Case 12


Wyatt's history and the clinical appearance and timing of the lesions (transition from summer to fall) make you most suspicious of a flare of atopic dermatitis because of an elevation in pollen counts. The dermatologic examination and cytology results are supportive of secondary pyoderma (most likely staphylococcal pyoderma) with concurrent Malassezia dermatitis. Wyatt's severe pruritus can be explained by a combination of allergic inflammation and secondary infection.

Because even the best-controlled atopic dogs will have occasional allergy flares, you elect to resolve the current ear and skin infections but will consider other possible differential diagnoses if Wyatt's signs do not improve as expected. Sarcoptes is endemic in your area but Wyatt's skin scraping results were negative, so you placed it lower on your initial differential diagnosis list.

You dispense the following medications and other therapeutic measures for Wyatt:

  • Cephalexin at 22 mg/kg orally b.i.d. for 21 days

  • Ketoconazole at 5 mg/kg orally once a day for 21 days

  • Gentamicin-clotrimazole-betamethasone ear suspension: 7 to 10 drops b.i.d. in each ear for 14 to 20 days

  • Prednisone at 0.5 mg/kg orally once a day for 7 days and then once every other day for 7 days; then discontinue

  • Weekly baths with a benzoyl peroxide-based shampoo; allow a five- to 10-minute contact time.

  • Continued weekly allergen-specific immunotherapy injections


The owners are concerned that their newborn baby might catch something from Wyatt. The best course of action would be to board Wyatt or have him stay with their in-laws until he has completed his treatment to limit his contact with the baby, true or false?




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Aaron Smiley, DVM
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