Looking at Pip does not reveal why this happened.
Significant hair loss and inflammation can have many potential causes.
Parasites may be involved.
Bacterial or fungal infections are possible.
Allergic or inflammatory disease can become severe.
Endocrine or immune-related conditions can affect the skin.
Several problems may occur together.
And once a dog begins scratching, chewing, or rubbing damaged skin, self-trauma can make the original condition considerably worse.
Pip needs a veterinary diagnosis rather than treatment based only on appearance.
His Belly May Be the Hardest Area to Protect
A dog can sometimes avoid placing one sore leg against the floor.
Avoiding the abdomen is harder.
Pip's belly naturally contacts bedding when he lies in many common positions.
Even curling onto his side can stretch or compress irritated skin elsewhere.
That leaves him with very few comfortable options.
Standing avoids much of the contact.
Sitting avoids some of it.
Neither is a good substitute for proper sleep.
Eventually, His Legs Start Shaking
Pip sits with his front paws planted ahead of him.
At first, he looks stable.
Then a faint tremor appears.
His legs have been supporting him for too long.
His back rounds farther.
His head drops.
His nose approaches the floor.
Pip's eyes close.
For several seconds, he appears to sleep.
Then his body sways.
His eyes open.
He catches himself.
A moment later, his head begins falling again.
Sleeping Upright Is Not Real Rest for Pip
His muscles still have work to do.
Balance still matters.
He cannot fully relax without falling sideways.
And if he does fall sideways, the very skin he is trying to protect may hit the surface.
So Pip remains trapped between exhaustion and discomfort.
He needs sleep.
But sleep requires letting go of the posture keeping his painful skin away from the floor.
The Medical Team Has to Break More Than One Cycle
First there is the underlying disease.
Then there may be inflammation or infection.
Then itching can lead to scratching.
Scratching can damage skin.
Damaged skin can hurt.
Pain can interfere with sleep.
Poor rest can leave Pip even more exhausted.
Simply stopping one symptom may not be enough.
His skin needs to heal while his comfort, nutrition, hydration, and ability to rest are supported.
The Raw Areas Need Protection From Pip Too
If Pip is itchy, his own paws and mouth can become additional sources of injury.
One hard scratching session can reopen fragile tissue.
Repeated licking can keep an area moist and irritated.
Protective measures may sometimes be necessary depending on where his lesions are located.
But anything touching Pip's body must be chosen carefully.
A poorly fitted recovery garment could rub against exactly the areas everyone is trying to protect.