Older dog skin issue

I have a 12 year old GSD. I adopted him out due to a divorce in perfect health but 4 years later I got a call he had to be returned so of course I took him back. when I got him he was emancipated, fur falling out, skin lesions and other problems. Of course took him to the vet and they put him on antibiotics, chlorhexadine shampoo, Nexgard and of course started on HWP. It’s been a couple months and he has gained his weight back but still gets these lesions that pop up and a crusty nose. Also noticed nerve damage in the one leg as he knuckles the LR paw until he starts walking. 

Hello - I'm not sure what's going on with the skin;  there are a range of things I wondered about, spanning the whole spectrum of severity levels, from yeast or bacteria (not yet cleared up) to ringworm (can appear when the immune system is struggling due to e.g. a neuro disease), to systemic infectious disease (although I couldn't find an obvious candidate) and even tumours.   Your vet will have a systemic way of ruling possibilities out until they find the correct one;  good questions are 'what differentials (possibilities) are you still to rule out?' and 'what are you wanting to do next to help you to do that?'    The other issue, the knuckling, is concerning as it implies damage to the nerves supplying the foot, somewhere between the spine (slipped discs etc) and the muscle.  Has your vet seen this?  Hopefully they have done a neurological exam and will have an idea what nerves they are concerned about and what functions your dog does and does not have.  Usually they can pinpoint an area of the spinal cord / nerve network / elsewhere where the problem might be - and this helps to suggest problems that may have caused it.  If the problem is spinal, they may suggest imaging next.  If your vet doesn't know about this problem yet, you should call them for triage (i.e. to decide how urgently the case needs to be seen).

My vet knows about the nerve issues but said he was an old dog and it was probably hip dysplasia and even though I asked about doing imaging he said not to do it. He did skin scrapings to rule out mites but said he didn’t think it was ringworm. I’m considering a different vet as he wasn’t too concerned about it. I do have to say that it’s VERY itchy and hasn’t spread to any of us thankfully. I have him on Dasequin for his arthritis and such but doesn’t help immensely. I was concerned about an autoimmune disorder such as lupus. Thank you for your prompt reply.

Ah, thank you for replying.  Your vet will always know more than us about a case.  Ringworm doesn't usually itch.  Mites, dermatitis, nerve damage, fleas, underlying pain (not always where the itching is), all can.  There are two parts to any skin case;  1) controlling the symptoms and 2) finding the cause.  Given what you've told me, I wonder if it's worth asking your vet whether more pain relief might be worthwhile?  I can't advise you on whether to change vets or not;  some vets suits some people better than others.  Many practices have more than one vet, partly for this reason.  We'd love to hear what happens next if you have any breakthroughs!

I will definitely schedule another appointment and ask the questions you presented. Thank you for helping me out, I know how busy y’all are. I will update with any changes