This document summarizes key points from a veterinary dermatology symposium. It discusses diagnostic steps and treatment options for common pruritic conditions in dogs and cats. Common causes of pruritus include demodicosis, cheyletiella, dermatophytosis, pyoderma, bacterial/fungal infections, parasites, and allergies. The document emphasizes the importance of thorough diagnostics before initiating treatment, as well as long-term management for chronic allergic conditions through elimination diets and immunotherapy. Compliance can be challenging but is critical for successful management of pruritic patients.

1. 2012 IVG Symposium
This session sponsored by:

2. The itchy patient:
interactive cases
Michaela Austel, Dr. med. vet., DACVD

3. Never forget to round up the
„usual suspects‟: *
- Demodicosis
- Cheyletiella
- Dermatophytosis
- Pyoderma
* diseases that may or may not be pruritic

4. - Bacterial infections/overgrowths
- Fungal infections/overgrowths
- Parasites
- Allergies
Allergy tests are RARELY the first
diagnostic procedure performed in pruritic patients

5. “Eike” German Shepherd, m, 3 y
Owner noticed dog scratching/biting
around the base of the tail and the hind legs
six weeks ago.
Owner detected several fleas, treated Eike
immediately with Frontline®.
Pruritus decreased a lot at first, but then it
returned plus problem “spread”.

9. Diagnostic tests:
- Flea comb (+ “water test”): negative
- Wood‟s lamp exam: negative

10. What is the next, most “reasonable”
(considering the history) diagnostic step?
1. Skin scrapes
2. Fungal culture
3. Trial treatment for
Sarcoptes
4. Bacterial culture
5. Cytology
6. 1 & 2
7. 3 & 4
8. Other

12. What is the next, most “reasonable”
(considering the history) diagnostic step?
1. Skin scrapes
2. Fungal culture
3. Trial treatment for
Sarcoptes
4. Bacterial culture
5. Cytology
6. 1 & 2
7. 3 & 4
8. Other

14. Treatment options
- shampoos
- conditioners
- oral antibiotics Cephalexin
Cefpodoxime
Cefovecin inj.
Enrofloxacin
Ciprofloxacin
Marbofloxacin
Orbifloxacin
Clindamycin, Chloramphenicol, Rifampin
Amoxicillin/Clavulanic Acid
Trimethoprim/Sulfadiazine
Ormethoprim/Sulfadimethoxime and more…

15. How long do you want to treat???
-> at least 3 weeks
-> one week past resolution of
clinical signs
Baseline: patient needs to be
rechecked!

16. “Max” Labrador Retr., mn, 5 y
Started with facial pruritus 3 years ago. Problem got
progressively worse plus spread to entire body. Any
treatment resulted in temporary improvement but no
resolution. RDVM treated mainly with oral antibiotics (for 3-
4 weeks) and steroid shots (once monthly) -> „some‟
improvement.
No other animals in the household. Owner has no lesions.
Owner mentions that dog has sometimes soft stool, but is
not sure whether this is due to the previous treatment
(antibiotics) or the fact that Max gets a lot of people
food/treats on a regular basis.

19. Diagnostic tests:
- Flea comb/‟water test‟: negative
- Wood‟s lamp exam: negative
- Fungal culture: negative
- Cytology: no microorganisms
- Skin scrapes: negative
- Trial treatment for
Sarcoptes: negative
- Food switched to „100% allergen free diet‟
(Pinnacle duck, OTC diet),
no treats, bones, etc.: no change
- IDAT: no positive reactions

20. What would you do next?
1. Specific IgE test („blood
allergy test)
2. Strict elimination diet for
10 weeks with
hydrolyzed soy
prescription diet
3. Start all over/repeat all
tests, something was
missed
4. Give oral cyclosporine
A/Atopica
5. Switch to grain-free diet
6. Other

22. What would you do next?
1. Specific IgE test („blood
allergy test)
2. Strict elimination diet for
10 weeks with
hydrolyzed soy
prescription diet
3. Start all over/repeat all
tests, something was
missed
4. Give oral cyclosporine
A/Atopica
5. Switch to grain-free diet
6. Other

23. Treatment options
- Symptomatic ?
- Immunotherapy ?
- Strict (!!!) elimination diet for a minimum of
8-12 weeks
a) dry prescription diets
(novel protein or hydrolyzed) +
b) canned prescription diets ++
c) home cooked diets* +++
* may be necessary in up to 20% of food allergic patients

24. „Beware of‟
- uninformed household members, neighbors
- flavored heartworm preventatives
- vitamin or mineral supplements, fish oil
- flavored tooth paste
- flavored nylabones
- cat litter boxes
- empty food bowls of other dogs/cats
- bones, raw hides, treats, pill pockets, etc.
- medications in capsules
--> nothing in the mouth but the diet

25. Compliance approx. 20% 

26. The owner is very unhappy about your
suggestion and rather wants to pursue
expensive symptomatic treatment instead.
Your answer is
1. Sure, let‟s give
cyclosporine A; it is
expensive but
convenient and
works for most dogs
2. This is most likely not
going to work in Max‟
case, because……
3. Other

28. The owner is very unhappy about your
suggestion and rather wants to pursue
expensive symptomatic treatment instead.
Your answer is
1. Sure, let‟s give cyclosporine A;
it is expensive but convenient
and works for most dogs
2. This is most likely not going to
work in Max
case, because……symptomatic
treatment does not work in the
majority of food allergic patients
3. Other

29. It can take several weeks of „dieting‟ until
symptoms improve……….

30. “Jimmy” from NY
DSH, mn, 3.5 y
• Only cat in the household
• Indoors/outdoor
• “Fur mowing” for 2 ½ years
• Nonseasonal problem
• Advantage + Revolution
every 3 weeks
• Responds to injectable
steroids (nearly 100%, owner
concerned because cat needs
more shots with larger dose)

32. Diagnostic tests:
- Flea comb/
paper towel test: negative
- Wood‟s lamp exam: negative
- Fungal culture: negative
- Cytology: negative
- Skin scrapes: negative
- Elimination diet
(RC rabbit for 10 weeks, strict): negative
- IDAT: positive*
* several pollen

33. What would you do now?
1. Desensitization
2. Oral cyclosporine
A/Atopica
3. 1) & 2)
4. 1) & oral steroids
5. Another food trial
with different brand
6. Home-cooked food
trial
7. Other

35. What would you do now?
1. Desensitization
2. Oral cyclosporine A/Atopica
3. 1) & 2)
4. 1) & oral steroids
5. Another food trial with
different brand
6. Home-cooked food trial
(pollen are
seasonal, Jimmy‟s problem
is non-seasonal!)
7. Other

36. Never forget to use common
sense when you look at either
IDAT or specific IgE level results

37. What if………….
Jimmy is not any better after a
correct home-cooked elimination
diet trial???

38. Up to 5% of atopic individuals do
not show positive allergy test
results (IDAT or specific IgE)
(Avoidance)
Symptomatic treatment
(Immunotherapy)

39. “Prince”
Labrador Retriever, mn, 5 y
Nonseasonal pruritus for almost 4 years
(initially seasonal). He responded well to
steroids in the past (not any more). Prince
underwent extensive diagnostics and
immunotherapy based on IDAT for 1.5
years without improvement. Most recent
treatment consisted of raw chicken
carcasses and herbal supplements for 4
months (no improvement). His level of
itchiness right now is 10/10.

43. Diagnostic tests:
- Flea comb/‟water test‟: 20x negative
- Wood‟s lamp exam: 5x negative
- Fungal culture: 2x negative
- Cytology: 25x various infections
- Skin scrapes: 25x negative
- Scabies trial treatment
(inj. ivermectin, lime sulfur
dip, still on Revolution): 3x negative
- Elimination diets
(hydrolyzed prescription diet,
home-cooked pork diet,
raw chicken diet): 3x negative
- Blood allergy test/IgE: HDM I+II, beef, eggs
- IDAT: HDM I+II & several pollen

44. No diagnostic tests (except for raw
chicken elimination diet) during the past
3 months

45. What would you do?
1. Vegetarian elimination diet
2. Hydrolyzed elimination diet
3. Repeat IDAT
4. Injectable steroids
5. Oral cyclosporine/Atopica
6. Start from scratch (repeat
ALL tests)
7. Check for infections
8. Other

47. What would you do?
1. Vegetarian elimination diet
2. Hydrolyzed elimination diet
3. Repeat IDAT
4. Injectable steroids
5. Oral cyclosporine/Atopica
6. Start from scratch (repeat
ALL tests)
7. Check for infections
8. Other

48. Staphylococcus
Malassezia
Trichophyton
Atopy

49. Immunotherapy:
Desensitization, Hyposensitization
Goal:
- increase the patients tolerance
- reduce the patients sensitivity
- Success rate approx. 75%
(final evaluation after 12 months)

50. What was missing in Prince‟s case???

51. desensitization
concentration
Symptomatic
Therapy
Desensitization
time

54. • No “universal” pruritus
treatment
• Diagnostics are key
• “Banana” technique

55. Surgeons are sprinters…..
Dermatologists are
marathon runners………