Dermatology in Small

Animal Practice
A practical Approach to Pruritus
and Alopecia in Dogs and Cats
 • Common reason dogs and cats are brought
Pruritus or Itch in for consultation
• Short response to remove irritants =
beneficial
• Chronic and persistent response = Alopecia
skin damage = affects quality of life
 • Manifestations:
Pruritus or Itch • Licking / over grooming [cats]
• Rubbing or rolling
• Biting and chewing
• Scratching
 Pruritus or Itch

CAUSES : PRIMARY OR TO DIAGNOSE AND TREAT

SECONDARY : SYSTEMATIC APPROACH
 Practical Approach
Signalment

History Taking : very important

Physical exam

List of differentials

Collect Samples

Arrive at the diagnosis : Tentative or Definitive diagnosis

 A Detailed History

1 2 3
Take time to ask Have Get copy of
questions questionnaires previous records
ready
What
Questions to Atopic Dermatitis Vs Food
Allergy

Ask Age of Onset

Parasitic
Duration of the
condition Pruritus first then hair loss
/ lesions: Allergy, sarcoptic
mange, Chyyletielosis
Sequence of
Lesions / hair loss first
Events: then pruritus : hormonal
diseases, demodicosis,
primary idiopathic
superficial pyoderma
What
questions to Other Pets in the Household? Are they Also
Pruritic?
Ask Exposure / socialization to other dogs and
cats

Recent boarding? Take to obedience school,

training or groomers? If so, when was the
last time?

These questions helps to understand if the

condition is contagious
What
questions to Is Pruritus Seasonal Vs Year round ? : Atopic Dermatitis Vs Food
Allergy

Ask Has the dog ever had ear problem : common clinical sign of Atopic Dermatitis?

What is the current food; did you make any current diet change
It is important to know in case you need a change of food for
dietary trial

Where does the dog spend time most : outdoor, indoor, both

Describe the environment

Questions
to ask Does the pet swim?

Previous therapy and

response to therapy
• Positive response to
glucocorticoids : Allergies
• Negative response to
glucocorticoids : parasitic
disorders
 General Physical examination

Detailed Dermatologic Examination

Practical • Type of Lesion and its Distribution:
• Caudal Aspect of the body: Flea Bite
Approach : dermatitis
• Ears, feet, face, axilla, abdomen, groins:
Examination atopic dermatitis vs food allergy
• Ears, elbows, hocks, ventrum: Mange
of the Pet • Salivary staining and evidence of self trauma
are indirect evidence of pruritus
• Severity of the lesions or pruritus: helps
Ear in the treatment
Examination: even if theplan
dog isand assess
presented with ear
problem as the chief complain, a complete skin exam
response to treatment
should be performed
…….At this point, So What?!?!

Develop a list of Differential Diagnosis base on

signalment, historical data and examination of the pet
 Differential Diagnosis

Naturally Pruritic Variably Pruritic

Allergy • Otoacariosis
• Atopic Dermatitis • Demodicosis
• Food Allergy • Superficial Pyoderma
• Flea Bite Dermatitis • Dermatophytosis
• Contact Dermatitis • Malassezia dermatitis
Sarcoptic mange • Pemphigus Complex
Collection of
samples
Collection of Close examination for external parasites: [fleas $
Samples: ticks] – coat combing for fleas
Skin scraping
Diagnostic Woods lamp
Tests Skin Cytology
Bacterial Culture $ Sensitivity
 • Food Elimination Trial : gold standard for
Food Allergy
• Therapeutic Trials
• Trichoscopy
Collecting • Fungal Culture
Samples : • Skin Biopsy
• Blood $ Urine test
Diagnostic tests
❖Selection of most appropriate tests will be
based on the most likely causes of pruritus!
Questions??
Practical Approaches
 Atopic Dermatitis
Food Allergy
Primary Flea Bite Allergy
Pruritic / Contact Dermatitis
Pruritic Sarcoptic Mange

Dermatosis Cheyletiellosis
Superficial Pyoderma
Malassezia Dermatitis
 Primary Pruritic: Atopic Dermatitis

History:
✓Age: 1-3 years of age
✓Breed: commonly – shih tzus, terriers, golden retrievers, Labradors
✓Family: stud, bitch, siblings, other ancestral
✓Environment: mainly indoors,
✓Pruritus / Itch: can be seasonal or year round
❑Initially erythema
❑Pruritus come before skin lesion
❑Later: alopecia, lichenification, hyperpigmentation, papules, pustules, crusts
❑Responsive to corticosteroids
 Primary Pruritic: Atopic Dermatitis
• Examination:
✓Distribution of Lesions:
❖Face: periocular, muzzles
❖Feet: Interdigital skin
❖Cranial elbows
❖Ears: ear pinnae, ear canals
affected; ear margins are not
affected
❖Axillae
❖Ventral Abdomen
❖Groin
❖Dorsal Lumbar area not affected
 Primary Pruritic: Atopic Dermatitis

Diagnostic Procedures: Diagnosis by exclusion!

❖ Eliminate other pruritic conditions
❖History $ Clinical signs should be characteristics
 Atopic Dermatitis
Food Allergy
Flea Bite Allergy
Primary
Contact Dermatitis
Pruritic / Sarcoptic Mange
Pruritic Cheyletiellosis
Dermatosis Superficial Pyoderma
Malassezia Dermatitis
 Food Allergy
History:
❖Age: mid age
❖Breed : Any breed ; similar to Atopic Dermatitis
❖Pruritus: Year round
✓Pruritus comes before skin lesions
✓Responsive to glucocorticoids
❖Reports of GI signs
 Food Allergy
Clinical Signs:
❖Distribution Of Lesions: similar to Atopic Dermatitis
✓ Face : periocular, muzzle
✓ Feet – interdigital skin
✓ Cranial elbows
✓ Ears
✓ Axillae
✓ Ventral abdomen
✓ Groin
❖Lesions:
✓ Initially: erythema
✓ Later: alopecia, lichenification, hyperpigmentation, papules, pustules, crusts alopecia
❖GI signs: more than 3 bowel movements per day / soft, unformed stool to watery diarrhea
 Food Allergy
Diagnostic Procedure:
• Food elimination trial – Gold Standard
• Feed commercial novel single protein/carbohydrate diet or hydrolyzed diet exclusively for
10- 12 weeks…
• When the signs subsides or 50% improvement : re-challenge with previous food for 2
weeks
• Exclude all other treats, rawhide, table scraps, chewable flavored medications,
flavored toothpaste

❖Skin and / or serum allergen specific IgE testings are done for the purpose of
developing antigen specific immunotherapy!
 Atopic Dermatitis
Food Allergy
Flea Bite Allergy
Primary Pruritic / Contact Dermatitis
Pruritic Dermatosis Sarcoptic Mange
Cheyletiellosis
Superficial Pyoderma
Malassezia Dermatitis
 Flea Bite Allergy

History:
❖Age : 3- 5, but be of any age
❖Breed: any
❖Pruritus: anytime
❖Concurrent: pruritus and skin lesions
❖Acute self trauma
❖Moderate to severe
❖Responsive to corticosteroids
 Flea Bite Dermatitis

Lesions: Clinical signs:

• Initially: erythematous papules • Distribution of lesions:

• Later: alopecia, excoriation, • Lumbosacral areas
acute moist dermatitis, lesions • Base of tail
associated with secondary • Caudal thighs
infections
• Scrotal area
 Diagnostic procedures:
✓Search for Fleas and /or Flea dirt
Flea bite dermatitis ✓Coat combing
✓Responds to flea control measures
✓Responds to GC
 Atopic Dermatitis
Food Allergy
Flea Bite Allergy
Primary Allergic Contact Dermatitis
Pruritic / Sarcoptic Mange
Pruritic Cheyletiellosis
Dermatosis Superficial Pyoderma
Malassezia Dermatitis
 Allergic Contact Dermatitis

History:
• Any age or breed

Pruritus:
• Any time of the year / year round
• Pruritus and skin lesion occurs simultaneous
• Responsive to corticosteroids
Other facts:
• Plastic Dish or collar
• Beddings
• Chemicals on the flooring
 Contact Allergic Dermatitis

Clinical Signs :
❖ Type of Lesions: erythematous papules, alopecia, lichenification, hyperpigmentation, pustules,
❖ Distribution of Lesions:
✓ Scrotum
✓ Ventral Abdomen
✓ Ventral Interdigital Skin
✓ Can be ears (occurs after a few application of ear drops)
✓ Others
Diagnostic Procedures:
✓ Avoidance of suspected triggers followed by exposure
✓ Patch testing
 Atopic Dermatitis
Food Allergy
Flea Bite Allergy
Primary Allergic Contact Dermatitis
Pruritic / Sarcoptic Mange
Pruritic Cheyletiellosis
Dermatosis Superficial Pyoderma
Malassezia Dermatitis
 Mange : Sarcoptic $ Cheylletiela

History:
• Any Age and Breed
• Pruritus:
✓ Year round
✓ Simultaneous Skin lesion and pruritus
✓ NOT responsive to corticosteroids
• Other Information:
• Contagious: dogs $ people (sarcoptes – rarely cats; chyletiella – cats and rabbits)
• Older Dogs with no previous history of pruritus that suddenly became itchy
• Has been to a dog show, boarded, dog parks, grooming salons, etc
 Mange: Sarcoptic $ Chelytiellosis

Clinical Signs
❖Type of Lesions:
✓ Erythema, papules, scales, crusts, alopecia, excoriation, lichenification, hyperpigmentation
✓ Dog is continuously pruritic / itchy

❖ Distribution of Lesions:
✓ ear margins, elbows, hocks, Ventral abdomen, ventral chest;
Chelytiellosis : along the dorsum

✓Reports that people in household may be also itchy

 Mange: Sarcoptic $ Chelytiellosis

Diagnostic Procedure:
❖ Multiple Skin Scrapping : demonstration of the parasite / eggs
✓Usually the margins of the pinna; pinnal-pedal reflex
✓Multiple skin scrapings
✓Parasiticidal trial
 Summary

History
❖Pruritus:
✓ Seasonality : helps differentiates food allergy Vs atopic dermatitis
✓ Sequence of events : helps differentiates allergic or parasitic vs other common dermatoses
✓ Distribution of lesions: helps create differentials
❖Other Historical Facts:
✓ Response the previous treatments i.e corticosteroid : Allergic Vs Parasitic Vs Infectious
✓ Contagious : Allergic Vs parasitic
 Summary

Diagnostic Procedure:
❖ Tailored for most likely differentials
❖Can be definitive or helps rule out other possible causes / diseases

DIAGNOSIS: Detailed History + Thorough Physical Examination + Appropriate Diagnostic

test
Questions :
Pruritic
Dermatoses
 Canine
Demodicosis
Inflammatory Skin Disorder
 Presence of more number
of demodex mites causing
skin inflammation
Canine
demodicosis Dogs have Demodex –
specific T-cell dysfunction
of specific degree
Canine Demodicosis
• Age of Onset : Juvinile or Adult Onset
• Extent of Lesions : Localized or Generalized

❖ Pruritus not typically present but may develop due to 2ndary skin
infections or concurrent allergies
❖General health status to determine underlying disease condition or
stress factors
❖Aggravating factors: Poor nutrition, endoparasites, debilitating diseases,
debilitating diseases, stress, estrus
Canine demodicosis
• Age of Onset:
❖ Juvinile: 3-18 months
✓ mostly less than 1 year of age
✓ It is inherited
✓ Generalized or localized
✓ Localized = most cases resolve spontaneously
✓ Can be due to immature immune system / demodex-specific T-cell
dysfunction

❖ Adult onset : >/= 4 years of age

✓ Associated with systemic disorders or use of immunosuppressive drugs i.e
GC, cyclosporine, oclacitinib therapy; hyperparathyroidism, hypothyroidism
Canine demodicosis

• Extent of Lesions:
❖ Localized:
✓Few lesions = small alopecic areas with erythema and scales
✓Usually face and limbs but also sometimes body trunks
✓Juvenile-onset resolves spontaneously
Canine demodicosis

• Generalized: involves large areas of the body

❖ Paws are affected / Pododemodicosis
❖Most cases do not resolve spontaneously
Canine demodicosis

• History
• Clinical signs
• Diagnostic tests:
❖Skin scrapings: Gold standard
❖Tricoscopy
❖Acetate tape Impression
❖Cytology of exudates
❖Skin Biopsy

❑ other tests to address underlying conditions

Canine Demodicosis: Skin Scrapings

• GOLD STANDARD
• Demodex mites are easy to find with correct / proper skin scrapping procedure

• Skin scraping: Proper procedure:

✓Place mineral oil on the blade or skin
✓Fold and squeeze the skin
✓Scrape until capillary bleeding is obtained
✓Perform multiple extensive scapings avoiding areas of draining tracts
Canine Demodicosis: Treatment

• Amitraz dip
• Moxidectine + Imidacloprid spot On ( Advocate)
✓Weekly to Bi-weekly applications
✓Better results with weekly doses and mild cases
✓Do not shampoo the dog for 48 hours before or after application
✓None reported side effects
✓Can be used once a month to prevent relapse
Canine Demodicosis: Treatment

• Adult-Onset Demodicosis: influenced by whether underlying disease can

be identified and controlled or resolved

• KEYS TO KEEP IN MIND:

❖Treat for 30 days past 2 consecutive negative skin scrapings
❖FF-up patient for 1 year before declaring cure
❖Treat secondary skin infections and control underlying diseases
❖Most common cause of re-currence is pre-mature treatment
interruption
Canine Demodicosis : Client Education

• Manages client expectation

• Do not Breed dogs with condition
• Reco to Spay and neuter affected dogs
• Adult onset demodicosis requires screening for underlying disease condition
• It may take months to more than 1 year to obtain 2 consecutive negative skin
scrapings
• Life time treatment in cases
• NOT contagious; NOT primarily pruritic
QUESTIONS
THANK YOU
Olga Lago, DVM