Well, I hope I don't come off as a holistic fanatic, but simply changing from kibble (I'm assuming you feed kibble?) to raw food can do wonders. My dog has done good, but not great on kibble and I'm about to switch him off to a raw diet. He developed hot spots a few years ago and has never really been in great shape. According to one source, simply changing from kibble to a raw diet can help the body to focus on bodily needs and help cleanse itself. I've spoken to a few raw feeders whose dogs had received cortisone shots to combat skin problems. Once they switched, they noticed a detoxification period which usually happens and it's a sign of the body "waking up" and cleansing itself. After the detox period, they noticed their dogs' coat were becoming brighter and glossier, and their energy level rising (in a good way). To their amazement, the skin problems began to vanish and now their dogs are in great shape and they swear by a raw diet. Gawd, I hope I don't sound like a one-sided holistic fanatic Anyhow, just something to think about if you want to move away from conventional practices.