Do you want to know the best questions to ask when you’re dealing with a dermatological problem? Well, in this blog post Anthony Chadwick goes over the questions that he has always asked in a dermatology consult. If you get these right, then quite often you’re pretty close to a diagnosis before you even look at the animal properly!
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Signalment is always important, ensuring we ask questions such as what breed of dog or cat it is? What is the age? What is the sex? Especially as we know that younger dogs are more prone to atopic disease, and we know that older dogs are perhaps more likely to get endocrine or neoplastic diseases. Of course, certain breeds also get specific problems. We know that west highland white terriers and basset hounds are very prone to Malassezia, which can then obviously lead to atopy as well. So, it’s important to just take a little bit of time at the start, to get some thoughts as to what the breed is, the age and the sex.
It’s always good to know familial history. Do we know about the mum and dad when the people bought, for instance, a puppy? Were they in good condition? For example, if there’s Demodex in the family, then that may explain why the puppies may have also got Demodex. When the owners acquired the dog or cat, did it immediately have the problem, or did it come very soon after? This may mean there may be a mite or a flea problem. So, all of these questions just help you to begin to make a broader, clearer picture of what might be happening.
When did the problem start?
If the dog or cat is pruritic, when did the problems start? Are the clients aware that the animal is pruritic? Quite often I would see a cat that was obviously over-grooming, and we’d ask the question “Is your pet itchy?”, and they would say no it isn’t. So then we’d ask “Is it always grooming itself?” and they would say yes, it’s always keeping itself clean. That may be a sign of pruritus, and maybe a sign of flea allergy dermatitis. When you go to test that animal for fleas, you quite often come back with a negative flea comb test because of course, the cat is removing the fleas with its own tongue.
Therefore, it is important to try and work out when the pruritis started, how severe it is, and what areas the dog or cat are itching on. A scabies dog will often be scratching at its elbows, ears and on its ventral as well. In fact, you can often do the pinnal-pedal reflex, where if you scratch the end of the ear on a dog with scabies, it often starts to scratch itself.
With itchiness, it’s also important to ask whether it’s a seasonal problem or whether it happens all year round. If you see something that’s very summer seasonal, it could well be that the dog or a cat has pollen allergies. If it goes on all year round, then it’s much more likely to be dust allergies and so on.
Sometimes you may have a problem that is at first seasonal, but then becomes more generalized. Sometimes an animal may go to kennels, and because it is outside the dust mites aren’t as much of a problem and it will actually improve in those two weeks that it’s been there. However, once it goes back into the centrally heated, warm house with lots of dust mites and dust around, the problem can reoccur.
Ask the clients to score the itchiness
When I was examining my patients, particularly the pruritic patients, alongside writing all my history notes and looking at the dog to get a sense of how itchy it was, I also asked the client to give me their perspective on a scale of 1 to 10 (1 being it never itches, and 10 being it itches incessantly). A 9 or 10 would then make me suspicious of scabies, although it could be a severe allergy as well. Getting a sense of this was also helpful for the following consults, where we could see if our treatment were helping. Quite often in the early stages, my treatment was not steroids because clearly, steroids would stop the itch, but they really cover the other problem and make it very difficult to come to an actual diagnosis.
Who else is in the house?
It is also an interesting question to know who else is in the house – are there any other pets? Do the other pets have itchiness or is it just this one? If there are lots of fleas around, asking the owners if they are getting bitten on the ankles is also useful.
I remember a springer spaniel case, where I asked the owners the question, “have you got any itchy spots?”, and they both had. They had perhaps not made that connection, but with just the history and almost without touching the animal, I knew that this was an infectious parasitic problem, and I felt very confident that we would be able to sort the problem out.
What is the animal’s diet?
Obviously, the theme continues, a lot of cases that I saw were itchy dogs who were uncomfortable. Therefore, what we had to do was to try and get to the bottom of what was causing the itch, with a view to then remove the cause or control it by use of medications.
Therefore, not a common problem, but certainly one that I think is important to look at is a food allergy or intolerance. I would say 5-10% of itchy dogs will have a component of food allergy or food intolerance. We must not miss that, because they can be really, really itchy. However, if you control that food allergy problem, then they will make a good recovery.
Have they been seen by other vets?
Clearly, sometimes with skin allergies, the problem has been a long seated one. They may have been to several vets before, so it is important to find out what medications have been used. Gather the treatment history so that you do not have to go over any old ground again. Figure out how often flea treatment was used, and if steroids were used, did they stop the itch?
Ask about the general health
Finally, it’s always important to get a sense of the general health of the dog or cat, because skin diseases can be an outward sign of an internal manifestation. Maybe ask the question “is the dog drinking excessively”, which it may do with Cushing’s disease. “Has he got diarrhoea?”, which it may have with a food allergy. Then follow this up with a clinical examination that starts as a general clinical examination before you rush to look at the skin problem itself.
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