You and your pet have been frustrated and miserable – long nights of itching and multiple steroid treatments can drive you both crazy. There is nothing like seeing your pet being bothered and not being able to help them. Many times steroids help, but only for a short time, and then the pet is right back to scratching and licking. It seems like a revolving wheel that you can’t stop. Your pet may be suffering from one or several chronic conditions; often more than just allergies. Dermatitis (inflamed skin) can be bacterial, fungal, allergic, neoplastic, immune-mediated, or idiopathic (no known cause). Our skin is the largest part of our immune system and when something about that skin and its outer lipid (oily) layer is disturbed, the skin is open to multiple secondary infections. One of the most important things to realize is that itchy pets are often not fixed with just one medication alone and that it often takes time and several tries until the right treatment and home care plan for your pet is developed. While the initial treatments can take time and money, it is important to remember that you are investing in your pet’s comfort and happiness and they will pay you back with love for a lifetime! The following describes for you some of the tests or treatments that your veterinarian may recommend for your pet:

Tests

(some of these tests may need repeated several times or combined with other tests as well)

Skin Scraping

Looks for mites such as demodex and sarcoptes that can live deep in the follicles

Skin cytology

Looks for bacteria and yeast, finding the cause of secondary infection

Fungal Cultures

Looking for fungus such as ringworm

Bacterial Cultures

Some bacterial infections don’t respond to traditional antibiotics so a culture is performed to see if it is a resistant skin infection

Blood Tests

Some internal diseases such as Cushing’s and hypothyroidism can lead to chronic skin disease and poor healing

Skin Biopsy

Helps to diagnose difficult cases that don’t respond to treatment by determining what the skin cells themselves are doing and helps find deep fungus or mites

Allergy Testing

Blood or skin testing, blood testing can be performed in general practice, skin testing done at a dermatologist specialty practice, these tests determine if and what things in the environment your pet is allergic to, then these results can be used to develop an injection or oral drops called immunotherapy. Immunotherapy helps “vaccinate” your pet against these allergens, this is a process that many humans go through as well.

Food Trials

Despite what pet food marketing wants us to believe, food allergies are not limited to “grains” or chicken alone, many pets are allergic to multiple proteins (chicken, fish, peanut butter, lamb, etc), some grains and even to yeast (an ingredient in many treats and supplements). Many allergic pets do better on a limited ingredient or fish-based diets, but if they truly have food allergies, using over-the-counter food is like throwing a dart at a dartboard – you may or may not pick the right food. The best way to know if your dog has a food allergy is to do an 8-week food trial where they are fed a prescription hypoallergenic food only for 8 full weeks with no other foods, treats, or table scraps entering their mouth. These prescription foods have the lines cleaned before they are made and have ingredients that are protein sizes that the pet does not recognize as foreign and therefore should not react. Once your pet has been on prescription food for 8 weeks, if they are doing well, the doctor may help you try to transition to an over-the-counter diet, but they may need prescription food for life if their allergies are severe. IT IS VERY IMPORTANT to realize that just switching the food your pet is on from one over-the-counter product to another (no matter how expensive) is not enough to know if food allergies are their problem – you may just have picked the wrong food to switch to. Using prescription allergy foods makes the timeline much shorter to diagnosing whether it is a food allergy or not. Yes, prescription foods are expensive, but they often reduce or eliminate the need for costly and sometimes dangerous medications for your pet.

Treatments

(many of these treatments are often combined together to give more effective results)

Topical Relief Products (Shampoos, Mousses, Sprays)

Topical is such an important part of the puzzle – this allows the product to come in direct contact with the skin. Once your pet has a diagnosis of the secondary infection, these products help kill the infection and also help replace the lipid layer on your pets’ skin making it stronger

Flea and Tick Preventatives

Even though you may have never seen a flea, if your pet is an allergic pet it is likely also to be allergic to fleas. If so, the bite of even one flea can make your pet’s skin flare up. The doctor will make a recommendation of the proper product to use based on your pet’s skin condition – it may be oral or topical but will be monthly on a year round basis. Fleas wreak havoc on allergic patients’ skin!

Vitamin Supplements

There are many over the counter skin vitamins- your doctor may recommend prescription or over the counter. It is very important to use Omega 3, 6, and 9 together, not just fish oil, in order to reduce inflammation. These also help the pet improve its response to other medications such as antihistamines.

Prescription Antihistamines

These products are safe for your pet to be on lifelong year round in most cases. However, most pets do not experience itch because of histamines. Histamines usually make our pets have runny eyes and noses. Some over-the-counter products such as Zyrtec and Benadryl can help with those symptoms, but may not be enough for many pets. Your doctor may prescribe an antihistamine such as hydroxyzine to reduce symptoms caused by histamines or may not feel that histamines are the culprit in your pet’s disease.

JAK and Interleukin Inhibitors Modulators

In the last decade we have had the blessing of development of two pet specific medications in this class: Apoquel and Cytopoint. These medications block the itch chain reaction in our pets without suppressing the immune system and can be incredibly helpful in making your pet comfortable while being a safe choice long term with minimal to no side effects.

Antibiotics

If your pet has a secondary bacterial skin infection, the doctor will likely place them on oral or injectable antibiotics in addition to topical therapy. For severe infections, a month of treatment or more is often necessary.

Antifungals

If your pet has a secondary yeast infection, these may be prescribed. Also, antifungals, such as ketoconazole, can be used to reduce the dose of other more costly medications, especially in larger dogs.

Steroids

Sometimes steroids like prednisone or triamcinolone are needed to stop the cycle of the itch. While the doctor uses them sparingly and feels that they can be dangerous long term, there are cases when they make good sense to stop the itching long enough for other treatments to start to take effect.

Prescription Diets/Food Trial

As described in the testing section, it is ESSENTIAL to use the recommended diet and only that diet for 8-12 weeks before deciding if your pet has food allergies or not. Occasionally this is an over-the-counter product with particular types of proteins, but most times the doctor will recommend a prescription food to start as to have the greatest chance of fast and significant relief for your pet while being sure adequate nutrition is provided. Healing Paws Veterinary Care does NOT recommend costly boutique diets (call us for specific brands to watch out for) as our doctors have seen many patients with imbalances while on this product line. Also, please be advised that grain-free diets of any kind have been proven to cause life-threatening heart disease in dogs so should be avoided at all costs.

Cyclosporine

This drug successfully treats 60% of atopic dermatitis patients. It can be used to reduce the amount of steroids needed or kept on a 2-3 time weekly dose to keep dermatitis pets comfortable. Cyclosporine is a drug that is started at one dose and weaned down by the doctor.

Topical Mite Treatments

Sarcoptes mites can be difficult to find on skin scrapings if they have buried deep within the skin. There are several preventative products that also treat mites so your doctor will likely be prescribing a particular flea/tick preventative for your pet in order to be sure that mites are not hiding in your pet’s follicles causing chronic skin disease.

Allergen Specific Immunotherapy – “Allergy Vaccines”

If your pet has been blood or skin tested for allergies, they can have their own specific allergy vaccine created as an oral drop or injection you give at home. This helps 60-80% of animals improve but can take up to 3-6 months to start to take effect. Therefore immunotherapy is often used along with other therapies to help heal your pet.