Symptoms and Root Causes – Itching, Ears, and Skin

If I had to pin down the most commonly seen problems in our practice, I’d choose itching/ear infections for the “Top 5” list. We could spend an eternity talking about these problems, but I’d like to try to offer a brief introduction to the deeper reasons for these things to happen. We’ll have to start by defining the things that we can see on a physical exam (the stuff you notice at home); and then the underlying reason they’re happening.

Symptoms: shaking of the head, scratching ears, foul smell, goopy waxy discharge (brown or yellow or pus) in the ears, swelling/redness of the ear, major swelling of the ear flap.
800px Ear infection in cocker spaniel

What’s happening: ear infection, called otitis externa. It’s generally caused by inflammation of the skin in the ear canal, which makes the skin susceptible to an infection by bacteria and yeast.

Symptoms : licking and/or chewing at the feet, red-brown staining of the fur on the feet, redness/swelling of the skin between the toes, swelling of the feet.

What’s happening: skin infection, called dermatitis, usually caused by bacteria and yeast infections. The skin is itchy, which is why dogs chew/lick.
Picture 240

Symptoms: hair loss, itching, flaky skin, red skin, rashes on the belly/armpits/groin, bad smell, oily/dull/dry coat, peeling skin, crusty skin, or wet/sticky ulcers on the skin surface.

What’s happening: skin infection, usually by bacteria and sometimes yeast, because of inflamed skin surface.
Malassezia dermatitis

In summary, dogs will have nasty ears, nasty skin, and ITCHING. It’s usually these things that drive an owner to call and make an appointment. It may be bad enough for an owner to lose sleep thanks to the licking or scratching going on all night long. (Dogs and cats both may also have gastrointestinal signs like vomiting and diarrhea from certain type of allergies.)

I’ll come right to the point. These signs and symptoms are NOT the underlying disease! We can treat the ears, feet, and skin with all sorts of different things. Ultimately, though, we’re just applying a bandaid that never really addresses the reason the dog is suffering these problems. We can provide temporary relief, up to a point.

The most common underlying cause of these chronic problems is an allergy. It’s not very common for dogs to have an anaphylactic response to something they’re allergic to. People who are allergic to shellfish, for example, will have swelling of the throat and go into shock if they eat shellfish. Thankfully, dogs don’t usually have such a violent response to an allergen. Pets can be allergic to things in the environment, or ingredients in their food.

With environmental allergies, we should think of the things that cause “hay fever” in people: pollen from trees/grass/weeds, dust, dust mites, molds. Dogs don’t get itchy/red eyes and runny noses as often as people do. They have all of those inflammatory reactions in their skin surface, which includes the ears and feet.

The other type of allergy that can cause trouble is a reaction to an ingredient in a dog’s food. The brand doesn’t matter, but the ingredients do! Corn, wheat, beef, poultry, and pork are very common ingredients in various types of dog food. Even a dog that has been eating the same food for several years can develop an allergy to the ingredients in the food. The brand doesn’t matter — the contents do.

Treating the allergy itself requires some testing to know exactly which allergy we’re dealing with. Some unlucky pets have both types of allergy (food and environmental). Thankfully, if we identify at least one of the allergy types, we can usually manage these pets successfully.

Testing for food allergy requires a special diet trial that lasts 8-12 weeks. Testing for environmental allergies requires either blood test or a skin test. THe skin test is much like the skin test that people get. Small injections are given in the skin, and the size of the red swollen area is measured to judge the response to the particular allergen that has been injected.

Treatment of an allergy consists of two major parts. First, we have to deal with the secondary effects of the allergy. This means treating the ear and/or skin infection aggressively. We may also need to control itching. Secondly, we need to treat the allergy itself. If we know what a pet is allergic to, we can treat that allergy directly. That’s the keystone!

Next week, I’ll start breaking down each type of allergy for a more in-depth look. In the meantime, how many of you have pets with chronic skin or ear problems?



Filed under dermatology, medicine

16 responses to “Symptoms and Root Causes – Itching, Ears, and Skin

  1. Chris

    No skin or ear problems here. Epilepsy and hip dysplasia, yes. Please, no allergies!

  2. Michelle

    I have had my Boston Terrier to the vet several times this year , he has lost almost all his hair and his skin is kinda of grey in color and he has lost weight and he has gone deaf and has caderatics in both eyes and he is 11 years old and the vet said he is old for a male boston and did all these tests for cushings and other things and said he is just old .Now has major diarreha and is still getting skinnier and I took him back again and he said to stop coming due to its costing me so much money (2000.00) so far . The dog never followed me around like he does now . Help I just dont know what to do . I think he is dying in small degrees .

  3. It’s a little hard to say without a lot more of the information from prior lab tests and examinations, but one particular idea comes to mind for your dog.

    Cushing’s disease is usually found by looking for one particular hormone called cortisol. However, some dogs with Cushing’s disease produce other hormones that have to be tested for separately. These hormones can cause hair loss and some of the other changes you’re describing. This testing can be done by the University of Tennessee Endocrinology Lab. This would be worth looking into if it hasn’t been done already.

    If you haven’t been to see a specialist, that would be another option for you. Generally there are board-certified internal medicine specialists within a reasonable driving distance.

    Please feel free to email me if you need help locating a specialist or with any questions you have. I’ll try to help!

  4. Michelle

    Hello, our Vet gave Harlem all kinds of cushing disease test and says eveything is normal and he said that other then doing the mri or cat scan which is very expense that I should just stop at this because I cant afford the more expensive tests . Personally he looks just like a dog with cushing’s . Can cushing kill him? Personally I feel the dog is dying in small degrees he doesnt seem to be in any pain yet . oh yeah I forgot to say my vet gave him extensive test s allergies and kidney and all tests show nothing he said the best and possible test to show what he has is the endocrinolgy test of the Cat scan or the Mri . I cant afford these test they are 2000.00 to 2500.00 and Im unemployed at this time . Thanks for your help . Bascially the Vet told me to take him home and let him finish his life out because he thinks its a tumor but with out the Cat scan test he cant be sure. So since I cant afford the money I will let him just be happy and live his life out .
    Thanks so much for your help , have a good day.

  5. I’m not sure I understand what the cat scan or MRI would be looking for. A pituitary gland tumor? A tumor somewhere else in the brain? Adrenal tumor? All of those things are related to Cushing’s disease. There are quite a few different tests for Cushing’s disease (ACTH Stim, Low-dose Dexamethasone Suppression Test, High-Dose Dex Suppression, urine cortisol to creatinine ratio); however, all of those look for just one hormone. Atypical Cushing’s disease can have other hormones that lead to Cushing’s signs. You may wish to look over some of the information at U.Tenn.’s web page:

    If Harlem is going blind, one of the other things to consider is a problem called SARDS. That stands for Sudden Acute Retinal Degeneration Syndrome. Those dogs fairly rapidly go blind for unknown reasons. We sometimes see that these patients look just like a Cushing’s patient, but they’ll test negative for Cushing’s. It’s very frustrating because there’s really not much that can be done. 😦

    Thank you for trying so hard to figure out what’s wrong with Harlem. As long as his quality of life is good, it’s absolutely OK to not do additional testing. Though I hate to say it, sometimes we have to admit that there is a limit to what we can do to help.

  6. Michelle

    Thank you for all th help. It makes me feel better that I have tried to do everything possible with in my means. Have a great day . And thanks for all the info .

  7. Mark Thaddeus.

    My puppy is just 1month when i took her from her mum.i have being feeding her with milk/pap.she just developed ear &swoolen red foot vetinarian gave me charmileplus,but am not comfortable with that.she stop eating well,whats your advice? thanks

  8. It’s unusual for very young dogs to have a food allergy. If your puppy is still only about 4 weeks old, you may need to use a puppy milk replacer until the baby teeth are present. Also, you could add water to a food like Puppy Chow and mash it up into a gruel for the puppy to eat.

    If just one ear and foot are red, it may not be an allergy. In my experience, dogs with allergies have trouble with both ears or all of the feet. Having just one red ear and foot may indicate that something else happened.

    I’m not familiar with the medication your vet gave you, so I can’t really comment on whether that might be a reason for your puppy not to eat.

    Based on what you’re describing, I recommend that you have your vet re-check your puppy. Something more serious than an allergy may be causing the red ear and foot.

    Thanks for writing!

  9. Jackie

    My dog has some weird issue and we plan on taking him to a vet but any advice helps. We took him in last winter he was a stray running the neighbor for weeks is what we were told by a neighbor. Shortly a few months after we noticed he had developed some sort of rash on his belly area. Between his hind thighs and his lower abdomen. I have noticed he does not have any brown in his ears but he has very greasy inside ears and he shakes them often as if they are itchy. I just gave him a bath with oatmeal shampoo and noticed it worsened! We have changed his food over 5 times this past year to ensure he was getting the proper diet he had allergies to a couple foods we tried and that’s why we kept changing it. We have him on blue buffalo wilderness which we told would be good if he has a wheat allergy. If you could help that would be great. We have another dog and she has no sign of these issues at all. If it was a mite we figured she would get it too. They are both red nose pitbulls. If there is any help you can give me that would be great. I just want to make sure it’s not a minor issue that can be resolved before heading to that expensive vet trip.

  10. Jackie,

    Thanks for writing! The problems you’re describing could definitely be an allergy. Two things need to happen for your pooch:

    1. Treat the ear and skin problems that are already there.
    2. Find out what caused the ear and skin problems and treat that reason directly, too.

    Allergies to food or environmental things such as pollen and mold are very common. They lead to skin issues for dogs more often than not, and that’s possibly why you’re seeing skin and ear issues.

    Your vet will need to get a swab sample of the oily/waxy stuff in the ears to look at under the microscope. Knowing whether bacteria or yeast are present in the ears lets us select the best medication to take care of that. Topical medication and a safe ear cleaner will probably be prescribed.

    Your vet may also need to get a skin smear to determine the presence of yeast and bacteria on the skin of his belly. Knowing what’s there will guide a choice between oral medication, medicated shampoos, etc..

    To get a handle on the underlying cause, a food trial or allergy testing may be necessary.

    A food trial requires that a patient get on a diet that has a protein and carb source that the pet hasn’t been exposed to before. Venison and potato; duck and potato; whitefish and potato; or a hypoallergenic prescription diet can all be used. It is ABSOLUTELY CRITICAL that your dog does not eat anything other than the food for 8 to 12 weeks. A single bite of a food he’s allergic to can cause the skin/ear problems to persist for another 12 weeks. i don’t recommend frequent changes of food. You’ll need to stick to that diet 100% perfectly to find out if food is the problem.

    Allergies to environmental things like pollen, dust, mold, etc. need to be tested for by drawing blood or having a skin test. There’s debate about the best method, so you’ll have to see what your vet or a vet dermatologist recommend. Ultimately, allergy shots are the treatment if your pet has an environmental allergy.

    Give your vet a call to ask about a dose for an antihistamine that might help with the itching in the short-term. Fish oil supplements can also be helpful (but take 2-3 months to reach peak effect). I’m sorry I can’t be more specific about dosing on these tips.

    Don’t hesitate to ask more questions if I haven’t explained things well. Good luck with your dog! πŸ™‚

  11. Kurtis F

    Hello, im hoping very much that you may help shed some light on an issue with my 4 year old APBT. We’ve recently moved back in with my father who has 2 dogs of his own. One of which has an infection of some kind the vet has prescribed cephalexin for on 2 different occasions. She looks very close to the picture above, where her tail and back are almost entirely bald. Very itchy, constant chewing, foul odor. The other dog chews and itches constantly but has no sign of fur loss. My boy has always been very healthy and shown no signs of allergies or any other health problems. recently he’s taken to scratching, chewing, he has the hair loss, flaky skin and an odor. The vet says the other dogs infection was not contagious, but Gannon emulates her problems exactly and the cephalexin only helped her for a short time before the problem came back….any advice you can offer is greatly appreciated.

  12. Thanks for writing! I’ll see if I can offer any insight.

    Skin infections from bacteria and yeast should not be contagious from one dog to another, but there are some scenarios where this could happen.

    If there is something in the environment that is causing the dogs to have inflammation in their skin, they could all be affected. Inflamed skin is more susceptible to infection, and if the dogs have close physical contact, it’s plausible that yeast/bacteria could be shared between pets. It’s tough to tell, though, because these organisms are on dogs all of the time. We see skin infection when the skin’s abnormal due to inflammation.

    Environmental allergies set in after a year of age. It doesn’t seem likely that all of the dogs in your family are affected by environmental allergies, I suppose that’s possible, too.

    Chemical contact in the environment usually doesn’t cause the kind of signs you’re describing. Again, I suppose it’s possible, but not very likely in my mind.

    Fleas are a very real possibility. If ALL of the pets in the household are on a topical flea control product recommended by your vet, then fleas are less likely to be the issue. If the dogs are NOT all on a good, regionally effective product, that may be your problem. Even an occasional flea bite can cause a dog to self-destruct.

    Multiple unrelated pets all having a food allergy is also unlikely.

    Mange mites are also another parasite that could be at work here. There are 2 types: demodex and scabies. Demodectic mange isn’t usually itchy until the skin gets inflamed and infected. Sarcoptic mange (scabies) is HIGHLY itchy. Extremely so.

    I would suggest that you have the dogs checked for fleas at minimum. Appropriate diagnostics like a skin scraping to check for mites and a skin cytology to look for yeast are also indicated. Cephalexin will clear up most bacterial infections on the skin, but it won’t help with yeast. A different medication or medicated shampoo would be needed.

    Flea treatment and then going through the steps of a food trial are the best steps to take.

    Let us know how things go! πŸ™‚

  13. Some creams for itching are very good for this, anyway, thanks for article! πŸ™‚

  14. Shelly M Robinson

    4 month old BT groin, belly, armpits just one day erupted in a rash and he’s constantly itching. Now 5 months and he’s eating and scratching himself raw! We’ve done a week of steroids, a week of antibiotics and benadryl along with a special shampoo. Changed his bed thinking maybe he was allergic to the fabric?! I really am out of ideas on what could be wrong with this sweet baby! He’s our 3rd BT and the only one we ‘ve had any kind of issue like this with. After doing some research maybe switching to grain free food might help although we slowly introduced our food from the breeders food and hes been on it for almost 2 months with no issues. He loves to lay in the grass so of course now I”m considering grass allergy. At a loss here!

  15. Shelly,

    I think you definitely need to talk to your veterinarian about a food trial and/or allergy testing/treatment. While steroids, antihistamines, and medicated shampoos can help us control symptoms, they don’t really treat the problem at its source.

    It would be uncommon for a dog that is only 4 months old to develop an environmental allergy to something like pollen or grass, but I won’t say it’s impossible. Same with a food allergy – not commonly seen in a dog this young, but I have definitely seen it before.

    If you’re going to change his food, you should purchase a hydrolyzed or limited-ingredient diet from your veterinarian. The over-the-counter food are almost always cross-contaminated and will NOT be effective in helping you diagnose a food allergy.

    Contact reactions are also possible. Shampoos, conditioners, other grooming sprays, bathing frequently, topical flea/tick prevention products, etc. can also cause itching.

    Good luck!

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