ACCREDITED CPD
Figure 2 - Peri-ocular dermatitis
Figure 3 - Axillae and inguinal regions affected
Figure 4 - Caudal aspect of front paw showing affected skin
become affected. Seborrheic skin disease and secondary bacterial and Malassezia infections may all
contribute to the objectionable odour of atopic dogs.
Non cutaneous clinical signs reported to occur occasionally in atopic dogs include rhinitis, asthma, urinary
and gastrointestinal disorders and cataracts.
Diagnostic approach
Any itchy dog may potentially have CAD, but there
are also many other causes of pruritus. A diagnosis of
CAD can only be made once all other causes of pruritus have been eliminated. This is done by following
a step by step approach to a pruritic dog. It is very important to make a diagnosis as some of the causes of
pruritus, e.g. flea bite dermatitis/allergy, mites and cutaneous adverse food reactions (CAFR) are treatable.
It is very important to explain to the owner of the pruritic dog that you are going to work according to a
plan to find out why their pet is pruritic. It is very easy
to just give a “magic” corticosteroid injection to take
the itch away, but obviously the pruritus will return
again and again until a diagnosis is made and treatment options can be given.
They should understand that it is in the best interest of
ACCREDITED CPD
their pet that a diagnosis is made from the onset and
treated or managed according to the cause. This process usually takes time and the owners and clinician
should not expect a cure in one visit for a problem that
has been going on for months/years. The relationship
should be cooperative and in the long run they will
save money and their pet will benefit.
termine the presence of secondary bacterial and
Malassezia infections on the skin. It is a good
habit to grade these infections at the various sites
from 0 to 4 +. This helps to determine response
to treatment. The presence of the numbers of
eosinophils, neutrophils, monocytes, etc. should
also be recorded and graded.
It is important to take time with the initial dermatological examination, to sit down with the owner and take
a detailed history. Thereafter it helps to hospitalise the
patient for a few hours and do the clinical examination
and in house diagnostic tests when there is more time.
The owners return later and the diagnostic and therapeutic plan is discussed in detail. Follow up examinations can be done in normal 15 minute consultation
slots.
5. Therapeutic trial
At this stage all secondary infections present
should be treated for a minimum of three weeks.
This is necessary in order to determine what
contribution the infections are making towards
the pruritus. Often the lesions will resolve with
this treatment, but not necessarily the pruritus.
Cephalexin at 20 mg/kg BID or amoxicillin-clavulanic acid at 20 mg/kg BID is effective in most
cases. Severe cases of Malassezia are treated with
systemic ketoconazole at 5-10 mg/kg once daily.
In less severe cases topical ketaconazole or chlorhexidine shampoos are