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Interview with Dr. Tobin, DVM

Dr. Stephen Tobin is a holistic veterinarian who providestreatment using homeopathic herbs and nutrition. He speaks with us about hisphilosophy of animal care, pet nutrition, and his experience with the LonglifeProgram in the treatment of his patients.

Read the interview

How Does Longlife Treat Hot Spots?

Longlife for Dogs contains pure shark cartilage, specially processed for maximum absorption into the bloodstream by your dog's digestive system. It contains Amino Acids and High Proteins, with natural Mucopolysaccharides. The anti-inflammatory properties of Longlife for Dogs help soothe irritated skin and remedy a host of skin diseases. A natural immune system booster, Longlife for Dogs promotes healing and good skin condition.

Causes of Hot Spots in Dogs

The majority of cases involve a natural portion of the skin called StaphylococcusIntermedius, which becomes pathogenic (disease causing) when the skin environmentchanges for any of a number of reasons. Other bacteria and microorganisms maybe involved, but some reports suggest that over 90% of cases have Staphylococcalinvolvement.

A hot spot starts because something irritates, itches, or causes inflammationof the dog's skin. In cases of itching, the dog rubs, licks, or chews the siteand exacerbates the problem. These sores can develop into severe problems inas short a time as an hour or two.

The most common irritants are probably fleasand allergies, which cause the itching that leads to the skin infection. Manyother possible sources of irritation, such as tick bites, besetting, burrs, mats,mosquitoes, summer heat, and other problems, can contribute to the initial irritationthat develops into a hot spot.

Symptoms of Hot Spots

The most common symptoms are itchiness, redness, often with pimples or scabs,and a bad odor. Surface pyodermas may show as areas of redness and irritation,often developing into raised, round scabs. Superficial pyodermas produce yellowspots which then break out into larger wheals and scabs. Deep pyoderma can makepets systemically ill and produce abscesses and oozing, inflamed channels inthe skin surface. Certain areas may be particularly prone to infection. Interdigitalareas, inside the ears, at the groin, and along the middle of the back are commoninfection sites. Other diseases, such as yeast infections, can look very similar,so if there isn't a rapid resolution with home treatment, seek professional advice.

Subsets. Asidefrom depth of the infection, one can subdivide hot spots/skin afflictions/pyodermaby way of origin and manifestation.

Primary pyoderma: There is little doubt that occasionallypyoderma may develop spontaneously and for no obvious clinical reason, or idiopathically.As with arthritis, there is simply no known cause. The general consensus is thatthese dogs probably have a compromised immune system or a congenital factor affectingskin immune systems. The exact genetic nature of pyoderma remains a mystery.

Atopy in Dogs

Atopy is a disorder by which dogs have a predisposition fordeveloping antibodies to environmental allergens. Atopy is the most common disordercausing hypersensitive skin reaction in non-flea allergic patients presentingwith dermatitis and accounts for up to 70 to 90% of all hypersensitive conditions.Although it has been found that up to 10% of dogs with atopy may also have foodallergies, up to 80% of dogs diagnosed with food allergies also have atopy, thusaccounting for the high rate of failure to treat food allergy patients throughmanipulation of diet alone.

Cause: Dogs that develop atopic dermatitis have a predispositionfor excessive production of immunoglobin E (IgE) antibodies. IgE antibodies arebelieved to be the primary immune defense against parasitic organisms. However,in humans and other animals, including the dog, these antibodies are also responsiblefor producing allergic reactions. When a hypersensitive dog is first exposedto an environmental allergen, such as pollen, mold, or dander, its immune systemwill begin to produce high levels of IgE antibodies that will accumulate in thetissues of the body. (In humans, IgE is found predominantly in the respiratoryand conjunctival mucus membranes, while in dogs, IgE antibodies locate predominantlyto tissues comprising the skin.) When the dog is re-exposed to the same allergenat a later time, IgE antibodies bind to the allergen and activate the releaseof histamines (chemicals that attract other immune surveillance cells to thesite of infection) from specialized, blood-derived immune cells called mast cells,which are involved in the inflammatory response. Histamine release results inreddened and itchy skin consistent with symptoms of dermatitis. In some instances,atopic dogs have been found to have non-reactive IgE antibodies, but demonstratedelevated levels of immunoglobin Gd (IgGd) antibodies. IgGd is a subset of IgGantibodies, a separate class of antibodies that predominantly circulates in theserum and is responsible for producing such conditions as anaphylactic reactions.Current studies are aimed at exploring the role of IgGd antibodies in the atopicdisease process.

Symptoms of atopy: The most common symptom of atopy is pruritis(itching), usually beginning around the face and paws and in some cases eventuallybecoming more diffuse over other areas of the body, particularly the ears, armpits,elbows, and groin. Recurrent ear infections are present in up to 75% of dogsdiagnosed with atopy. Skin lesions are not usually apparent, unless resultingfrom excessive scratching, but a raised, pustular rash with or without hair lossmay occur as a result of secondary pyoderma. Some dogs may develop conjunctivitis.

Diagnosis:Because many other dermatologic disorders may presentwith similar symptoms to atopy, certain criteria have been established to selectsymptomatic patients for further in vitro testing and to identify the causativeallergen:

  • Member of a breed with a known predisposition for atopy
  • Clinical symptoms manifesting between 6 months and 4 years of age
  • Waxing and waning symptoms associated with seasonal changes
  • Positive response to glucocorticoid treatment

Though symptoms during seasonal changes are the best indicator of atopy ina dog, a diagnosis of atopy should not be excluded in the absence of seasonalsymptoms, since it has been found that up to 80% of dogs with atopy will demonstratecontinual, year-round symptoms. When these criteria are met and other differentialdiagnoses are ruled out, then allergy testing to identify the responsible allergen(s)becomes the next consideration.

Principles of Canine Allergy Testing

In general, mixed allergentesting (combining antigens from different sources together, in the same waya human might be tested, say on his or her back) may be performed. Since thepurpose of testing is to identify a specific allergen or allergens for immunotherapy,testing each allergen individually is the preferred method. Common testing allergensinclude: grasses, trees, shrubs, weeds, molds, house dust mite bodies, mite eggs,mite larvae, mite feces, fleas, ants, flies, cockroaches, mosquitoes, moths,feathers, nylon, wool, silk, and tobacco. Food allergen testing is rarely effectivefor identifying food-related allergens; therefore, food elimination testing isthe preferred method for screening for food allergies (to be discussed in anarticle in the next series). Selection of allergens for the purpose of treatingdogs with immunotherapy (hypo sensitization treatment) may be done either throughintradermal testing or in vitro testing. Each method has its strengths and weaknessesin terms of laboratory analysis. With intradermal testing, a commercially availableantigen is selected and injected under the skin and the site of the injectionis observed for signs and intensity of an allergic response. Many dermatologistsutilize intradermal testing because it has a high level of specificity and thuspositive results are more likely to be true-positives. The main limitation withthis test is the occurrence of false-negatives because of poor sensitivity associatedwith this form of allergen testing.

An alternative to intradermal testing is in vitro allergen testing. This secondmethod requires reacting serum from the dog with a commercially-available antigenthat has been bound to a solid substrate in a radioallergosorbent test(RAST)or enzyme-linked immunosorbent assay (ELISA), which measuresthe amount of IgE in the patient's serum that binds to the allergen. This testis particularly useful in evaluating dogs that have already undergone or arecontinuing treatment with glucocorticoids (since these drugswill inhibit intradermal test reactions yielding false-negative results). However,in vitro allergen testing has a higher degree of non-specificity and, therefore,false-positive results. Recent modifications to methods of in vitro allergentesting by the Veterinary Allergy Reference Laboratory (VARL) have provided ameans to increase the level of specificity of these in vitro tests aimed at detectionof IgE through the use of monoclonal anti-IgE reagents. Additionally, this testingmethod also seems to provide comparable specificity while providing greater accuracycompared to intradermal testing for detecting insect-associated allergies.

Ectoparasites

These include, especially, fleas. Apart from the trauma andirritation of individual flea bites, many dogs develop an allergy to flea saliva,which causes generalized skin inflammation and can lead to pyoderma. A whole host of other afflictions, known as Parasitic Skin Disease, can resultfrom ectoparasites.

Fleas: There are many types of fleas, but for dogs, it isoften the cat flea that causes the problem. Fleas will not live or breed on humans,although they may bite us. They are dark brown, vertically flattened, and veryfast moving. They breed in carpets and bedding, usually inside. Every adult femaleflea has the potential of laying up to 200 flea eggs per week inside a house,so it doesn't take long for tens of thousands of fleas to develop. The flea eggfalls to the floor, lies in a carpet or between the floor boards, hatches, andforms an organic scavenging pupa, which then forms a cocoon before emerging asthe adult flea. The life cycle can take from two weeks to six months or more.

Fleaprevention: We believe that the best anti-flea products are obtaineddirectly from your veterinarian, when your pet has an active flea problem. However,you should try to prevent flea infestation before it starts. Once treatment starts,it is important to provide constant flea control, as a break of even a monthwill allow fleas to start breeding again in your household.

Determining the presence of fleas: To conduct a very simpletest for the presence of fleas, start by placing a layer of damp tissue papertwice the size of the dog on a tabletop. Place the dog on the tissue paper andcomb all areas of the coat, especially the middle of the back, onto the tissuepaper. Then look for black/brown granules that absorb water and form a russetbrown ring around the granules. These are flea dirts and indicate an active fleapresence.

Life Cycle of Fleas: Dog fleas will lay their eggs on a petin their close proximity. These develop into organically scavenging pupae incarpets and skirting boarding and, depending on climatic conditions, will developvia a cocoon phase into adult fleas between two weeks and six months after deposition.Movement in a room triggers the hatching of the cocoon larvae into the adultflea.

Other Flea-Caused Canine Skin Conditions

Ticks: These are common parasites of dogs that walk in long grass. They areable to spread some intracellular parasites. The bites can also cause local skinreactions, such as tick bite granuloma.

Cheyletiella: This is a mite that can live on the skin ofdogs. It particularly likes the dorsal surfaces and will cause intense irritationand heavy scurfing and dandruff in limited areas, especially on the dorsum (uppersurfaces) of the back.

Lice: These external parasites are becoming increasingly rare and are speciesspecific. They are usually 1–2 mm in length and a faun to plum color. They willcause intense irritation on all body surfaces, especially over the body whereareas of hair loss and skin inflammation may occur.
Ear mites: Also known as Otodectes, these are common parasites of the ear canalof the dog which may cause intense irritation and excessive wax production. Theyoften cause secondary irritation around the ear flaps.

In any case of pyoderma, assume fleas may play a role until proven otherwise.

Other Causes of Skin Irritation in Dogs and Cats

Dietary allergy: Not as common as people would like to believe, but occasionallyseen in dogs because of a daily inclusion of beef, chicken, and wheat-based productsin dog foods.

Skin trauma: Working dogs in particular will suffer occasionalwounds when working in rough patches.

Poor grooming.

Seborrhoea: Seborrhoea can be idiopathic (developingfrom an unknown source, often congenital or inherited) or secondary to otherfactors (see below). The two primary presentations are:

Seborrhoea oleosa or oily seborrhoea. Oily seborrhoea isdue to excessive production of skin oil, waxes, and skin cells. The coat takeson a matted look and a greasy feel, and oily dandruff clogs the base of the hairs.There is often a strong and unpleasant odor to the skin. Many dogs are pruritic(itchy) and nibble and rub themselves persistently, causing hair loss, inflammation,and secondary infections.

Seborrhoea sicca or dry seborrhoea: Dry seborrhoea iscaused by an excessive production of skin cells. The coat takes on a dull look,with excessive scaling of the skin producing a heavy dandruff. These dogs arealso pruritic and again may bite and nibble, setting up areas of inflammationand hair loss in which secondary infection may occur.

At-risk breeds: West HighlandTerriers, Springer Spaniels, and German Shepherds appear to be at the greatestrisk for congenital seborrhoea.

What to look for: There are many different sources:

  • Allergies – Environmental, food allergies, contact, etc.
  • Endocrine deficiencies – such ashypothyroidism. Defects in fat absorption or metabolism.
  • Parasitic infections – Flea allergic dermatitis, sarcoptic and demodectic mange, harvest mites, cheyletiellamites.
  • Fungus – Melassezia yeast is the most common.
  • Dietary deficiencies – Protein, zinc, and vitamin A (unlikely with high-quality, complete dog foods).

Other lesions: Can be caused by furunculosis (often inherited)to "hot spots" due to excessive licking and scratching.

Principles of Allergy Testing

In general, mixed allergen testing (combining antigens from different sourcestogether, in the same way a human might be tested, say on his or her back) maybe performed. Since the purpose of testing is to identify a specific allergenor allergens for immunotherapy, testing each allergen individually is the preferredmethod.

Common Pet Allergens

Common testing allergens include: grasses, trees, shrubs, weeds, molds, housedust mite bodies, mite eggs, mite larvae, mite feces, fleas, ants, flies, cockroaches,mosquitoes, moths, feathers, nylon, wool, silk, and tobacco. Food allergen testingis rarely effective for identifying food-related allergens; therefore, food eliminationtesting is the preferred method for screening for food allergies.

Selection of allergens for the purpose of treating dogs with immunotherapy(hypo sensitization treatment) may be done either through intradermal testingor in vitro testing. Each method has its strengths and weaknesses in terms oflaboratory analysis.

Intradermal Testing

With intradermal testing, a commercially available antigenis selected and injected under the skin and the site of the injection is observedfor signs and intensity of an allergic response. Many dermatologists utilizeintradermal testing because it has a high level of specificity and thus positiveresults are more likely to be true-positives. The main limitation with this testis the occurrence of false-negatives because of poor sensitivity associated withthis form of allergen testing.

In Vitro Allergen Testing

An alternative to intradermal testing is in vitro allergen testing. This secondmethod requires reacting serum from the dog with a commercially-available antigenthat has been bound to a solid substrate in a radioallergosorbent test (RAST)or enzyme-linked immunosorbent assay (ELISA), which measures the amount of IgEin the patient's serum that binds to the allergen. This test is particularlyuseful in evaluating dogs that have already undergone or are continuing treatmentwith glucocorticoids (since these drugs will inhibit intradermal test reactionsyielding false-negative results). However, in vitro allergen testing has a higherdegree of non-specificity and, therefore, false-positive results. Recent modificationsto methods of in vitro allergen testing by the Veterinary Allergy Reference Laboratory(VARL) have provided a means to increase the level of specificity of these invitro tests aimed at detection of IgE through the use of monoclonal anti-IgEreagents. Additionally, this testing method also seems to provide comparablespecificity while providing greater accuracy compared to intradermal testingfor detecting insect-associated allergies.

Long-Term Effects and Prevention of Hot Spots

The natural reaction of the dog (biting and scratching) will worsen the affliction,which only encourages more biting and scratching. This cycle can go on rapidlyand spread widely. The descent to weepy, almost syrupy skin can occur very rapidlyand be quite frightening. What is then seen is an area of hair loss with veryred skin that may be exuding serum. In some cases there isn't much hair lossbut the skin gets crusty or scabbed anyway.

The best action here is prevention.Keep your dog free of fleas. Groom and bathe your dog as necessary to keep thehair coat in good condition. Limit sources of irritation to the best of yourability. If allergies are a problem for your dog, work with the vet to controlthe itching they cause. Though these measures may not prevent hot spots in alldogs, they will certainly help in many cases.