Itchy dog

Question
Hello,
I have a itchy westie who is almost 8 years old. We adopted her last year from a breeder. We are at the point that she might have to be put on medication and I'm between Atopica and Temaril P.
Since we got her she has been itchy. She itches her legs mostly and paws. We have tried lots of different foods and she is now on a raw diet of elk, peas, yams and cooked grain free, corn free, pasture raised pork. Even with the raw food, she is still itchy.

We have gone to a holistic vet and have tried acupuncture, nettles, and other remedies but to no avail. We are reluctant to put her on medication but she is not getting any better, she seems to be getting worse in some situations. We didn't want to use flea medication, but she has gotten fleas a few times and then has gotten a skin infection after. So now, although also reluctant, we are using Advantage on her since she has flea bite dermititis after with scabs. She has since been getting red areas on her skin (under her tail, on her chest) and she itches and chews on her paws until the skin is broken. she did have hot spots as well and has to continually be on anti biotics on and off. We bathe her 1-2 times a week with fatty acid shampoo and nizoral/pyoben if her skin seems infected.

Our vet has suggested a lymdyp to try for the next step which we will do (even though she is white). If this doesn't work we are between Atopica and Temaril P. I'm concerned of the long term use of steroids (and short term) and was leaning towards Atopica. I know this is a newer medication though and don't know the long term side effects of this. Our holistic vet is leaning towards Temaril P. What would you suggest?
Thank you, your help is appreciated.

Answer
Because your dog is a Westie, she is most likely is suffering from Atopic Dermatitis or environmental skin allergies.  If she is a young dog, I would recommend having her allergy tested so that you can get allergy shots to help desensitize her to whatever her skin is over reacting to. The hyposensitization is done over several months.  If she needs to have something to calm her skin down, then I would recommend a combination of the atopica and some steroids initially to get the skin itching and redness under control.  It will take a full 15 days for the Atopica to start working.  If your vet can prescribe some dexamethasone or some prednisone, that may help for the initial 2 weeks. If there is a skin infection causing additional problems, then an antibiotic and/or an antifungal would be helpful. I would also start the dog on Omega3 fatty acid dietary supplements, which will take 30-45 days to start working.  In Atopics, this is very beneficial to make the skin less porous for the allergens to get under the surface and cause the allergic reaction.  Continue flea control and frequent bathing to remove allergens.

Once the skin is under control, then you can back way down on the medications.  I often use Atopica twice weekly for maintenance and then, depending on what the dog is allergic to, I may increase medication during the season that the allergens are present (a certain pollen or grass, for example).  If she is allergic to things in your home, then a good cleaning and year round medication may be necessary.

The side effects of Atopica are minimal...mostly vomiting because it has to be given on an empty stomach.  Prednisone (the "P" in Temaril-P) can cause excessive urination and excessive thirst at higher doses.  This medication should be used twice daily initially and then weaned down to every other day.  This may be needed for years and that will cause side effects, mostly skin thinning and belly sagging.