The first visit to the vet Otis was treated for possible allergic reaction to a bug bite or something environmental.
We treated with hydroxyzine for the itching and an antibiotic to prevent possible infection due to scratching. We were also given instruction to bathe in order to help with itching or discomfort. Nothing seemed to help and he was getting worse.
What he looked like at first visit, seems harmless in the picture. Except his feet…ouch.
canine pemphigus foliaceus 
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