Jonathan Smith, VMD

Here in the Washington, D.C. area, skin disease is one of the most common complaints at the veterinarian during the spring, summer and fall months. It is important to understand that the cause for skin disease and itchiness is different for every dog. It can also be one of the most frustrating situations for the owners, our pets, and for your veterinarian.  If you have an itchy dog, your appointment might go something like this:

Why does my dog keep getting skin and ear infections? I think we need to use a different antibiotic…

Recurrent skin and ear infections are usually secondary to a primary cause for skin inflammation. Therefore, if we don’t assess or treat the primary cause, the skin infection and itchiness will continue to be a problem. Depending on the underlying cause, your dog may have problems once a year, or it could be constant. The most common causes for itching in dogs are underlying allergies and external parasites.

Hey Doc, my roommate’s puppy had mange a few months ago, and now I think my dog has it. Look! He’s so itchy!

Mange is a very important and common cause for skin disease in dogs. However, it is very important to recognize that there are two types of mange, and only one of them is contagious. Demodectic mange is something we see commonly in puppies. It is caused by a mite that normally lives in the hair follicles of dogs and people alike. Normally, a dog’s immune system keeps these mites in check, but if the dog is young and their immune system is underdeveloped they can lose hair and acquire skin infections. Most cases of demodectic mange resolve on their own as a dog ages; some require a course of anti-parasitic medication. Sarcoptic mange is another story. This is a contagious mite that can be passed between dogs or from exposure to wildlife (usually foxes or other canids). Patients with sarcoptic[1] mange are usually very itchy, and have lesions on the tips of their ears and hocks (ankles). Veterinarians diagnose both of these mites with a test called a skin scraping; however, it is very common for us not to find sarcoptes on a skin scraping and rule it out with[2] a topical medication called Revolution. Remember, demodectic mange is not contagious; sarcoptic mange is.

My dog won’t stop licking in between his toes, I think my jerk neighbor sprayed something on their lawn and my dog is having a reaction…

Licking and chewing in any area is a common sign of pruritus (itchiness). While it’s possible for a dog to have a contact reaction to anything, most of the time licking in between the toes is a sign of underlying allergies. The most common types of allergies are to inhaled allergens, their food, or to flea bites.

Whoa, whoa, whoa! My dog does NOT have fleas! I use Frontline every month!

Well unfortunately, many times dogs with flea allergies do not have fleas on their skin when they are present with itchiness or skin infections. Frontline is a great product, but it requires the flea to jump on to your pet and bite before they die. Therefore, you may have fleas in your home, which jump, bite, and cause a reaction before they die and are never seen again. Patients with flea allergies usually have problems during the spring, summer, and fall months. They also usually have problems near the base of their tail, ventral abdomen (belly), and dorsum (along the top of their body).

When we suspect flea allergies, it is ideal to switch to a flea/tick preventative that has repellant characteristics such as Canine Advantix or Vectra-3D. It is also important to apply it every 3 weeks year round. This will prevent fleas or other parasites from jumping onto your pet and causing an allergic reaction. Please read the label on these products, as many of them can be toxic to cats. It is also very important to treat all of the pets in your house (cats, rabbits, and dogs alike), even if they are indoors only. It is very common for cats to be reservoirs for fleas in your home. While this seems ridiculous, flea allergies are by far the easiest type of allergy to manage and prevent.

Okay, so I do all that stuff and my dog is itchy year round. What’s the deal?

Whenever we have a pet we suspect has allergies, our first question is whether they have any months where they are not itchy. If the answer is yes, the underlying cause is likely something that varies with the seasons. If the answer is no, then it’s strongly suspicious for food allergies.

Whoa, whoa, whoa! My dog has been eating the same food for years! Plus, it’s grain free!

Right. Food allergies in dogs are different than they are in people. It is not likely that a single new item (such as seafood, peanut butter, etc. in people) causes a skin reaction. With dogs, this occurs gradually, often over many years; not suddenly. Usually, the culprit is a protein or carbohydrate source. The most common problematic proteins in dog and cat food are chicken and beef. The only way to diagnose and treat food allergies is to select a new diet with a novel protein and carbohydrate. The most common diets available have ingredients such as venison, rabbit, or duck as their protein source and pea and potato as a carbohydrate source. Grain allergy alone has not been established in veterinary medicine. It is likely extrapolated from celiac disease in human medicine.

Okay, where can I get these foods?

There are many quality over-the-counter diets available that claim to be hypoallergenic and appropriate for food allergies. For many pets, these are appropriate. However, none of these diets are regulated by the FDA, and they may include small amounts of chicken or beef by-products that will still cause a reaction in your pet’s skin. If an over-the-counter diet doesn’t work for your pet, your veterinarian will likely still recommend a prescription diet

Yup! I’ve tried all those diets in the past, and they didn’t work. What else have you got?

Okay. With food allergies, things take time. If you decide to perform a novel protein diet trial, it is very important that it is strict. This means that during a 10-12 week period, nothing else should go into your dog’s mouth. This includes treats, beef/chicken flavored toys, or any flavoring. We even recommend switching to a tablet or topical heartworm preventative. If your dog’s skin improves during this time, then they have food allergies! While this seems a bit ridiculous, it is much easier to control their diet than to manage environmental allergies.

Okay, my dog is still itchy and has an infection after my 12-week food trial. I’m very frustrated. Can I see the nice female vet?

No. As I have mentioned, skin issues and allergies can be frustrating for all of us. If we have ruled out all of the above and your dog still has problems with itching, it is likely that they have atopy. Atopy is an allergy to inhaled substances such as pollen, dust, molds or anything else in the environment. This can cause itchy eyes and sneezing, but can also present as itchiness. Unfortunately, there are no medications that we can give that will cure atopy. Similar to people, we can give medications such as antihistamines (benadryl, zyretc, chlorpheniramine, etc.), steroids (prednisone, medrol, etc.) and immunosuppressants (cyclosporine). These medications often work very well; however, they simply manage their symptoms and do not correct the underlying cause.

 

 

Well, my dog does great on prednisone. Just give me a bottle of that and let’s call it a day.

 

Steroids are great tools to decrease inflammation and keep our pets comfortable while we treat infections. However, unless we have tried other methods, it is not ideal to keep them on these medications for the rest of their lives. Steroids have many side effects, short- and long-term.

 

 

What about cyclosporine?

 

Cyclosporine is an immunosuppressant drug used for many conditions. It works well for atopy and has far fewer side effects than steroids. However, it is expensive, and for larger dogs, it is often cost prohibitive. It is less cost prohibitive for patients who have symptoms a few months out of the year and only require this medication every few days. If you are interested in more details about cyclosporine, feel free to discuss it with your veterinarian.

 

 

Hmmmm…. veterinary dermatologist? This sounds expensive….

 

So in order to correct atopy, we have to help your dog’s immune system. This involves either blood work or skin testing to determine what is causing the allergy. Then, allergy injections are created and used to desensitize them. This testing usually requires a visit to a veterinary dermatologist. With time, approximately 75% of dogs will show improvement. However, it is important to understand that some dogs still require medications to help control their itchiness seasonally. The goal is to try to correct the underlying inflammation which leads to recurrent skin infections. It is always easier and cheaper in the short-run to keep treating the symptoms and infection; however, years down the road, it is a much better investment (for your wallet and pet alike) if the underlying condition is treated.

 

 

As veterinarians, we are here to help treat your pets and do our best to keep you happy. If you have a pet with skin disease, please be patient. It is often a process of eliminating all of the potential caus

Jonathan Smith, VMD

Here in the Washington, D.C. area, skin disease is one of the most common complaints at the veterinarian during the spring, summer and fall months. It is important to understand that the cause for skin disease and itchiness is different for every dog. It can also be one of the most frustrating situations for the owners, our pets, and for your veterinarian. If you have an itchy dog, your appointment might go something like this: Why does my dog keep getting skin and ear infections? I think we need to use a different antibiotic… Recurrent skin and ear infections are usually secondary to a primary cause for skin inflammation. Therefore, if we don’t assess or treat the primary cause, the skin infection and itchiness will continue to be a problem. Depending on the underlying cause, your dog may have problems once a year, or it could be constant. The most common causes for itching in dogs are underlying allergies and external parasites. Hey Doc, my roommate’s puppy had mange a few months ago, and now I think my dog has it. Look! He’s so itchy! Mange is a very important and common cause for skin disease in dogs. However, it is very important to recognize that there are two types of mange, and only one of them is contagious. Demodectic mange is something we see commonly in puppies. It is caused by a mite that normally lives in the hair follicles of dogs and people alike. Normally, a dog’s immune system keeps these mites in check, but if the dog is young and their immune system is underdeveloped they can lose hair and acquire skin infections. Most cases of demodectic mange resolve on their own as a dog ages; some require a course of anti-parasitic medication. Sarcoptic mange is another story. This is a contagious mite that can be passed between dogs or from exposure to wildlife (usually foxes or other canids). Patients with sarcoptic mange are usually very itchy, and have lesions on the tips of their ears and hocks (ankles). Veterinarians diagnose both of these mites with a test called a skin scraping; however, it is very common for us not to find sarcoptes on a skin scraping and rule it out with a topical medication called Revolution. Remember, demodectic mange is not contagious; sarcoptic mange is. My dog won’t stop licking in between his toes, I think my jerk neighbor sprayed something on their lawn and my dog is having a reaction… Licking and chewing in any area is a common sign of pruritus (itchiness). While it’s possible for a dog to have a contact reaction to anything, most of the time licking in between the toes is a sign of underlying allergies. The most common types of allergies are to inhaled allergens, their food, or to flea bites. Whoa, whoa, whoa! My dog does NOT have fleas! I use Frontline every month! Well unfortunately, many times dogs with flea allergies do not have fleas on their skin when they are present with itchiness or skin infections. Frontline is a great product, but it requires the flea to jump on to your pet and bite before they die. Therefore, you may have fleas in your home, which jump, bite, and cause a reaction before they die and are never seen again. Patients with flea allergies usually have problems during the spring, summer, and fall months. They also usually have problems near the base of their tail, ventral abdomen (belly), and dorsum (along the top of their body). When we suspect flea allergies, it is ideal to switch to a flea/tick preventative that has repellant characteristics such as Canine Advantix or Vectra-3D. It is also important to apply it every 3 weeks year round. This will prevent fleas or other parasites from jumping onto your pet and causing an allergic reaction. Please read the label on these products, as many of them can be toxic to cats. It is also very important to treat all of the pets in your house (cats, rabbits, and dogs alike), even if they are indoors only. It is very common for cats to be reservoirs for fleas in your home. While this seems ridiculous, flea allergies are by far the easiest type of allergy to manage and prevent. Okay, so I do all that stuff and my dog is itchy year round. What’s the deal? Whenever we have a pet we suspect has allergies, our first question is whether they have any months where they are not itchy. If the answer is yes, the underlying cause is likely something that varies with the seasons. If the answer is no, then it’s strongly suspicious for food allergies. Whoa, whoa, whoa! My dog has been eating the same food for years! Plus, it’s grain free! Right. Food allergies in dogs are different than they are in people. It is not likely that a single new item (such as seafood, peanut butter, etc. in people) causes a skin reaction. With dogs, this occurs gradually, often over many years; not suddenly. Usually, the culprit is a protein or carbohydrate source. The most common problematic proteins in dog and cat food are chicken and beef. The only way to diagnose and treat food allergies is to select a new diet with a novel protein and carbohydrate. The most common diets available have ingredients such as venison, rabbit, or duck as their protein source and pea and potato as a carbohydrate source. Grain allergy alone has not been established in veterinary medicine. It is likely extrapolated from celiac disease in human medicine. Okay, where can I get these foods? There are many quality over-the-counter diets available that claim to be hypoallergenic and appropriate for food allergies. For many pets, these are appropriate. However, none of these diets are regulated by the FDA, and they may include small amounts of chicken or beef by-products that will still cause a reaction in your pet’s skin. If an over-the-counter diet doesn’t work for your pet, your veterinarian will likely still recommend a prescription diet Yup! I’ve tried all those diets in the past, and they didn’t work. What else have you got? Okay. With food allergies, things take time. If you decide to perform a novel protein diet trial, it is very important that it is strict. This means that during a 10-12 week period, nothing else should go into your dog’s mouth. This includes treats, beef/chicken flavored toys, or any flavoring. We even recommend switching to a tablet or topical heartworm preventative. If your dog’s skin improves during this time, then they have food allergies! While this seems a bit ridiculous, it is much easier to control their diet than to manage environmental allergies. Okay, my dog is still itchy and has an infection after my 12-week food trial. I’m very frustrated. Can I see the nice female vet? No. As I have mentioned, skin issues and allergies can be frustrating for all of us. If we have ruled out all of the above and your dog still has problems with itching, it is likely that they have atopy. Atopy is an allergy to inhaled substances such as pollen, dust, molds or anything else in the environment. This can cause itchy eyes and sneezing, but can also present as itchiness. Unfortunately, there are no medications that we can give that will cure atopy. Similar to people, we can give medications such as antihistamines (benadryl, zyretc, chlorpheniramine, etc.), steroids (prednisone, medrol, etc.) and immunosuppressants (cyclosporine). These medications often work very well; however, they simply manage their symptoms and do not correct the underlying cause. Well, my dog does great on prednisone. Just give me a bottle of that and let’s call it a day. Steroids are great tools to decrease inflammation and keep our pets comfortable while we treat infections. However, unless we have tried other methods, it is not ideal to keep them on these medications for the rest of their lives. Steroids have many side effects, short- and long-term. What about cyclosporine? Cyclosporine is an immunosuppressant drug used for many conditions. It works well for atopy and has far fewer side effects than steroids. However, it is expensive, and for larger dogs, it is often cost prohibitive. It is less cost prohibitive for patients who have symptoms a few months out of the year and only require this medication every few days. If you are interested in more details about cyclosporine, feel free to discuss it with your veterinarian. Hmmmm…. veterinary dermatologist? This sounds expensive…. So in order to correct atopy, we have to help your dog’s immune system. This involves either blood work or skin testing to determine what is causing the allergy. Then, allergy injections are created and used to desensitize them. This testing usually requires a visit to a veterinary dermatologist. With time, approximately 75% of dogs will show improvement. However, it is important to understand that some dogs still require medications to help control their itchiness seasonally. The goal is to try to correct the underlying inflammation which leads to recurrent skin infections. It is always easier and cheaper in the short-run to keep treating the symptoms and infection; however, years down the road, it is a much better investment (for your wallet and pet alike) if the underlying condition is treated. As veterinarians, we are here to help treat your pets and do our best to keep you happy. If you have a pet with skin disease, please be patient. It is often a process of eliminating all of the potential causes one by one, which can take time and dedication from everyone in your family. With your help, your veterinarian can hopefully keep your pet healthy and itch-free as they develop these frustrating reactions to things in their life. For more information, please visit the website: veterinarypartner.com. Excellent articles include:

–Itching and Allergies in Dogs –Food Allergies –Food Allergy Diet Trials –Airborne Allergies (atopy) –Fleas: Know Your Enemy –Sarcotic Mange –Demodectic Mange

es one by one, which can take time and dedication from everyone in your family. With your help, your veterinarian can hopefully keep your pet healthy and itch-free as they develop these frustrating reactions to things in their life.

 

For more information, please visit the website: veterinarypartner.com. Excellent articles include:

 

–Itching and Allergies in Dogs

–Food Allergies

–Food Allergy Diet Trials

–Airborne Allergies (atopy)

–Fleas: Know Your Enemy

–Sarcotic Mange

–Demodectic Mange