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Ryan Hospital Philadelphia, PA

Itchy Izzu

Date: Jan 3, 2018

At age seven, Izzu had already been an itchy dog for a few years.

His chronic skin disease had been treated with antibiotics, antifungals, and steroids. He was frequently bathed with an anti-microbial shampoo. He was even placed on multiple diet trials to determine if he suffered from a food allergy.

Izzu’s symptoms would improve temporarily, but nothing seemed to cure him. Then two summers ago his chronic skin disease worsened. Large areas of his skin were crusting and scaling. Izzu also had a horrible smell.

His owner, Jeanette Urquhart, was at her wits end.

“It was frustrating for me and I was feeling so bad,” said Urquhart. “He was uncomfortable all the time. I was trying to do all the right things and wasn’t getting any answers.”

Urquhart was referred to Penn Vet’s Ryan Hospital in August of 2016, making the trip from Cape May Courthouse, NJ.

Izzu's first visit to Ryan Hospital revealed significant bacterial infection.Penn Vet Dermatology

“We see about 2,000 patients a year,” said Christine Cain, Section Chief and Assistant Professor of Dermatology. “Unfortunately the majority of our patients have a long history of chronic skin disease.”

Dermatology resident Katherine Backel examined Izzu and found significant bacterial infection on his skin and in his ears. These types of infections are frequently secondary to allergic disease or other diseases.

In addition to a possible underlying food allergy, Backel was suspicious of a possible endocrine disease, such as hypothyroidism or Cushing’s disease, often seen in older dogs. She submitted testing to rule it out.

Backel prescribed Izzu with yet another antibiotic, a medicated shampoo, and ear medication.

“It is hard,” said Backel. “I respect owners so much who can keep up with the home treatments. You want to make your pet feel better and you’re trying. It’s a huge investment of time and effort.”

Beginning to See the Light

Izzu returned in September for a recheck. Urquhart reported his itching had improved and he smelled better.

“Jeanette was very happy about the smell going away,” said Backel. “That was a big issue. You could definitely smell him walking into the room before.”

However, while the bacterial infections were clearing up, Backel found new types of skin lesions on Izzu’s hind end. She was concerned about a possible drug reaction or an underlying disease such as the autoimmune diseases erythema multiforme or Pemphigus Foliaceus.

September's recheck showed the appearance of new skin lesions.Backel took a skin biopsy to determine what might be causing the lesions. Based on the results, she could plan the best course of action going forward. In the meantime, she switched his medication and prescribed a new topical medication for his ears.

The biopsy results confirmed it was Pemphigus Foliaceus causing the lesions and crusting of Izzu’s skin.

“An autoimmune disease is not expected,” said Backel. “Diagnosis can be tricky as the lesions look like bacterial infection. You won’t know what you get until you biopsy.”

Although seen infrequently, Pemphigus is one of the most common autoimmune diseases of the skin in dogs and Ryan sees about one or two cases a month in both younger and older dogs. While it can occur spontaneously, it can also be associated with certain triggers such as drug reactions, infection, or cancer.

After the diagnosis of Pemphigus, Izzu returned for a recheck in October. Izzu’s hair was growing back and he was more comfortable. Urquhart was thrilled.

Izzu at his recheck in October 2016. His hair was growing back and he looked much better.“Once we got the diagnosis, they knew how to treat him,” said Urquhart. “Now it’s been great. It was worth the trips to Ryan.”

“We got lucky that Izzu responded really well to the first treatment,” said Backel. “Sometimes we have to try three or four medications before we find something that works, so it can take some time.”

One Year Later

Izzu looking great in front of the tree at Christmas 2017 In the past year since his last recheck at Ryan, Izzu’s primary care vet has been seeing to his treatment and he looks wonderful. The areas of crusting have disappeared and his hair has grown back much thicker.

“His hair is back, he doesn’t itch, and my house smells good again,” said Urquhart. “I’m so grateful to Dr. Backel for figuring out Izzu’s problem and giving me my healthy, happy dog back.”

“Izzu was one of the sweetest patients,” said Backel. “When he came in not feeling well he was really patient. He didn’t even cry when we took the biopsy. I’m glad we were able to quickly help him.”