Updated November 28th, 2020
If you’ve got an itchy dog, it gets very frustrating very quickly. Nothing seems to help for long, and everyone tells you something different. Is it the food, is it grass, is it mites?
I’ve been seeing itchy dogs for nearly 30 years and I’ve yet to see one who can’t be helped. Here I’m going to boil down all the conflicting advice into a simple step by step approach.
First, let’s define what makes an itchy dog.
Signs Of Pruritus In Dogs
The sensation of itchiness on its own (called pruritus) only causes the skin to look pinker than normal. That would be as far as it went if it wasn’t for two unavoidable consequences:
- Dogs are unable to resist the temptation to bite, scratch or lick at an itch
- Dog skin quickly gets secondary infections with opportunistic yeasts or Staph
It’s these two effects that really create the typical appearance of an itchy dog. This could be any of the following:
- Ear infections
- Licking the feet and chewing at the paws
- Red-brown saliva staining in the coat
- Hotspots and skin infections
- Hair loss and a doggy smell
- Thickened or black skin
8 Steps To Stop A Dog Scratching
The following is my approach towards a more comfortable dog, and could be your pathway too. Each is a trial: we keep what works, and keep going until everybody’s happy. Some steps are for you alone, others are in partnership with your vet.
When I do this in my clinic I will often change the order or overlap the steps depending on the situation. Your vet is likely to do this a whole different way, and that’s fine too.
Step 1: Eliminate Secondary Infections
Stopping a dog from itching, scratching or biting is impossible if there’s any secondary infection. Therefore, you need to see a vet straight away if there are signs of the following:
Then come back to this list!
Step 2: Parasite Control
Let me be blunt. There is no place for “my dog is scratching but he doesn’t have fleas“. Not in an age of excellent, affordable flea control. Especially not when mange mites can be eliminated in the same step.
Allergic dogs carry fleas in numbers that are too low to detect, and you’ll never see mites. Therefore, whether you believe in it or not, please, please start out by using a good parasite prevention. Think of it like an insurance policy.
I would only use one of:
Step 3: Shampoo
Never underestimate the effect of bathing done properly. The myths about bathing dogs too often are outdated and based on bad shampoo choices. Every dog should get the opportunity to see if bathing can help.
Bathing will work if it can remove the offending allergen or irritant without disturbing the skin’s barrier function. I ask owners to use soap-free shampoos like Aloveen at least once a week, but preferably twice. For yeast I will use Malaseb.
Dogs prone to ear infections often benefit from a flush with products like Epi-Otic afterwards.
Then there are the moisturisers. Each good shampoo company has a matching conditioner or spot-on treatment. These aren’t always necessary, but definitely worth trying.
Step 4: Food (Part I)
I’ve discussed before the reasons why food is over-hyped in itchy dogs, but it still plays an important role, twice.
Here and now, we want to try food as a form of medicine. So I ask you to use a diet specifically formulated to reduce itch in dogs. These are not elimination diets (yet). Two examples are:
- Royal Canin Skin Support
- Hills Sensitive Skin
Skin foods work by containing all the known nutritional supplements that can help reduce itch in dogs. They are not spectacular, ever, but they always help a bit.
If you don’t want to change the diet, then at a minimum add fish oil to the diet at a rate of one gram per 4.5kg bodyweight. Stop immediately if it causes tummy upsets.
Step 5: Prednisolone Trial
After all this is done (and still being done) I will usually try a short course of prednisolone. You can read more about the approach here, but what I’m looking for is that third of dogs who will tolerate its side effects while achieving relief of symptoms.
Here I’m getting controversial, and in fact I skipped this step with my own Jack Russell. However, if you can get it to work, prednisolone is a far, far cheaper option than what is to follow.
Step 6: Food (Part II)
A lack of response to prednisolone at regular doses pushes food allergy higher up the list, enough to justify the next step. Now we perform a strict elimination diet. These are not for the half-hearted as you’ll see at the link.
I am very tired of seeing poor dog owners who’ve been told at the beginning that their dogs have a food allergy (usually wrong) and then put on a different food (that almost never works). I often only learn of this six months later after they’ve given up.
There is a widespread lack of understanding about what constitutes an effective food trial. Just changing brands it is certainly not. It’s an eight-week highly controlled diet with very limited chances of success. That’s why it’s this far down the list: important to rule out, but not high priority.
Step 7: Cytopoint or Apoquel
At this point, we’re out of simple options, and the problem looks like it’s here to stay. Only five years ago, such dogs had to suffer, but now we have two further choices:
- Apoquel is a tablet that suppresses a range of inflammatory cytokines involved in inflammation
- Cytopoint is a monoclonal antibody injection that binds to interleukin-31 and prevents it initiating inflammation
These drugs are generally well-tolerated and extremely effective. I find that both work best if they are started early in the course of dermatitis, before secondary skin changes develop. The disadvantage of both is price; indications of each can be found at the links.
Step 8: Referral
If all the treatments we’ve tried so far haven’t given enough relief, now is the time for a veterinary specialist dermatologist. Hopefully you’re lucky enough to have one nearby. Here in Adelaide we can arrange referral to one of two vets who deal exclusively in skin problems.
Of course. this step doesn’t have to be last. At any stage you can ask for referral, and we will happily provide it. However, my own approach is to pick all the low-hanging fruit I can before sending you away.
Costs only go up, which means this isn’t for everyone. But it’s usually worth at least just taking the first appointment to see if there’s anything simple that’s been missed.
These 8-steps are a very individual approach. Not unconventional, just my personal take on a complex problem. Here are some other treatments you’ll also get advised:
- Antihistamines are often added early in the process. I don’t think they work very well, but I can’t criticise the attempt. We’re all trying our best.
- What about all the creams, ointments, lotions and sprays? I do use them from time to time, but overuse can cause skin damage, toxicity or increased licking. Their best application is for small areas when the rest of the skin is under control.
A Plug For Insurance
I once heard from a pet insurance company that their number one payable condition is dermatitis, and I’m not surprised. But if your dog already has symptoms, it’s too late to get them covered. This is what we call the pre-existing condition exclusion.
Therefore, if you’re the owner of a young, healthy dog, do consider pet insurance. I can think of no better example of its effectiveness than all the dogs with atopic dermatitis. If your dog is unlucky enough to get it, then insurance means being able to take all these steps without hesitation.
Even if this isn’t an option, and funds are limited, a way can usually be found to make your dog comfortable again. So don’t suffer in silence!
Have something to add? Comments are welcome below and will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.