Skin, Ears, Lumps & Bumps

Dear Erica and Ralphie, This is a common and frustrating problem with many dogs in Auckland and is exceedingly prevalent in Westies (the breed not the location). It is possible to have intradermal skin tests performed by a specialist to identify specifically what allergens Ralph is reacting to, and thus the true cause of his affliction. Intradermal results can assist in managing allergic skin conditions but often specify a variety of common grasses or house dust mites which are impractical to avoid. This leaves us reaching for a range of treatments. I totally support your caution over the use of steroids, they are a useful medication but you need to use the lowest dose that works and then only when totally necessary. Firstly, flea treatment must be maintained religiously. Any parasite irritation to Ralph will make his skin a million times worse, even when a flea allergy has been discounted as the primary cause.

Even if you’ve never seen a flea on Ralph, please treat him anyway. Antihistamines are a safe alternative to steroids that can help some dogs with their allergies. Unfortunately they are usually not as effective as in people and take up to 2 weeks to peak in effect. A good quality anti-inflammatory, antibacterial shampoo will help soothe the skin and minimize secondary infections that jump into damaged areas of his skin.

Ralph would definitely benefit from daily essential fatty acid supplementation, flax seed oil is a good source of this which can be added to his meals. His diet will also play a role, high quality, solely white meat derived food is usually helpful for inflamed skin. A variety of specialised low allergen dry food is available from your vets, designed specifically for these types of skin problems.

Don’t underestimate how much of a positive impact a tailored diet can have on skin allergies. As with any allergy where it is impossible to remove the offending allergen, you are left with having to manage a lifelong condition. This requires making use of a variety of products to control the skin condition, and a lot of patience. I hope some dietary modifications will be of help to Ralph, kind regards,

Dr Alex Melrose.

Hi Merlyne, with Matai’s age and reduced energy levels, and because of his necessary (often the case with Malamutes) long-term drug treatment we will first blood test him. This will check organ function, drug elimination abilities, white and red blood cells, and it also never hurts to check thyroid levels in these guys. Malamutes are very prone to Hypothyroidism which causes long term skin problems, among other things.

A small mass like that is most likely to be benign, possibly a lipoma (fat growth) but all lumps should be tested. We will take a fine needle aspirate i.e. a needle into the mass and then onto a slide for the lab to test for unusual cell types. This is pretty painless (honestly), quick and inexpensive and often gives clear results.

Matai’s seasonal dermatitis will be exacerbated by his very thick coat trapping heat and bacteria. We are likely to reach for antibiotics, and possibly anti-inflammatory or antihistamine therapies for this. Atopica, an immune modulator is also among our treatment options. We’ll keep up his zinc supplementation (usually very deficient in this breed) and 1 tablespoon of flax seed or fish oils daily to reduce skin and joint inflammation.

Twice weekly medicated shampooing, at least of the affected area acts to reduce bacteria and fungal numbers on his skin and in-turn further reduce the quantities of oral meds he will get through during his life.

A. Ralph was having an anaphylactic allergic reaction to something he contacted at the park. Some type of plant would be at the top of the list of suspects with the pattern of bumps you’ve described, possibly Wandering Dew.

Antihistamines are safe and work well to settle these acute contact allergies quickly. We often use human products like Clarytyne at a high one off dose.

As you found washing helps and by trialing certain areas of the park at a time, you can often hone in on the offending plant and where to avoid it.

Hi Shanyn. Many older cats (especially if partially deaf or blind) can start doing some peculiar senility-related behaviours and vocalizations.

In this instance I think there is too much scratching going on here for that to be your scenario. As far as the fleas go, never rely on just not seeing fleas on her as they spend 90% of the time off the animal.

Stand her on white paper or other material and comb her fur so her hair falls all over it. Check for any black specs. If you find some please add water to them. If a reddish tinge comes leaking out they are flea droppings, the red being partially digested blood. If the combings are all clear I would consider three other causes of sudden scratching centered on the head.

Dietary allergies will often cause self trauma, particularly around the head but at the senior age of 12 would require a sudden change of diet. Ear mites and tooth root disease are more likely and will both cause dramatic signs like those you’ve witnessed.

To assess things further you really need to have a vet's experienced assessment and either medicated ear drops or the removal of offending teeth. I think it would be a great idea to give her a check over with us here at VetCare to narrow down the possibilities, kind regards, Dr Alex Melrose.

Otitis is an inflammation of the ear and it is one of the most frequent reasons for owners to seek a veterinarian's help. This condition is often very painful and if left untreated seldom resolves. The term ‘otitis’ does not refer to a specific disease, but it is a symptom of many diseases and not a specific diagnosis.

Causes

• Allergies, such as inhalant allergy and food allergy
• Foreign bodies
• Parasites such as ear mites
• Endocrine diseases such as hypothyroidism
• Auto-immune diseases like lupus
• Tumors

Chronic inflammation stimulates the proliferation of the skin lining the ear canal. As a consequence, thickening of the canal occurs and leads to narrowing of the canal. More importantly the skin is thrown into numerous folds, and this inhibits effective cleaning and the application of medications. These folds act as a site for the perpetuation and protection of secondary micro-organisms like bacteria.

Diagnosis of otitis externa The identification of the underlying cause responsible for otitis externa is of crucial importance. We must take a complete history that includes information concerning the age of onset, progression of the disease and response to previous treatments.

Step One: Ear examination.

Perform a thorough physical examination of the ears to detect the presence and condition of tympanic membrane, the severity of changes in the ear canal and also the rest of the body to detect signs of concurrent skin or internal disease. In order to do this it is important for your veterinarian to be able to examine the ear canal completely. Because the ear is often so painful the veterinarian may need to sedate or anaesthetise your dog to achieve this.

Step Two: Ear cytology.

Examine the ear discharge under the microscope to identify the organisms that are perpetuating the infection. Ear cytology may often be performed during a consultation to give rapid information about the likely bacteria involved. The most common organisms are Staphs and Malassezia (yeasts). Bacterial culture may be necessary in cases that have been treated by numerous drugs with only moderate improvement, because some of the bacteria tend to become rapidly resistant to commonly-used antibiotics. Any time rods are detected on cytology, a bacterial culture/sensitivity test is warranted to investigate whether Pseudomonas or other difficult bacteria are present and what antibiotics they are sensitive to.

Step Three: Treatment.

Thoroughly clean the ear canals. Topical therapy is vitally important for successful management of otitis. Ear flushing under sedation or general anesthesia is required in most cases to remove the discharge that is present in the deep part of the ear. The ear must be cleaned very gently as the tympanic membrane is often obscured and is often unhealthy and therefore prone to rupture or may already be ruptured. We use gentle flushing/suction with saline or a dilute antiseptic detergent solution.

Once the ear canal is clean, the medication chosen and applied will be much more effective, as it will contact the canal epithelium more effectively. Failure to remove this material will result in poor response to treatment and relapse of infection as soon as therapy is discontinued. There are many different ear medications. They contain variable combinations of anti-inflammatory drugs, anti-fungals and antibiotics. Your veterinarian will choose the most appropriate medication based on the diagnostic steps described above.

Causes

Inhalant allergy is extremely common in dogs and is the most common underlying cause for recurrent otitis externa. Clinical signs are initially seasonal. Progressive worsening with time is also typical. At least 50% of these dogs have bilateral otitis externa. In up to 5% of cases, otitis may be the only complaint. These dogs tend to have itchy feet, itchy face and itchy ears. They are predisposed to secondary skin and ear infections that tend to recur after treatment unless the underlying allergy is well controlled.

Food allergy. Over 20% of these cases start with just otitis externa and ear disease is present in 80% of the cases. It should be considered as a top differential for otitis externa in any dog less than one year of age. Food allergy, however, can occur at any age and may mimic clinical signs of inhalant allergy. These animals tend to have recurrent skin and ear infections unless the underlying allergy is identified and addressed.

Foreign bodies. Typical causes are plant material (seed awns) and other debris such as impacted wax. In most cases this is a unilateral otitis, which means it only affects one ear. Any sudden acute discomfort in your dog’s ear could indicate a foreign body and warrants an immediate trip to the vet.

Endocrine disorders. Hypothyroidism and Cushing's disease are the most common endocrine diseases that can cause otitis externa. If a middle-aged dog keeps relapsing with otitis externa and is not itchy, then endocrine disease should be considered as a possible underlying cause.

The ear mite (Otodectes cynotis) is occasionally seen, usually in young dogs. The discharge is often dry, dark and crumbly and the mites are easily seen. In recurrent cases it is possible that other in-contact animals can act as asymptomatic carriers. This is one of the most common causes of ear problems in cats.

If you are concerned your dog could be suffering from ear problems please contact us

Hi Steve, I think you should get this lump of Wolfe’s looked at straight away. We would examine the mass and look for certain danger signs. Anytime there is rapid growth, inflammation, redness, discharge, ulceration or discomfort we usually need to take some immediate action.

These are all signs of change and of potentially aggressive behaviour of a skin mass. We need to get a sample and have that tested at our local Laboratory. The characteristics of a mass determine which method of sampling we would employ.

Some small, shallow lumps can be aspirated with a needle painlessly while the patient is conscious and a slide then prepared for microscopy (cytology). In Wolfe’s case it is more likely we would perform an excisional biopsy. We would usually give patients a very brief general anesthetic for this although sedation and local anaesthesia is also available to us.

A slice of tissue from this method gives us more detailed and accurate information (histology) on the type of growth and also on whether or not we got it all out by checking all the edges are clear of neoplastic cells. Lab results are returned within days. From what you describe Wolfe could have a benign Histiocytoma, common in young dogs.

These masses usually require removal anyway as they become very itchy. The more serious and rarer Mast Cell Tumour has a similar appearance and provides a strong example of why everything like this should be tested, if not removed.

Hi Sarah and Rufus,

I’d love to be able to diagnose this for you but unfortunately there isn’t a person on the planet who could accurately tell you what type of skin growth that is just based on description. What we do know is that we do commonly see malignant skin masses in young animals e.g. mast cell tumours, so only being three years old isn’t an automatic exclusion. We also know that these nasties can sometimes mimic the appearance of very common benign lumps such as lipomas or papillomas. And in this instance we can’t be sure about rapid growth or change in appearance.

Because of this we really need to have a look at it closely and then recommend at least a fine needle aspirate to make a microscope slide from its cell type to identify it accurately. This gives us a guide to planning treatment, from not needing to do anything, to removing the mass with small margins with sedation and local anaesthesia block, to taking out wide margins of tissue under a general anaesthesia for more dangerous cancers which can have invisible spread of abnormal cells far out from the mass edges.

The odds are really in your favour but definitely pop Rufus in for a quick and painless exam and fine needle test to be sure we get him the best treatment.

Kind regards Dr Alex Melrose.

Hi Andrew, thank you for contacting us and mostly, thank you for giving wee Piko a loving home. We can help you export Piko back to Australia when the time comes, there are lots of vaccinations and worm treatments he will need but we have already assisted 3 dogs return to NZ and Australia this year.

In the meantime, Revolution or Advocate used every 10 days is effective and safe in many demodectic mange cases. Take him to the beach and keep him in the water for ten or so minutes regularly to kill any fleas. We arrive on the island with a team of vets on 4th November and will be happy to provide antibiotics and further mite treatments then, plus of course, we should de-sex Piko so he doesn’t wander or add to the already terrible over-population problem. We will be providing free de-sexing clinics for the whole of Tonga, plus we can also assist with any other ailments. Best wishes and see you soon, Dr Alex Melrose and South Pacific Animal Welfare. 09 361 3500 http://www.spaw.org.nz/

Hi Lesley, I’m sorry to hear of your l puppy’s skin problems, very distressing for her and for you. Certainly a dietary trial is a good safe option when we suspect food allergies and you need to feed that type of hypoallergenic food exclusively for 6 weeks solid before judging results.

Fish and Flax Seed oils help with all dermatitis. Atopica (cyclosporine) is a great, safe drug for certain types of skin allergies, its only real drawback being cost, so these are all great questions to ask.

However the big clue here is her age of onset of clinical signs. It’s very rare for a dog to develop a skin allergy as young as 2 months. It usually requires a longer period of exposure for the body to mount an inappropriate overreaction, more typically showing up between 6 and 12 months.

Especially in a Staffie, being predisposed by breed genetics, I would be very suspicious of Demodex Mites, possibly even Sarcoptes.

I think the next step is to perform skin scrape tests which provide slides for microscope examination. Bring her in and let us see if we can find any of these cigar-shaped, multi legged critters wriggling around. Kind regards, Dr Alex Melrose.

Hi Lesley, I’m sorry to hear of your l puppy’s skin problems, very distressing for her and for you. Certainly a dietary trial is a good safe option when we suspect food allergies and you need to feed that type of hypoallergenic food exclusively for 6 weeks solid before judging results.

Fish and Flax Seed oils help with all dermatitis. Atopica (cyclosporine) is a great, safe drug for certain types of skin allergies, its only real drawback being cost, so these are all great questions to ask. However the big clue here is her age of onset of clinical signs. It’s very rare for a dog to develop a skin allergy as young as 2 months.

It usually requires a longer period of exposure for the body to mount an inappropriate overreaction, more typically showing up between 6 and 12 months. Especially in a Staffie, being predisposed by breed genetics, I would be very suspicious of Demodex Mites, possibly even Sarcoptes.

I think the next step is to perform skin scrape tests which provide slides for microscope examination. Bring her in and let us see if we can find any of these cigar-shaped, multi legged critters wriggling around.

Firstly it’s unlikely to be skin mites as these are usually accompanied by a lot of self trauma, hair loss and bacterial pimples. We can check for these by running a skin scrape test. Also unlikely is a primary bacterial or fungal infection. Typically this would appear as moist dermatitis, pimples or circular crusts.

We can also run skin tests for these. In Alice’s case it sounds more likely that we are dealing with a low grade skin allergy. The most common categories of allergens are Fleas, Food, Contact or Atopic.

Allergies, once diagnosed, are usually present for life and require long term management. A fleabite allergy is most common and in 50% of these cases you will not find fleas on the animal. The little “bloody” parasites spend most of the time in the environment and allergic animals only need a couple of bites and their skin overreacts badly. Alice is on an excellent diet but it is still a slight possibility for her to be reacting to a particular protein (chicken in the case of Eukanuba) or additive.

Food allergy lesions are often around the face and perineum and a 6 week dietary trial can be performed with a special diet to confirm this. Contact allergies present with a ventral distribution i.e. lower limbs, paws, abdomen and muzzle. Atopic allergies are also common and environmental allergens can range from pollens to moulds or house dust mites.

Dogs typically get dermatitis around the head, feet and legs and rub, lick or scratch themselves. Atopic and contact allergies are often worse during certain seasons (particularly spring to summer). So after this overview where do we start with Alice?

The first thing is to put her on Flax Seed Oil, ½ a tablespoon daily for a medium sized dog. This is an excellent immune regulator and assists with production of beneficial oils for the skin surface. I would also use, initially weekly, a good soothing antibacterial shampoo to remove dandruff. Massage this in well and try to leave on her skin for 10 Minuits to work its stuff.

Next use a good quality Flea product to rule out this potential irritant, natural products are not suitable for dogs like Alice that show any signs of dermatitis. Above and beyond these basics we can look at a great side-effect free, immune modulator, called Atopica.

For dogs with more severe allergic dermatitis we often have to reach for repeated courses of prednisone, antihistamines and antibiotics. Atopica is a great, safe alternative to these, and very effective in some cases.

None of these later treatments would be required for Alice’s mild skin problems. Let me know how the Flax Seed Oil works, kind regards, Dr Alex Melrose.

At the visit to the vets, the vet commented that it is probably a plant allergy as it started early in summer and the sores are located in the lower leg area. This has been slowly moving up towards his upper back. Are there any special baths, creams, treatments you can suggest that are affordable and easy to use? The vet has suggested that if the second cream does not work, we should take him to a skin specialist. Thank You. B.

Hi Beth,

Sorry to hear of your troubles. Skin problems can be very frustrating for both dog and owner.

With any skin condition at all I would be applying Frontline much more often, you get strong results from it for about 3 weeks, and this removes fleas from a potentially complicated problem, especially important over summer when flea challenge soars. As vets we all have cases like this that can’t be fixed with a quick solution, despite skin disease being external, and visual, the diagnosis often requires a lot of process and elimination of pathogens or triggers.

What you describe could well be an allergy, possibly even a plant allergy, although with the age of your dog it could also be non-seasonal, allergies typically showing up for the first time around 1 year of age after months of exposure. Malaseb shampoo is my favourite for knocking down bacterial and yeast numbers.

Fish or flax seed oil dietary supplements are great for skin inflammation control. Shortening the coat helps application of creams but also further exposes skin to more allergens. Auckland’s rock-star of a veterinary skin specialist Allan Bell is available on 09 473 5795, he’s helped us solve some pretty tough cases, you will need to communicate with your own vet to get a referral to him, best wishes, Dr Alex Melrose

A. Hi, ouch, sounds sore. It is definitely possible, especially if that blanket has been washed in household washing powder and some residue remains. What is more common, especially at this time of year is a plant/pollen allergy causing an allergic reaction we call Atopy. This often arises in the areas you have highlighted, i.e. lower limbs, feet and tummy. The skin turns darker as it thickens in response to ongoing inflammation and trauma from scratching.

With help from your vet you should be able to narrow down the causative allergen, and get relief for your shepherd from scratching and secondary yeast and bacterial infection which will be lining up to invade that damaged skin.