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Familial Shar Pei Fever (FSF), Hyaluronanosis and Amyloidosis

  


 
HAS2, FSF & Hyaluronanosis explained in simple terms:
 
(JL Wortham-Morgan, July 2011)

What is hyaluronanosis?
 
The HAS2 genetic duplication mutations are what cause Chinese Shar Pei to produce excess Hyaluronan…
that clear, thick & sticky substance in Shar Pei skin. This excess Hyaluronan is what gives the breed their
characteristic wrinkled appearance. It also may cause or contribute to a number of health issues.
The Hyaluronan, when undamaged or in larger (high molecular weight-HMW) fragments promotes health,
is anti-inflammatory and otherwise beneficial. When the Hyaluronan is degraded (broken down) into small
(low molecular weight-LMW) fragments it can initiate AND amplify inflammation. This means it not only causes
inflammatory responses, it also amplifies (worsens) them which can in some cases create a self-perpetuating
inflammatory cycle.  The definition for the suffix “osis” is: “Diseased or abnormal condition”.
So hyaluronanosis is when the hyaluronan (that all Pei have in abundance) becomes degraded resulting in a
diseased state or abnormal condition. Since all Shar Pei carry copies
of one or both of these 2 HAS2
genetic duplication mutations, they can possibly all be affected by these issues to one degree or another.

The number of copies of the HAS2 gene mutation each individual dog has is referred to as their CNV
(Copy Number Variant). The higher the dog’s CNV #s the more hyaluronan they produce. Because the
hyaluronan (HA) is system wide in the Shar Pei body and concentrated in certain areas with rich blood
supply, the impact of this degraded hyaluronan is widespread and varied.  A variety of things can degrade
hyaluronan into these small fragments… trauma, inflammation as well as exposure to hyaluronidases
(enzymes that degrade HA), etc. From minor irritation of skin to full blown FSF, degraded hyaluronan
(and the inflammation it causes and amplifies) can become a significant factor (whether a primary, secondary
or just an exacerbating factor) in many of the breed specific health
issues including (but not limited to)
the following:

 Allergies/sensitivities:  These reactions can damage the HA causing an inflammatory cycle that is self-perpetuating.

 Skin Issues:  Issues with Yeast overgrowth or bacterial infections are problematic as yeast and some bacteria excrete
hyaluronidases that degrade the HA into lmw fragments. Skin Allergies & sensitivity reactions are often exacerbated by
inflammation due to degraded hyaluronan.

 Ear Infections:  Like any infection these cause inflammation which can be worsened by Hyaluronanosis. Additionally,
inflamed ear may canals restrict air flow and may contribute to bacterial or yeast growth. Inflammation in ear canals
can complicate the infections and increase pain as well as make it difficult to get meds into the deep areas of inflamed
ear canals.
 
 Respiratory issues including “breather pups”:  Inflammation in lungs/airways worsened by Hyaluronanosis inflammation.
Possibly a complicating factor in sinus infections as well.

  Any infection:   May be complicated by Hyaluronanosis related inflammation.
 
 Irritable Bowel Syndrome:  Inflammation more extreme in intestine due to degraded HA.

 Many Insect stings, bites:  Many of these venoms contain hyaluronidases that degrade HA causing more severe
inflammatory response.

 Snake bites:  Certain snake venoms contain hyaluronidases, enzymes that degrade the HA thus increasing
inflammatory response.

 Familial Shar Pei Fever and resulting renal or hepatic amyloidosis:  Severe presentation of hyaluronanosis
that triggers the auto-inflammatory system and causes episodes of fever and/or other inflammatory events and may
lead to further complications including amyloidosis related organ failure. Basically FSF is just a more extreme presentation
of hyaluronanosis….it is the same thing to a greater degree.

 Swollen Hock Syndrome:  Episodes of Inflammation of hock joints may or may not be accompanied by fever…not to be
confused with hock swelling due to injury/infection or lymphangitis/lymphedema.

 STSS-like infections, vasculitis, sepsis and system-wide inflammatory response:  Certain types of bacteria secrete
hyaluronidases that degrade the HA and can lead to potentially dangerous systemic infection & inflammation. Inflammation
may also compromise circulation leading to tissue death (necrotizing fasciitis).

  Mast Cell Tumors and other cancers:  Certain cancers may be complicated/exacerbated by inflammation and other
factors due to excess hyaluronan.

 Entropion:  Entropion issues may be complicated by inflammation around the eyes due to hyaluronanosis both in primary
and in spastic entropion.

From what I understand thus far, the degree of risk for severe hyaluronanosis correlates to 2 things:
 
1)	The number of duplications (CNV-Copy Number Variants) that the individual dog has inherited.
2)	The individual dog’s “triggers” for inflammation…anything that can trigger the auto-inflammatory system directly
(infections, injury, etc) or anything that can degrade the HA into LMW (pro-inflammatory) fragments.

Presently the DNA test to determine each dog’s individual CNV #s is in development and will hopefully be available to the
public soon. ALL Shar Pei should be tested to determine their individual risk factors so that both one knows whether a dog is
an acceptable candidate for breeding (if one is considering such) and also so that one can determine the best way to offset
the risk factors to give their Pei the best chance for a long and healthy life.

In the meantime, Pei with clear signs of auto-inflammatory issues (FSF/SHS) should be on a treatment protocol
(either Colchicine or Lita’s remedies) and ALL Pei (except as listed on the HyVitality instructions as otherwise) should
be on Dr Tintle’s HyVitality supplements as well as a good pharmaceutical grade Omega FA fish oil (Dr Sears Zone
brand’s Omega Rx is optimal) as well as the other supplements listed under Dr Tintle’s article on Hyaluronanosis,
FSF & Amyloidosis (link below). Additionally ALL the care instructions (bathing, etc) listed in this article
should also be followed for ALL Pei to best minimize/offset inflammation and its triggers. Traditional Shar Pei 
were found to carry a different mutation and they are not affected by SPAID/FSF. 

More information on these issues can be found at the links below.


Dr Tintle’s monograph on Hyaluronanosis, FSF & Amyloidosis
  


Dr Tintle’s article Shar Pei & Hyaluronan


 PLos Genetics (HAS2 published paper)


Dr. Vidt's Article "The Answer"


HyVitality Website


HAS2 & Cutaneous Mucinosis



Other Breed Health Issues

  

Health Issues that may effect the Shar-Pei
In general, dogs with any of the following conditions should not be bred. 
You want to make sure that the parents of the puppy you may be considering
have been cleared or checked for any of these conditions.
If your veterinarian requires more information about the Chinese Shar-Pei,
send the name and address of your veterinarian (for overseas orders, send
$2.00 in U.S. funds for postage) to:
Jeff Vidt, DVM
210 S. Park Street
Westmont, IL 60559-1940

ENTROPION

The Shar-Pei are 1 of 14 breeds that can have this condition. This is where the eyelid rolls in towards the eye, rubbing against the cornea and irritating this sensitive structure. Watery eyes, infection, even a corneal ulcer, can occur. Surgical correction may be required. Dogs with this Primary Entropion should not be bred, as a genetic component is suspected.

EYE TACKING

Puppies open their eyes at about 10-14 days of age. In Shar-Pei, this is often when the first symptoms of entropion appear. Typically the puppies open their eyes, but quickly they begin squinting and closing them. Often there is a mucous eye discharge and these puppies usually don't eat well or gain weight like their littermates. EYE TACKING is a temporary measure in which sutures (stitches) are placed in the eye lids to roll the lids "out" of the eyeball. Often this can be done without anesthesia in very young puppies (2-4 weeks of age). Sometimes gas anesthesia is used. Nylon sutures or surgical staples are placed in or near the eyelids which opens the eyes. Often an antibiotic eye ointment is dispensed to help heal any corneal ulcers and prevent secondary bacterial infections. These sutures are left in place for as long as possible, up to 4 weeks in some cases. The tacks can be replaced as needed until a permanent repair procedure can be done. If the sutures loosen up or are causing problems, they can be removed. Eye tacking can result in permanent repair of entropian, but its primary goal is to prevent serious eye damage until the pup is old enough to undergo permanent entropion repair - around 12 months of age or the puppy grows into the excess skin resolving the entropian issue. Puppies who have their eyes tacked may or may not need permanent entropion repair later on - there is not much correlation between the two. ENTROPION IN YOUNG PUPPIES CAN RESULT IN CORNEAL ULCERATION AND IS A MEDICAL EMERGENCY - SEE YOUR VET IMMEDIATELY!

ENTROPION REPAIR

Permanent ENTROPION SURGERY is often done in Shar-Pei after they reach the age of 12 months old. This is the age at which most pups are full grown and have "grown into" their heads. Permanent repair is a surgical procedure that will result in correction of any structural problem with the eyelids. Its success depends on the experience and artistry of the surgeon and often times referral to a veterinary ophthalmologist is recommended. Generally a regular Vet who is experienced with the breed will serve best. The procedure involves various techniques to remove excessive eyelid tissue from the lids, tighten up the eye opening and sometimes remove extra folds of skin around the eyes. Typically the dogs look worse for a few days after the surgery due to the swelling that occurs and they often sport an Elizabethan or "lampshade" collar to protect the sutures. Stitches are usually removed in 7-14 days unless dissolvable stitches are used. It should be noted that CSP’s eyes can be very sensitive or allergic to irritants and their eyes can swell shut due to environmental allergens (dust, cigarette smoke), this can cause the appearance of entropion but doing the surgery will not solve the problem. Tracking down the offending allergen and removing it from the environment will correct the problem. Entropion can also be cause by stress – commonly referred to as "stress entropion" – this is again a temporary situation and once the dog is removed from the stressful situation, the eyes will recover. If their cornea gets a scratch, or if they bump their eye again the tissue surrounding the eye can swell, causing the eye to shut, tacking is advised for these situations, as it is a temporary problem. There are rare incidents where an injury or allergic reaction with prolonged, sustained swelling can damage the structure of the lid causing Secondary Entropion. This is not a genetic issue unless there was a pre-existing Primary Entropion issue. We had one who sustained this after sustained severe swelling of the face and lids following a severe reaction to spider toxins.

CHERRY EYE

Cherry eye – protrusion of the third eyelid - is another fairly common problem in the breed. The gland for the third eyelid becomes unattached and can be seen a round red blob in the inner corner of the eye. When particularly large it can in fact obscure the entire eye. Whilst it doesn’t hurt the dog or affect it in any way it is unsightly and if left untreated can cause problems. Treatment consists of surgery to place the gland back into place and tie it down with sutures. This type of surgery is generally very successful though there are rare occurrences when the gland pops back out. If this should happen then it is generally recommended that the entire gland be removed. Should the gland itself be removed then drops have to be put in the dog’s eye for the rest of its life to prevent what is commonly referred to as "dry" eye. It should be noted that if one of the glands comes lose, the other eye will also be affected. Should this happen to your dog it is worth trying to wait an extra couple of weeks, if possible, to see if the other gland goes so your dog doesn’t have to go through two doses of anesthesia in a short period of time. Unfortunately, there is no way "preventive" surgery can be done, the gland actually has to come out before it can be repaired.

HYPOTHYROIDISM

The thyroid glands secrete a hormone which controls the basic metabolic rate of the entire body. Inadequate hormone levels reset the body to function at a lower metabolic level. In that case, dogs fatten easily on a normal diet, become sluggish, and are easily chilled. Hair changes are most noticeable and include loss of hair from the flanks and back, increased pigmentation of the skin, scaling and seborrhea (an abnormality in the production of skin cells.) secondary bacterial infection of the skin is common. The ears may also be affected, filling with thick, yellow greasy material which may predispose the dog to ear infections. Blood tests will determine the level of thyroid function and administration of thyroid hormone can treat the condition. Thyroid issues in Shar Pei can best be detected by having a 6 panel Thyroid test run…ideally the blood sample should be sent to Dr. Dodds at Hemopet (see links page) for the most accurate analysis and diagnosis.

FAMILIAL SHAR PEI FEVER (FSF)

*see also article above* Familial Shar-Pei fever also known as "Swollen Hock Syndrome" (SHS) typically may include the following symptoms: Swelling of the hock joint and sometimes other joints can be affected. Reluctance to move. Sometimes a swollen painful muzzle. Abdominal pain, vomiting, diarrhea, and shallow breathing. "Familial Shar-Pei Fever (FSF) is an episodic fever disorder. Shar-Pei with this disorder have one or more bouts of unexplained fever, usually 103-107 degrees but rare cases may go higher. Fevers usually start when they are less then 18 months old but sometimes the first attack is not until they are adults. Fever episodes usually become less frequent with age. Fevers last 24-36 hours in most cases without treatment". The disorder is "thought to result from an inability to regulate the auto-inflamatory system. Dogs suffering from this disorder are at risk of dying from a related disorder, amyloidosis. Dogs diagnosed with FSF/SHS should be maintained on a treatment protocol (either conventional or homeopathic) as early as possible to help prevent amyloidosis related organ failure. Affected Shar-Pei with amyloidosis have an inability to break down chemicals released in the bloodstream when inflammation results from abnormal deposition of amyloid protein throughout the body. While not all dogs with Shar-Pei fever die of amylodosis, when they do, death most commonly occurs between the ages of 3 and 5 years". While puppies can fever for a variety of reasons (infection, vaccine reaction insect bites/stings, reactions to toxins or certain meds) it is important when there is a fever to diagnose or rule out typical causes. FSF is an UNEXPLAINED series of fever episodes. If your puppy is given a "definitive" diagnosis of FSF thru appropriate diagnostic testing to rule out other causes and the history, clinical signs, it is essential to begin a treatment protocol ASAP to prevent potentialy deadly complications. For information on conventional protocols (Colchicine) see Dr. Vidt's & Dr. Tintle's website and for Homeopathic protocols see Pets 4 Homeopathy website (on our "links" page).

PATELLAR LUXATION

Is where the knee cap slips out of its socket. Any Shar-Pei with this condition should not be bred.

HIP DYSPLASIA

A dysplastic dog has an abnormal hip joint where the femur and acetabulum are misaligned. This can range in severity from mild (controllable) pain to dogs in such agony they must be put down. Make sure the parents of any puppy you consider has been cleared of Hip Dysplasia through the Orthopedic Foundation for Animals. (see links page for OFA website for further info)

REGURGITATION/VOMITING

REGURGITATION/VOMITING Megaesophagus and/or diaphramatic or hiatal hernias may or may not be detected until the dog is much older when they will appear underweight or emaciated with a history of vomiting. This is a developmental defect possibly a delayed maturation of the esophageal neuromuscular system. Primary symptoms to watch for is frequent regurgitation and a history of upper respiratory infections/pneumonia. Many Vets will not catch this initially as this is not a common condition, so if you note these symptoms ask your Vet to check for this specifically. Mild cases in young dogs can sometimes improve with careful feeding and management. Extreme cases may require intensive levels of care and feeding. There are also new techniques being used to treat this, including surgical repair that, while a relatively new procedure, is showing some very successful results. For more information on MegaEsophagus and related conditions and treatment/management options for these see info at the link below. Canine MegaEsophagus page MegaEsophagus is thought to be genetic in some cases. Afflicted dogs and close familial relatives of such should not be bred.

CUTANEOUS MUCINOSIS

Mucin is the substance in the Shar-Pei skin that causes all the wrinkling. It is clear and stringy and acts like glue in fight wounds." Some Shar-Pei have an excess of Mucin causing it to form clear bubbles on the skin that may rupture and ooze. May be associated with possible allergies and can be treated by a alternate day steriod therapy. Mucin is what makes Shar-Pei skin wrinkle and gives them padding on their muzzles and hocks. It is normal for Shar-Pei. Sometimes excessive mucin bubbles up in the skin, forming vesicles. This is called cutaneous mucinosis. These vesicles can be fragile and spontaneously break if the condition is severe or the bubbles of mucin may rupture during rough play, etc., causing the sticky substance to ooze out. It is normally not a problem for the dog. If it is excessive, e.g. causing much spontaneous rupture followed by healing scabby areas or if the skin is tearing frequently, the production of mucin can be shut down by low dosages of prednisone or other corticosteroids. Usually very low doses of alternate day prednisone result in dramatic improvement. If it is not bothering the dog, I would not treat it because corticosteroids are not without risk. Sometimes Shar-Pei will “lose” their muzzles because of steroids administered medically or because they are stressed by fever or illness and their own body’s production of cortisol by the adrenal glands will cause the mucin to “shrink”. Usually, they will return to normal with time but sometimes they never regain their old appearance. Many have used the supplement MSM to successfully manage mucinosis, this of course is preferable to steroids. Mucinosis frequently occurs on the neck, forelimbs, shoulder area, hocks and about the anus. Many individuals have had good success using MSM (supplement) for managing mucinosis outbreaks. Mucinosis is a symptom of overproduction of hyaluronan.

TORSION/BLOAT

Being one of many deep chested breeds, bloat can occur in Shar-Pei. Although similar to colic in horses, "bloat and torsion occur when the stomach swells with gas and then twists and cuts off its blood supply. Without timely surgical intervention the condition is fatal". The dog must see a veterinarian as soon as possible.

CHRONIC INFLAMATORY BOWEL DISEASE

Often complicated by food allergies and or Chronic stress diarrhea. Usually responds to a strict hypoallergenic diet.

CANCER

In regard to cancer, several forms have a high incidence in the breed. At present, the CSPCA is surveying club members to determine which are most prevalent. Once isolated, the organization's Charitable Trust plans to fund relevant cancer research.

ALLERGIES

Inhalant allergies are not uncommon in dogs. The symptoms generally express themselves in hair loss, intense itching and infected ears, watery/irritated eyes, clear nasal discharge, the skin between the toes of the feet might well be swollen and red. Allergies are caused by an overreaction of the immune system and again can be split into two groups, acquired and inherited. Acquired allergies show up in a mature dog which previously never had any problems. Trying to find the offending substance can be like searching for a needle in a haystack, various allergy tests are offered and can be either by the traditional "skin scrape" method or by blood tests. The blood test is mostly used in an attempt to track food allergies, it is not a terribly reliable test, but it is useful in indicating what direction to go in. The "skin scrape" is similar to the kind of testing done in people. Food allergies, whilst hard to track down are pretty rare also relatively easy to treat - the offending food substance is removed from the dog's diet. The best way to prevent food allergies is to feed your dog a high quality, PREMIUM dog food, (without soy, corn or wheat). Or feeding a natural diet (RAW or homecooked that is grain free). This is the same for a food intolerance. A food intolerance is common when we feed significant amounts of inappropriate foods for a specific species…like grain based foods to dogs. Inhalant allergies are, for the most part, impossible to eliminate but often can be treated/managed. Inhalant allergies are generally worse in the and fall when pollen, molds and seeds are abundant. Antihistamines may help control the symptoms. As with people, it is possible to get "allergy" shots for dogs which might help to alleviate some of the symptoms. Inherited allergies will generally show up in a much younger dog, sometimes as young as three months but nearly always by the time a dog has turned a year. Again dogs with inherited allergies should NEVER be bred. The treatment for dogs with inherited allergies is the same as for those with acquired.

FLEAS

Another very common cause of skin problems are fleas. Many dogs are very sensitive to the saliva of the flea and some are highly allergic. Symptoms are mild to intense itching and scratching; it can take only one bite to set a severely sensitive or allergic dog into ripping its skin apart. The best solution for fleabite sensitivities/allergies is PREVENTION. These days there are some excellent flea preventives available, both Frontline and Advantage are highly recommended, Program is another method, however this particular method does not actually kill the fleas that are biting your dog but sterilizes them so they can’t re-produce. If fleas are a problem you also have to treat the environment your dog lives in by removing fleas from your house and yard and treat the environment repeatedly as new eggs hatch. Diatoms are a natural solution that we advise to destroy flea eggs in the environment (home & yard).

SKIN ISSUES

  


SKIN ISSUES OVERVIEW
By JL Wortham-Morgan

Skin issues, though not life threatening, are often the most frustrating.
Since skin issues can be caused by a number of things and accurate diagnostic
testing for such can be challenging, invasive and expensive, often we look
first to the most probable causes and eliminate these as we go along. Even
more challenging is that many skin issues can easily become combo
issues.....multiple causes due to reactions, immunosuppression and chemical
imbalances. Once the body's natural defenses have been challenged by one
issue, other opportunistic organisms can gain a foothold. Also some treatment
protocols can complicate matters. It is essential to find and eliminate/manage
the root cause AND prevent or treat secondary issues at the same time.

It is VERY important to learn all you can....do not depend on your Vet to have
all the answers...some Vets are better with skin issues and Breed specific
issues than others. Empower yourself with knowledge, do some online research
and DO NOT allow yourself to be intimidated by your Vet. If you arm yourself
with knowledge you will know if your Vet's treatment protocol is logical and
appropriate....if it is not, challenge it or seek another Vet.

Most common causes of skin issues are generally as follows:

1)Fleas.....fleas can cause a number of issues and lead to secondary issues.
Flea sensitivity which is normal inflammation/reaction to flea bite. Itching
leads to chewing which can lead to bacterial infections, etc. Actual flea
allergies which are similar in symptom type though much more intense reactions.

2)Pyoderma (bacterial infection, usually staph). (symptoms: Hair loss,
redness/inflammation, pustuals/pimples, lesions, skin, odor, itching) This can
be either a primary cause (due to immature or suppressed immune system) or a
secondary issue. Bacterial infections of the skin need to be treated with an
appropriate antibiotic protocol of sufficient doses, for extended periods of
at least 2-3 weeks following cessation of all symptoms. This is because Staph
bacteria is extremely tenacious and is often resistant to antibiotics. It
usually takes at least 2-3 weeks to even begin to see clear improvement with
antibiotics. Often antibiotic protocols for Pyoderma are ineffective for the
following reasons: The antibiotic was not the appropriate antibiotic for the
specific bacterial strain, the dosage was insufficient, the course of
treatment was not long enough to wipe out the bacterial population OR there is
an underlying or secondary issue that hasn't been dealt with.

Appropriate antibiotic will vary due to resistant strains. Generally the drug
of choice for treating this is Cephalosporins (broad spectrum antibiotic).

In cases of resistant bacterial strains (evident by either lack of improvement
on the Cephalosporins after several weeks or relapse following FULL course of
treatment)....the next step is often to have a culture and sensitivity test
run to see which antibiotic is most effective. Often a more narrow spectrum
antibiotic that is specifically targeting a bacterial strain that is sensitive
to it will be prescribed with resistant Pyoderma.

While on any antibiotics it is especially important to manage diet to
prevent/counter yeast overgrowth. See below #3

3)Yeast overgrowth. (symptoms: Hair loss, redness/inflammation (especially 
in armpits, groin, neck and chin, between toes), weeping lesions/skin, odor,
itching, chronic ear infections) This can be a primary issue or secondary to
other issues. To eliminate this is a 4 pronged approach: 1/ Eliminate sugars
and excess refined carbohydrates from the diet. Feed low grain or no grain
diets with "cool carbs" instead of grains....and no sugar of any kind. 2/Add
probiotics to the diet: plain yogurt, acidophilus, enzymes or such
supplements. 3/ Adjust body PH....1-2 teaspoons plain vinegar to drink water
daily. 4/ Topical preparations like colodial silver spray, Monistat cream or
SharpSue's Pei Powder (recipe below) may help.

SharpSue's Pei Powder recipe: 1 part boric acid to 6 parts cornstach. Place
the powder in a terry washcloth( this sifts the powder really fine, and is why
it works so well) And tie or rubberband the cloth shut. (a powder puff) Dust
the effected areas with the puff. Do this two to three times a day.

4)Demodectic Mange mite overpopulation. Note: Demodex is NOT contagious.
(Symptoms: hairloss either in patches or thinning "moth eaten" patterns).
With straight up demodex you don't usually see itching or redness. This may,
(and often is), however accompanied by other issues....usually bacterial
and/or yeast, so all symptoms may manifest for these issues. Localized demodex
is usually confined to an area or is just a limited number of effected
areas....if the immune system is not compromised, this may clear up on it's
own or be "spot treated" topically. Generalized demodex can occur for a number
of reasons, some genetic others not. In immature immune system may not yet be
sufficiently developed to counter a demodex overgrowth. Use of steroids can
cause a demodex infection to go generalized. An illness or a genetic issue can
cause the immune system to be compromised and thus be followed by generalized
demodex.

IMPORTANT NOTE: Often skin scrappings are inadequate as a diagnostic tool for
demodex in this breed due to the unique nature of their skin, (probably due to
the high mucicin....that's my guess on it anyway). Most skin scrappings will
return negative results even when there is a demodex issue present. The only
adequate way to test a Pei accurately for this is a skin biopsy....since this
is expensive and invasive, many Pei experienced Vets will forgo this and
simply treat if mange is suspected. Other vets will run scrapping after
scrapping (at your expense) while the mange goes unchecked.

Demodex is generally treated with either a serious of special dips or
injections that your Vet may prescribe. Any underlying causes should be tested
for and any secondary issues need to be treated/managed simultaneously.

5)Environmental agents can cause irritations, sensitivities or even true
allergic responses. One must determine what in the immediate environment may
be the cause. Household chemicals/cleaners/deoderizers etc., pesticides,
herbicides, lawn products. Seasonal issues with inhalent allergies, etc. One
must meticulously inventory and monitor any potential environmental cause and
eliminate or limit exposure.

6)Food allergies. Food allergies rarely manifest as skin issues. It CAN
happen....just isn't the most likely culprit. Elimination diets, diets that
limit ingredients and additives can help to determine the presence of food
allergies. There is also allergy sensitivity testing available. Although food
allergies are uncommon, many dogs do not tolerate Grains well….many are also
sensitive specifically to wheat, corn or soy. Try a low grain or no-grain food.

7)Thyroid issues. (Symptoms: Unexplained weight gain, Thin or "coarse" coat,
Greasy skin/coat (even right after a bath), Regurgitates his/her food
(different than vomiting -- time factor)(other megaesophagus symptoms),
Aggressiveness,  Slow heart beat, Possible seizures, Stiffness, cold
intolerance, Lethargy, Hyperexcitability, Chronic offensive skin odor).
Thyroid issues are considered genetic and as with any suspected genetic issue
the animal should not be bred. Thyroid testing (full 6 panel test). Thyroid
issues can be treated. Ideally the test should be done by sending the blood
sample (drawn by your Vet) to Dr. Dodds at Hemopet (link below) for testing
and evaluation.

http://www.itsfortheanimals.com/HEMOPET.HTM

8)Other underlying causes of skin issues may include Cushings disease and
other possible factors including auto immune disorders and immune deficient
disorders. 
Some theories say vaccines(over vaccination and vaccine reactions) may
contribute to some of these issues.

Most skin issues I have seen or heard of occur around "adolesence" as the
immune system is maturing. Especially around the ages of 4-8 months. This is
the time when Mother's immunity is wearing off and the developing immune
system is struggling to take over the job. This is ALSO the time when we are
challenging the young immune system with a barage of vaccines. I feel that
during this age of susceptibility we need to be extra careful both to minimize
insult to the immune system AND offer additional immune support as it is
developing.

To minimize overloading the maturing immune system we adjust vaccine protocols
during this time especially. I avoid "comb vaccines" and alternate “Core”
vaccines (of the major threats Parvo, Distemper, Corona, Rabies). I avoid
Lepto vaccines prior to 6 months and I avoid Bordtadella vaccines altogether.
I also give supplements for immune support during this time. I give 500mg
Ester C, 200-400 IU Vitamine E and 500-1000 mg MSM daily.

AND.....do NOT allow treatment with systemic Steroids to control inflammation,
itching, etc. The only time steroids should be used to treat skin issues is
when you have a confirmed diagnosis (thru allergy sensitivity testing) of
chronic allergies that cannot be managed any other way....AND any possibility
of infection has been definitively ruled out.

Steroids used systemically suppress the immune system and will not only
complicate or even create a skin issue due to infection, they can invite
numerous other issues as they compromise immune system function.

Topical Steroids can be used in cases of extreme itching/inflamation but are
not generally recommended in cases of infection.

****Skin issues of any cause may be exacerbated by Hyaluronanosis...see article
and the links at top of page for Hyaluronanosis info.