Under the skin

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Treating an itchy pet means considering several different factors and medications. There is not a one-size-fits-all approach to targeting the source of an itch. Adam Christman, DVM, MBA, of dvm360 Live!, spoke with Julia Miller, DVM, DACVD, about multimodal treatment plans for a pet and what options are out there for pet owners.

Adam Christman, DVM, MBA: Topical treatments for canine pruritus vary widely. What are the key considerations when selecting a topical therapy for an itchy dog?

Julia Miller, DVM, DACVD: There are a few things to consider. Is it just an itch? Is it an itch accompanied by a bacterial or yeast infection? Does the dog have greasy or dry skin? Unfortunately, treatment must be patient tailored, but the good news is there are a lot of products on the market to fit the needs of every pet.

Julia Miller, DVM, DACVD

Christman: Could you elaborate on the role of topical corticosteroids in managing pruritus in dogs? How do you balance their efficacy with potential adverse effects?

Miller: I’m careful with topical corticosteroids. Most of the steroids available in the US are potent, which means if you use them too much, they can cause the skin to thin. The skin can then get blackheads, tear easily, and be more prone to infections. I believe topical steroids are useful, with the caveat of using the right dose for the right patient.

Christman: How do you address adherence issues with topical therapies in dog owners? Are there specific strategies or tips to improve adherence to treatment plans?

Miller: The market has changed in the last few years, mostly because of the realization that leaving on certain products, like shampoo, can be difficult for pet owners. There are sprays, mousses, spot-ons, and other products that make it much easier for clients to be [adherent]. With
every client, I ask, “What can you do?” so I don’t send them out the door with a product they won't use.

Distractions make application easier for pets. Giving a pet a special treat or a lick mat alongside their treatment mixes the good with the bad. It could make them less likely to run away.

Christman: Could you discuss the importance of proper skin barrier maintenance in dogs experiencing pruritus and how topical therapies contribute to this aspect of care?

Miller: The epidermal barrier is something we have done more research on in recent years. We think of allergic animals both from the inside out and the outside in. It is important to keep the skin hydrated, so the epidermal barrier remains intact. If it breaks apart, allergens, microbes, and yeast can penetrate the skin, leading to secondary bacterial infections and a greater itch. Certain medications like Apoquel or Cytopoint are more effective with a healthier skin barrier.

Christman: In cases where systemic therapies are also prescribed, how do you determine the synergistic role of topical treatments in managing itchiness alongside oral medications?

Miller: Allergy management is multimodal. It is unlikely I will send a client home with only 1 treatment and call it a day. If you approach an itch from a whole-animal perspective, it helps you use less medications. It also lessens the number of allergic flares. I’m able to reduce the necessity of medications by supporting the epidermal barrier. On top of pills, I’m usually checking in with clients about whether they could use a spot-on treatment or spray to better enhance the efficacy of the treatment.

Christman: What emerging topical therapies or innovations do you find promising in alleviating itching in dogs?

Miller: PYOspot is a spot-on treatment that goes along the top of the animal like a flea preventive treatment and has been proven to reduce bacterial pyoderma. Bio-Bomb is also an incredible product that, without being too greasy, hydrates noses and paw pads. The next product I recommend is Essential 6, which is an essential oil that moisturizes the skin. What I love about this line of products is they are wholistic and seek to benefit the pet as much as possible.