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I will commonly hear from clients that their dog use to be seasonally itchy and now it is year round itchy. The occasional seasonal problem use to not be a big deal and now things are out of control with the skin. Why is this happening?
Here are somethings that could be occurring:
1- It is possible the dog has a secondary bacterial and/or yeast infection that may have developed during its allergy season that has carried through into the non season. It’s the infection that is keeping the pet itchy now. Do skin cytology!
2- It is possible the pet’s environmental allergy has now become year round, so a worsening of the allergy. If let’s say this pet was managed with Cytopoint just during its season it may now need Cytopoint more often.
3- The pet may have developed a new allergy. Always check the pet is on good flea prevention. Otherwise, consider food allergy and start a diet trial.
4- Let’s not get tunnel vision and just thinks it’s all about allergies. If all the above have been ruled out then consider other skin disorders. Mites? Epitheliotropic lymphoma? Etc Etc.
I post a lot on dog ear problems, but cats can also get ear infections. Ear infections in cats are not common. When present it is important to look for primary causes like ear mites or mass effects like polyps and tumors, the latter two would cause unilateral ear problem. This video is of a 10 year old FS cat who presented for significant pruritus of the ears and bilateral otitis. Therapies the referring had tried were not working and she was referred for evaluation of polyp in the ear. I used video otoscopy to show the owner that this was not a simple polyp problem, the disease was much more extensive. The ear canal of both ears was obliterated by these nodular growths which may possibly be ceruminous cystomatosis. These growths have occluded the ear canal and led to secondary bacterial infection. The ear infection will not resolve until these growths are removed through either laser or surgery.
This is a 6-year-old male Labrador that I recently saw with severe pododermatitis and several draining tract lesions on its body.
Please take note that lesions like these are indicative of a deep infection.
This patient had been on and off antibiotics without resolution and worsening as the weeks went by.
When a patient is presented to me with these types of lesions and a long medical history of antibiotic use, cultures of the skin are necessary. In this pet, I did not want to blindly guess on an antibiotic that would or would not work.
Culture! Culture!
For this pet, we proceeded with skin cultures. Since the infection was deep, I took biopsies of the skin and submitted the infected tissue to the lab for analysis.
The cultures of the skin grew a methicillin resistant staphylococcus infection, or MRSP.
Deep infections require minimum 6-8 weeks of antibiotics. This is minimum, so it may be longer.
Do not forget to look for the underlying cause!
I also took tissue biopsies for pathology. Anytime I see severe pododermatitis like this I want to rule out demodex, and this pet had not been on any flea preventative like an isoxazoline. It is hard to do skin scrapes on inflamed paws like this and therefore biopsies are necessary. No mites seen on biopsy.
Cause- likely allergies to food or environmentals. It is hard to believe that an allergy can cause a pet to get this bad, but it can when you have severe secondary infection. Sometimes the infection can be worse than the disease!
I wanted to share with you a unique case of Nodular Dermatofibrosis.
This is an 8-year-old M/N Mixed breed dog that for the last 4 years has had these growths throughout its entire body. On exam, dozens of these growths were on the head, trunk, and extremities.
Closer look you can see that these growths were raised firm cutaneous nodules of varying sizes. On the dorsal trunk the growths caused the hairs to tuft up that from a distance “appeared” as hives. This begs the importance of parting the hair and looking to see what is under those raised tufts of hair.
When I saw these growths, I knew it was time to biopsy. Biopsies were sent to a dermatopathologist, Dr. Karen Trainor, @innovativevetpath. The biopsies revealed nodular dermatofibrosis.
This is a rare skin disease where collagenous type of skin growths appear on the skin as a manifestation of internal disease or paraneoplastic syndrome. Nodular dermatofibrosis has been associated with renal (kidney) cysts, cystadenomas, or cystadenocarcinomas. In female dogs, it has been associated with uterine leiomyomas.
This condition is primarily seen in German Shepherd dogs and may have a hereditary component, however, there are reports of this condition occurring in other breeds.
If you diagnose this skin disease, it should warrant evaluation of the kidneys thru bloodwork and ultrasound.
This case highlights that diseases that are typically seen in a certain breed of dog, can still occur in other breeds. Also, I like to point out the importance of a dermatopathologist reading skin biopsies, as they are able to assess these rare skin conditions.
Who has seen this condition before in a non-German Shepherd breed?
Lateral ear resection is a surgery where the lateral wall of the vertical ear canal is removed. Veterinarians once thought that removal of this part of the ear in a pet with ear infections would make it easier to treat the patient’s ear. If done properly, it allowed easier access to the horizontal ear canal for application of topical ear medication. However, if the horizontal part of the ear canal is diseased, stenotic/closed/scarred ear canal, then a lateral ear resection does not help the patient because topical medication still cannot get thru a closed ear canal.
Since allergies are the most common cause for a dog’s ear infection, the chronic changes that affect the vertical ear canal will also extend to the horizontal ear canal. With that said, lateral ear surgery does not resolve the primary cause, the allergy, which is affecting the ear. The pet will keep having ear infections even with this surgery.
Lateral ear resection makes sense if there is a growth in the vertical part of the ear canal blocking the ear. However, it is important to make sure the rest of the ear canal is normal, possibly using imaging like CT or MRI.
There is thought that this procedure may help some dogs if done early before there has been chronic changes to the ear canal or in breeds like Shar-pei’s that have stenotic vertical canal.
I graduated from vet school 22 years ago and learned about this surgery to help with otitis cases. The surgery has since fallen out of favor as most dogs with chronic changes to their ears, which cannot be managed medically anymore, they need a total ear canal ablation surgery.
If the allergy is addressed early before chronic changes develop in the ear, we can avoid any kind of surgery to the ear.
Let’s save these ears my fellow colleagues!!
I would love to hear if anyone has had success with lateral ear resection surgery for otitis cases.
It is rare that a cat that is over grooming and pulling out its hair has an anxiety or stress disorder.
The barbs on a cat’s tongue can cause an incredible amount of damage on the skin with over grooming and look like the cat in this video.
It is important to work up the cat patient for medical causes for the itchiness: mites, dermatophyte (causes occasional itchiness) and allergies ( flea, food and environmental).
A trial course with an isoxazoline is a good start as it rules out mites and fleas.
And yes! even an indoor cat can get fleas. Finding a flea on a cat can be difficult because due to their over grooming the flea gets eaten up. Flea preventative is a must in your work up of a pruritic cat.
Unilateral otitis- look for a growth in the ear canal. This growth ended up being a polyp.
The eosinophilic plaque is a cutaneous reaction pattern commonly seen in cats with allergies to either flea, food or environmentals. It is commonly seen on the flanks, ventral abdomen, and thighs. These lesions can be extremely pruritic.
The eosinophilic plaque is part of the eosinophilic granuloma complex, that also includes the eosinophilic granuloma and indolent ulcer. A cat can present with 2 or 3 of these lesions at the same time.
I encourage general practitioners to do cytology of these lesions as they will often have bacteria. You may be surprised how a course of antibiotics will aid in the resolution of these lesions. I have had case referral that were only treated with steroids and had no resolution to the lesions due to the secondary bacterial infection.
Cats with skin lesions should also have skin cytology done just like dogs.
The ventral aspect of the paw is a common area affected by allergies. A client may say that their dog flips its paw over and licks and chews the bottom of the paw.
When examining a pet with these signs make sure to check this area of the paw well: turn the paw over and separate the digits. You may find erythema and greasy like debris. Make sure to do cytology to look for bacterial and malassezia organisms. I find it easier to do tape cytology as I can get the tape well into this space.
I like to treat these paws with an antimicrobial shampoo. I emphasize to the client the importance of getting the shampoo well on the undersurface of the paw to remove any debris, grime and pollens that are acting as an irritant.
I like to say paw baths are better than paw soaks. Meaning the client needs to get that shampoo well into every little space of the paw than just soak the paw in a bowl of shampoo and water.
Let me know what you think.
