…Excerpted from a Plant Healer Magazine article last fall.

Hot spots

It’s possible that hot spots are THE single most asked-about canine issue I encounter on the net, over 20 years of yahoo, AllExperts, various forums and now Facebook. Hot spots are very nasty to deal with, and the conventional approach is harsh, the natural one not always effective. For me, the lack of efficacy is related to a focus on astringency and topical healing, whereas I like to work with other herbal actions (according to the stage of the wound) and address it internally as well. I hope this approach can be useful for the many who deal with hot spots (believe me, I have been there personally as well as professionally) and offer a more comprehensive set of ideas.

First – what are “hot spots?”

The veterinary description of hot spots is an “Acute moist dermatitis” (or pyoderma)  caused by a localized overgrowth of the normal bacteria found on the skin. Causes include fleabites or other insect stings, which the dog then licks and licks and creates a moist environment for bacteria to flourish…but a dog may also lick a painful area that is related to muscle or joint injury. Allergic dogs (environmental, flea, food) are most susceptible , but long haired or thick coated dogs, dogs who swim a lot, or obese dogs are also at risk. In many cases, we can find an issue with the immune system underpinning recurrent hotspots, and this needs to be addressed over time, too. To quote Peteducation.com – – hot spots are “ circular lesions, usually found on the head, over the hip and along the side of the chest. They will be moist, raw, inflamed and hairless, and can be quite painful. Animals usually lick, bite or scratch the area, and thus irritate the inflamed skin even more. In fact, hot spots are sometimes called ‘pyotraumatic dermatitis’ because the self-trauma is a major factor in the development of hot spots.” 1

Hot spots are frustrating for the owner and very unpleasant for the dog, and I have some critique of both conventional veterinary management and the popular press idea of what helps. But right here I want to say, this is a condition that can make a dog’s life miserable, so if the spot is large enough – they can spread quite rapidly –  the dog is in pain, and the owner is feeling unable to cope, by all means, please go to the vet! Relief for the dog is paramount here….but let’s look at what can be tried, beyond green tea bags and (yikes!) painful salt, undiluted/generic tincture and apple cider vinegar.

Conventional veterinary approach: The standard veterinary approach here is to trim and shave the surrounding fur, apply a topical disinfectant (such as Nolvesan, or chlorhexidine diacetate) 2 and send the dog home with an Elizabethan collar to prevent licking, and a topical steroidal creme. The dog is often sedated for the procedure, and local anaesthesia may be necessary. The treatment is effective in most cases, but harsh, and will not prevent recurrence, as underlying causes are not addressed. Many vets will recommend a monthly flea preventive such as Advantage (imidacloprid and pyriproxyfen) 3  to prevent the likelihood of another spot arising from fleabites. But all of this involves harsh chemicals that many people seek to avoid, especially if the hot spots are a recurring problem. What then, are the usual holistic recommendations?

Standard natural  treatment: A quick peruse of the Internet will reveal thousands of pages devoted to natural animal care, and many will address hotspots; few I have seen, however, go much beyond the topical. Looking around for this article I saw a lot of coconut oil, apple cider vinegar and oil of oregano – all of which are popular and in some cases helpful, but more often then not, we are looking at an allopathic approach using milder but less effective treatments than the vet has to offer. I for one just shudder at the thought of putting even diluted apple cider vinegar on an open, extremely raw and painful hot spot; the application of creams, however wholesome the ingredients, don’t work for me either, until the heat has dissipated and the wound healed over somewhat. The very popular green tea bag compress does offer some vulnerary/astringent actions and can be tried up until the point where the hot spot has opened up – then it will simply sting (if less than the vinegar) and incite the dog to lick even more. Topical astringents and salves are the usual prescription for natural support,  sometimes essential oils, but I have found this approach rather limited and not often successful in healing up the sore. I would personally never apply essential oil to a hot spot.

What I Do: For me, the first thing to evaluate is how severe the spot is and whether the dog is experiencing some mild to moderate discomfort, which is usually manageable, or in deeper pain, in which case I do encourage a vet visit at least to manage the pain and risk of spreading (some hot spots can grow to very large areas), with more systemic measures to follow. So let’s say this spot isn’t too large, raw or painful, you can first work with it topically, and this may require a little herbal sedative to calm the dog first (depends, of course, on the individual). The internal aspects need to be assessed and addressed, as well – these are really key for prevention of recurrence.

I keep a tincture bottle on hand with 2 parts each California poppy (Eschscholzia californica) Wood Betony  (Stachys betonica) and Lemon Balm (Melissa officinalis) and one part Wild lettuce (Lactuca virosa);  I’ve found this formula works a treat to calm and steady an anxious dog – if there is still evidence of pain, you can add another one part of Corydalis ( Corydalis yanhusuo).   Give  1- 2 mls per 20 pounds body weight.   Once the dog is relaxed, have someone hold her head or gently restrain while you trim back the fur all around the area, and then flush the spot with a mild, diluted Echinacea/yarrow/goldenseal rinse. To make this rinse, I use 30 drops of each tincture in a cup of warm (room temperature) distilled water and apply with a dropper. Flush the area and trim back long hairs around the sore if indicated. Keep the dog in an E-collar to prevent licking, and just let it be, at this point. Exposure to air, and the antimicrobial action of the rinse will start the healing process from the outside in. (Note there are many other herbs that could be used, but this is what I have found most effective after treating  a whole lot of hotspots.)

Now, if the area seems too raw and painful to tolerate even dilute tincture, you can consider making a decoction of Echinacea, Licorice (Glycyrrhiza glabra)  and Goldenseal root, and using this to flush the area.  THIS MAY BE THE BETTER WAY TO GO FOR MANY DOGS, as even diluted tincture can really sting.   Gotu Kola (Centella asiatica) is superb here as well, internally and topically.

(Standard veterinary protocol might suggest Betadine here, diluted in water, and this is not a terrible option by any means – but herbally we can offer more than simple disinfectant here). To make the decoction, add one teaspoon each of the Echinacea, goldenseal and licorice, to 16 ounces of water- bring to a gentle boil cover and simmer 20 minutes, then turn the heat off and allow the decoction to sit for an hour. Cool until room temperature and flush over the hot spot  – gently.

Narrow leaf Plantain(Plantago lanceolata) makes a superb vulnerary to use on hotspots, if you happen to have the fresh plant handy!

I don’t compress hot spots when they are open, I find it is too uncomfortable for dogs – but gently flushing every hour or so is great…let the area dry out an repeat up to 4 times. You don’t want it to stay wet, just clean it well. Once you have done a few flushes, leave it to dry out, simply leave it alone and monitor. If it begins to heal over, you can apply a powder (not salve or ointment at this point) based on clay, arrowroot, with added Goldenseal, Echinacea,  Birch, Licorice, Gotu Kola,  Rose petals, Willow bark (all in powder). I have used only one of these or all of them together (according to what I have in stock) and always seen what I consider to be great results (continued healing, reduction of irritation, no need for the vet).  I put the powder in a shaker bottle and lightly sprinkle over the (dry) hot spot, don’t pack it over tightly or wet it down. Here is a sample recipe (and you can play around with anti-inflammatory, anti-microbial and analgesic herbs such as the ones listed above.)
Remember only to use cultivated Goldenseal, too – while it is a superb herb for dogs and one I could not be without, it is on the at-risk list, so no wildcrafted Goldenseal, please!

Powder recipe

Powders are super simple to make. I combine about 1/2cup each arrowroot and clay (cosmetic grade) with  ¼ cup powdered herb/ ¼ cup contains about 4 level Tbsps of powdered herb,or 12 teaspoons,  so you could use 2 Tbsps each of Echinacea and Goldenseal as a basic recipe – or try 1 Tbsp each Goldenseal, Echinacea, Willow bark powder and Licorice root. This powder can also be used all through the coat in summer, to help keep the skin dry and infection at bay.

As the hotspot heals over, a salve can be applied too, although I prefer to leave it alone and work on the internal aspects. If you do use a salve, consider one with Calendula, Poplar or Cottonwood resin, and St.John’s wort.

It’s a good idea to address the underlying issues internally as well as topically, and start doing so right from the moment you find the hotspot, but don’t expect dietary changes and herbs to kick in right away. The idea is to strengthen the immune system (which can mean dietary changes as well as gut-healing herbs and supplements that impact directly on the immune system, such as probiotics and various fungi)  reduce inflammation in the skin, help build digestive system health and support liver function.  First, you need to ascertain what the contributing factors are, and I always start with diet.   Many home prepared recipes for dogs are not nutritionally adequate – while they provide fresher and healthier foods, the nutrient balance, unless carefully considered, is very often out of whack. Especially with home cooked diets. I routinely see low levels of VitaminD, zinc, Vitamins A and E, and more.

If you are feeding a home made cooked or raw diet and not supplementing, or relying on guesswork, it could well be time to take a deeper look at the diet. Chronic low levels of essential nutrients can wreak havoc with health, including the immune system. Conversely, a dog fed a high carb, lower quality commercial diet will be susceptible to nutritional issues as well. In any case of recurrent hotspots,  evaluate the diet as a starting point. The addition of EFAs, particularly EPA and DHA in the form of fish body oil as well as GLA (gamma-linolenic acid) in the form of borage or evening primrose oil, may be very helpful in reducing skin inflammation. I like to start with fish oils 1000 mg capsules per 20 pounds of bodyweight, making sure the capsules provide a good amount of EPA and DHA, look for 200-300 mgs of DHA per capsule.

It’s important to add supplemental Vitamin E with extra PUFAs in the diet (polyunsaturated fatty acids, which include fish oils)  but no need to megadose, which can carry  some risk of bleeding (Vitamin E is a powerful anticoagulant). I generally use 100IUs of natural Vitamin E for smaller dogs, up to 30 pounds, 200 for medium dogs between 30 and 60 pounds and 400IUs for dogs over 60 pounds, along with the fish body oil (make sure you don’t use cod liver oil, which contains very high levels of Vitamin A).

Borage or evening primrose oil can be added at dose of   50 mgs per kg of Body Weight, but you can go as high as 400. I personally prefer to start at the lower end and build if indicated. I’ve used the high end of the range with some auto-immune disease, but stick to 50 – 100 mgs (per kg BW) with skin issues such as hotspots.

If your dog does suffer from food intolerances or environmental allergies, these will need to be addressed with a diet geared to his or her specific sensitivities. Intolerances arise quite frequently with dogs, who are so often fed a diet that consists of the same food all the time. Using novel foods, and emphasizing lower histamine recipes can help reduce the inflammatory response as well. The underlying cause may not be dietary or immune-related, but these often play a role. If pain related to orthopedic or muscular issues is at the root of the licking, this needs to be addressed as well.

Finally – in all cases of hot spots, I recommend herbs to support gut and liver health, and some lymphatic  support, if there has been infection/medication. We’re looking here at astringent/vulnerary herbs with affinity for the digestive tract, and at anti-inflammatory herbs and alteratives, all of which should be started at the first sign of the spot and continued for about 6 months, along with any other changes. If there is indication of low immune function, such as other recurrent illness/infection I include immune amphoterics as well. Selection as always should be based on the individual, including constitutional type (as these herbs may be given over time) veterinary history, any medications and how the history presents (pattern of hot spots, diet etc). Some common and very helpful choices include Burdock, Calendula, Milk thistle, Plantain, Chamomile, as well as  Astragalus, Reishi and Cordyceps (my top choices here) for immune support)  and adaptogens such as Schisandra or Milky Oats if there is a stress-factor. This may take some research or  working with a herbalist or holistic vet, to optimize diet and personalize the herbs – in my practise,  we put a stop to recurrent hot spots with this ongoing approach, and not simply managing the infections as they arise.

Formula for recurrent Hotspots ( especially for stressed out dogs)

Combine 1/3 cup organic Calendula flowers, ¼ cup organic Wood betony and 2 Tbsps organic Red clover(Trifolium pratense)  and Dandelion leaf (Taraxacum officinale).  Next, two teaspoons each of cut and sifted organic Burdock root (Arctium lappa)  and organic Sarsparilla (Smilax aristolochiaefolia) in 16 ounces water – bring to a gentle boil, cover and simmer 15 minutes. Add one Tablespoon of the  calendula mixture, mix well and cover – allow to sit up to 4 hours. Strain and dose at about ½ cup per 20 lbs Body weight, ideally divided into three servings daily, preferably in food.