I was looking up stay sutures this morning, but came across this quick and dirty summary of allergic skin disease management for dogs. We also call it atopic dermatitis, if you are looking for the medical terminology.
It’s written by The Derm Vet, and if you aren’t aware of Dr. Ashley Bourgeois, check out her Instagram and podcast.
As the article says, it is not a one size fits all treatment protocol for allergic skin disease in dogs.
It can be one of the most frustrating things for pet owners because it is not always easy to manage, nor is it inexpensive. But when you get a dedicated owner it can be one of the most rewarding outcomes. My most memorable was an owner coming in for a QOL (quality of life) discussion asking me if she should put her dog down because he was suffering. Six months later the owner tells me I am the dog’s godmother. I saved his life.
He was the saddest little white foo-foo with severe redness, lichenification and crusting from the tips of his toes to the hocks and elbows. He was bleeding in his skin folds. He just lay on the exam table while I scrubbed the crusts out from between his toes. We agreed to a short course of steroids because it was this or a dose of euthanyl. I managed to talk the owner into trying Cytopoint, despite its expensive price tag. Then the owner was diligent with shampooing daily. I love the Douxo Pyo products for the pro-ceramide in it. But also use the DermaChlor 4% chlorhexidine shampoo, and the DermaChlor conditioner spray for spot treating. The key is contact time. Everyone should know now in the days of COVID, you need to have the soap on your hands for a minimum amount of time to address any infectious organisms. The owners need to lather up those problem spots and then set a timer for 5 to 10 minutes before rinsing. Do not forget to dry them thoroughly! Yeast and bacteria love a warm moist environment!
The last time I saw my ‘God son’ he was in a stroller, tail-wagging, coming in happily for his Cytopoint booster. He looked white and fluffy, no longer red and greasy.
If you are a pet owner with an atopic dog. My sincerest condolences. You are not alone!!
The key is to understand that it is multimodal therapy.
To the veterinary students. The one thing that I need to say is… do not try one thing, and then tell the owner to come back if it doesn’t work. Start with multimodal therapy and wean down or off the ones that aren’t needed.
1) Control the itch. This is a vicious cycle. Itchy skin leads to the break down of a healthy skin barrier, more allergens, bacteria and yeast move and penetrate this barrier causing more cytokine release from inflammatory cells. More inflammation and itchy skin. Repeat. I have seen allergy tests for dogs where they are allergic to Malassezia, a yeast organism that naturally occurs on the skin. We need to break that itchiness pathway to give the skin time to heal. Even if you can get the owner to commit to a short course of Apoquel. Yes, there are other less expensive options. You just need to ensure that the owner is aware of the risks and side effects of your prescriptions.
2) Treat the infections. While you may want cytology to confirm infection, using topical 3-4% chlorhexidine is helpful for those crusting pyodermas. I like topicals if the owner can do it. Then I know I’m being diligent with my antimicrobial use. In severe cases, or cases where the owner just cannot bathe the tail crusting off their angry maltese cross, I have prescribed a first-generation cephalosporin. The last thing the dog needs is a multi-drug resistant bacteria.
3) Rule out fleas and mites. Even if you cannot see fleas, they may be allergic to the saliva in a fleas mouth. Skin scrape, cytology, treat accordingly.
4) Diet. I have clients fight me on this one. This is the hardest one for me to convince owners on. They have read on X forum that kibble is bad. They have read on such and such blog that raw is better. When I ask dog owners the reasoning behind their decision for raw #1 is allergies, #2 they thought it was healthier. The one thing that I can convince them on however is increasing the DHA/EPA content of what their dog consumes. Omega 3 fatty acids, fish oils (not flax) are both anti-inflammatory and help improve the phospholipid bilayer of the skin. It should be given at a higher dose than is provided in commercial dog food diets. The veterinary prescribed skin diets are meant to have these in higher levels. There are a lot of products out there. I usually use Eiocosaderm which comes with a convenient pump. I have seen a lot of recommendations on the Nordic Pet Omega product as well. Check for quality control. We want low heavy metals/mercury and toxins. You do want to check for concurrent food allergy. You cannot use a raw diet as an elimination diet, but you can use a home cooked elimination diet. Try looking at the recipes on BalanceIT.com go to the EZ balancer for vet patients and select skin conditions. Try a pork based diet as it seems to be one of the least allergenic proteins.
The page should look like this…
Just let the owners know that they will have to send your clinic a request for approval. Then you can log in, adjust the calories that the pet should be consuming, and approve the supplements.
As always, the opinions in this blog are my own! I do not benefit from any of my product recommendations in this post. They are for your knowledge and for you to understand the wide array of treatment plans to address atopic dermatitis.