The Pomerama

Black Skin Disease 

Maintained by Susann Philbrook

Brenda
[On a sad note, Brenda lost her little Pom about 8 months later.]
Alopecia is the loss of hair. In dogs, it is accompanied by deterioration of the skin; it becomes very thin and brittle. One of mine has just been diagnosed and the vet wants me to turn him over to someone doing research on the problem. She says he will die young (maybe 8) probably from infection due to skin problems. As no one locally is interested, that probably will not happen. Of course, this is my favorite dog of all time! In the meantime someone suggested giving vitamin E because it has skin-healing properties. My Smooch is almost 4 years old, has always been an easily stressed, was anorexically thin as a youngster, and suffered from continual diarrhea from weaning until about 6 months (until I found a vet who determined he could not tolerate fat, wheat, beef, etc.). Strictly lamb/rice diet has sustained him ever since. During his very thin days he suffered from sporadic seizures, and will still occasionally have one if he gets thin, like when the girls are in season.
I always felt something was seriously wrong, but we've never been able to determine what. Interestingly, he had an adequate coat before one year, but when trimmed on the backside or around the ears, it would take forever for the hair to grow back. He began to seriously lose coat about 9 months ago, was tested at nearly 1/2 normal thyroid levels in May, after 90 days on Thyroxine it brought the levels up, but still not normal. Six weeks ago we upped the Thyroxine again looking for coat with no result. So a skin biopsy was taken from 3 places on his body. Determination of Michigan State University is Alopecia, or do not expect the coat to ever return. Also over the last year or so the skin is changing to a bruised blue look on the back legs, much thinning, and in general a very fragile look and feel. The skin changes are what caused the vet to give the poor prognosis of short-lived and probable infections. So far Smooch does not notice problems with his skin other than getting cold, but he does scratch a lot! It is the future skin unhealthiness that the vet warns me to expect. For me, it is important to worry about the complications, not the amount of coat. I would love for him to look his beautiful self again, but I do not expect that to happen. Because Smooch's skin is so fragile we have discounted the idea of his having black skin. You most certainly could call it Severe Hair Loss Syndrome though. We've been through the tar/sulfur weekly baths with no change, so I don't know what else to try. I am giving him the Vitamin E, just in case it may make some difference. If I'd been told "black skin" or "SHL" syndrome right off, at least I would not have felt like we were all alone, dealing with something no ome else ever had. Although I do not wish this on anyone's dog, it is helpful to know others have dealt with the same problems and can share success/failures in treating it.
After reviewing all the wonderful responses to my plea, several suggestions have emerged to which I'm trying to relate and make some sense. I understand your thoughts are sometimes examples of other dogs and not necessarily speculative diagnosis of my dog's problem.
1. Dolly says the loss of hair in Poms is "black skin" or "SHL". I'm understanding this to mean these terms are generic and not strictly a diagnosis but more a slang.
2. Charlotte offers the prospect of "Compensatory Hypothyroidism" or "Sick Euthyroid Syndrome (SES)" and we perhaps have a false hypothyroidism diagnosis. She mentions extensive tests. What test(s) are these that are not already commonly done. Smooch has been tested before medication and again 90 days after medication with continued low results. Is there something regarding thyroid diagnosis that we should do? Charlotte also discusses tar/sulfur shampoos which we have already tried with continued deterioration of coat and skin.
3. Marie reports her dog with similar symptoms also has soft skin and no soreness. Apparently she was not given the dire prognosis that I received. Same problems? Who knows.
4. Happeth says black skin does not cause death and asks if he were tested for hormone problems. Specifically what tests come to mind; what hormones should we be looking at? She later believes I am describing classic black skin disease. Which symptoms are classic? Are we talking generics? She offers an ointment to use on the bare patches of skin.
5. Diana offers the idea that Alopecia is not a disease in itself but a symptom of something else. Of those things listed I would muse that Cushing's, Addison's disease (neither have been specifically tested for) or stress are the most likely culprits. She also indicates a dog is labeled "black skin" only after all blood/skin tests rule out known diseases, again making black skin a generic term. She also offers the story of a dog with SOME dark skin as sun exposed skin. Smooch is dark in the back but pink everywhere else.
I'M CONFUSED. Yes, he is a black skin dog in the generic usage meaning there is severe hair loss; there is no thickening/cracking of the skin, in fact the opposite-thinning, fragility. He has been medically tested for thyroid function twice. He has been through the tar/sulfur bath routine with worsening results. Perhaps we need to test for Cushing's and Addison's? Just what exactly does the diagnosis of "Pomeranian Alopecia" from the skin biopsy mean anyway??? I don't know where the vet gets the short-lived prognosis, but we are unable so far to bring the skin back to normal conditions. We have no environmental changes I can think of, no fleas, no insecticides.
From what I've read I think this sounds like my course:
1) Possibly change to Cytobin
2) Test for Cushing's
3) Try to find another dermatologist
4) Neuter
ARE THESE THE SAME TORTURES EVERYONE ELSE HAS GONE/IS GOING THROUGH OVER COAT LOSS?
From Brenda Hutton/email: NHWC36A


Beverly
For one thing, talk to your vet and see if he will get him off thyroxine and get him on soloxine. He will probably stabilize better.
I have had 3 with SHL - none ever had any kind of infection, just dark, thin skin. None were sickly. Didn't itch, smell or bother them at all. I coated one by using Nizoral shampoo and cream. Shaved him down in September and he had enough coat to show as a special in March. Nozoral had no affect on other 2. Another one I re-coated by topically using the oils Erika mentioned that she feeds orally. However, it did not work on the other 2. One of the 3 didn't re-coat no matter what I did. 'Tis a mystery
I know this may seem far out to others and maybe you too, but unless your vet has come up with some proven medical reason that your dog will be short-lived and have lots of skin infections, sometimes it is best to just buy him a sweater and quit all the fussing other than getting the "extensive" thyroid tests. In Texas, this means sending it to A&M instead of having the vets lab do the check. I have never seen one have infected skin from it. Then again, none of mine ever got the thickened, elephant skin version. Mine were all thin skinned, but definitely never scratched.
There is a separate product called Thyroxine that we put Chief on for awhile, but it did not work because that product does not correct both T3 and T4, which he needed. When he was first tested the T3 and T4 were so low they could not be recorded. With 1/3 tablet of Soloxine twice daily, he stabilized and stayed that way for years. I have no idea if it is what you are talking about but I know they were not the same product.
From Beverly Henry/email: FKWV33A@prodigy.com


Charlotte
In a 1995 issue of the AKC Gazette was an article entitled "The Enigmatic Nature Of Hypothyroidism Makes It Difficult To Distinguish From Other Diseases." I think that this may be what we are dealing with in many cases. In this article it states," a common condition known as compensatory hypothyroidism or sick euthyroid syndrome (SES) may account for many of the false diagnoses of hypothyroidism. The difference between true hypothyroidism and SES is that in SES, the thyroid gland retains the ability to return to normal function. SES describes the situation in which dogs with normally functioning thyroid glands have decreased thyroid hormone levels with an appropriate cause. Virtually any condition - trauma, stress, injury, illness, poor diet - can affect thyroid hormone levels and cause SES. (I think this is what we are seeing often with our Poms) The article also states, " Further compounding the problem is that whatever initiates SES may be vague and difficult to identify. Without comprehensive diagnostics and evaluation, low thyroid hormone levels may be the most obvious abnormality, leading to a MISDIAGNOSIS of hypothyroidism. If a dog with SES is misdiagnosed and is supplemented with thyroid hormone, the body's protective mechanism can be negated. As metabolism increases, so does energy requirements, which may detract from the body's normal demands. And because the underlying cause of SES is overlooked, another disease persists undiagnosed and untreated." I wonder how many dog people have put their dog on thyroid with very little thought and definitely not the extensive test that are needed to truly diagnosis it?
When "Poasty" was eight years of age she became very ill with a urinary track infection and her fever went to 106. She lost all her hair. The vet assured me that it was not the skin disease because of her age and she had never had a problem before. ( But as one can see with illness and stress from the illness ) well I think that is what caused it. Also, (as a novice and listening to dog show folks had put her on thyroid and she had been on it for several years) I, without notifying my vet at about the same time she was ill, took her off the thyroid- cold turkey - My vet like to have stroked out- when I told him what I had done. Needless to say, we put her back on it and then took her off it gradually. She has been totally off it for about two years now. I gave her the tar-shampoo baths about 3 times per week. She coated up shortly afterwards and has never lost her coat since. I think two things occurred: First, she survived the illness which was extremely stressful, and secondly, She was taken off the thyroid under controlled conditions. Also, the tar shampoos, got rid of the old dead skin. Another situation has occurred with me recently... that is my second experience with skin problems. A male that I was specialing and then retired when my friend started specialing her boy ( we had agreed to this prior) - after I left him home while I attended the shows suddenly lost his coat (he is 6 years old) no problem in prior to this. After researching - I found that my new kennel girl used a dip net to catch him to put him up!!!!! He was one that did not want to come in. In essence, she was terrorizing my baby while I was away. Since then, I do not leave him at home - he goes everywhere with me. I believe the stress that he was under caused this. I am now giving him the tar shampoo baths to remove the dead skin and he lives in the house with me. He does appear to be growing new hair. Time will tell. Whatever the cause and their are many, many, many, I believe thatstress is somehow related.
"Poasty" has not had any more problems and she just turned 12 years old and has coat like her great grandmother Bev-nor's Sweet and Sassy. Both, Sweet and Sassy had and Poasty has coat like a male special!! I believe that we are dealing with a multitude of problems generally. And, yes we must rule out all the many things, before calling a dog - one with the skin condition! And what we need is more dialog among breeders. Don't give up. We must within the APC [American Pomeranian Club] continue to push for research. I believe this is the biggest threat to our Poms today.
From Charlotte Creed/email: ANTV62B@prodigy.com


Claire
Just peeked into this topic and noticed the note about your Pom with Alopecia. You've had him tested at MSU and this is their diagnosis so I assume they're correct but, I did want to mention to you, my Keeshond, Sean always had a beautiful coat but following some surgery to remove an adipose tumor and some cysts his coat didn't seem to be growing back from the areas where it was clipped. This was in mid March. By late spring he started to break out in a rash. He was tested for thyroid and put on medication although his thyroid reading was only marginally low. The hair loss became worse mostly on the rear legs, around his neck and his sides. This hair loss is fairly symmetrical and he has had numerous skin infections, sores, bumps, etc. His rear legs and hip areas have become dark and shiny (sounds similar to what you are seeing) He also gets black pimple like bumps. After additional testing my vet diagnosed Cushings syndrome. Could this be a possibility for your Pom? Did they test for this at MSU?? There is medication for Cushings although one form carries significant risks because it destroys the adrenal gland so you must very carefully monitor cortisone levels. The other drug only suppresses this over production of cortisone but it is very expensive...around $5/day for a dog Seans's size. But a Pom is much smaller and wouldn't require nearly as much medication so if this is your problem the medication would probably be fairly affordable and wouldn't have so many risks as are associated with the less expensive drug.
Just thought I'd mention the Cushings since Sean's symptoms sound rather similar. His testing for Cushings was also marginal...he's still on thyroid but it hasn't done much good. We use antibiotics as necessary to control the skin problems, medicated baths, etc. Haven't gone to the medication for Cushings as the vet hasn't felt it was necessary yet. If we must we'll use the expensive stuff. So far there is no indication of organ damage and he's doing pretty well with only occasional outbreaks, but he does look "ratty", most of the undercoat is non-existent and he's got all sorts of lumps and bumps. Still, he seems perfectly happy, his organ scans are good (no sign of any internal problems) and except for some itching he's doing pretty well.
BTW, I've seen pictures of dogs who were treated for Cushings and their coats did grow back. If the skin infections pick up I won't hesitate to go with the drugs. In fact, we'll be testing again in March and then make a decision. Sean is turning 13 so we've been hesitant to do anything that might cause worse problems or complications. Considering how well he's doing except for this, at his age, we hate to tempt fate so to speak!
I didn't know Kees and Poms shared some of the same problems with skin/coat but it doesn't surprise me considering their similar evolution from the Spitz. I did find in one of my dog books, mention of something called "post clipping Alopecia syndrome" which sounds to me something like Sean (my Kees) experienced. However, the book also says hair usually regrows within a year or so. This has not been the case with Sean. Also, the hair loss around the "ruff" was not involved in the clipping although much of the other bare areas were clipped during removal of the sebaceous cysts. BTW, Sean does not wear a collar so that is not a factor in the hair loss in this area. I do however feel there is some connection to the stress and trauma of the surgery. This dog never had any skin/coat problems before (other than an overabundance of hair) with the exception of some itching during late summer when some bushes or grasses around here shed tiny barbed "seed" type things which used to work their way down through his coat and into his skin. After the clipping for surgery the hair simply didn't regrow and within weeks he suddenly developed pimples, rash, itching, irritation. That's the key for me because we never saw this condition at all before and it came on within 60 days of the surgery. At the time I assumed some relation to warmer weather, perhaps some irritant in the grass, etc. and promptly forbid the lawn care service from using and fertilizers, etc. without my express permission. Over the past couple of years there has been increased hair loss, especially along both of his sides and the ruff area.
I suppose you could insist upon the Cushings testing, it's a couple of blood tests for the dog and at least you have the results as a reference point should future tests become necessary. When I take Sean in this spring, if there isn't any particular change I'm not going to fool with things. Yes he has lots of bumps and lumps but I'm not going to put him through having them excised. That's what seemed to get me into this in the first place. And he is just too old to go through it again.
From: Claire Lancz/email: VFFF00A@prodigy.com


Diana
There are many things which can cause Alopecia: Hypothyroidism; Cushing's disease; Addison's disease; contact and/or generalized allergies; excessive female estrogen (usually found in recently neutered males); stress; fleas; mites; mange; unknown (usually labeled "Black Skin Disease").
Some of these problems are genetic, some are familial, and some are neither. Interestingly, many of these conditions affect males much more often than females. You must rule out all other possibilities via skin and blood test before you can label a dog with "black skin disease". Also, be aware that hypothyroidism will increase a dog's chances of having allergies and other diseases as the thyroid is an important part of the immune system. I have rescued dogs with several of these problems and most have been returned to good health and decent (if not improved) coat through proper diagnosis and treatment.
One of my dogs in fact, a finished champion, began to show thinning hair on his back end along with definite hair loss on his hocks and chest. He later began to rip his coat out in swaths from behind his ears and eventually came to look fairly "bare butted" with the skin turning dark on his butt and thighs. The skin was being darkened by exposure to the sun (it stayed pink on his chest) and most labeled him as having "black skin disease" - wrong!
My vet determined that because his hair loss pattern began with his hocks and chest as well as his butt, that he must have some sort of contact dermatitis - but to what? I noticed that he really started to tear at himself when ever he was in contact with anything which had been flea sprayed. After testing him on several carpet flea sprays and flea shampoos, it became obvious that he was allergic to pyrethrin. Anything that contained pyrethrin was an irritant! Removing pyrethrin from his domain stopped his coat tearing but did not regenerate coat. I tried several food additives but nothing worked until Dianne Johnson recommended Lip-A-Derm (in most pet stores and catalogs). This renewed coat at a remarkable rate especially around the ears and hocks but did not seem to do much for his chest and butt.
I should add here that my dogs were primarily kept in indoor runs bedded with cedar shavings. When I moved to Opal, VA my dogs finally had a huge grassy yard to play in so there was no need for indoor runs. Within two months of moving there, my dog grew back all of his chest and almost all of his butt hair! When I told my story to Jackie Rayner one day, she remarked that she had always had coat problems with Poms when kept in any environment with any woody fiber bedding (pine shavings, cedar shavings, straw, etc...).
After that, several others confirmed Jackie's assessment of woody fiber bedding causing skin problems in their Poms! I hope all this helps. Don't give up but do keep a detailed log of all tests and noticeable improvements and periods of deterioration. We should know soon whether Dr. Foil or some other vet will be back on the case for the APC's research. You can then turn your info over (along with his pedigree which is important) to help in the research without your dog ever leaving home.
I can see why your confused. According to Dr. Foil (get a copy of her lecture on Pom Skin disease from the Louisiana specialty), "Pom Skin Disease" or "Black Skin Disease" is an unknown. We don't know what causes it and we don't know what cures it. The only thing that we do know is that it is familial and is suspected to be genetic. She says that a dog should not be labeled as having "BSD" until all other possibilities have been systematically ruled out. Dogs suspected as having BSD have been neutered for ages without previous extensive testing and yes, most all have returned to full coat. The problem with this method is that hormone problems can not be ruled out because they were not tested for prior to the neutering. Neutering will cause a decrease in testosterone over time and that may be why the coat renews. On the other hand, some dogs acquire Alopecia after being neutered. This is usually due to excessive female estrogen (due to the lowered testosterone to balance the estrogen) and is characterized by hair loss, excessively oily skin which smells, and usually very waxy ears.
On the subject of thyroid, some dogs do not respond well to synthetic thyroid (Thyroxine, soloxine) and must be placed on natural thyroid. Natural thyroid is not as easy to dose because it is somewhat variable in every pill. I have a dog who's thyroid levels actually got lower when put on synthetic thyroid but bounced back on natural thyroid. Allergens - most dogs acquire allergies at or around the age of 2. The allergen may have been present all its life (as in my dog's case) but they are only now allergic to it. Most allergies start out as contact (or localized) allergies causing itching in only a few places at first. With repeated exposure to the allergen, all dogs get generalized dermatitis. This means that they scratch their entire body as their whole system is now out of whack, no matter what body part is in actual contact. And don't forget inhalants.
Addison's and Cushing's diseases both cause shortened live spans in dogs (and other mammals) but many can live well for years. They are characterized by hair loss along with a thickening and darkening of the skin all over with a definite cracking pattern. They are often called "Elephant Skin Disease". Bev mentioned Nizoral shampoo. This is a shampoo made to treat human ringworm but I have heard several stories of it helping dogs with Alopecia even though skin scrapings have proven that they do not have ringworm. Unfortunately, the benefits of Nizoral are usually short-lived and the dogs return to their original coatless state. I have also heard of many dogs being helped with repeated tar/sulfur shampoos and their coat regeneration seems to be permanent.
As you can see, one can make an occupation of studying Alopecia. Alopecia is the generic term and Black Skin Disease should only be used when all other options have been ruled out. One interesting fact about Black Skin Disease is that most breeders have already determined that it is genetic (the scientist are more conservative and call it familial). Those that I know of who have tried to track it have all tracked it back to one Pom, named A-Lil Mischief's Towntalk (3-55). My vet, agrees that it is very possible that there was a gene mutation in one dog which may have caused the problem. Only through breeders being honest with other breeders, and open with the researchers, will we ever really know the cause of this disease, find a test for it, and cure it. Hopefully, we're on the right track with Dr. Foil.
From Diana Downey/email: ZQLJ23A@prodigy.com


Dolly
Alopecia is the scientific term for the loss of the hair. Pomeranian hair loss is now commonly referred to as genetic Alopecia - along with Keeshonds, Chows, Akitas, and service breeds. In Poms, it is referred to as "Black-Skin," or "SHL." This syndrome was discussed in an article by Dean Hebert for the Pom Reader a while ago. SHL is currently being researched by Dr. Foil, a Dermatology Specialist for LSU.
There are many generic names for "Black Skin," also known as "Pseudo-Cushing's". "SHL" which stands for "Severe Hair Loss," also called "False Hypothyroidism". Shampoos, ointments, medications..bat spit, incantation, may work - or not work! Poms, and other breeds, have hair-loss on the back, loins, buttocks and hind legs. Most hair loss from contact dermatitis or other allergic reactions cover any part of the dog's body including the face, this is not a form of "black skin."
From Dolly Trauner/email: HPDG39A@prodigy.com


Happeth
The problem was rampant in my line of dogs so much I have had to stop breeding Poms. I would go to another vet. Black skin disease does not cause death of a dog or much skin problems. The skin usually thickens rather than getting thinner. Was your dog checked for hormone problems? Alopecia just means loss of hair but there are quite a few conditions that can cause loss of hair. It now sounds like your are describing the classical black skin disease. Since you are already giving him the tar and sulfur shampoos mix up the following and apply to the bald areas after he is dry from his bath. Then mid week apply again. Once a week give him the tar and sulfur shampoo and re-apply the ointment. I have gotten coat on two dogs with this method. Also one of my boys. (that's Clipper Marie) was neutered and this brought him into magnificent coat except for one bald spot on the rear and the ointment is bringing coat back in this spot. The neutering does not work on all Poms but does with some and in my case it worked. Here is the ointment. Go to a drug store and buy flowers of Sulfur. (this recipe may be on the bottle) then put the sulfur through a flour sifter to get out the lumps and mix one part sulfur with six parts lard. This makes a nice yellow clean ointment. This is what you rub on the bald spots. This method only works though on the bald areas as it is too thick to apply to the hair so it is no good for the thinning areas. If you need to apply to thinning areas there is a messier harder but more effective method that Sue Goddard told me about and I have used successfully in the past. I have forgotten the measurements however so you would have to call her for the recipe.
From Happeth Jones/email: XGQQ40A@prodigy.com


Jane
Before we determined one of my males was allergic to Ethoxyquin, he was losing hair and his skin was flaky and turning dark due to sun exposure. I heard about putting baby oil on him and letting it soak for 45 min., then washing him in Palmolive dish soap to get out the oil. What this does is cleans out the pores that can get clogged up. This, in conjunction with feeding only food preserved with Vitamin E brought his coat completely back and he has kept his coat completely ever since. You may want to see what preservatives are in the food, but I believe Ethoxyquin is no longer being used. Another product to try is called Nioxin shampoo, which is purchased from a beauty supply house. This is used to bring back hair growth on humans by cleaning out clogged pores. The baby oil method would also be good for dry skin and the itching that was complained about by one of the *P posters.
From J. Manuszak-Lucido/email: GNSN54A@prodigy.com


Mary
There is a subject "Cushings Disease" that you might want to investigate. I have a little boy - 6 years old - that I assumed was a "skin condition" because several of his relatives were so diagnosed (not by any veterinary tests that I could find out about, though, at least in most of the cases). Anyway, he did recoat spontaneously a couple of years ago, without my doing anything at all. He had to be shaved a while back and the hair did not grow back. I had just read the discussion on Cushings and thought "what the *ell?" and had him tested by the ACTH stimulation test. That was very indicative. His stimulation was very high, and my vet feels that the diagnosis can be made. We are going to start him on Lysodren just as soon as I get back from NY - I have to be here, because the first few days of this treatment are critical. I have heard of several "skin condition" dogs recoating when treated with Nizoral. This is an antifungal agent, but it is considered quite a dangerous medication because one of it's side-effects is the suppression of the adrenal cortex - the site of cortisol production. Of course, Cushings is caused by an *excessive* production of cortisol, which is why the Nizoral works on some dogs, not because the "condition" was caused by a fungus.
From Mary Allen/email: MFXG02C@prodigy.com


Marie
I have a little 3 1/2 lb one (only needs two points to finish) with a problem. I give him 100 i.u. of vitamin E and also wheat germ granules daily. It helped some but never put him in show coat again. I think maybe we don't have the same problem. My little guy has NEVER been uncomfortable nor does he even know he has a problem. His skin is not sore at all- he just is bald around the tail area. He certainly is not unhealthy - he just looks different. Mine, also, has NEVER been bred nor will he EVER be bred. I might not be able to stop this problem but there is NO WAY that I will add to it! It's true that the coat growth seems to be temporary. In fact, my little guy seems to have regressed a little. His baldness could be likened to a bald headed man. His skin is soft with no soreness at all-it just doesn't have any hair!



Another Case of Hair Loss

Jonathan
Our four year old neutered male Pomeranian is gradually losing his fur (but is otherwise healthy). It is most noticeable on the back of his legs, rump and back. The skin underneath is rather black instead of pink. Our vet thought he might have low thyroid levels and gave him a supplement but this hasn't helped. Has anyone else experienced this problem and found a solution?
From Jonathan Simon/email: jonathan.s.simon@USPPL.mail.abb.com


Kara
The hair loss you discribe is called "The Condition". This affects the dogs hair only and not his health. It is a hereditary condition usually passed through the male as females with the condition can't usually get pregnant. The "condition" affects dogs that have a very soft, cottony coat as puppies, with little or no guard hairs. If you are not aware of the signs you don't know your dog has it until he is anywhere from 1 to 5 years of age when he will loose his hair. Hair loss starts at the base of the tail, back legs. and moves up the back. He will keep the hair on his feet and head and a little around his ruff. As far as the vet is concerned, save your money. Although there is research being done, there is no known cure. They'll want to do skin tests, thyroid tests and will blame it on allergies. When the skin turns really black and has lost all hair treat these areas with cream to keep them from cracking. Sometimes at about 7 or 8 yrs of age the hair will grow back on its own. Don't forget the sunscreen.
From Kara Greenwood/email: greenwo@nbnet.nb.ca


Shelia
It may be a fungus. If there is an odor with it, it is likely to be fungus. However, Muffin has both fungus and allergies. Shampooing with Selsun Blue people dandruff shampoo helps-also give 500 units Vitamin E. Muffin also tested for thyroid ($52 test), but it was negative.
From Sheila R Sheffield/email: ssheffie@mailer.fsu.edu


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