In the previous post in this series we talked about two big tips for helping reduce the anxiety and stress that patients with skin disease may experience. The first was stopping the itch by visiting your veterinarian and committing to therapies that are effective, work fast and get the pet back to normal again. The second was putting the treat into treatment. In other words, consider your pet’s behavior and discuss options for anti-itch therapy that suit your dog’s needs with your veterinarian.
There is a third step to help reduce fear, anxiety, and stress (FAS) for your dog with itchy skin: Commit to the diagnostic work up to determine the true cause of your dog’s itchy skin!
A diagnosis for skin disease is crucial given disease commonly starts at a young age and typically lasts a lifetime. When a diagnosis can be made definitively, a long-term treatment plan can be determined and anxiety and stress may be reduced for everyone involved.
The pathway for making a final diagnosis to the cause of your pet’s skin disease can be broken down into a streamlined diagnostic approach.
Stop the itch. Keep your dog comfortable from the beginning of and throughout the diagnostic workup. This step was discussed in the previous posts in this series, which can be found here. If you don’t have time to go back and visit each post, here is a short summary: Make an appointment with your dog’s veterinarian to stop the itch. Unlike over the counter remedies, your veterinarian has therapies that are effective and work fast.Your dog deserves comfort and relief from anxiety and stress. You deserve peace of mind.
Rule out parasites. Diagnostic tests that help veterinarians during this step are using a flea comb, skin scrapes, and starting oral ectoparasite (flea and tick) therapy. Therapy must be given persistently and consistently for maximal effect. We recognize that exposure to fleas and ticks is ongoing any time a pet is outdoors. Truth is, fleas and ticks can hitch a ride on people and be brought inside so that even indoor only pets can be exposed. Has your vet ever told you that your pet is allergic to flea bites, but you never saw a single flea? The best analogy is that of a mosquito bite. Think about how many times you have experienced an itchy spot on your skin because of a pesky mosquito that you never even saw. Unless we put our pets in a bubble, we can’t protect them 100 percent from exposure to these parasites. The great news is the current medical evidence suggests rapidly-acting oral products in the newest class of flea and tick therapy, the isoxazolines, provide the most effective flea and tick control.2,3 Your veterinarian can help you choose the best product for your pet.
Treat skin infections. Manage secondary infections as they occur. Infections on the skin and in the ears are common in the world of veterinary dermatology, and allergic skin diseases are the most common cause of those repetitive infections. The only way your veterinarian can truly know how to treat those infections is to first determine which infections are present. The two most common infections on the skin are Staphylococcal bacteria and Malassezia yeast. Ear infections can be caused by even more organisms. A diagnostic test called a skin or ear cytology should be performed for every patient to verify the presence of infection. Once the presence of infection is established, your veterinarian can choose appropriate therapy.
Conduct a food trial. Food allergy should be considered, and an 8-week food trial conducted, for dogs with year-round symptoms. Recently a series of papers were published in which the authors compiled all previous work on food allergy in dogs and cats.4-8 One of the highlights of those publications was a list of foods that commonly cause allergies. It is widely believed that a grain-free diet is the best place to start to diagnose a food allergy. Yes, it is possible for dogs to be allergic to wheat or corn, but this only occurs in 13 percent and 4 percent of dogs respectively. The only way to truly determine if your pet has a food allergy is to conduct a food trial. Think of a food trial like this: if you were having ongoing skin or gastrointestinal problems that your doctor believed were food related, you would have to change your diet drastically to figure out the culprit(s). No doubt it would not be easy or fun. It would take time and patience, and you would miss your favorite foods. However, you would want to approach this diagnostic test with the mindset of doing it the best you possibly could the first time around to get the diagnosis as quickly as possible. This holds true for a food trial for you beloved pet. We have data that shows many over-the-counter foods and treats contain ingredients not listed on the label, ingredients that are common allergens and could derail a food trial.9,10 Trust the food and treat recommendations made by your veterinarian. They recommend specific prescription diets made by specific pet food companies because of trust in the ingredients and trust in the medical literature.
Confirm atopic dermatitis. The final step of the diagnostic pathway is making the diagnosis of atopic dermatitis once the other causes of allergic dermatitis are excluded and/or managed. Atopic dermatitis is caused by allergies to environmental components like grass, tree, and weed pollens. It may also include sensitivity to house dust or house dust mites. It typically starts at a young age and tends to get worse over time. The veterinarian’s goal is a long-term plan to minimize flares to maintain comfort with targeted therapy. You are an important part of creating this long-term goal. Don’t be afraid to be honest if you know you won’t be good at remembering to give medications to your dog by mouth. Feel confident sharing how your lifestyle might affect the long-term goals. You can reduce anxiety and stress by helping shape a long-term plan that is sustainable for your pet and for you. It is important to understand the lifelong nature of this disease and understand flares will occur. It is not because you have failed or your veterinarian has failed; it is simply the nature of atopic dermatitis. When targeted therapy seems to fail, it is important to return to the basics and schedule a recheck exam for your dog as soon as you notice your pet’s condition changing. The sooner the veterinarian can reexamine your pet, the sooner he or she can determine the following: Is flea and tick control being used correctly, has infection returned, or has there been a food indiscretion? If not, the flare might be related to an increased burden of pollens in the air and the plan must be modified, perhaps only for the short term, to get you pet back on track.
The diagnostic pathway as described above is straightforward and admittedly tends to wax and wane depending on the allergies involved. Pursuing a diagnosis is the most efficient and cost-effective way for veterinarians to help their patients. When allergies are well managed, anxiety and stress decrease!
References:
- Muller & Kirk’s Small Animal Dermatology. William, Miller, Craig, Griffin, Karen, Campbell. Saunders‐Elsevier, St Louis; 7th Edition, 2013:
- Dryden MW, Canfield MS, Kalosy K et al. Evaluation of fluralaner and afoxolaner treatments to control flea populations, reduce pruritus and minimize dermatologic lesions in naturally infested dogs in private residences in west central Florida USA. Parasit Vectors. 2016;9:365.
- Dryden MW, Canfield MS, Niedfeldt E et al. Evaluation of sarolaner and spinosad oral treatments to eliminate fleas, reduce dermatologic lesions and minimize pruritus in naturally infested dogs in west Central Florida, USA. Parasit Vectors. 2017;10:389.
- Olivry T, Mueller RS, Prélaud P. Criticallyappraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Vet Res. 2015 Aug 28;11:225.
- Mueller RS, Olivry T, Prélaud P. Criticallyappraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats. BMC Vet Res. 2016 Jan 12;12:9.
- Olivry T, Mueller RS. Criticallyappraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats. BMC Vet Res. 2017 Feb 15;13(1):51.
- Mueller RS, Olivry T. Criticallyappraised topic on adverse food reactions of companion animals (4): can we diagnose adverse food reactions in dogs and cats with in vivo or in vitro tests? BMC Vet Res. 2017 Aug 30;13(1):275.
- Olivry T, Mueller RS. Criticallyappraised topic on adverse food reactions of companion animals (5): discrepancies between ingredients and labeling in commercial pet foods. BMC Vet Res. 2018 Jan 22;14(1):24.
- Raditic DM, Remillard RL, Tater KC. ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials J Anim Physiol Anim Nutr (Berl). 2011 Feb;95(1):90-7
- Okuma TA, Hellberg RS. Identification of meat species in pet foods using a real-time polymerase chain reaction (PCR) assay Food Control. 2015 April: 50:9-17.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
This article is brought to you in collaboration with our friends at Zoetis Petcare.ZPC-00378
