Diseases and Treatment of Skin in Pets

This page is about the treatment of skin problems in dogs and cats. As with our other treatment pages, I'll begin with general comments and a description about what to expect if you were to come to our hospital with this problem.

Of course, other veterinarians might handle similar cases differently.

Following our intial description of how I handle typical skin cases, you'll find articles, discussion, & information about specific diseases of the skin, treatment options and so forth. In addition, I am hoping to attract other vets and dermatolgic specialist to contribute to this page. And finally, you'll find links to other sites with good information. Thanks, Roger Ross, DVM

On This Page

Our General Skin Exam and Discussion about Common Skin Problems; includes treatment information about allergies, fleas, and atopy.

About Lick Granulomas in Dogs (Rodent Ulcers, aka Proud Flesh)

Eosinophilic Granuloma Complex in Cats...coming soon

Anal Gland Problems

Pyoderma (Bacterial Infections of the Skin)

Seborrhea, Dandruff, and other flaky, scaly skin diseases

Stud Tail

About Mange (Ear Mites, Sarcoptic Mange, & Demodex or Red Mange)

About Lice

About Atopy

About Miliary Dermatitis...coming soon

About Flea Allergy Dermatitis...coming soon

About Food Allergies...coming soon

About Immune mediated Dermatoses...coming soon

About Sex Hormone, Thyroid Hormone, and Growth Hormone related Skin Problems

About Feline Symmetrical Hair Loss (Alopecia)

About Fungal & Yeast Skin Infections...coming soon

Our General Skin Exam for Dogs and Cats:

We see more pets for various skin problems...mostly allergies...than for any other problem.

Here's what to expect at our clinic if your pet has a skin problem:

A good history and Exam: In addition to our normal head to toe exam, we'll be paying special attention to:

The Duration of the problem.

The location and type of lesions on the skin are significant

Is it seasonal?

Are there fleas, microscopic mites, or other parasites?

Do other pets or people in the household have similar problems?

Has the pet had similar problems in the past? What treatment seemed to help?

Have we been in heat recently, had puppies or kittens recently etc?

Is there significant gingivitis? (a possible cause of bacterial inocculation to the skin!)

What diet, treats, and scraps are fed?

Note; allergies to pollens, molds, dust mites, and foods are a factor in a large percentage of skin diseases in pets.

During and after the exam, we'll discuss & consider doing some tests:

Microscopic skin scrapings to rule out mites and to see what the hair follicles look like which are clues to hormone related problems

Microscopic ear wax smears to rule out the ears as a source of infection, mites, and yeast.

Fungal Ringworm and Yeast Culture: Surprise; often positive when not strongly suspected.

Bacterial Culture: especially if a non-staph infection is suspected

Thyroid testing

CBC & Chemistry if metabolic disease suspected

Skin biopsy

A trial of Hypoallergenic diet...it's important to do this right; not just switch from one brand to another.

Allergy Testing and Desensitization: I don't allergy test pets at our clinic, but we'll certainly talk about this fairly expensive option and refer you to specialists if you're interested.

*Don't panic...we will only recommend those tests that are appropriate

Depending on the results of the exam and lab results, then we'll consider some treatment trials:

Topicals:

Almost all skin disease benefit from cleaning and minimizing the bacteria and fungi that love to invade inflammed & injured skin.

In many cases we'll recommend Coal Tar/Sulfur Shampoo, Oatmeal-antihsitamine Shampoo, other specialty shampoos, or LymSulfa Dip depending on the situation. To work well, shampoos need to be used fairly often for the first couple of weeks.

For hot spots (inflammed and infected smaller areas of skin) we will also dispense Nolvasan Solution and often a topical antibiotic/anti-fungal ointment

Systemic Treatment:

Antibiotics: I usually choose cephalexin in dogs and Baytril in cats

Antihistamines: Usually benadryl or chlorpheniramine.

Immune modulation: Sometimes very helpful in chronic bacterial cases

Prednisone (a steroid with potentially bad side effects if used for very long)

Methylprednisone Injection

Other Steroids if needed; Megace, Testosterone,

Antioxidants to reduce oxidation of sebum and to speed healing

Doxepin (an antihistamine with strong sedation) to allow sleep without constant scratching

Prozac or similar if anxiety suspected as a major cause of itching

Nutritional Treatment:

Diet changes: Possibly a trial of a special diet to rule out food allergies

Fatty Acid/Omega 3 Supplemention; extremely helpful in about 20-30% of cases

EFFECTIVE FLEA CONTROL

I capitalized Flea Control for a reason...they are extremely inflammatory to the skin of those dogs and cats who are sensitive. And note that I said effective flea control; most flea products available have become nearly useless. Check out our page devoted to the effective control of fleas

Control of other Parasites if Found

Other common parasites that cause skin disease are two different types of mange mites as well as ticks.

For Ticks: I recommend either Frontline or Revolution Plus a Preventic Collar

For Sarcoptic Mange: we recommend dipping with ParaMite Poison Plus Revolution

For Demodex Mange: we recommend dipping with Amitraz Poison Plus oral Ivermectin

Some comments about how we treat skin allergies & Atopy at our clinic:

("Atopy" refers to skin allergies due to inhalants such as pollens and mold.)

Dogs and some cats suffer from allergies due to pollens & ragweed & house dust just like people do....but with one big exception...they itch rather than sneeze. The mast cells that release histamine and other irritating substances are concentrated in the skin and ears instead of the respiratory system. And because the allergies irritate the glands in the skin, more sebum is produced which makes the skin more likely to get bacterial, fungal, yeast, and parasitical infections.

What a mess, and an itchy one too. And a vicious cycle...the more the itch, the more the inflammation, and the more the inflammation, the more itchy invaders thrive.

There isn't really a cure, but with a little effort we can usually make your dog pretty comfortable. And with a little luck, we can do so without using steroids for too long.

Here's how we handle the problem

STEP ONE: We make reasonably sure we don't miss mange mites , fungus, ringworm, or bacterial infections. Because dogs with allergic skin problems have irritated skin, they are more prone to other skin probems too. So start with a good physical exam to include skin scraping for mites and a fungal-ringworm culture.

STEP TWO: Real flea control. Fleas are super allergenic and we simply must get decent flea control to have a good chance of making a sensitive pet comfortable. Fleas have become quite resistant to most flea control products you can buy over the counter. It's important to use one of the newer products if you want decent results.

STEP THREE: Frequent bathing with the right shampoo. Some shampoos might dry out your pet's coat and cause rashes, but the right shampoo will soothe and condition and remove excessive sebum, wax, and bacteria that contribute to itching. If your dog hates bathing, consider with your vet buying a few inexpensive tranquillizers so the experience isn't so traumatic. You'll need to bathe one to two times weekly for a few weeks to make much difference.

STEP 4: In between baths, use Relief Oatmeal & Antihistamine lotion or spray if needed for especially itchy areas. If this isn't enough, there are several other choices that sometimes work when another product won't.

STEP FIVE: Try some of the new fatty acid/Omega 3 products along with antihistamines such as diphenhydramine (Benadryl), Atarax, or Chlorpheniramine.

None of these products are likely to completely solve your problem, but they help quite a bit and are safe and inexpensive.

STEP 6: We like to avoid steroid use, but if none of the above treatments are working well, consider a short trial of steroids to allow the skin to return to normal.

Steroids have lots of potential problems (weight gain, liver damage, immune suppression, adrenal gland damage, and increased incidence of bladder infections and diabetes), but these potential problems are not likely if used for short periods of a few months or less.

And nothing works as well in controlling most allergies.

For Dogs I perfer using prednisone tablets

For Cats I perfer using methylprednisolone Injections

STEP 7; Consider trial of a special test diet to see if the food you're feeding happens to be a part of the problem. Pets become allergic. Sometimes to food they've been on for a long time. (More information coming soon about food trials at our page about Nutrition)

Acral Lick Granulomas, Proud flesh, & Rodent Ulcers in Dogs:

Acral lick granulomas are a common problem in dogs and refer to the raised reddened, tough tissue that results from dogs licking the same area over and over again.

The cause if this is usually because of underlying allergies, anything else that itches in the area, or possibly from boredom and anxieties...kind of like us biting our fingernails to the quick.

Sometimes we luck out and treatment is easy, but it's usually frustrating in the sense that the simpler treatments that are likely to be tried at first will prove to be insufficient. So be prepared for repeated attempts.

Step 1 is a good exam looking for infection, underlying injury or bone infection, for other signs of allergies etc. This includes a skin scraping for mites, especially in young dogs.

Step 1-A is to treat any underlying allergy found

Step 2 is topical treatment to reduce the itch, to help repel licking, and to treat surface infection. I like to use a combination of prescription strength hydrocortisone cream, Malotic Ointment, a bandage, and sometimes an elizabethian collar. Sometimes repellents like bitter orange help.

Step 3 is systemic treatment if needed with antibiotics, possibly steroids, and antihistamines.

Prozac or other compulsive disorder medications might be suggested and tried with success. These medications, including the antibiotics sometimes need to be used for long periods of about 2 months.

Fatty Acid Supplementation is often very helpful

Consider immune modulators like Immuno Regulin

Consider long acting steroid therapy such as methylprednisolone injections

Step 4. Accupunture may be recommended. Results?

Step 5. Surgical removal is sometimes needed to prevent

or treat lameness or for cosmetic reasons.

Referral for cyrosurgery?

Anal Gland Problems

If you didn't know it, both dogs and cats have little glands (so do skunks mink, and ferrets) just under the skin right beside their anus. The smelly stuff made by these glands is unique to each pet and a little bit of anal gland juice leaks out of it's duct into the anus every time a dog or cat defecates.

As I said, the smell is unique to each pet and that is what all that smelling of hind ends is about...it's what pets do instead of saying "Hi, my name's Bob, what's yours?"

Sometimes these glands produce way too much glandular goo or the ducts get clogged up with goo causing the glandular sacs to swell. This is all very irritating to the pet so they scoot along the ground or carpet and are generally irritated back there. Very distracting.

Goo is not a medical term. So sue me.

Why anal glands produce too much goo is not really known...but here's what we do know: This is mainly a problem with smaller breeds of dogs, especially overweight ones lacking good muscle tone.

The glands can be overactive due to infection, or they can become infected because they're overactive...but neither is too common.

The most accepted theory is that the glands are overactive and the secretions too thick because of allergies...especially food allergies.

Here's what we can do about it:

Usually we just express the glands as needed. This means we squeeze the crud out gently with our fingers. I recommend gloves. Once or twice monthly for those dogs that need this. It's easy to tell when they need it...they start scooting across the floor. If you or your groomer have trouble getting the goo/crud out with external squeezing, you may need a vet to do it for you. He or she will use a lubed and gloved finger inside the rectum and will be able to do a better job, but it takes experience not to cause damage to the tender rectal tissue or to the inflammed anal gland tissue, so don't try this yourself.

If the goo that comes out looks like it has some pus in it we'll treat with antibiotics

This treatment usually works, but often only for a while...and that's because the infection wasn't the original cause of the dog producing so much goo. It was an additional problem.

Because this trouble is often associated with allergies...either inhalant allergies to pollens, molds, and dust mites, or to food allergies...we often have to treat the allergy to solve the problem:

1. Get effective flea control...the #1 allergen is a flea. Fleas on a sensitive dog or cat are like lice or poison ivy to a human. Very allergenic to the skin and underlying glands. Go to our section on Fleas.

2. Consider a special diet to test if a food allergy is involved. For more information go to our section on Foods , Special Diets & Supplements.

3. Try benadryl or other antihistimines to see if we luck out and it helps.

4. Consider a prednisone (steroid) trial. Usually very helpful and unlikedly to get any serious side effects if not used for more than 4 weeks.

(See our section on Comments and Warnings about Medications)

5. Consider trying omega 3 fatty acids supplements since they change the nature of the goo...making it less thick and tacky. This treatment is more preventive than cure.

If all the above isn't helping much:

Put on a higher fiber diet on the theory that more and larger stools will some how cause more muscular eliminations and there-by help empty out the glands on a more regular basis. I don't have a lot of faith in this theory, but it certainly makes sense to put overweight pets on lower calorie, higher fiber diets to get their weight down. That takes time but it will help.

Consider a procedure done under anesthesia where we put a catheter (little tube) up the anal gland duct and flush out the gland and then inject a combination of antibiotics and anti-inflammatories and DMSO directly into the gland. This often works well, but it often doesn't work for long.

And finally, we can surgically remove the anal glands...which you might think simple enough...but what a high risk place for surgery, so we try to avoid this. You see, the anus is full of, well, bacteria, so post op infections can be a big problem. And the anus area doesn't hold sutures well...it's spongy and expandible, and tears easily.

And the animal doesn't like having sutures in this area. But all this is minor compared to the problem of getting the glands out without harming the tiny nerves that control the anal sphincter. This is such a high risk that I like to recommend these pets to a specialist so that if anything goes wrong you can blame him (or her).

Eosinophilic Granuloma Complex in Cats

More common names for this problem include "Rodent Ulcers", "Cold Sores", Lick Granulomas, and Eosinophilic Plaque.

As an aside, whenever you see the word "Complex" or "Syndrome" used in medicine, it often means we in the profession aren't quite sure what's causing the problem, and that's the case here.

We know cats often get these erosive lesions of the lips, genitals, and abdomen, and if the lesion is studied under the microscope that we often find lots of esosinophils (a type of white blood cell which we associate with allergies and parasites). Here are some more things we know:

More female cats than males are affected

Neutering is not a factor

A majority of cats with lesions are either white or partly white

Blood work, Fungal Cultures, Skin Scraping, and Urinalysis are usually all normal

And there seem to be three different types of the disease:

Rodent Ulcers found on the upper lips and sometimes the neck and thigh. Often responds to steroid therapy. Often returns months later. And like our human cold sores, may or may not be associated with a herpes virus. (If it is associated with herpes, it is not contagious to people). Occasionally, lip ulcers can turn into cancer.

Eosinophilic Plaques are similar to the ulcerative type lesions except that they appear a little different, are deeper into the tissue, and are more often found on the belly.

Intradermal or Linear Granulomas are also similar to the other two types except they seem to affect mostly young cats under a year old and the lesions tend to be on the real legs and on the inside of the front legs as well as the lip. And as the name implies, they are often linear in shape as opposed to round.

The only consistently successful treatment for any of the types of granuloma complex, as far as I know, is combinations of surgery and steroidal therapy at fairly high doses.

Pyoderma (Bacterial Infections of the Skin)

It's normal for the skin to contain a certain level and certain types of bacteria. Pyoderma refers to abnormal levels or types of bacteria that causes inflammation and damage to the skin and also results in pus.

I'll briefly discuss some of the more common types of pyoderma:

Acne

People are sometimes surprised to learn that dogs and cats get acne. Just like in humans, it is mostly a disease of puberty affecting the sebaceous areas of the chin and lips and sometimes the inner thighs, belly, and tail.

Topical cleansers are usually enough to control the problem, although some cases require antibiotics and anti-inflammatory steroid therapy as well.

Hot Spots (Acute Moist Dermatitis, Eczema, Pyotraumatic Dermatitis)

We vets see a lot of these in dense coated dogs, but any type of dog or cat can get these painful, rapidly occurring patches of skin infection.

They are the result of scratching or biting an area of the skin to the point that skin bacteria, or bacteria from the environment establish themselves in the inflamed skin and go "hog wild", causing an incredible amount of surface damage within 12-48 hours.

The initial irritant could be anything that itches from an insect bite, an ear infection, or anal gland irritation, but I think most cases involve a local reaction to fleas and ticks.

The treatment is straight forward, but it's important that you complete the treatment until the lesion is well healed or it might come back. A few of the treatment steps can be omitted for MINOR lesions. Here we go:

1. General exam to include skin scraping for mites if suspected, possible ringworm or yeast culture, and inspection for fleas, ear infection etc

2. Sedation or light anesthesia is often necessary to allow through clipping and scrubbing of these very tender areas

3. Clipping of the hair around the hot spot. This is critical in all but very small hot spots. If you have a dog going to a show soon and don't want to clip the area, you might get away without clipping, but it really helps.

4. Scrubbing with an medicated shampoo that removes the surface crud, sucks out the sebaceous goo from the deeper layers of the skin, and kills bacteria, fungus, and yeast. I personally use a coal tar and sulfur shampoo for this, but many vets like other combinations that also work well. You need to do this 1-2 times daily for the first few days until the skin stops producing the ooze. (Crud, Goo and Ooze aren't exactly medical terms, but I like to think I'm professionally distinguished enough to get away with their use)

5. Treatment of the underlying problem, whether it be an ear infection, fleas, ticks, ringworm, or poor grooming. A badly matted coat or burrs can also lead to hot spots.

6. Antibiotics to kill the bacteria too deep in the tissues for the antibiotic shampoos to reach. In severe cases, I start with an injection of high dose penicillin combined with gentocin, followed by oral cephalexin for 10-14 days. Your vet may choose different antibiotics for various reasons; each choice having advantages and disadvantages. I only mentioned the combination I usually use simply because it's a very common protocol for good reason; these medications are now relatively inexpensive and quite affective for the vast majority of hot spots. More potent antibiotics, however, will be needed in some of the deeper pyodermas that will be discussed below.

7. Something to stop the itching. Choices include different types of antihistamines, short term courses of prednisone, and a wide range of topical sprays and lotions.

8. Sometimes physical or chemical restraint is needed to stop the patient from itching long enough for the lesion to heal. This may be in the form of restraint collars, bandages, or tranquillizers. It depends on the case. Usually none of this is needed if all the other steps are done well.

9.Immune System Stimulants. Staphage Lysate injections both desensitize and boost the canine immune system. I've used this medication with great success on several miserable dogs where antibiotics were not enough. There are other immune stimulants, but as far as I know, only Staphage lysate is approved so far and working well on staph skin infections.

Other types of Superficial Pyodermas include Folliculitis, Skin Fold Dermatitis, and Impetigo (superficial pustular pyoderma)

All of these are similar in that they involve flare ups in the local population of otherwise normal skin bacteria and treatment is quite similar to the treatment for hot spots listed above. The only difference is that the cause is more subtle and the outcome usually less dramatic. In the case of the different types of skin fold infections where the problem is where skin touches skin (vulva lips, tail to anal area, lip folds, and breeds and individuals with facial skin folds, or Sharpeis where the whole body is made of skin folds) life time hygiene is sometimes needed to control the disease. This simply means frequent cleaning of the area.

What is known as Deep Pyodermas are more serious. Underlying causes often include allergic or immunologic abnormalities for which there is no cure...just control. Or better nutrition in cases where you're feeding discount brands of diet or table scraps. Types of Deep Pyoderma include Intradigital, Juvenile (Puppy Strangles), Pressure Point Pyoderma (Callus), Perianal, and Generalized Pyoderma.

Certain breeds of dogs are prone to the various types of Deep Pyodermas, but regardless of that, with the exception of Puppy Strangles which is usually easy to treat (although it can take 2 months to heal), all the deep pyoderma diseases can be frustratingly difficult to treat. And if treatment is successful, then recurrence is often a problem.

Treatment involves ruling out underlying causes, especially demodex (a type of mange mite), hypothyroidism, ringworm, hormonal imbalances, and allergies. Expect a prescription for long term antibiotics. Your vet may recommend skin biopsies and cultures in order to get a better diagnosis and for choosing the best medication.

Seborrhea, Dandruff, and other flaky, scaly skin diseases

Some Cockers and Springers get true seborrhea, which means abnormal sebum secretions which leads to oiliness, scales, increased ear wax, "doggy" odor and dandruff. This is usually life long and very difficult to treat.

Most seborrhea though, in both cats and dogs, is simply secondary to other diseases that affect the sebaceous glands. These include food allergies, atopy, flea irritation, poor nutrition, vitamin deficiencies, thyroid and other hormone imbalances, and all the different parasite, fungal, bacterial, and yeast problems.

So the main point here is to figure out the underlying problem. So allow your vet to spend a little money and time ruling everything out until the problem is solved. And remember that a lot of these diseases are not exactly curable...but they are controllable with a little effort and understanding about what's going on.

Stud Tail (Supracaudal Gland Infection)

There is a sebaceous gland near the base of the tail in both dogs and cats that sometimes becomes over active and/or infected. In cats, this condition is called "stud tail" even though the problem sometimes occurs in females and castrated males. In dogs, the same condition is usually just called by it's medical name: Supracaudal Gland Infection or Supracaudal Gland Hyperplasia. If no underlying problems (typically fleas) are found, then treatment consists mostly of cleaning with degreasing shampoos and possibly short term steroids and antibiotic therapy. In dogs, every once in a while, surgical reduction or removal of the gland is needed. In cats, castration often helps.

About Mange

Mange is the common name for skin diseases due to parasitic Mites. Mites belong to the same scientific order as ticks, but are much smaller, microscopic in fact, and different types of mites can cause and carry diseases or cause inflammation and irritation of the skin in man and animals, the feathers of birds, and the leaves of plants.

For the purposes of this simplistic and practical article, there are three types of mange that we worry about in dogs and cats. The reason I divide them up into three groups is because the treatment is different for each group. Here we go:

Ear Mites: Ear mites aren't usually referred to as "mange" but it is, in fact, our most common mite problem in pets. Suspect ear mites if your cat has blackish ear wax or is scratching at it's ears. Dogs can get ear mites too, but the same symptoms in dogs are more likely to be an infection and not mites. Ear mites are contagious to other cats, and from cats to dogs, and vice versa, but they are not contagious to humans

Ear mites, like fleas have gotten pretty resistant to over the counter pesticides, so don't be surprised if your home treatment fails. But your vet will have no problem in either diagnosing or successfully treating this problem with the new prescription medications available. At our clinic, treatment consists of through cleaning of the ears followed by ivermectic drops, followed by an application of Revolution.

Sarcoptic Mange: This mite burrows into the skin to lay eggs and is extremely itchy. Dogs and cats with this type of mange itch "like crazy" and as a result of both the inflammation caused by the burrowing mites and the itching, the skin is soon very red, raw, and covered with secondary scabs, scales, and infection. There is usually a lot of hair loss too. This type of mange is very contagious to both cats, dogs, and other carnivores, so if you have more than one pet, the other pets in your household or neighborhood may also be affected. Humans are only rarely susceptible to these particular mites.

Here's the thing: most people that call me at the clinic to tell me their dog has mange turn out to be wrong! They phone hoping I'll tell them what to do over the phone so they can avoid the expense and trouble of coming into the clinic, and that's understandable except for two big problems (and several legal ones). Problem number one is that most skin diseases that people mistakenly call the mange turn out to be allergic or bacterial problems which requires a very different treatment than mange. And problem number two is that if it is mange, we have to know which type, which we can only tell by looking at a sample under the microscope, to know which medication to choose, because there isn't a treatment yet that will cure both sarcoptic and demodex (red) mange.

The treatment for sarcoptic mange is as follows with possible variations by your vet:

1. Confirm diagnosis with skin scrapings and a microscope.

2. Remove the surface scales and bacteria with a good medicated shampoo so that the dip can penetrate deep into the skin where some of the mites are hidden.

3. Apply an effective dip (poisonous pesticides...pay attention to your vet's instructions) to the surface of the skin and allow it to soak into the skin for at least 10 minutes before rinsing. Each time you do this you will be killing a large percentage of the adult mites, but you will also be leaving a small percentage of adults and a large percentage of eggs and larvae. Because of this, you will need to repeat the dips, usually weekly, for 3-8 times. There are a lot of mail order pesticides and home remedies (motor oil, sulfur, kerosene) that will kill sarcoptic mites to different degrees, but you risk both poor results and a very sick dog (and probably a dead cat) if you don't use the newer prescription dips available from your vet. This is not a good time to skimp.

4. In addition to all the above, I now also apply Revolution (the fairly new flea and heartworm control product from Pfizer) every 2 weeks for a couple of times because Revolution also does a fair job of killing sarcoptic mites not only on the skin but also any larvae living around the environment.

5. Speaking of the environment, it's probably not necessary to wash all the pet bedding or to saturate the kennel with pesticides. These mites can only live for about 3 days off a warm body and besides, the larvae are resistant to the pesticides.

6. Treatment of the secondary problems if present. This often includes antibiotics for infection, and antihistamines to help control the itching.

7. Your vet may also recommend higher quality diets, vitamins, and/or fatty acid supplements to improve the general health of your pet's skin and to speed healing.

Demodex Mange (also known as Red Mange)

This type of mange is quite different. It looks very different under the microscope and it's resistant to both the pesticide dip used to treat sarcoptic mange and to Revolution.

It often doesn't itch much, so what you notice is simply patches of no hair, often about the size of a nickel. On the other hand, demodex can cause severe skin lesions covering large areas of the body and can itch 'like crazy'; just like sarcoptic mange. And like sarcoptic mange, there are often secondary problems such as infection.

Demodex, though, is NOT contagious. In fact, all dogs and cats probably have small quantities of demodex mites living in their skin just like all pets (and humans) have small numbers of skin bacteria. And just like all homes have small numbers of dust mites. The trouble is that in dogs (and occasionally cats) with the disease of Demodex Mange, the numbers of mites have multiplied to the point where they start to cause trouble, immune reactions, inflammation, irritation, and stimulation of the sebaceous glands. The reasons for this aren't clearly understood but have to do with immune suppression and hormone changes. This disease is usually associated with puberty so is most common in puppies between 4 and 16 months of age.

But we also see it occasionally in any animal of any age that is immune suppressed, either genetically, from poor nutrition, from parasitism, or from certain medications and certain diseases. Or from hormonal changes and stresses such as pregnancy or nursing. We also think that testosterone may be a culprit because castration often helps with the cure (although not usually critical to the cure...but if it isn't a breeding animal, consider this anyways.)

Diagnosis is the same as for sarcoptic mange; we can usually find it easily under the microscope with skin scrapings.

The treatment is different though.

1. We look for causes of immune suppression or stimulation of the sebaceous glands.

We make sure the patient isn't infested with worms, other parasites, or on a poor diet.

2. Since patients with poor immune systems are susceptible to many diseases, we look extra hard for secondary infections, ringworm, and so forth.

3. Oral ivermectin is used by a lot of veterinarians because it often helps achieve a quick cure, but the dosing protocol is different for each vet, and some vets don't use it at all because this medication is NOT approved. That means that if anything goes wrong, and ivermectin is a potent drug, he or she might be considered legally liable for the problem. Using such medications is NOT illegal, but is rather called "off label". We vets are fairly used to this situation; a lot of drugs, for example, legally available for humans, are known to be useful in animals too, but were never approved for that use, or at least for that particular animal. Getting a drug approved is very, very expensive, so the drug companies don't bother. And they like to avoid potential legal liability too. Besides, they know we're going to use them anyways, and by being off label they avoid both the expense of getting them approved for each species and they're off the hook legally if your pet happens to die from a medication.

At any rate, your vet may or may not recommend using ivermectin. Or maybe only if you take the precaution of first doing blood work to make sure the kidney and liver (which metabolize medications) are working well. Remember that demodex is associated with immune diseases that affect the whole body.

4. Dipping with amitraz pesticide. This is a very potent poison, so listen to instructions. Tell your vet if you're pregnant...or at least let someone else handle the treatments. This dip is also somewhat poisonous to the patient to pay attention to problems like vomiting and seizures. Keep in touch with your vet if there are problems. In fact, some vets insist on doing the dipping themselves in order to make sure there aren't major problems. I don't mean to over scare you, usually everything works out fine, but amitraz is a potentially dangerous pesticide, but it's about the only thing working well.

The dipping is usually repeated at weekly intervals until all better.

5. Some vets supplement this treatment with immune stimulants, vitamin and nutritional support, fatty acid supplements, and anti-oxidants. In addition, we need to treat for any secondary infections, ringworm, etc.

I didn't tell you this, but some cases are mild enough that they are self curing. On the other hand, a very few cases are incurable. The pet responds to treatment, but only for a short period. This occurs with severe immune system deficiencies. Most cases are in the middle; the disease is serious and uncomfortable, as well as ugly and smelly, but quickly gets better with professional treatment.

About Lice (Pediculosis)

We don't see this too much in this country, but there are two groups of lice; those that suck blood and tissue fluids, and those that bite and chew at your tissues. Lice spend their whole life cycle on the animals and are generally species specific which means you only get lice from close contact, and except in rare cases, you only get lice from members of your own species. (dogs, cats, sheep, horses, and humans or any creature you might sleep with all belong to different species)

This has never been a big problem in small animal medicine because any flea shampoo is likely to kill lice...just repeat every couple of days for a few times.

The only reason I mention the problem is that every year we get a few phone calls from anxious parents who have a child infested with lice and they want to make sure the family pet isn't the cause or a carrier. We, of course, would be happy to take skin samples and check under the scope, although I usually simply ask if the pet is itching a lot. If yes, then we check to see why. If no, I simply recommend a few baths in a pyrethrin (flea) shampoo as insurance. But again, lice are species specific.

About Atopy...

Atopy has a specific meaning, but for practical purposes, I think of atopy as any skin allergy not caused by food allergies, flea bites, or other parasite irritation. For all practical purposes that leaves the still huge category of allergies to molds, pollens, and dust mites. Pets often have food allergies and skin that is especially sensitive to fleas IN ADDITION to atopy, but we separate these different problems out because the treatment is different.

Cats have skin allergies to inhalants too, but this discussion is going to refer to dogs. For a very similar discussion in cats, see "miliary dermatitis" directly below.

If your dog is sensitive to pollens, molds, or dust mites, then a long chain of events occur in your immune system that cause mast cells to release histamine, serotonin, and prostaglandins. These are chemicals made by your body that have legitimate functions, but when over produced lead to the discomfort of respiratory constriction, sinus irritation and watery eyes in some species (humans, and to some degree in pets) and itchy skin in other species (dogs and cats).

Treatment choices include combinations of:

1. Attempting to avoid the allergen...often not possible unless a food is involved.

2. Anti-histamines...generally safe, but often only somewhat helpful

3. Steroid therapy...usually very successful but also lots of potential side effects

4. Supplemental therapy...fatty acids, immunne modifyers (controversial), and frequent shampooing and flea control

5. Allergy Testing and Desensitization...more effort and expense involved than the other options listed above, but more potential for a successful control of the problem. More about this subject coming soon.

About Miliary Dermatitis

This disease is similar to Atopy in Dogs. More details soon

About Flea Allergy Dermatitis...coming soon

About Food Allergies...coming soon

About Immune mediated Dermatoses...coming soon

About Sex Hormone, Thyroid Hormone, and Growth Hormone related Skin Problems

coming soon...

About Feline Symmetrical Hair Loss (Alopecia)

coming soon...

About Fungal & Yeast Skin Infections...coming soon

Ringworm: New treatment option: high dose Program...will talk about this soon