Scratch scratch scratch - Part 1 of 2
Vets often hear this complaint in the examination room, where clients complain about the incessant itching and scratching of their pets. This is a more common complaint with dogs where the nightly thump, thump, thump of a hind limb hitting the floor keeps the owner and the dog awake for hours. If it is irritating and hard wearing on the owner, then equally so, if not so much more for the affected pet. Skin problems in dogs and cats make up by far the biggest number of cases seen by vets. This is understandable given the fact that the skin is the biggest organ in the body. By definition, it is also the organ which has the greatest exposure to the environment.
Although there are several causes of skin irritation in pets, it usually results in a limited number of symptoms of which itching and scratching are the most visible (and sometimes audible) to the owner. The diagnosis of the condition which leads to the symptoms may not always be as straightforward as one might think. Similarly, the treatment options also vary dramatically from condition to condition. One treatment which may be effective for a specific cause of skin disease may actually exaggerate and worsen another skin condition. Therefore, it is imperative that the vet does a proper clinical examination accompanied by an accurate history of the condition, provided by the owner. People often say vets are so great because they make diagnoses without the patient being able to tell them what is wrong. In certain cases, this may be true, but in most cases, vets rely strongly on the history of the condition, provided by the owner, and therefore the owner has to speak on behalf of their pet. In most cases, it is far more complex and difficult to make a diagnosis when there is no history of the condition available than when the owner of the pet can give a detailed and accurate history of the symptoms and behaviour leading up to the condition.
There are several causes of itching and scratching in pets such as parasites, allergies, hormone disorders, infections and behavioural problems, to mention but a few. In order for the vet to make a proper diagnosis, there has to be a systematic approach. Starting with the most obvious and common causes would be the first line of approach. If this does not lead to an immediate and correct diagnosis there has to be a process of elimination with the exclusion of one possibility after the other until a definitive diagnosis can be made and a specific treatment can be prescribed. Sometimes this may be a very simple and straightforward process and treatment may be successful in a very short period of time. Most clients will tell their friends how wonderful and clever their vet is and how quickly and effectively he or she managed to solve their pets’ problem. Other times it will be a complicated, long drawn out and difficult process to make a diagnosis and treat the pet effectively, often times not having a definitive cure and leading to frustration and despair on the part of the owner for the vet’s inability to treat the patient successfully. In many cases these clients will go from vet to vet for several opinions, trying to find a solution and cure for their pet’s condition, and often these clients will lose faith in the veterinary profession’s ability to effectively diagnose and treat their pet’s condition. Vets find these cases as frustrating and demoralising as owners and realise that the cost involved in making a diagnosis and treating the pet was never something the owner prepared or budgeted for. Sadly many pets are eventually euthanased as a result of the incredible cost of treating such a pet effectively. The moral debate on whether this is fair and correct will rage on forever, but suffice to say that with modern veterinary medicine, euthanasia should not be necessary with difficult to treat skin conditions.
So where does one start with the diagnosis of an itchy and scratchy pet? The first place is a good clinical and physical examination by the vet. This examination has to be accompanied by a thorough history of the condition and many vets will actually use a pre-set questionnaire which they will use to go through a systematic progression of the condition, covering various aspects of pet’s environment, habits, diet and exposure, to determine the cause of a condition. Whilst obtaining the history of a condition the vet may try to establish if a condition started as an itch, which then leads to the animal scratching, or alternatively if the animal started scratching first, which then lead to further itching. This simple “chicken egg” scenario may give some important clues to the underlying cause of the condition.
An important part of making a diagnosis is the breed, the age and the gender of the animal. Certain conditions are genetically inheritable and prevalent in certain breeds, and the presentation of a specific breed of animal with specific symptoms will often be a dead giveaway to the possible underlying cause of the condition. Without jumping to a conclusion in certain breed-specific conditions, the vet may be able to speed up the diagnostic process by keeping these conditions in mind.
Following on the clinical examination and history, the vet may need to do some diagnostic tests. These tests may include skin scrapes, skin tape tests and impression smears, blood smears, comprehensive blood screening tests, blood hormone assays, injection challenge tests, allergen screening blood tests, needle aspirate examinations, hair pluck examination tests, cultures or ultraviolet light examination, to mention a few. (The list mentioned here is by no means a comprehensive list of the diagnostics tests available for use by vets, but merely an indication of some of the tests which the vet may recommend, in order of make a diagnosis.)
Some of the diagnostic tests mentioned above can be done immediately, at the time of the first clinical examination, and a definitive diagnosis may be made there and then. One has to be careful though, as sometimes one obvious diagnosis may in actual fact be a cause of another underlying condition. A simplistic approach to diagnostics and treatment may lead to resolving the initial symptoms associated with the obvious or secondary condition, without addressing the primary or underlying condition. This approach may lead to treatment failure in the long run and to a condition deteriorating over time. The follow up of treatment therefore actually forms an important part of the diagnostic and future treatment process of an animal with a skin condition.
In part two of this article, we cover more specifics in terms of the causes and treatments of skin conditions which lead to itching and scratching.
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