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Unidentifiable skin... rash?

My poor boy is always itchy. He chews his feet, tail and back nonstop. He's taken off chunks of his fur before, and right now has no fur in between his toes. Sometimes he also shows what looks like hives or something on his belly, but they aren't there at the moment.

Have seen MANY vets for this over the past 5 years. We've tried different dog foods. Have tried benadryl - did nothing. Then was told it was probably an allergy to bermuda sod, but then we moved to a place with no bermuda sod... didn't help.

About a month ago, I ran him to the emergency vet when he couldn't walk on his front left foot because it was swollen to the size of a softball. That vet said he gave himself an infection from chewing and put him on cephalexin and prednisone. We also soaked his foot in epsom salt/water. Swelling healed up, but the steroids made him a little nuts. Kind of glad he's off those to be honest!

Then I noticed he had a very large scab on his back (from chewing). I shaved around it so I could inspect it and clean it out, and while I was shaving I noticed a second. So I kept shaving to see where the irritation ended and wound up shaving almost his entire back. On the right side of his spine between midback and the start of his tail, I saw what looked like a rash. It was about 6 in by 3 in. I started cleaning his wounds I noticed the 'rash' patch came off... and it was actually dried blood! So thinking this might be a flea allergy (due to location) I gave him a bath with an anti itch shampoo and gave him flea meds. Never saw fleas on him, but was told only takes one bite. Now two or three weeks have gone by and the 'rash' is back! I swear, it looks like the poor kid is bleeding through his pores!

I'm at a loss here. All the vets tell me the same thing - new food, flea meds, etc. But I've done it all, and nothing fixes it. I'm just hoping this sounds familiar to someone and can point me in the right direction...
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The most common reasons for itchy skin in dogs include skin infections, microscopic skin parasites such as fleas, scabies or demodex mites, food allergy, or pollen/dust allergies. The rash and hairloss/swelling of the foot the you describe are suspicous for a bacterial skin infection, secondary to the underlying cause of the itch. Your veterinarian can take skin scrapings to examine under the microscope for parasites and for skin infection.  If skin infection is present, it is treated with antibiotics for 3-4 weeks and mild antibacterial shampoos. If your dog is not already on a good monthly prescription flea preventative such as Frontline, Advantage or Revolution, then your veterinarian can prescribe an appropriate choice. The itch can be treated symptomatically with mild oatmeal shampoos, fatty acids, antihistamines or a short course of oral steroids, but steroids are not a good choice for long term treatment due to their many side effects. If your dog's itch persists or recurs despite antibiotics, parasite control and symptomatic medications, then I would suggest talking to your veterinarian about a prescription hypoallergenic diet. There is no accurate skin or blood test for food allergy; the test and the treatment are the strict hypoallergenic diet trial for 6-8 weeks with no other treats or foods. Lastly, if your dogs' symptoms persist despite all of the above, or if the symptoms only occur during certain seasons, then talk to your veterinarian about referral to a veterinary dermatologist for possible allergy skin testing and desensitization injections for pollen/dust allergies to identify and treat the underlying cause of the itch and recurrent infections, rather than just treating symptoms with medications (veterinary dermatologists can be found in your area by going to www.acvd.org and clicking on the "find a dermatologist" button). Hope that helps!
Kimberly Coyner, DVM
Diplomate, American College of Veterinary Dermatology
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