The classic just rear end itchy dog may be a no brainer for flea allergy.

However, I will often see dogs with combination of allergies.

For example, a dog with pedal pruritus and rear end itchiness. The paw issues likely not flea related, but the rear end distribution yes.

Make sure anytime you see rear end itchiness that the pet is on good flea control.

#fleas #fleaallergy #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin
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74 3

Pseudomonas otitis infections are challenging otitis cases. Clinically these cases present with purulent to black tarry exudate (as seen in this picture) and erosive to ulcerative otic canals of one or both ears.

The intrinsic multi-resistant genes of this bacteria, plus their gram-negative cell wall, efflux pumps, and biofilm production contribute to their natural resistance to antibiotics. Their destructive enzymes (i.e., proteases and collagenases) cause significant epithelial damage to the ear canal and will often rupture the tympanum. It is for this reason that most Pseudomonas cases are otitis media cases. The majority of these cases need to be treated as middle ear disease.

Treatment involves a middle ear flush under general anesthesia, this is important to remove all the exudate that is in the ear canal and middle ear. After the procedure, the client will clean the ear daily to twice daily with an ear cleaner that is good at breaking up biofilm. Ear cleaners with triz edta are good for this. The constant cleaning is crucial. Systemic antibiotics will depend on culture. I will often use a polymyxin otic topical as my first line. Anti-inflammatories, like steroids, in both oral and topical forms, are a must for these cases. Pain control is also helpful. These ears freaking hurt!

Pseudomonas infection in the ear is serious, and needs to be treated quickly and aggressively. These cases should be referred to a dermatologist.
#dogears #otitis #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet
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When faced with recurrent ear infections in a dog ask yourself these questions:
1) Have I addressed the primary cause to this ear infection? Allergies are a very common cause

2) Has this ear infection turned into a middle ear infection? Look at the ear drum: is it intact ? If the ear drum is not present then that’s middle ear disease. If the tympanum is bulging or discolored that can also mean middle ear infection.

3) Do I have a resistant infection in this ear? Do your cytology and if you see rods then it’s important to rule out Pseudomonas with culture.

4) Is the ear canal stenotic? An ear canal that has been scarred due to repeated infections can predispose the ear to continued infections. Organisms will become trapped in that abnormal ear canal. The normal self cleaning mechanism of the ear is disrupted in these ear canals. Try steroids to see if the ear canal will open up.

5) Is the client applying ear medications properly? I often find this is a common cause. Either the client doesn’t know how to apply it, or the pet doesn’t allow them to apply it or the client is not applying enough meds. Teach the client how to apply. Consider pain meds or anti inflammatories for these pets. Make sure the client is putting enough volume of med in the ear. Two drops of ear meds into a Rottweiler ear is not enough meds to fill the ear canal and treat the ear.

##miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #dogearinfections #dogears #vet #veterinarian
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I posted about this case on my story, it’s also under “cases” on IG profile. Thought it might be worth sharing here too.

This 5 yr old Schnauzer had these lesions (crusts, papules) over its entire back, neck and top of head. Few on the ventrum. Pruritus was associated with these lesions.

Mites negative. Cytology showed bacteria.

This dog had a bacterial folliculitis secondary to very likely an allergy that we will be investigating for.

There were no comedones or had there been previously.

Not all Schnauzers with bumps on their backs have Schnauzer comedone syndrome. Schnauzer comedone syndrome is usually asymptomatic and comedones are found along the spine of the back. This pet had lesions in other places besides it’s back.

It’s important when you have a case like this that it be worked up for other causes.

#schnauzer #schnauzersofinstagram #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet
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65 0

This is Maggie. She’s one of my oldest atopic patients. She is 14 years old and still going strong.

Maggie was started on immunotherapy 10 years ago at the initial stages of her atopic signs.

Since then she has been doing incredibly well with minimal to no symptoms, just receives her allergy vaccine monthly.

If immunotherapy is started early, the better chance we have to improve the pet's symptoms and change the course of their allergic disease process.   

We may see a young atopic with mild signs and think well let’s give him/ her time and see how things go for this pet. It’s possible the signs stay mild, but for many, especially certain breeds, this is not the case. As they get older their atopic signs worsen.

If you have an atopic pet, which may be in the early stages of its disease process, seriously consider allergy testing for immunotherapy.  

#immunotherapy #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet
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64 0

I will often get referrals for allergy testing. Clients are under the impression that the allergy test will quickly tell them what’s making their pet itchy. And… if they can eliminate it out of their pet’s environment or life then problem solved. The thing is it’s not that easy. The allergy test will more likely than not tell you things the pet is allergic to in the environment that it CANNOT avoid (i.e. pollens, dust, molds etc). Once I know what these allergens are I make a serum for immunotherapy. If a client comes with a pet with nonseasonal signs and a diet trial was not done then I have to go through that explanation of why a diet trial is important. Once you reach the point of skin or serology allergy testing it is because you know you have an atopic pet and the client wants to pursue immunotherapy. Hope that clears things up. #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet ...

213 12

The multimodal approach to atopic dermatitis in dogs, is an important principle to keep in mind when managing an atopic dog.  It underscores the fact that for many atopic dogs there is not just one medication/treatment that is going to be the magic potion to take away their itchiness.  

If you find that one medication is not working to completely lower the itchiness, then consider adding on something else...

Therapies to keep in mind:

I can't say enough how important medicated baths are in managing atopic pets.  Baths remove pollens/allergens, remove/treat infections, repair the skin barrier and soothes the skin (therefore decreasing pruritus).

Seriously consider immunotherapy. This is one of the best long term management plans for an atopic pet.  It gives a chance to change how their immune system reacts to the allergens. 

Essential fatty acids (EFAs).  EFAs by themselves are not enough to completely reduce pruritus. In combination with other therapies may help with improving the skin barrier and reduce pruritus thru its antiinflammatory effects.  Whether you do this topical, oral or in diet --> try it!   

Some clients ask about antihistamines.  These agents like EFAs by themselves are not strong enough to reduce pruritus.  They may help mild atopics.  But for moderate to severe atopics, I dont think you will find they will work well (other than maybe sedating the pet).  Think about it, it is only working on histamine, and we know there are a bunch of other cytokines that contribute to pruritus.  I dont find much harm in using them if the client asks.  Therefore, something to consider in conjunction with other therapies.

Some other thoughts when managing an atopic dog….

* Make sure to treat infections on the skin properly --> these contribute to pruritus.  Use your antimicrobials!  Proper dose/proper length of time.

* We run to Apoquel or Cytopoint, nowadays to relieve pruritus.  Yes, these work great, but dont forget Atopica is still another good choice should Apoquel or Cytopoint fail

Share your experiences with managing an atopic pet in general practice.

#vet #veterinarian #petdermatology #atopy #dogallergies
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89 14

This is Dante. Doesn’t he look amazing for 13! He’s an atopic cat that has been our patient for 11-12 years.

Our clinic participated in the cat Atopica FDA approval studies some 10 years ago and Dante was one of the study participants. It was a double blinded study but it was obvious by how well he was doing that he did not get placebo. Atopica did wonders for his allergies.

We lost track of Dante for a few years and during that time he was placed on generic cyclosporine.
His allergies progressively worsened and it seemed like the cyclosporine wasn’t working so it was discontinued which made matters worse. He was also having digestive issues on cyclosporine.

We saw Dante recently and we placed him back on brand Atopica, added a gastroprotectant and now he’s doing much better. Pruritus minimal.

Have you seen a difference between generic vs brand cyclosporine? #catsofinstagram #atopica #catopy #vet #veterinarian #catallergies
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79 10

Interdigital paw problems in dogs can be a very frustrating condition to manage even for me as a dermatologist. Here is a picture of an extreme case.

Some things to keep in mind:

Most of these cases have deep bacterial infections and require a good amount of time on antibiotics. If the pet has been on antibiotics without good resolution, then you may need to culture the paw. Tissue biopsies are usually best. Base your antibiotic choice on culture. Minimum 6-8 weeks of treatment time.

There is an underlying cause to these cases, most often due to allergies. The constant licking of the paw due to the allergy can create irritation on the skin and lead to the cysts/nodules.

I always want to make sure there aren't mites on those feet. If the interdigital swelling is severe then biopsies are necessary to properly rule out mites.

For some dogs, a contributing factor is a paw conformation problem, weight problem or arthritis. The manner in which the pet walks can lead to undo pressure in areas of the paw that shouldn't bear weight leading to callused/thickened areas of skin. The hair follicles in these callused areas of skin become plugged, then turn into cysts and then rupture with the draining tract moving dorsal.

Look at this picture of a dog with a dorsal interdigital lesion. The ventral aspect of the paw on the same interdigital space has swelling/irritation. Just looking at the foot you can see how abnormal it is. It is hard to fix a foot conformation problem.

Anti-inflammatories like steroids are often necessary in these pets. I often find that cyclosporine works really well for me, and for my serious interdigital cases I will keep them on it long term. I think we should seriously consider weight management and pain management (for those with possible arthritis) as part of the treatment plan.

The patient in this picture is currently being managed on Cyclosporine. She has atopy, so the cyclosporine is working well to control the allergy, the itchiness and inflammation of the paw. Can you guess what breed this paw belongs to???
#dogpaws #interdigitalcyst #vet #vetdermatologist #veterinarian #englishbulldog
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278 12

Atopic dogs with recurrent bacterial and yeast skin infections may actually have a type 1 hypersensitivity to these organisms as been shown thru studies.

A few of these organisms on the skin can be enough to incite an allergic reaction and make the atopic pet extremely pruritic.

Make sure to be doing your cytology to look for these organisms and treat appropriately.

Some dermatologist like to do immunotherapy against staph and malassezia. I haven’t had much success with this, but my sample size has been small to be honest with you.

I often find that if a client can do frequent baths with an antifungal and antibacterial shampoo it’s enough to make a difference in decreasing that bacterial and yeast load on the skin. So therefore besides environmental allergens, keep staph and yeast on your mind as functioning as an allergen. #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet #305
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261 9

Speaker at Emerald Coast Veterninary Conference. Ready to share some derm knowledge. #emeraldcoast #vetconference #vet #veterinarian #sandestingolfandbeachresort ...

180 10

I can’t believe it’s been about 15 years since I’ve been back to my old stomping ground- the city of Gainesville. Years of vet school here and then derm residency. So many memories here. ❤️#gainesvilleflorida #universityofflorida #gatornation #vet #veterinarymedicine #vetdermatologist ...

213 4

Mira quien llego a Miami @veterinariadiegodacak @diegodacak Good times! #veterinario #vet #veterinarios #paraguay ...

77 2

This Golden Retriever is one of our patients. Blaze is a search and rescue dog. He was one of the first dogs called out to the tragic collapse of the building in Surfside- in Miami Beach. Please keep Surfside in your thoughts 🙏🏻🙏🏻 I believe in the power of prayer. I believe in miracles. #surfside #surfsidebuildingcollapse #miamibeach #searchandrescuedog @blaze_search_k9 ...

377 18

Personal post here.... Missing dad so much today. Happy Father’s Day to all the dads out there. ❤️❤️❤️❤️ ...

42 0

I am joining Gisela from My Dog Miami grooming for an instagram live session this Friday. I’ll be answering questions about skin, coat and ear problems in pets. This is for anyone but especially pet owners and groomers. Groomers notice skin and ear issues probably before their clients see it - and they can bring awareness of problems before it’s gets too advanced. Join me this Friday at 9 am eastern time. Follow me on Instagram @gotitchypet ...

38 5

Mast cell tumor- the great pretender- on the chest of a Basset Hound. #mastcelltumor #cancer #dogcancer #vet #veterinarian ...

132 6

Thru the years of managing atopic pets I have come to appreciate this concept of pruritic threshold. Not every atopic pet is the same, nor is their pruritic or itch threshold. What pushes one dog over the edge to become clinically itchy and miserable is different for another. It could be the change in pollen load? Or here in Florida, fleas are a big issue- did the pet get flea bites? Is the pet now infected? In essence some will tolerate more than others. For your long term atopic pets it’s important to keep this concept in mind because you want to try to avoid the things that will push the pet over its threshold. 🙌🏼🙌🏼 #itch #pruritus #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #miamivet #305 ...

53 1

Severe bacterial otitis externa secondary to pemphigus foliaceus. Most otitis are secondary to allergies, but there are other primary causes like in this patient. Topical therapy to treat the otitis is helpful, but true resolution comes when addressing the pemphigus with immunosuppressive drugs. This pet also had lesions throughout his body. #otitis #dogears #pemphigusfoliaceus #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #miamivet ...

470 26

Our gentle giant patient came back for a follow up today. It’s been a process managing his environmental allergies and we are starting to see progress. #greatdane #greatdanesofinstagram #vettech #vettechlife #mondaymorning ...

105 1