The following is a plan to both eliminate pruritus and determine its cause in most cases. An article utilizing an older version of this chart by example is entitled "Itchy Dog, Head to Toe, Year Round", Vet Forum, 7/97 and is available at http://www.dermapet.com Small Animal Ear Diseases: An Illustrated Guide by Lou Gotthelf, Saunders, 2000, has a chapter "Diagnosis and Treatment od Pruritic Ear Diseases" also available at the web site.
1. Shampoo Therapy: Shampoo daily with a hypoallergenic shampoo. Removal of the offending antigen from the coat is fundamental. If a pyoderma, use MalAcetic Shampoo or MalAcetic Conditioner or MalAcetic Wet Wipes/Dry Bath twice weekly. If pruritus is severe, then use an oatmeal shampoo instead of the hypoallergenic. After bathing (or on a dry animal), use a leave-on oatmeal conditioner.
2. Prescribe an omega-3 and omega-6 fatty acid supplement, preferably with antioxidants. Our OFA cap has the right proportion of fatty acids with zinc, garlic and Vitamins C and E. Even if this fails to reduce the pruritus; it should leave the coat shiny.
3. Follow a strict hypoallergenic diet for 30 days. Home-cooked, all vegetable, turkey, or lamb diet with rice-is preferable. A copy of a home cooked diet is available in "Food Allergy" a chapter by Kevin Byrne in Skin Diseases of Dogs and Cats, Melman, DermaPet and "Diagnosis and Treatment of Pruritic Ear Diseases", a chapter in Small Animal Ear Diseases: An Illustrated Guide by Lou Gotthelf, Saunders, 2000. The latter chapter is available at our website http://www.dermapet.com
4. Low-dose, short-acting corticosteroid use. It is important to stop corticosteroids at 10-12 days and not restart them until the trial is over.
5. Antibiotics are only used if a pyoderma is present. (cephalexin 10mg/#/BID/21d)
6. Treat phantom endoparasites with an anthelminthic that also targets whipworms
7. Treat ectoparasites (Scabies and fleas). Begin a flea-control program. Since frequent bathing is recommended, a compound that is supposedly not washed off or neutralized by shampooing, such as fipronil or imidicloprid, is preferable. The advent of selamectin (Revolution) affords the clinician a single treatment to eliminate fleas and scabies. Some may still wish to use lvomec (ivermectin) 0.1 ml/10lb weekly for four weeks. The extralabel use of this drug requires informed consent of the client
8. Treat Malassezia: MalAcetic Shampoo every other day, MalAcetic Wet Wipes and/or Conditioner every day. Use antibiotics for concurrent pyoderma. Please see the previous email on a 3-phase plan toward treating Malassezia dermatitis.
Discussion:
The key is to not stop two treatments at any one time. If you stop the prednisone and antibiotics and/or food elimination on the same day, it is impossible to make an evaluation based on either failure or success.
Inhalant allergy requiring hyposensitization is the conclusion when pruritus resumes after stopping the prednisone. This is not to say that su`clinical forms may exist which are not pruritic as a result of various reasons including stopping the itch-scratch-itch cycle with prednisone, OFA caps and/or shampoo therapy.
Since this is often a trial to prove a dog has inhalant allergy and some allergy tests are interfered with by corticosteroids, taking blood and "banking" serum is recommended.
Some dermatologists recommend using antihistamines in other trials. This is not recommended in my trial as they are not effective often enough to eliminate any diagnosis. After a diagnosis of inhalant allergy is made then they can be utilized on a trial and error basis.
Ivermectin is still considered my favorite anti-scabicide although it is extra-label. However, the introduction of selamectin (Revolution) with a label claim for scabies enables clinicians to eliminate ectoparasites with one application.
| Steven Melman VMD DermaPet Animal Dermatology and Behavior Clinics Potomac, MD 20854 |
dermapet@aol.com http://www.dermapet.com 800-755-4738 fax 301-365-0191 |
8909 Iverleigh Court 
Potomac, Maryland 20854
301-983-8387 800-755-4738 Fax 301-365-0191
E-mail dermapet@aol.com