In Episode 3 of the Skin Flint Podcast, we invite dermatology specialist Janet Littlewood to join us to discuss a very popular breed of dog - West Highland White Terriers (Westies). Janet has over 30 years' experience in referral dermatology, holds the RCVS Dilpoma, and is an RCVS Recognised Specialist in Veterinary Dermatology.
John introduces Sue & Paul, before briefly addressing the topic to be discussed and who is joining us on episode 3.
Chapter 1 (03:08) - Why Westies?
Sue introduces Westie skin disease and Janet talks about whether this breed is more likely to suffer from skin issues. John then asks if there is a link between the white coated nature of the breed and the skin disease and Janet points out there is not any evidence of a link and there are also other white coated breeds which aren't as prone to skin problems.
John then poses the question as to whether there is anything potential owners can do to reduce the risk of getting a Westie puppy likely to have skin disease. Janet talks about seeing the mum and dad of the puppy, especially the mum, and looking for saliva staining on the hair coat (rusty/reddish-brown) as a suggestion of allergy being in the genes of the puppy. But she also points out this isn't a guarantee and some severely affected puppies come from mildly affected parents.
Sue brings up Lucy's Law, which regulates people buying puppies from breeders and not bad sources. Janet also urges caution in having a rescue Westie, as they are often rehomed because of skin disease, but may well look fine at the point of rehoming as the rescue centre they are in is a low allergen environment. Janet shares a story of rehoming a dog herself, but it very quickly became symptomatic when she arrived home.
Chapter 2 (10:35) - Westie Skin Disease
John asks if it is only allergy we are talking about with ‘Westie skin disease’, which Janet clarifies: it is generally an environmental allergy with secondary issues from something like bacterial infection. It is sometimes, but not often, a food rather than environmental allergy.
Sue talks about the horrible black thickened skin Westies can get and Janet talks about this being a result of a long-term secondary infection, referring to it as a dysbiosis (see next question), often caused by a yeast infection called Malassezia dermatitis. She mentions these are even more itchy and hard to control with anti itch therapy such as Oclacitinib (Apoquel), Lokivetmab (Cytopoint) or glucocorticoids (steroids) than the allergy itself. As such the vet should find out what micro organism is overgrowing on the skin.
Sue then clarifies the word dysbiosis, and Janet talks about this being the imbalance of micro organisms on the surface of the skin, micro organisms which are naturally on the skin already. This imbalance causes an overgrowth of one organism, bacteria or yeast, which is what she says is often called infection.
Chapter 3 (14:14) - Diet
Sue summarises the way allergy unsettles the skin and brings the conversation back to Westies; she asks what can Westie owners do? Janet suggests a diet high in essential fatty acids - this can normalise the skin barrier, and she clarifies she's not referring to hypoallergenic foods but diets with these specific oils added. Sue clarifies what these oils are found in.
Sue then asks if Malassezia (Yeast) infections can be solved with a no-yeast diet. Janet clarifies the skin yeast isn't like brewers yeast in bread but a skin surface yeast, and diet would not contribute to this yeast overgrowth. These yeasts are normally in the skin in certain areas naturally, but they get out of control when the skin becomes upset.
John again summarises how we get to this point and that owners can use a combination of things to help manage this. John then asks Janet whether a raw food would solve the problem. Janet suggests first of all, the importance of bathing with a medicated shampoo as well as her previous recommendation of a diet with fatty acid in, as washing the coat can look after the skin and also wash off the particles they are allergic to. She then goes on to talk about the question of raw food, and puts forward that cooked meat is less likely to cause an allergic reaction than raw meat, so there is no science to suggest raw feed would work and no veterinary bodies recommend this at this time.
Sue talks about studies showing the essential fatty acid benefits on the skin, and further points out these are not in raw food.
Chapter 4 (23:02) - Shampoos & Foam
John raises the question of how an owner even begins to work out what to use to treat the skin. Janet says as a dermatologist she takes an evidence-based approach, so talking to a vet or vet nurse is the best thing for an owner to do.
Sue asks what an owner should look for in a shampoo for good anti-bacterial and anti-yeast activity.
Janet mentions chlorhexidine-based shampoos (Clorexyderm 4% shampoo, Peptivet Shampoo) and for shampoos with Chloroxylenol as well. For confirmed yeast issues they need anti-fungal elements and Janet suggests shampoos with Miconazole (Malaaseb) and other ‘..azoles’ as she calls them. Also shampoos with acids, such as lactic or acetic acid and points out there is an evidence base for using all these ingredients.
Sue asks about moisturises for the skin barrier as mentioned earlier, in the form of foams and sprays and Janet reflects on success she has seen in cases using the anti bacterial and/or anti-fungal shampoo alongside a moisturising shampoo or foam/spray. She also mentions how a chlorhexidine-based spray or Foam daily (Clorexyderm 4% Foam and Spray) has been shown to be as effective as a shampoo and with a better residual effect.
Janet point out that different recipes work for different dogs.
Chapter 5 (27:09) - When To Go To The Vet
John brings the conversation to a close asking about a disease being a sign of skin disease and also what flashcards Westie owners should have in their minds for deciding when to visit the vet. Janet explains redness, rubbing, head shaking and scratching of the ears are all signs of a disease and concurs this is a sign of skin disease. Also sore feet, and rashes or what to look out for with general Westie skin disease and all of these should direct an owner to visit the vet. Janet says any time these things occur for a second time it is a warning sign of energy and so an owner should push the vet for more investigations if they are not doing this. She mentions the possibility of a vaccination against an allergy and suggests these investigations could help to treat your skin condition long-term, rather than always treating the symptoms in the short term.
John then asks when an owner should in Janet's opinion push for a specialist. Janet again says the second time you see the signs in a Westie, as this is the best way to get better management long-term if this is not happening in the owner's practice.
Sue clarified that the specialists as well as having more training also have more practice and Janet echoes these sentiments, saying even if your dog responds well to the first dose of treatment, to push when the problem returns to investigate the cause and not just keep repeating the same treatment over and over.
John, Sue and Paul conclude the conversation and say how much they enjoyed speaking to Janet. John asks another tricky question to end the episode.
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