Ashley Bourgeois, DVM, DACVD: Hello, and welcome to this DVM360® Insights titled “The Itchy Dog: A Multimodal Approach and Behavioral Considerations.” I’m Dr Ashley Bourgeois. I’m a board-certified veterinary dermatologist and a co-owner of Animal Dermatology Clinic, practicing in Portland, Oregon. I like to educate veterinarians through my podcast and social media platform, The Derm Vet. I am very fortunate to have this discussion with 1 of my favorite colleagues, Dr Christopher Pachel. He is a board-certified veterinary behaviorist and the owner of the Animal Behavior Clinic in Portland, Oregon. You can find his additional content on his website, www.drpachel.com. In today’s discussion, we’re going to provide insights into the itchy dog and the multimodal approach necessary for appropriate management long term. We should just get started and jump in because we have a ton to talk about, and we’re both very passionate people on our specialties.
Let’s start easy. We’ll ease our way into it. How can a dog exhibit itch or pruritus? It’s going to make sense if I take the lead on that first because we’re diving right into the heart of dermatology. Then we’ll bring in the behavioral component because there are definitely some considerations for that. How can a dog exhibit itch or pruritus? This is an important question. When I’m talking to a client, I oftentimes just ask if the dog is itchy, because the way a client perceives itch can be much different from what a dog actually does. For example, I have had numerous cases where I will just say, “Is your dog itchy?” And the client will say, “Not really. I don’t really consider them to be a particularly itchy dog.” Then I’ll rephrase it, “OK, so you don’t notice any paw licking, head shaking, scratching, chewing, overgrooming, or anything like that?” And they’re like, “Oh, they lick their paws incessantly. They just won’t stop.” There are a lot of ways that we can see dogs exhibit itch. Make sure to be specific about that and lead your questions into what the client is saying. For example, scooting is a way that they can exhibit itch. If I’m doing an exam on a dog, and I start to notice the peri-anal region is really inflamed, I may ask, “Do they tend to scoot? Do they lick toward their rear?” Because those can be ways of exhibiting pruritus. But clients also often think of this behaviorally. They think, “Well my dog is showing these OCD [obsessive compulsive disorder] tendencies. They’re incessantly doing this, and it’s because they’re stressed.” Dr Pachel, I’d love to hear your take on this. How do you correlate something when a client has ended up in your hands and is starting to mention these behaviors? How do you start to distinguish the behavior changes vs true pruritus?
Christopher Pachel, DVM, DACVB, CABC: That’s such a great question, Ashley. We’ve got so many things to be able to tease out within that. Especially if we pull that lens back, even just a little, with an acknowledgment by saying that anything the animal does is behavior. Itch is 1 of the possible explanations that a client might create for that. If we ask itch, we’re expecting them to funnel all that together into that particular label. In fact, if we start getting to the actual licking, scratching, scooting, and chewing, those are a lot more easily identifiable. They’re more observable characteristics. What I love about that, in the beginning our conversation, is that it not only starts to narrow that conversation of, “We’re skewing our conversation toward itch,” but it also establishes our clinical baselines that we can then refer back to later on: “When we met 3 weeks ago, you told me that licking was happening 3 times a day,” or whatever the baseline happened to be. We’re establishing a barometer in the process of establishing a communication. I love being able to make sure that the client and I are talking about the same thing from the get-go, and that our interpretations are as close to being on the same page as they need to be for us to start moving into the clinical conversation.
Ashley Bourgeois, DVM, DACVD: That’s an important point, because of how behaviors change. We’re going to dive into history soon, but how is that behavior a year ago vs now? A lot of times I’ll hear things like, “We moved, and then it got worse. I think it’s just because they’re stressed.” Are they doing that methodical licking vs are they whipping their head around and chewing quickly at their rump? Those can all be things that are quite different. But you’re right: It’s a change in that pet’s behavior, even though it might not necessarily be because of a behavior problem. It’s just a different way that they act. When I think of behavior changes and the mimicry with that, within dermatology I think of severe otitis. I’ve had patients who come in and they have a very severe otitis, it’s really cyanotic, it’s really edematous, it’s swollen, and they’re super painful. I will barely palpate that ear, and they’ll try to bite or scream or not act like themselves. But it’s not because of behavior problem. It’s because of a manifestation of their dermatologic disease. I’ve seen cases completely change their behavior, whether we’ve treated a really deep pyoderma or a really nasty, swollen edematous otitis. All of a sudden, within a recheck or 2, they couldn’t care less if I go in their ears or touch their paws. They’re not trying to bite me. Their behavior changes are all reflection of other problems. Just recognizing that is extremely important in these pets.
Christopher Pachel, DVM, DACVB, CABC: One last thing that I’ll mention is that we’re often looking at the outward sign. They’re doing something unusual: licking, scratching, biting. They’re doing something there. It can go in the other direction too. If an animal is uncomfortable, we may see behavioral inhibition, where walking around the house is now uncomfortable because we’ve got some degree of a photo dermatitis. We can see it going the other direction too, where the animal is just not themselves, but it’s the lack of normal behavior, as opposed to a new expression. What I really try to get to the heart of what the differences are. What are the deviations in behavior from what we consider to be normal or appropriate for that animal, that may start to tip us into 1 direction vs another in our explanations?
Ashley Bourgeois, DVM, DACVD: I love that. You’re absolutely right. There are a lot of pets where the owners start to say, “’They’re not as social. They’re not going to play with my kids. They’re not running around the backyard.” You’re absolutely right. When you get those swollen cases of photo dermatitis, you can see that. I’ve recently seen a dog who all of sudden was attacking the other dog at home, and that wasn’t like him. He had really swollen nasty photo dermatitis. Unfortunately, this owner has 2 dogs with terrible allergies and the other dog self-isolates. When his disease is really bad, he won’t play as much with his brother because he’s in so much pain. That’s a super important point: we can see both ends of the spectrum, not from that primary problem but from the secondary issues they’re showing us from their behavior changes.
Christopher Pachel, DVM, DACVB, CABC: Exactly.
Transcript edited for clarity.