Skin Issues and Allergies in Maltese x Shih Tzu Dogs: Causes, Solutions, and Prevention

For our canine family members, skin issues and allergic disease are intimately linked, meaning that it would be impossible for us to discuss Maltese Shih Tzu skin problems without also touching upon how to treat Maltese Shih Tzu allergies. In this article, we’ll explain the link between allergic and non-allergic skin disease and provide an all-inclusive guide to managing skin problems and overcoming allergies in Maltese x Shih Tzu dogs.

The skin is the largest organ of your Malshi’s body, and provides constant, dutiful protection against harmful invaders such as bacteria, yeast and virus particles. So, when something goes wrong with your pup’s skin, the consequences can be dramatic!

But what about the Maltese Shih Tzu hybrid, specifically? As an owner (or would-be owner) of this gorgeous breed, you may be wondering: are Maltese Shih Tzus prone to skin problems?

Grab a hot beverage of your choosing, and take a seat, my fellow Malshi lovers. We have a lot to discuss!

Common Skin Issues in Maltese x Shih Tzu Dogs:

Does your Maltese Shih Tzu have itchy skin? Is he or she scratching, but has no fleas? Perhaps their skin or coat simply doesn’t appear as healthy as it once did, or you’ve noticed a sudden change and are wondering what could be going on.

Every skin issue deserves to be seen by a veterinarian, but of course it’s never a bad idea to familiarise yourself with some of the more likely possibilities. Let’s take a look at the most common causes of skin issues in Maltese x Shih Tzu hybrid dogs.

1. Seborrheic Dermatitis

Seborrehic dermatitis, or “seborrhea”, is a skin condition known to affect Shih Tzus⁸ and which therefore may also affect Maltese x Shih Tzu mix dogs. The condition causes skin scaling, crusting, a dull, dry coat and (in some cases) excessive skin oiliness. Seborrhea occurs due to a defect involving the proteins in your dog’s skin barrier, so it also leaves their skin more vulnerable to infection.

Seborrehic dermatitis can be primary, that is, occurring without an obvious underlying cause, or it can occur secondary to another condition. The most common problems that spark a secondary case of seborrheic dermatitis are allergies and hormonal disorders³.

Signs of Seborrheic Dermatitis:

2. Follicular Cysts

Shih Tzu dogs are genetically predisposed to developing follicular cysts⁷, and Maltese Shih Tzus are therefore also at risk. Follicular or “epidermoid” cysts occur when fluid or a thick material builds up inside a hair follicle, causing it to dilate. The content of follicular cysts (when opened and drained) is usually similar in appearance to cream cheese, or sometimes chocolate frosting (beige, grey or brown)….sorry if I’ve just ruined your lunch! Outwardly, a follicular cyst looks like a hard, round nodule (lump) in the skin; they tend to occur on the head, neck or torso rather than the limbs.

Signs of Follicular Cysts:

3. Acute Moist Dermatitis ('Hot Spots')

Maltese Shih Tzu hot spots can occur very suddenly, seemingly overnight in many cases! A hot spot (medically termed acute moist dermatitis) is where the surface (superficial) layer of skin has become infected, sore and very, very itchy! The main (primary) bacteria involved are usually staphylococci, although other bacteria will quickly join the party if the hot spot is not rapidly identified and treated.

Hot spots are often very moist and smelly, due to the heavy bacterial involvement. They are usually a consequence of something else (such as allergies, or insect bites) initially causing an itch, which the Malshi will then obsessively begin to lick and chew, further damaging the skin and encouraging bacteria to thrive.

Signs of Hot Spots:

Occur suddenly!
Patch of skin which is red, raw, sore and very itchy
Unpleasant smell
Hot spots are usually wet in appearance, leaking clear, yellow or white fluid
Swelling will also occasionally occur

4. Malassezia Dermatitis

Malassezia is a common, microscopic yeast that lives on the skin of most dogs. It causes no harm when present on the skin at low levels, in non-allergic individuals. In some cases however, malassezia overgrowth can occur, resulting in very high levels of yeast on the skin, which can quickly become very itchy; at this point, we have ourselves a case of malassezia dermatitis!

One of the most common reasons why malassezia dermatitis develops is that the dog has underlying allergies which are not well controlled. So, if your Maltese Shih Tzu mix suffers frequently or recurrently with malassezia dermatitis, you and your vet really need to consider that there could be more going on than a simple yeast infection.

Signs of Malassezia Dermatitis:

Tends to affect the lips, ears, armpits, groin, underside of the neck, or skin between the toes
Usually very itchy
Skin will often discolour, turning brown or grey
Skin will become thickened, and begin to feel like rhino or elephant skin to the touch, if the dermatitis is left untreated for a long period of time

5. Allergic Dermatitis

Finally, allergies are an incredibly common cause of skin issues in our canine family members; so common in fact, that they have earned their own subheadings going forward, as you’ll notice! Skin allergies occur when the immune system reacts excessively (as if it’s under threat) to something in the environment or the food which is actually harmless to your pet.

It’s estimated that 3-15% of dogs are affected by skin issues resulting from environmental allergies alone⁶, before we even begin to account for flea and food allergies. And – importantly – allergies can be an underlying cause of many of the other common skin issues already discussed: seborrheic dermatitis, hot spots and malassezia dermatitis are all potential consequences of untreated allergic dermatitis in Maltese x Shih Tzu dogs.

Maltese Shih Tzu food allergies — Allergy testing

There is strong evidence to suggest a genetic basis for allergic skin disease in dogs, meaning that some breeds are more likely than others to be affected, and that allergic skin disease can be inherited from a parent. A number of specific genes have been identified that appear to be involved, including genes identified in Shih Tzu dogs⁵. We can therefore answer the question “do Maltese Shih Tzus have allergies?” with a confident “yes!”, as allergy-related genes may certainly be passed from a Shih Tzu parent to Malshi offspring.

Common Allergies in Maltese x Shih Tzu mix Dogs

There are three main types of allergies that cause skin issues in Maltese Shih Tzu hybrids, as well as in other dogs.

The most common is flea allergic dermatitis (FAD)². Maltese Shih Tzus affected by FAD are allergic to flea saliva, meaning they can have a very dramatic skin response to flea bites far above that which would be seen in a non-allergic pet.

A second widespread cause of allergic skin disease is “canine atopic dermatitis’ (CAD), which is really just a fancy way of saying environmental allergies. Common offenders include tree and grass pollen, house dust mites, yeast and mould spores. Some of these allergens (like dust mites and yeast) can be present in your Malshi’s environment all year round, whereas others (like pollen) may only cause problems seasonally.

Finally, food allergies account for around 1% of all canine dermatology cases seen by veterinary services¹. Usually, proteins in the diet are responsible for setting off the allergic reaction and resultant flare-up on itchy skin. The most common “guilty” proteins are beef, dairy products, chicken and wheat⁴.

Signs of Flea Allergic Dermatitis:

Intense itching, often accompanied by hair loss, scabs and crusting
Usually affects the lower back, sometimes extending down the backs of the hindlimbs too
You may or may not find evidence of fleas on your Maltese Shih Tzu; flea-allergic dogs can have a very dramatic reaction to even one or two bites from a passing flea, even without a full-blown flea infestation

Signs of Flea Environmental Allergies:

May (or may not) be worse at certain times of year, depending on whether the allergen is present seasonally or all the time
Itching (mild to severe)
Your Maltese Shih Tzu may develop a red, patchy skin rash over the affected areas
Itching (with or without rash) tends to affect one or more of the following areas: the face (especially around the eyes and mouth); the ear flaps; the skin between the toes; the groin and the armpits
Sometimes a trigger (or triggers) can be identified: for example, your dog is worse after field walks, suggesting pollen may be involved

Food Allergies:

The secondary consequences of untreated allergies can also include seborrheic dermatitis, hot spots, malassezia dermatitis and ear infections.

Overcoming and Preventing Non-Allergic Skin Issues

A vital first step that must be undertaken when it comes to overcoming most skin issues in Maltese Shih Tzu dogs is to identify and treat any underlying allergies; allergy treatments will be discussed in greater detail in the following section of this article. Where seborrheic dermatitis is involved, it’s also important to consider and identify any underlying hormonal imbalance, via blood tests.

In addition to being conscious of the possibility of underlying allergies, you can help to prevent hot spots and malassezia dermatitis by bathing your Maltese x Shih Tzu hybrid once or twice weekly in a mild, antimicrobial shampoo such as Malaseb, or Duoxo Pyo S3 shampoo. These contain antibacterial and anti-fungal agents and regular use can prevent skin levels of bacteria and yeast from getting out of hand. You should also place a buster collar on your Malshi at the first sign of obsessive licking or chewing at an area of skin, whilst waiting for a vet appointment.

It’s also helpful to keep ears clean using a pH balanced, antimicrobial ear cleaner such as EpiOtic or TrizAural; this too will help minimise bacterial and yeast levels. If you think your Malshi could be currently suffering from an ear infection, be sure to see a vet before putting any products into your pet’s ears, as cleaners can be harmful if an infection has caused damage to the eardrum.

Finally, always ensure appropriate nutrition, whether this be a hydrolysed diet for a food allergic Maltese Shih Tzu, or simply ensuring a balanced, healthy diet for non-food allergic dogs. We all know that Malshis can be fussy, and the temptation to feed a human or home-cooked diet can be very prominent. However, such diets are almost always unbalanced, unless formulated with the input of a veterinary nutritionist. So, be sure to enlist professional help, or stick to high-quality cooked commercial dog foods. Be aware too, that there is no evidence that raw diets are beneficial for skin issues in dogs, and such diets are undoubtedly dangerous for the dog, the pet owner, and public health generally.

Healthy Skin = Happy Pups

Maltese Shih Tzu Allergy Management

Flea Allergic Dermatitis

Flea-allergic Maltese Shih Tzu dogs must be kept up to date with a kill-before-bite flea protection product at all times, to prevent the occurence of allergic skin reactions. For the best defence, all other dogs and cats in the household should be kept protected too.

It’s important to use an effective, prescription product which must contain an active ingredient to which the flea population is not yet resistant. Be aware that fleas can become resistant to anti-flea products in a similar fashion to bacteria developing resistance to antibiotics, so a number of older, widely used flea products may no longer be effective.

Food Allergies

The only way to successfully eliminate the symptoms of food-related allergic skin (and gastrointestinal) complaints in your Maltese Shih x Tzu mix is to ensure every protein that your Malshi is allergic to is permanently removed from his or her diet. It takes 8-12 weeks following the diet change for allergy symptoms to fully resolve, in most cases.

By far the easiest and most reliable way to achieve this is to feed your Maltese Shih Tzu a “hydrolzed” hypoallergenic or anallergenic diet. The proteins in these special diets have undergone a process called hydrolysis, which breaks down the larger protein molecules into such tiny fragments that they can no longer be recognised by your Malshi’s immune system (or cause an allergic response). To be effective, the diet must be strict and absolutely nothing else can be fed – not even dental chews, and not even a scrap of turkey at Christmas time!

Environmental Allergies

The management of environmental allergies is complex, because in most cases it is simply impossible to prevent exposure. You could have the cleanest house in the world, and it will still be home to microscopic dust mites.

You could remove every tree, bush and shrub from your garden, but unless you keep your Maltese Shih Tzu locked in a bubble they are still going to contact allergens out on walks.

And you could wash your Malshi daily, but microscopic yeast species such as malassezia – a normal part of the skin flora in most dogs – will undoubtedly still remain in small numbers. Unfortunately, malassezia is also a very common allergen contributing to allergy flare-ups!

So, because we cannot prevent contact with allergens for these pets, we have to aim to reduce allergen exposure but also to manage symptoms through a treatment plan (that will be individually tailored to your Maltese Shih Tzu by your veterinarian), and – in some cases – providing medications to calm the immune system’s response to allergens.

These days, there are blood tests available that can help identify the environmental allergens that your Malshi is reactive to. However, this information is actually of limited use when you think about it, because allergen exposure often can’t be realistically prevented. Allergy testing is most useful when you have chosen to pursue immunotherapy treatment for your dog, which involves a lifelong course of “allergy vaccines” to desensitise the immune system to your pet’s specific allergens.

Key Points

Skin problems can be life-limiting and difficult to live with for Malshi and pet parents alike!
The consequences of untreated skin problems can include discomfort, poor quality of life, and in some cases (such as with malassezia dermatitis) eventual irreversible thickening and discolouration of the skin.
Untreated allergies are a common cause of many other skin problems. Treating the underlying allergy is the best way to prevent the secondary skin issue from coming back.
Appropriate nutrition cannot be overlooked when it comes to maintaining a healthy skin barrier. Feeding raw diets and human foodstuffs should be avoided.
And, as always, any concerns regarding your Maltese Shih Tzu’s skin should be discussed without undue delay with your veterinarian; skin issues are always easier to treat in the early stages and will nearly always progress if left untreated.

Hopefully, now you feel more confident identifying the signs of Maltese Shih Tzu skin problems, and have an understanding of how to treat Maltese Shih Tzu allergies – so…go forth and help your fur baby glow!

References:

Groves, E. (2022) Diet in canine dermatology part 2: management of cutaneous adverse skin reactions. The Veterinary Nurse. Available at: https://www.theveterinarynurse.com/review/article/diet-in-canine-dermatology-part-2-management-of-cutaneous-adverse-food-reactions#:~:text=Food%20allergies%20account%20for%20around,commonly%2C%20a%20fully%20hydrolysed%20diet.
Jeschke, P. and Nauen, R. (2005) ‘Flea Allergic Dermatitis’, Comprehensive Molecular Insect Science. Available at: https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/flea-allergy-dermatitis
MSD Veterinary Manual (2022) Seborrhea in Dogs. Available at: https://www.msdvetmanual.com/dog-owners/skin-disorders-of-dogs/seborrhea-in-dogs
Mueller, R.S., Olivry, T. and Prelaud, P. (2016) ‘Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats’, BMC Veterinary Research, 12(9). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710035/
Outerbridge, C.A. and Jordan T.J.M. (2021) ‘Current Knowledge on Canine Atopic Dermatitis’, Advances in Small Animal Care, 2, pp. 101-115. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204668/
Saridomichelakis, M.N. and Olivry, T. (2016) ‘An update on the treatment of canine atopic dermatitis’, The Veterinary Journal, 207, pp. 29-37. Available at: https://www.sciencedirect.com/science/article/abs/pii/S109002331500386X
VCA Animal Hospitals (2023) Cysts. Available at: https://vcahospitals.com/know-your-pet/cysts
Yoon, J.S., Nishifuji, K., Ishioroshi, S., Ide, K. and Iwasaki, T. (2013) ‘Skin lipid profiling in normal and seborrhoeic shih tzu dogs’, Veterinary Dermatology, 24(1), pp. 84-89. Available at: https://pubmed.ncbi.nlm.nih.gov/23331684/

Dr Daisy May

Daisy qualified with distinction from the University of Liverpool Vet School in 2019. During her academic years she completed a wide variety of placements, including a competitive final year elective at Chester Zoo – one of the largest zoos in the United Kingdom! Since graduating, she has hung up her zoo medicine hat and focused her attention on smaller patients, developing a particular passion for feline and canine internal medicine and dentistry.

Daisy has spent the last two years working in first opinion small animal practice as a consulting and surgical Vet. A typical day can involve anything from routine procedures, diagnostic imaging and consulting, right through to life-saving emergency surgeries. When she is not in the clinic, you’ll find her at her laptop in a shaded part of the garden, cup of tea in hand, authoring practical and easy-to-follow pet care articles to ensure top quality advice is available to each and every “pet parent” at the touch of a screen.