• DVM360_Conference_Charlotte,NC_banner
  • ACVCACVC
  • DVM 360
  • Fetch DVM 360Fetch DVM 360
DVM 360
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
By Role
AssociatesOwnersPractice ManagerStudentsTechnicians
Subscriptions
dvm360 Newsletterdvm360 Magazine
News
All News
Association
Breaking News
Conference Coverage
Education
Equine
FDA
Law & Ethics
Market Trends
Medical
Politics
Products
Recalls
Regulatory
Digital Media
dvm360 LIVE!™
Expert Interviews
The Vet Blast Podcast
Medical World News
Pet Connections
The Dilemma Live
Vet Perspectives™
Weekly Newscast
dvm360 Insights™
Publications
All Publications
dvm360
Firstline
Supplements
Vetted
Clinical
All Clinical
Anesthesia
Animal Welfare
Behavior
Cardiology
CBD in Pets
Dentistry
Dermatology
Diabetes
Emergency & Critical Care
Endocrinology
Equine Medicine
Exotic Animal Medicine
Feline Medicine
Gastroenterology
Imaging
Infectious Diseases
Integrative Medicine
Nutrition
Oncology
Ophthalmology
Orthopedics
Pain Management
Parasitology
Pharmacy
Surgery
Toxicology
Urology & Nephrology
Virtual Care
Business
All Business
Business & Personal Finance
Hospital Design
Personnel Management
Practice Finances
Practice Operations
Wellbeing & Lifestyle
Continuing Education
Conferences
Conference Listing
Conference Proceedings
Resources
CBD in Pets
CE Requirements by State
Contests
Veterinary Heroes
Partners
Spotlight Series
Team Meeting in a Box
Toolkit
Top Recommended Veterinary Products
Vet to Vet
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us

© 2023 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Advertisement
By Role
  • Associates
  • Owners
  • Practice Manager
  • Students
  • Technicians
Subscriptions
  • dvm360 Newsletter
  • dvm360 Magazine
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us
  • MJHLS Brand Logo

© 2023 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

A logical approach to pruritus (Proceedings)

August 1, 2009
Karen Kuhl, DVM, DACVD

Being confronted with a pruritic dog or cat is an extremely common occurrence in general veterinary practice. So, we need to be prepared.

Being confronted with a pruritic dog or cat is an extremely common occurrence in general veterinary practice. So, we need to be prepared.

Really, working up a pruritic patient involves starting at the beginning. You usually have to slow down the people attached to the animals and get them organized. So, the beginning is the history. Is this an acute or chronic issue? What age did problems start? Did the "rash" onset prior to the "itch" or vice versa? How severe is the pruritus? Is there exposure to other animals? Are other animals or people in the household affected?

You should also be looking at signalment, seeing what types of lesions are present, which area of the body are affected. All the above will help you determine which tests are most appropriate.

Advertisement

A more acute presentation might lead you to think more of ectoparasites or dermatophytosis. A more chronic presentation would be more typical of allergy. A young age of onset might be more typical of ectoparasites. Typically atopy and flea bite hypersensitivity occur most frequently in the 6 mos. to 4 years age group. However, food allergies can occur at any time. The severity of the pruritus varies tremendously. If a patient is a 10/10 on the pruritus scale or is scratching in the exam room, it is prudent to rule out ectoparasites (including fleas and sarcoptic mange) prior to proceeding. If other animals or persons in the household are affected, then a contagious entity becomes more likely. These are all, of course, generalizations, but can be very helpful when working up a case.

When first examining the patient, it is important to categorize the areas of the body that area affected. Again, this can help you start to pigeonhole the etiology of the pruritus. So, if the caudal dorsal lumbosacral region is affected, you should consider ectoparasites. If the face ears, elbows, ventrum and hocks are affected, you should consider Sarcoptes scabiei. If only the ears are affected, you may want to consider allergy, ectoparasites or autoimmune. If the face, feet, axillae, inguinal region ears are affected, you should consider allergy, autoimmune, demodicosis, dermatophytosis. Obviously, if fleas or flea dirt are noted, appropriate flea control should be instituted.

So, this gives you some basics. However, most importantly, you will need to do a logical work-up. You should always do skin scrapings. If ectoparasites are found, then you should treat as indicated. If any arthrospores are visualized on the hairs, then a dermatophyte culture should be done. If melanin clumping is seen, further work-up for follicular dysplasia/color mutant alopecia may be necessary.

If there are any clinical signs suspicious of pyoderma or Malassezia, tzanck preparations should be done as well. If cytology is indicative of a bacterial infection, then appropriate therapy should be instituted. The case should then be re-evaluated upon resolution of the skin infection. If the pruritus is still present, further work-up for allergy or ectoparasites would be appropriate. Additionally, if Malassezia is present, then a similar approach would be taken. It is very important to always clear secondary infection prior to evaluating the pruritus. It is also important to not give corticosteroids at the same time or else it's really hard to evaluate the effect of clearing the infection on the level of pruritus.

So, if you've ruled out ectoparasites and treated for secondary infections, it is time to do an allergy work-up. Obviously in non-seasonal cases, you should start with a food elimination diet of a novel protein and carbohydrate. If this is negative and you've ruled all else out, then you have a diagnosis of atopy and need to decide which therapeutic approach is most affordable and effective for your particular patient.

Related Content:

Dermatology
Molecular allergology: what you need to know about the future of allergy testing
Molecular allergology: what you need to know about the future of allergy testing
Topical therapy and immunotherapy can save time and frustration with dermatology cases
Topical therapy and immunotherapy can save time and frustration with dermatology cases
Comparing treatments for restoring the skin barrier in atopic dogs
Comparing treatments for restoring the skin barrier in atopic dogs

Advertisement

Latest News

3 Must-sees for Women's History Month

News wrap-up: This week’s headlines, plus Embrace announces its top Irish pet names

Oldest tortoise at Houston Zoo becomes father to 3 hatchlings

Veterinary tech students awarded national scholarship

View More Latest News
Advertisement