Veterinary Medicine - October 2008 - (Page P5)

Canine pruritus: Diagnostic approach to the pruritic dog Infectious dermatoses 1. Rule out scabies by history, physical examination, negative skin scraping, and a lack of response to treatment: • Selamectin at initial examination; repeat 30 days after - Oﬀ label alternatives: Ivermectin—three treatments at 14-day intervals; lime sulfur—three treatments at 14-day intervals; ﬁpronil spray—three treatments at 14-day intervals; milbemycin; organophosphate rinses • Treat all in-contact dogs. 2. Rule out Malassezia colonization with physical examination, cutaneous cytology, and lack of response to treatment: • Ketoconazole 10 mg/kg every day for 30 days - Alternatives: itraconazole, ﬂuconazole or terbeniﬁne • Antifungal shampoo—PRN, 10 minutes of contact time (chlorhexidine, miconazole, ketoconazole, selenium) • Leave-on rinse (25% vinegar, miconazole, ketoconazole). 3. Rule out Staphylococcus colonization with physical examination, cutaneous cytology, and lack of response to treatment: • Identify and treat the underlying cause - Skin scrape to rule out demodicosis - Check thyroid status - Weight loss if infection involves intertriginous areas • Systemic antibiotic for minimum of 14 days for superﬁcial infections - Cefovecin, cefpodoxime, cephalexin, clindamycin, lincomycin, ormetoprim/sulfadimethoxine • Antibacterial shampoo-PRN, 10 minutes of contact time (benzoyl peroxide, ethyl lactate, chlorhexidine, triclosan). Allergic dermatoses 4. Rule out ﬂea bite hypersensitivity with history, physical examination, identiﬁcation of ﬂeas, ﬂea feces, and intradermal test with ﬂea allergen: • Treat or prevent ﬂeas - Selamectin, ﬁpronil, imidacloprid, or other adulticide • Treat secondary infections with antibiotics or anti-yeast products • Treat pruritus with a short course of corticosteroids. 5. Rule out an adverse reaction to foods with history, physical examination, and a minimum of one month of a novel protein and carbohydrate diet trial. 6. Diagnose atopic dermatitis with history, physical examination, positive response to treatment with corticosteroids, and exclusion of all other causes of pruritus: • Treat with safe doses of corticosteroids • Control infections • Try antihistamines, omega-3 fatty acids or cyclosporine • Intradermal test or allergen-speciﬁc IgE serology to select allergens for allergen-speciﬁc immunotherapy. SPONSORED BY PFIZER ANIMAL HEALTH 5

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Veterinary Medicine - October 2008 Contents Leading Off Clinical Exposures Idea Exchange Stalking Stones Vaginitis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - October 2008

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