When managing patients with skin or intestinal issues, often times, many visits are required to narrow down all factors involved in your pet’s symptoms. Many conditions are secondary to underlying illness which can only be managed, not cured. These secondary conditions must also be treated in order to achieve success of managing all symptoms.

Differential Diagnoses:

Atopy: environmental allergies- seasonal reactions to environmental allergies (pollens/molds/dust mites) resulting in symptoms to include licking paws, itchy skin, rashes, and ear infections. These patients will flare up with symptoms during specific seasons, or exposure to specific irritants (dust mites, detergents)
Food Allergy: Of all allergic dogs, only 20% are actually allergic to proteins in their diet. Dietary intolerance to certain proteins in a diet are most commonly beef, dairy, chicken or pork, rarely grains. Symptoms may range from itchy skin, ear infections that do not seem to resolve, or intestinal intolerances (vomiting or diarrhea). These occur in younger patients, and will persist year round if not properly managed.   Over the counter foods have been found to be contaminated with chicken proteins despite labelling as other protein sources (fish, lamb, etc). Many over the counter “Grain Free” diets use these novel protein sources (fish, lamb) but have been implicated in Dilated Cardiomyopathy, a serious and potentially fatal silent heart disease. These diets may not provide adequate nutrition, and are not recommended.
Bacterial/Malassezia dermatitis: Secondary skin infections due to itching, caused by bacteria, such as Staphylococcus, and yeast.
Otitis Externa/Media: ear infections caused by yeast or bacteria overgrowth within ear canals secondary to allergies
Enteritis: small intestinal diarrhea, likely secondary to intestinal bacterial flora imbalance, from dietary indiscretion or intolerances.
Colitis: inflammation of colon, leading to straining to defecate from diarrhea.
External parasitism:

  • Demodectic Mange: mite parasite overgrowth in the face of immunosuppression from chronic disease, results in moth eaten hair loss, may or may not be itchy
  • Sarcoptic Mange: intensely itchy reaction to a mite infestation of mites burrowing through the skin, results in hair loss especially over feet, face and limbs
  • Fleas/Ticks: these parasites can produce an allergic reaction to their saliva resulting in itchy skin and hot spots

Medications frequently recommended and reasons for use:

1. Antibiotic: Convenia is an injection to treat bacterial skin infection- one injection lasts for 2 weeks and is commonly curative for Staphylococcal infections.
2. Anti-allergy options:

  • Apoquel May be used chronically, or through allergy seasons to prevent flare ups of secondary infections and reduce the itch sensation. Best to reduce inflammation caused by allergic infections.
  • Cytopoint is a monoclonal antibody that tells the body to not react to environmental allergens

3. Anti-diarrheal medications:

  • Metronidazole is an antibiotic against intestinal bacteria such as Clostridium and Campylobacter that can overgrow in the face of stressed intestinal flora.
  • Diagel is an oral anti inflammatory supplement to help cease diarrhea, with pre and pro-biotics
  • Biosponge is a intestinal health supplement designed to help support healthy gastrointestinal function by absorbing toxins and irritants from the intestinal tract
  • Probiotic: Probios- probiotic powder is recommended to replace intestinal flora of diarrhea

5. Oti Pak: long acting lanolin based medication instilled into both ears to treat otitis, and yeast overgrowth
6. Shampoo: Miconazole/chlorhexidine shampoo: anti fungal/ antiseptic shampoo for secondary yeast and bacterial skin infections- may bathe as often as daily to at least twice weekly to control secondary skin infections and overgrowth of yeast when diagnosed with these secondary infections.
7. Antiparasitic treatment Bravecto is recommended to treat possible parasitic causes of skin diseases, 1 chew treats parasites for 3 months, and can cure a demodectic or sarcoptic mange infection.
8. Diet modification: Hydrolyzed diets are manufactured to provide nutrients in a way in which the immune system cannot recognize as an allergen- the size of the proteins in these formulas are not the ideal size for the immune system to bind against. These diets are also formulated with increased pre and probiotics to aid in digestion, as well as fatty acids that reduce inflammation. When feeding these diets, no other treats should be offered, as it may introduce an allergen that your pet cannot tolerate. Prescription formulas are manufactured so that cross contamination from other product lines or unwanted proteins does not occur.