Itchy pets 101 (Part 2: Diagnosis)
Now that we’ve established that you have an itchy pet...and I’ve informed you of the likeliest causes for said itchiness (in Part 1 of this three-part series), it’s time to get started on ways in which you can get to the bottom of the problem.
For starters, understand that “itchy skin” is not a diagnosis in and of itself. You’ll need to get to the source of the problem before you can treat it as effectively as possible (which I’ll outline in Part 3 next week). More important, still, is to understand that if you don’t know what’s causing the itchiness, your chances of creating new problems (through inappropriate treatments) and inadvertently propagating the misunderstood disease process means more suffering for your pet.
But where to start?
1. Your veterinarian
Strange as it may sound, many pet owners choose to live with itchy pets for long periods of time before they decide it’s time to seek some professional help. They either assume that a high degree of episodic itchiness is normal and will eventually go away, or they’re unconvinced that it’s a big enough problem. In fact, it’s only when major lesions result (loss of hair, bloody “hot spots,” hives, etc.) that some pet owners think it’s finally time to enlist the vet.
Not so. Though some itchiness may be mild and transient, any itch that lasts for more than a day at a time should be checked out.
2. The basics
A “history” is what docs call the part of the office visit when we ask you to explain the problem in your own words. How long has it been there? Does it come and go? have you changed anything in her environment recently? Does she live indoors or out?
Seems simple...and yet so crucial.
The skin is an organ that reflects the workings of the rest of the body. For that reason, a full physical examination is always the first step for your veterinarian. And it’s not just about looking for subtle skin changes you may have missed (or misunderstood). It’s also about the entire pet––start to finish.
Except perhaps in the case of the most obvious skin troubles (think fleas), basic laboratory tests are usually necessary to get the complete picture of a pet’s health and to rule out skin manifestations of internal disease (bloodwork, urinalysis). This becomes especially important for older animals but makes fundamental sense for all itchy pets.
Thyroid hormone testing deserves a special mention here. Since this hormone is commonly implicated in itchy skin, it’s a must for most non-straightforward cases of itchiness in pets.
3. Superficial skin tests
If the itchiness has led to changes to the skin (however subtle they may be), tests to examine the skin contents itself are often undertaken. This may happen with skin scrapes (to unearth microscopic parasites and examine hair shape), impression smears (a way to dislodge and evaluate cell types along with miscroscopic growth of bacteria and yeast), fungal cultures (performed by plucking hairs and placing them in a cuture medium for a few days before investigating any growth microscopically), bacterial cultures (usually of suppurating infections) and/or swabs (from the ears, for example) to look at the cell types present and for microscopic bugs that may be infecting them.
4. Deeper skin tests
A biopsy of the skin may be necessary depending on the type of lesion(s) present. Though more invasive than the scrapes, smears and plucks, sometimes this is the only way to rule out some of the more tough-to-diagnose diseases (autoimmune diseases and hormone-related diseases, in particular).
5. Provocative tests
Sometimes we’re really stumped. And sometimes it simply makes sense to proceed stepwise with our investigation of a not-so-obvious skin problem. Whatever the case, it’s clear that itchy skin disease can often be evaluated based on the skin’s reaction to shampoos, drugs and other ministrations. We call these “provocative” tests––as in, provoking a response to help narrow down our diagnostic choices.
6. Food trials
A food trial is a way to help evaluate the skin’s potential response to proteins and carbohydrates, often a source of skin allergies.
7. Allergy testing
Though food trials are a form of allergy testing, as are many of the other tests above, more direct testing for allergies happens often through either blood testing or direct skin testing. These tests are geared to checking a long list of potential allergens against the blood or skin’s reaction to them. Though expensive, these tests help tabulate a very specific list of items your pet is allergic to.
8. Keep your eyes on the prize
Unfortunately, the goal is not always to make your pet feel 100% better immediately. Sometimes we have to meander through some or all of these tests, interspersed with therapeutic approaches, before we can get to the bottom of the problem and either cure it or manage it as best we can. Frustrating as it may be, this is always the right approach when you consider the alternative: masking a deeper problem or worse...prolonging suffering by closing our eyes to the bigger, long-term picture your itchy pet presents.
Dr. Patty Khuly