervision, of course?

[idlemoon]

Bet you have both a bacterial and yeast infection. How much does your guy weigh? Cephalexin is the best skin antibiotic for the buck if your pet tolerates and is not resistent.

If he were mine:

1. Back to the vet for skin cytology look for bacteria and yeast.
2. Skin scraping to rule out demodex mites, not a common presentation, but with the distributions of the lesions I would for sure make sure I was not missing something.
3. Treat appropriately with proper dose and duration of antibiotics for the bacterial infection. 7-10 past clinical cure, meaning past 100% normal. Cytology of area prior to stopping meds.
4. Treat appropriately with proper dose and duration of anti fungal. I prefer fluconazole. Again, usually at least 30 days.
5. Try cleaning these areas topically with medicated wipes twice daily for 30 days.
6. You must get the infections under control while looking for an underlying cause. All the grain free, raw, limited Ingredient, homeopathic, ultra expensive food from that posh doggie botique run by rich ladies with nothing better to do is not going to do squat to fix what infections are already present.
7. Switch to crock or stainless steel bowls, just cause of the WAY off chance a contact allergy to plastic.
8. May do a short oral course of steroids ie pred, Temaril-p… To break the itch cycle, 3-7 days tops.
9. Antihistamines if still itchy for a couple of weeks then stop. I like to see how much the infections are causing the itch. The less infection the less itch… That would be goal.
10. Strict food trial with a novel protien or hydrolysate diet. Minimum 8-12 weeks.
11. Find myself a good veterinary dermatologist to hold my hand and allergy test my dog with an intradermal allergy test if no resolve or recurrent. Or skin biopsy depending on what it looks like. Skin biopsies ALWAYS show SOMETHING maybe not a “name” for the disease but shows what going on microscopically. Most important thing is to send the biopsy to a dermatohistopathologist, a pathologist that specializes I reading skin biopsies.

Www.acvd.org

Good luck!

[irkenequine]

Wooooo ditto idlemoon’s post. That covers it A-Z.

I don’t work around skin anymore but isn’t there some sort of localized fungal immune issue that happens around the bridge of the nose and eyes that is managed with steroids that looks very similar to that presentation wise?

[SMF11]

Mange!

Mange causes intense itching, and usually does not show up in skin scrapes under the microscope.

If you’ve ruled out most other things, and it sounds like you have, I’d revisit this. It doesn’t always show up in “typical” ways as well – my collie had intensely itchy ears and my vet was doubtful it was mange b/c it wasn’t presenting in the typical way. However, I saw my dog pick up a mangey fox and so know he was definitely exposed. I insisted he be treated, and it cleared up. My vet was still reluctant to do the follow up shot b/c he still doubted it was mange until I pointed out not only did the dog have symptoms that fit with mange, the treatment worked – if it were allergies or something else Ivermectin would have done nothing.

My dogs have had mange a total of three times over the years; because the mites don’t show up usually in a skin scraping I guess some vets are not quick to think of it as a diagnosis. However I think it is not rare in the country.

[duster]

Wow! Thank you so much for all of your suggestions! We go back this afternoon to see a new vet in the same practice. I guess skin stuff is more his thing.