Client: For the past five days, my dog, Angie, has been getting progressively itchy. She is licking her paws and groin area, as well as becoming snappy when I attempt to examine her myself. Her ears are also red and inflamed. Her quality of life is poor, and she is keeping me up at night.
Veterinarian: Poor Angie! And poor you! What you describe is a common reason for veterinary visits. Let’s have a look at her and see if we can help her feel more comfortable.
Client: Thank you, it is so hard to see her like this.
Veterinarian: After examining her, I notice that she has very inflamed, moist skin and ears, with areas of hair loss and redness. Her feet are raw as well from chronic licking. We should start by taking some samples from the surface of her skin, using tape impressions, and look for secondary bacteria/yeast/mites under the microscope while you wait here. It will
just be a few minutes.
Client: That sounds like a good start.
Veterinarian: After looking at the tape impressions from the affected areas under the microscope, I did not find any mites, but she does have significant bacterial and yeast infections caused by her licking the affected areas. We will start her on a course of antibiotics to kill the bacteria and an antifungal to clear up the yeast. I feel she has what we would call canine atopic dermatitis or atopy. She could be allergic to her food, or to the environment (dust mites, grass, pollen, molds, weeds, insects). The primary goal is to determine what she is reacting to, and avoid that substance, if possible. In the short term, we need to stop the itch to prevent further self-trauma. Have there been any changes in her diet recently? Are you feeding a different brand, or has she had any new treats?
Client: There has been no recent change in her diet, or to the environment to which she has been exposed to. Why would she suddenly have problems now? Could she have fleas?
Veterinarian: Excellent question. Allergies can develop at any point in a dog’s life, causing reactions to things they have never reacted to before. They can also reach a threshold where just one extra allergen throws them over the edge. As you mentioned, fleas are another source of the itch. Just one flea bite can cause flea bite allergy dermatitis. Treating a dog with a
flea or food allergy is much easier than if we are dealing with an environmental allergy or canine atopy. It is not always easy to see evidence of fleas, especially in a thick-coated dog like Angie, so we will put her on a preventative product for fleas and ticks, such as Bravecto, in case she does have fleas.
Client: She has been exposed to ticks before, and has been treated for Lyme disease. Could this have affected her immune system resulting in allergies now?
Veterinarian: No, we cannot blame Lyme disease for her current itchiness. Our best path to follow is to start her on something called Apoquel, or Cytopoint to help stop the itch. Adding in a medicated shampoo will help us get her skin infection under control quicker. By using all these medications together, it is more effective than just using one single therapy alone. We
call it a multimodal approach. If this does not clear it up, we will then address potential food allergies and look at an eight week trial of hypoallergenic food. We would feed her strictly this food with no treats. It would tell us if she is reacting to the common ingredients in diets such
Client: What is the difference between apoquel and cytopoint? Why would you choose one over the other for my dog?
Veterinarian: Before Apoquel and Cytopoint were developed, we were limited to the use of steroids to help our itchy pets, which caused increased thirst and urination, liver disease, and risk of infections. The use of antihistamines was not always effective and caused lethargy. Now with Apoquel and Cytopoint available, we are seeing a great improvement in these patients’ quality of life, without unwanted side effects. They can both help reduce the itch within 24 hours by blocking the itch cycle, and they have no reported drug interactions. Cytopoint is given by injection every 4 – 8 weeks. It is an antibody therapy that stops the brain from sending an itch message to the rest of the body. The onset is rapid, and the return of
symptoms is gradual. It is not a drug, as it is composed of proteins rather than chemicals, and has fewer effects on the immune system so it can safely be used with underlying disease or neoplasia. It can also be used in animals of any age. Apoquel is an oral tablet, given twice a day for two weeks, then once a day. It can be used short or long term and can be stopped suddenly with no weaning down. It is antipruritic and anti-inflammatory. It is a drug though, so can have more side effects than cytopoint with possible gastrointestinal upset. It is avoided if there is underlying neoplasia and it will worsen cases of Demodex. It can only be used in animals over one year of age. The benefits of Apoquel far outweigh the risks of side effects with it.
Client: I think Angie would prefer a daily tablet. It would be more convenient for me than trying to bring her in for an injection every month. Thank you so much for your help. I am looking forward to a good night’s sleep again soon.
Veterinarian: I am looking forward to seeing Angie feel better as well. We will follow up in a few days and see how she is tolerating the new antibiotics, the antifungal, the bathing and the apoquel. Any problems with them let me know.
There is no quick and easy cure for canine atopy. It is often a long and involved process of diagnosing it by ruling out other potential causes for the itch and bringing it under control. Treatment is often life long. The cost involved can be significant. But with help from your veterinarian, and the use of newer products and diets your pet can live a normal, comfortable life and you, the owner, can sleep again at night.
If this is what you and your pet are experiencing, constant licking, chewing, scratching, painful ears/skin/and feet, then speak to your veterinarian. There are solutions available.
If you have any questions, give us a call at 902.443.9385.