By Dr Monica Burger, Bergzicht Animal Hospital

“You are not alone in this – don’t give up, don’t become frustrated or despondent. Allergies cannot be cured, only managed. I’m here to help you, every step of the way!”

The most important thing is to understand that your vet is not only prescribing treatment to soothe the itch, but he/she is also following a diagnostic algorithm to ultimately rule out causes for the itchy skin so that a specific diagnosis can be treated. This process is of cardinal importance for long term management.

1. Vet consults:
   Please avoid vet-hopping (we follow a process of elimination of causes which can take weeks!), please follow up as requested and please comply as best as possible with all instructions given. Itchy skin cannot be cured, it can only be managed. If you are unclear or unhappy with the process, please chat to your vet for clarification!
2. FLEAS and other parasites:
   Even though you have not seen a single flea in 5 years and your dog lives indoors only: if you have a pet with itchy skin, you MUST treat for external parasites routinely. External parasites break the skin barrier and release proteins through their saliva (which some pets are allergic to) making them super itchy! Think about a mosquito-bite, it can itch for days!
   We cannot rule out fleas as a cause if it is not treated for!
   Use a systemic product (not flea powder / shampoo) which covers fleas, ticks and mites for an extended period (to cover their lifespans).
3. Shampoos:
   Any skin allergy, whether caused by food or the environment may have self-inflicted secondary infections which must be managed with shampoo alone – gone are the days for courses of antibiotics for superficial skin infections! This causes marked antibiotic resistance (a topic outside the scope of this page). There are specific shampoos for specific conditions – enquire and use the right one the right way! Even once infection has resolved, itchy pets benefit from topical washes as a maintenance routine.
4. Rebuilding the defective skin barrier:
   Our skin acts as a protective barrier keeping the environment outside. Pets with itchy skin often have a defective barrier. The supplementation of a specific essential fatty acid (EPA) to rebuild this defective barrier will aid with long term management as it prevents allergens (pollens, moulds, dust mites, etc) from reaching the deeper areas of the skin which causes the inflammatory reaction which sets off the itch! This rebuilding process takes 6 weeks. There are many ways to supplement EPA, but the most effective and balanced way is with Hill's Prescription Diet Derm Defense as it also contains other ingredients to soothe the itch and supplement the skin!
5. Cortisone and other immunosuppressive drugs:
   While these drugs have a place in the management of skin disease, I personally feel they are being overused and abused. With a proper diagnosis and management plan, the itchy skin can be managed without chronic medication in most animals with short courses of cortisone used for bad flare ups only. As far as possible, topical cortisone sprays should be used rather than systemic medication to avoid the many side effects of long term use. Very itchy pets who respond poorly to the above treatments warrant chronic use of immunosuppressive therapy - alternative medication such as cyclosporine should be considered over cortisone (this will be prescribed by your vet).

By Dr Monica Burger
Bergzicht Animal Hospital