Highlights from Dermatology & Our Pets: Vet Advice on Common Skin Conditions, Such as Allergies and Ear Infections

Allergic Symptoms in Dogs and Cats

Scratching is typically the first symptom we think about with allergies. For dogs, if they scratch toward the back portion of their body, it could be fleas. With dogs that have red paws, itchy ears, or a red face, the allergy might be environmental.

Short coated dogs can have lesions that look like small areas of hair loss with scales. With bacterial infections, short coated dogs have patches of skin loss.

With long coated dogs, dry, flaky skin can be an active skin infection. You must part the hair to get a closer look at the skin.

Recurring ear infections are also common with dogs. They range from mild to very severe with a lot of bacteria and inflamed ears. Ear infections are associated more commonly with food allergies or bacterial infections rather than fleas.

With cats, they can lick and chew their feet just like dogs. Cats can also have ear infections. This is often the only physical manifestation of an allergy.

Diagnostic Plans and Treatment

You always want to rule out other causes, and then treat for secondary infections. Treating secondary infections will often help alleviate allergic reactions.  A skin scrape is usually the first diagnostic test. A skin scrape can diagnose mites, either scabies or demodex mites. Scabies are contagious and difficult to see in a skin scrape while demodex mites are not contagious.

Another test your vet could utilize is a flea comb to look for flea dirt that would indicate your pet has fleas. A trichogram can be used to examine cat hair and determine whether cats are overgrooming which can indicate an allergy. A Woods lamp also helps rule out ringworm, as well as a ringworm culture. A skin or ear cytology helps determine if there’s yeast or bacteria overgrowth.

Bacterial Skin Infections

Antibiotic resistance does occur. With a skin infection, you’ll want to have your pet on a minimum of three weeks on an antibiotic treatment. Previous antibiotic treatment does increase the risk of resistance. If your pet does not respond to treatment appropriately, your veterinarian will want to prescribe a different antibiotic.

Ear infections

There’s always an underlying cause for recurring ear infections, such as a food hypersensitivity or flea allergies. Chronic ear infections can result in your pet needing ear surgery so it’s best to seek treatment early to avoid surgery.

A young ginger tabby cat on the wooden floor.

Allergies or Atopic Dermatitis

The immune system overresponds to allergens such as indoor or outdoor allergens and food sensitivities. Allergy patients tend to have a different skin barrier that allows them to absorb allergens more than dogs without allergies.

Food hypersensitivity can look identical to environmental allergies but are not seasonal. It can occur at any age and is usually not associated with a change in diet. The dog must eat the same food for 1-3 years before developing sensitivities. An elimination diet is the best way to determine a food sensitivity because, unfortunately, allergy testing still is not accurate for food sensitivities.

84% of atopic dermatitis in dogs is mostly indoor while 24% is seasonal. Allergy testing can be used to identify the offending allergens.

Symptomatic Therapy: Antihistamines

Antihistamines can be effective in very mild cases. These don’t typically help for really allergic dogs and cats, and they don’t work right away. They usually take several weeks in order to provide relief.

Symptomatic Therapy: Steroids

Steroids work very quickly but over time lose effectiveness, and there is an increased risk of side effects like Cushing’s disease and diabetes. Therefore, steroids are safest in most patients for short term use at the lowest possible dose.

Symptomatic therapy: Apoquel/Cytopoint

Each medication blocks one mediator in the itch pathway. They are not a steroid and can provide immediate relief. Apoquel is not as specific as its target so there is a contraindication in the label with a history of cancer or severe infections. The advantage to both medications is that they don’t interfere with intradermal allergy testing. It is important to remember that neither of these medications should be a replacement for diagnostics such as a skin scrape.

Atopic Dermatitis

In the past, treatment to atopic dermatitis has been reactive. However, it requires an integrated approach. There is no quick “cure” for allergies, so you must find the safest long-term plan. This often requires pet parents to seek out a specialist to identify short-term and long-term goals. Allergies typically get worse every year, so a plan going forward is needed to keep the reaction under control.

Allergen specific immunotherapy is the only treatment option that does not suppress the immune system and can provide long term management. Intradermal skin testing tends to be the most accurate versus blood testing because it is more specific.

Allergy testing can be done in both dogs and cats. Most are a combination of grasses, weeds, trees, and molds. Unfortunately, you can’t completely avoid these allergens. The allergy serum is formulated and will be specific to each patient.  This is the safest, most affordable option for long-term management, especially if the pet has a history of cancer or some other underlying disease.

Dr. Brown’s Responses to Unanswered Questions from Class

Should you blow-dry the dog if you are bathing them daily due to allergies and using medicated shampooing?

I would say, it’s fine to blow-dry if they will tolerate it. But I wouldn’t use high heat to avoid excess itching.

What shampoo can I use with my cats to help with their itch as they over groom?

I would suggest any type of oatmeal or medicated shampoo, if it’s labeled safe for cats. Always, investigate the underlying cause if both cats are itching. Be sure they are on flea control to remove any external parasites as well!

What about allergies and continuing anal gland issues? I’ve had several dogs with allergies, and they all have seemed to get very full anal glands quite quickly. Is there a connection, and is there anything we can do to help the anal glands specifically?

Anal glands could potentially be related, because if the skin is inflamed, the anal glands could also be inflamed. If the pet is scooting or licking the area often, it could stimulate the area. I would recommend an allergy work-up to determine the cause.

I’m curious how allergies tie in to SLO (symmetrical lupoid onychodystrophy). My mother’s Greyhound has it, and I’m wondering if environmental or food allergies that are untreated can be a contributing cause to his SLO flares (which result in him losing a nail at random).

There have been some cases of SLO that have been related to food hyper-sensitivity, but that is not always the case. Many dogs have SLO with no underlying primary factors. Greyhounds are predisposed to this disease and will require, to some extent, lifelong therapy such as pentoxifylline or doxycycline /niacinamide. Fatty acid and Vitamin E supplementation may also be helpful if the patient continues to have problems. On these meds, you can also consider a food trial.

Is there a copy of this webinar for notes?

We will have the recording available for today’s session on this same website (hfu.hollywoodfeed.com) by next week.

My dog has ear infections, hot spots, warts on the paws. I recently got her tested for allergies, and she is allergic to EVERYTHING. What do you suggest for long term feedings? I have gone to preparing my dog meals. She is an American bulldog.

Many dermatologists feel like a homecooked diet is the best option to eliminate food hypersensitivity. I would contact a board-certified nutritionist to design a diet specifically for your pet if homecooked meals will be fed long term. This is to ensure the diet consists of the proper balance of vitamins and nutrients that your dog needs.

Is it dangerous to give hemp oil to my senior dog?

I would need to know more about this pet. I wouldn’t feel comfortable making a recommendation without knowing more about this pet & their needs.

My 10-year-old Yorkie has developed what the vet called papilloma.  She recently had an ear infection and after the treatment, she got these places all on her spine (primarily).

Multiple types of masses can occur as pets get older, some are benign and cosmetic – while others can be more serious. We usually recommend a fine needle aspirate and cytological review and removal if indicated.

Any information on tear staining? Our dog does not itch, and ears are fine but lots of tear staining.

This is a common problem in certain breeds. This may be a better question for a veterinary ophthalmologist.

In your profession, have you noticed general care vets turning to Apoquel and Cytopoint to just “treat the symptoms” instead of actually trying to determine the cause of it? I hear this a lot and have experienced with my own dog. I have been to multiple vets in different cities, and I always just get a prescription for Apoquel every single time, no matter the problem, with no care or explanation as to what it could be.

I think the veterinarian’s goal is to make your pet feel more comfortable. However, those things don’t treat the underlying problems. So it is important to do skin scrapings & cytologies.

Is a mouth swab allergy test accurate?

We do not believe mouth swabs or hair allergy tests are accurate currently.

Does Hollywood Feed have a natural product that includes vitamins, minerals, herbs & supplements like others you see on TV (that you sprinkle on their food) that work well in slowing the itching & really helping with their bones & tendons where they can walk & get around better?

Prudence Immune Health and Prudence Hip & Joint both contain natural ingredients including vitamins, minerals, and herbs. We see fantastic results from both of these supplements.

We have a topical itch relief spray with lidocaine. Is this safe to use on paws, if the dog is prone to licking their paws?

Lidocaine and other topical anesthetics such as Pramoxine are safe to use topically, but they may not be enough to reduce the itch.

With the scooting of the butt on the rug, what do you suggest for ease of comfort?

I would recommend following up with your vet. Consider these questions: Do the anal glands need to be expressed, and is the area itchy due to yeast or bacteria that might need to be treated?

My dog was tested at Dr. Brown’s office, but it’s been 2+ years since he has been on the vaccine, can he resume without retesting?

If we were doing well on immunotherapy before, we may not need to retest in order to resume the serum. We understand life happens, and it’s hard to follow up with the treatment long term. If the serum was discontinued because you feel like it wasn’t working, we can repeat allergy testing to identify new allergens. Contact Dr. Brown’s office for options!

I have a papillon that was diagnosed with PLE 4 years ago and has developed allergies and chronic ear infections more and more in the last couple of years. Most recently we used a different ear drop with an infection and she went deaf. She can’t really stomach steroids anymore and we’ve tried the Cytopoint shots. Do you have any recommendations and anything at all that might bring her hearing back as well as good shampoos or topicals to use during skin infections and itchiness?

More than likely the ear infections & skin infections are due to allergies. Even with PLE, you could pursue an allergy work-up such as intradermal testing. That would be a safe option with the current medications. Without knowing more about the medication used for her ears, I can’t comment on regaining hearing. There is a hearing test, but I would start with an Otic Exam.

What is a good shampoo to use?

If they are prone to skin infections, I would suggest a medicated shampoo. If not, a general shampoo labeled for pets would be fine to use.

I have a Shepherd Corgi mix with hot spots, dark skin spots, and crusty areas. Is fish-based food the best to change to? He is on Just 6 (turkey formula), and he is hypersensitive at springtime. Also, he has paws that lose hair and are itchy. He sneezes and does this weird cat cough. Vet keeps saying its allergies and we tried Apoquel. He responded badly to it after 3 weeks on it, with aggressive tendencies. He has been trained; the medication just made him unruly, so we took him off, and he’s back to normal).

I agree that you have some level of environmental allergies because you’ve noticed seasonal flares. It sounds like he has an active skin infection with the crust and dark spots. This may be why other symptomatic therapies have not helped. It’s a rare side effect, but I have had patients have changes in their behavior while taking Apoquel.

What should I look in a medicated shampoo and conditioner or sprays?

For medicated shampoos, I often use a 3-4% chlorhexidine. For a lower concentration of chlorhexidine mixed with an antifungal such as miconazole. Some pets can be hypersensitive to chlorhexidine. In those cases, I might use a benzoyl peroxide product for antibacterial properties.

I have a light golden who has significant bronzing on the cheeks, under ears, tail and paws but does not scratch nor lick. He does also have significant dark brown almost black goopy debris in the ears that I clean out frequently.   Anything else that can cause this bronzing? Is ear and skin cytology the best first step?

I would say ear & skin cytology is the best first step. It sounds like you may have mild allergies. Some patients that are very low level of itch and frequently lick can have significant bronzing, and others that lick their feet all the time can have no bronzing. For the ears, your pet may be making excess waxy debris, but if you don’t have an ear infection associated with it, continuing to use an ear cleanser to remove excess debris is a good idea.

My baby is on Cytopoint and Ketoconazole. What are some great topical items? My dog gets super smelly, like rancid smelly. We are bathing 2-3x a week.  There’s a waxy build up on the skin, and you can see it washing away. Baths sometimes relieve the itch and the stink and waxy build up can be back within a day. No ear infections, itch on the face, sides and paws, loss of hair at the paws and around the eyes. What does the waxy build up and smell tell you?

The waxy build up and smell tells me that the glands of the skin are inflamed and overproducing substances. We often see this with allergy patients. You are doing a good job with topical therapy. And I would use the medicated shampoo twice a week up to every other day. Treatment of the underlying allergy such as allergy testing and desensitization may help the problem more than Cytopoint. Cytopoint only helps the itch associated with the allergy.

I have a Husky about 1 and 12 years old and a small Chihuahua. The small dog licks the ear of the husky, and the husky has developed a reoccurring ear infection. What do we do?

The dog that is licking the other dog’s ear is not a primary cause. The husky is presenting signs of ear infections, but the infections are not being caused by the other dog.

Can i give my dog Apoquel and Zyrtec in the same day?

You can give these medications together.

Our dog (5 yrs) seems to have seasonal allergies – late summer fall itchiness started at 2 years old.  Two years she’s had minor skin infections between toes and abdomen.  Have cleared up with antibiotics from the vet.  Her allergies are fairly “under control” between using a prescription medicated shampoo weekly or more on feet and Benadryl all fall season. We start that when she begins itching in July and August and stop it usually in November.  We live in Iowa so with fall season she still is itching but this year and last is not developing skin infections or more severe things that we can tell.  Would you recommend keeping this approach as long as she isn’t severely symptomatic (still feel bad for her with itchiness) or is it worth trying one of the newer allergy medicines?  Not sure if it’s worth the potential side effects or unknown risks since they are “newer”.

I think you’re doing a great job managing her allergies with topical therapy and antihistamines. It sounds like the allergies are still mild. If she has an acute flare up and is uncomfortable, it’s not wrong to reach for new medications and therapies. If her allergies escalate and you’re having to get these medications on a regular basis, I would contact a local dermatologist for a work-up.

Since I’ve had blood allergy panel and still having issues mentioned above that you addressed, should we have intradermal test to get more specific?

If you have had the blood allergy panel and immunotherapy was not helpful, I would consult with vet to see if intradermal allergy testing would be your next step.

How often can I give Chlorpheniramine on a daily basis? The bottle says 2 – 3 times a day but I have heard long term it can cause organ issues. Also, how long does it take to start working?

We think that antihistamines are safe 2-3x times a day. We usually recommend giving these medications up to 2 weeks to determine if it’s beneficial or not.

If a dog has chronic yeast infections, ears or skin, will a low glycemic diet be beneficial E.g. raw frozen, Zignature or Country Naturals LID?

There is not a correlation between glycemic index and yeast overgrowth. I would focus more on avoiding any potential food hypersensitivity.

The cat I have was feral and has now become a pet. She has anxiety but now has bumps on her neck and is losing fur. All my cats are on flea, lice and mite meds. We tried changing her diet, but nothing has help. We can’t get her to a vet because she will not get in a carrier. I also cannot get a vet to do home visits. Do you have any advice of what meds to try or food to give?

If all the cats are on good flea control, it’s likely that you do have food hypersensitivity or environmental allergies. You can try an elimination diet with novel proteins. If you tried this in the past, it’s likely environmental. I would continue trying to look for more home veterinarians.

My dog has what the vet calls warts. Do they need to be removed or how can I treat them when they open? He has them on his feet, back, and neck.

If the skin masses are benign, they do not need to be removed. But if they are bothering your pet and becoming itchy or bleeding, they may be removed by something like a punch biopsy or a surgical removal.

EFAs and fish oils are recommended for skin and coat health.  With the warnings of heavy metal toxins, how do we choose a safe supplement?

Look for essential fatty acid supplements that are available for pets.

Would you suggest Betadine or Eqyss Antimocrobial shampoo for a regular weekly washing?

I would have to know the percentage of betadine to be sure it wouldn’t irritate the skin. I am not familiar with Eqyss. It seems like it’s formulated for horses. If this is for a cat or dog, you would need something that is formulated for them.

What is your biggest struggle when it comes to food elimination trials? What suggestions do you have that may help ensure owner and patient compliance?

One of the biggest struggles is if the patient is on oral medication and finding ways to give the meds using a treat that does not go against the trial. Also, making sure that everyone in the household is on board with the food trial.

Have you seen a correlation between dogs with atopic dermatitis with over-stimulated immune systems who have also been over-vaccinated (i.e. more than what’s recommended by AAHA protocols)?

I have not seen a correlation between these two things.

What is your opinion on Dinovite?

I don’t have a lot of experience with it. I have had some clients report to me that it didn’t work well for them, but that may be because those were extreme patients.

Which topical anti-itch medications do you recommend? I’ve been tempted to use hydrocortisone cream or betamethasone cream, but I’m afraid my pets will lick it off. Also, which medicated shampoos can help eliminate itching? Dogs are already on Apoquel and Zyrtec.

We do routinely use topical steroids, and minimal ingestion is usually okay. I would start with hydrocortisone. I would use sparingly on areas where the skin is thin like the abdomen.

Are Bichons predisposed to environmental allergies? What about food allergies?

Yes, this breed is definitely predisposed to environmental allergies. Food allergies are common, too.

How long should you keep your dog on Apoquel?

We use this medication to keep patients comfortable, but I would avoid chronic, yearlong usage of the medication.

Which non-prescription topicals do you recommend?

There are some over the counter promaxine containing and hydrocortisone containing topicals that could be used to spot treat those areas. However, speak to your primary veterinarian first.

What medicines are in “medicated” shampoo that help with infection resolution and itching?

 Most common antibacterial agents are chlorhexidine and benzoyl peroxide. For yeast, it’s miconazole. There are other meds that work by changing PH of the skin that help keep bacteria & yeast growth minimal.

Do you believe early weaning for a puppy can cause allergy symptoms later in life due to not receiving enough mother’s milk? In Memphis, we see a ton of bully breeds that were weaned and sold too soon. We almost always deal with itchiness and sensitivities as the puppy grows into adulthood.

I don’t know if there is any consensus on how age of weaning affects predisposition. However, bully breeds, especially in Memphis, are often predisposed to allergies.

One of my cats chews the fur on his legs and tummy. There is no redness on his skin. Is it allergies or stress?

More than likely allergies.

What kind of flea prevention works best?

This is individualized based on the pet and the household. I would need more information.

Will supplements for skin, like Omegas, help the skin defend better against allergens?

There are some studies that show that it can help provide anti-inflammatory mediators. However, in very severe allergies it may not be enough to completely alleviate a problem.

 

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