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5175 Pacific St., Ste B
Rocklin, CA 95677
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(916) 632-2400

Dermatology 101

FALL IS COMING

Mary Sakai

With school starting, summer coming to an end and allergy season winding down you may be breathing a sigh of relief. However, fall is the worst season for fleas and ticks!

Usually, fleas are not seen on our pets until the flea population is very high. However, every time your pet goes outside they have potential to get flea bites. Flea eggs are carried by most furry creatures (opossums, skunks, raccoons, feral cats, etc.) and fall off these critters as they pass through our yards. The eggs will hatch into a larva and then spin a cocoon. Adult fleas are triggered to hatch from their cocoons by the vibration of an animal walking by. Once the flea hatches it jumps onto the animal and bites.

As the weather cools the fleas and ticks are very happy. They like moderate temperatures and humidity (don’t we all). So do not forget your flea and tick prevention as autumn nears. 

Mange

Mary Sakai

Miscoscopic image of Demodex canis mites

Miscoscopic image of Demodex canis mites

You may have heard the term “mange” used to describe various types of skin problems, but what does a diagnosis of mange really mean?  Mange is a layman’s term used to describe a mite infestation.  The two most common types of mange seen in dogs are Demodectic mange (demodicosis) and Sarcoptic mange (scabies).

Demodectic mange is an overgrowth of Demodex mites.  Symptoms include hair loss, comedones (blackheads), redness of the skin, and sometimes scabs and pimples.  In severe cases we can see swelling, oozing, bleeding skin lesions, and enlarged lymph nodes.  Demodex canis and Demodex injai are the mite species most commonly involved in canine demodicosis, and they reside in the hair follicles and sebaceous glands in the skin.  All dogs have a small resident population of Demodex mites; colonization from mites living on the mother’s skin occurs in puppies shortly after birth.  Most of the time, the dog’s immune system keeps the mite population in check, and there is no resulting skin disease.  In certain situations, the immune system is no longer able to control the mite population and we see mite overgrowth and skin disease.  Fortunately Demodex mites are species specific – canine demodicosis is not contagious to humans!

There are two forms of demodicosis- localized and generalized.  The definition is somewhat flexible, but in general we consider the disease to be localized if there are 5 or fewer focal lesions on the body, otherwise it is considered generalized disease.  The disease can also be classified based on the age of onset – juvenile onset demodicosis occurs in dogs around a year of age or less.  If the disease symptoms begin later in life we consider it to be adult onset demodicosis.

The diagnosis of demodectic mange is made by finding mites on skin scrapings.  Treatment of Demodicosis is evolving dramatically.  In the past, medications like amitraz (applied topically as a medicated dip) and ivermectin were the mainstays of therapy.  Both of these medications have potential to cause significant toxic side effects in some patients.  Bravecto (fluralaner; Merck), NexGard (afoxolaner; Merial), and Simparica (sarolaner; Zoetis) are isoxazolines – these three products are safe, effective, and FDA approved medications for oral administration to dogs for prevention of fleas and ticks.  Recent research has shown that the isoxazolines also have anti-Demodex mite activity. 

Sarcoptic mange, or scabies is the type of mange that gives us the “creepy crawlies.”  Scabies is caused by an infestation of the mite Sarcoptes scabiei var. canis.  Scabies mites live in the superficial layers of the epidermis and are highly contagious between dogs!  Sarcoptes scabiei var. canis prefers a canid host, however these mites can transiently infest and cause symptoms in some humans.  Scabies mites are typically contracted from direct or indirect contact with other dogs or wildlife such as coyotes and foxes.  Symptoms of scabies include moderate to severe itching, hair loss, scaly skin, redness, and crusting.  The ear margins, elbows, and hocks (ankles) are sites where we often see skin lesions in dogs with Sarcoptic mange, however the lesions can be generalized. 

The diagnosis of Sarcoptic mange is confirmed by finding mites on skin scrapings, however these mites can be difficult to find, and dramatic skin disease can be caused by a very low number of mites.  Because of this, we often treat dogs for scabies based on clinical suspicion.  The only way to 100% rule out scabies is to treat the dog!  When treating for scabies, all dogs in the household must be treated in order to eliminate the infestation.  Some dogs do not display significant clinical symptoms even when carrying scabies mites, so it is critical to treat all household dogs regardless of whether or not they seem itchy.

Revolution (selamectin; Zoetis) is a safe and effective topical medication that is FDA approved for prevention of fleas and heartworm and the treatment of Sarcoptic mange in dogs.  At this time, Revolution is our mainstay of treatment for dogs with scabies, however with the release of the isoxazolines as discussed above for demodicosis, we may someday have evidence that these drugs could be used for treatment of scabies as well.

Introducing Our Staff

Mary Sakai

One of the things that makes Animal Dermatology & Allergy really stand out is the exceptional quality of our staff.  Having a great team of staff members allows our doctors to provide the absolute highest quality of medicine to our patients, and allows us to provide our clients and patients with highly individualized attention and service.  We’d like to take some time this month to introduce you to our skilled and experienced staff members.

The first faces you will see when you walk in the door belong to Lindsey and Lisa, our receptionists. 

Lindsey is our primary receptionist and has been with ADA since November 2014 and has spent over 10 years working in the veterinary field.  We really depend on Lindsey’s superior communication and organizational skills.  One thing that Lindsey enjoys about working in veterinary dermatology is getting to see the improvement in our patients from visit to visit.  She also likes getting to chat with pet owners about how their fur babies’ quality of life has improved since coming to Animal Dermatology & Allergy.  Lindsey and her boyfriend have four pets: two Corgis- Doug and Tilly, and two cats- Raiden and Ms. Puss.  Outside of work Lindsey spends time hiking and trying to rock climb.  She has a twin sister who is 7 minutes older than her.

Lisa started at ADA in 2007 and has been working in the veterinary field for 9 years.  Lisa is our part-time receptionist and over the years has been a reliable and dependable part of our team.  If you visit our clinic on a day that Lisa is working you will notice that she always has a smile and a kind word for our clients and has a quiet, gentle way with our patients.  Lisa enjoys the satisfaction of helping out pet owners and watching our patients improve over time to experience a better quality of life.  At home Lisa has a pretty busy life- she and her husband have two active boys ages 12 and 15 and two 9 year old dogs (Labrador retriever and a border collie/Aussie mix).  She has lived in the Sacramento area her whole life.  Lisa enjoys photography, and she and her family spend time hiking with the dogs, and going to the boys’ baseball and football events. 

When you bring your pet in for an appointment you will initially meet Jessica or Juliann, our veterinary technicians.  Jessica and Juliann work closely with Dr. Cannon and Dr. Sakai; they often speak with pet owners to get updates on patient progress or answer questions about medications or special diets that the doctors have prescribed.

Jessica has been with ADA since February 2010 and she has been working in the veterinary field for 16 years.  She has worked in both large animal and small animal veterinary practice and her experience adds an important dimension to our team.  Jessica cares deeply about maintaining a standard of excellence in our practice, which shows through in her dedication and hard work.  Jessica particularly appreciates working with different dog breeds, and is very knowledgeable about breed-specific skin and coat properties.  She also looks forward to learning about new advances and growth in the field of veterinary dermatology.  In her free time Jessica and her husband enjoy camping, riding horses, fishing, shooting, and riding quads.  They have a variety of pets – Fuller (1 and ½ year old pit bull terrier), Lucky (14 year old pit bull terrier), Cody (29 year old quarter horse), and Kitten (17 year old domestic medium hair).  Jessica has held two past rodeo queen titles and once was the overall swine showmanship winner in the state of California.

Juliann received her registered veterinary technician certification in 2012, and joined ADA in 2013.  She has spent 5 years working in the veterinary field.  Juliann has an upbeat personality and is always cheerful, empathetic, and caring.  She is a great communicator and our clients and patients love her!  Juliann finds it rewarding to observe the before and after transformation in our patients and to see the joy in our clients, especially in the severe cases where treatment “brings back” the pet they used to know.  Juliann has one dog at home – a 5 year old Chihuahua named Skittles.  Juliann and her fiancé spend time outside of work watching her son’s sports activities, having family movie nights, and watching hockey games.  Juliann is currently working towards a veterinary technician specialty certification in dermatology.  She plans to take the certifying examination in 2017, and will be among the first group of technicians in the country to attempt this prestigious national certification.

Next time you visit us, we hope you will have a new appreciation for our staff members – we can’t say enough good things on their behalf.  Animal Dermatology & Allergy wouldn’t be what we are today without them!

Yeast Infections in Veterinary Dermatology

Mary Sakai

Malassezia otitis cytology.jpg

Skin and ear infections with yeast are frequently diagnosed in dogs evaluated by veterinarians for skin problems.  Yeast skin and ear infections are also seen regularly in cats, however not quite as often as in dogs.  Most cases of yeast skin or ear infection are triggered by an underlying disease affecting the skin, such as allergies or endocrine disease (hypothyroidism, Cushing’s disease, etc.).

The type of yeast we see on the skin and in the ears of cats and dogs is almost always Malassezia yeast.  This is a different  than the yeast which causes most yeast infections in humans- Candida.  Malassezia yeast are a normal inhabitant of the canine and feline skin.  In an animal with normal skin, these yeast organisms live on the skin surface and in the ear canals in very low numbers and do not cause a problem.  When an animal has a disease affecting the skin, there are changes in the skin barrier function, skin immune system, and the skin microenvironment.  These changes can allow the yeast population to get out of control, leading to a yeast overgrowth or yeast  infection.  Because there is usually an underlying disease process leading to the yeast infection, these are referred to as secondary infections.

The symptoms of yeast skin infection in dogs and cats can include scratching, licking, biting, chewing, rubbing, dandruff, skin changes (redness, dark pigmentation, greasiness, or thickened skin), red-brown discoloration of the fur and claws, and malodor.  Symptoms of yeast ear infection can include redness, thick dark brown ear discharge, malodor, head shaking, and ear scratching.  Yeast infections can be suspected based on observation of these symptoms, but since other skin/ear problems can cause similar symptoms, the diagnosis is confirmed by performing skin surface or ear cytology.  This is an in-clinic test in which the doctor will collect a sample from your pet’s skin surface or ear canal and examine the sample under the microscope.  This quick and easy test will allow the doctor to confirm the diagnosis of yeast skin or ear infection by observing the characteristic Malassezia  yeast organisms under the microscope.

Treatment of yeast skin or ear infections in dogs and cats involves the use of antifungal medications administered orally and/or topically.  It is also important to investigate any potential underlying diseases which may be triggering the yeast issues, as mentioned above.  For example, if the patient has an untreated allergic condition, the yeast issues will continue to be a recurrent problem until the allergic disease is addressed.

There are a lot of common misconceptions about yeast infections in pets.  The one that we probably hear most often is that yeast skin and ear infections occur because of a dietary imbalance.  Special “yeast diets” for pets which attempt to minimize dietary sugars are promoted all over the internet.  This idea draws from the fact that there is some evidence to show increased intake of dietary sugars can predispose people to Candida yeast infection/overgrowth of the genital or gastrointestinal tract.  Unfortunately, these “yeast diets” are ineffective in dogs and cats with Malassezia skin and ear infections.  Not only are we dealing with a different type of yeast in our veterinary patients, we are also dealing with different body locations (skin and ears versus gastrointestinal or genital tract).  Malassezia yeast infections in pets are not affected by dietary sugar content. 

Secondary yeast skin and ear infections are a common problem in dogs and cats, however with proper diagnosis and treatment these infections can be controlled and symptoms minimized or eliminated.

Food Allergies and Common Pet Food Myths

Mary Sakai

While flea and environmental allergies (Atopic Dermatitis) account for the majority of skin allergies, food allergies account for about 15% of allergies in pets.  There is a lot of misinformation about food allergies and foods for our pets.  Here are 6 True or False questions that relate to food allergies, with the answers and explanations following.

1)      Grains are the most common cause of skin problems.  T or F

2)      Raw or organic foods do not cause food allergies.  T or F

3)      Dogs do not get food poisoning (salmonella or E. coli)  T or F

4)      Carbohydrates and sugars in the diet will make the yeast on the skin worse. T or F

5)      Yogurt, Probiotics  and / or vinegar  will help with the yeast on the skin T or F

6)      Allergy testing can pin point the exact foods my pet is allergic to.  T or F


All of the above are false!

1)      The most common ingredients that dogs and cats are allergic to in their diets are chicken, beef, (fish- cats), dairy, egg, wheat, and corn in roughly that order.  Two scientific studies have demonstrated that some over the counter  “limited ingredient diets” contain chicken, beef, and soy – ingredients that are not indicated on the labels.  So, unfortunately changing to different diets that you can find over the counter may not help diagnose or treat a food allergy.

2)      If a dog or cat is allergic to say chicken, then he/she will be allergic to chicken whether it is raw, cooked, organic, chicken meal, or chicken byproducts.  They are all sources of chicken.

3)      At veterinary emergency clinics dogs are frequently seen for “food poisoning.”  There have also been reports of people getting food poisoning from handling raw pet foods (JAVMA 2001, 219:9; JAVMA 2005, 226:2).

4)      Yeast skin infections are very common in allergic pets, especially dogs.  The yeast that normally lives on the skin of both dogs and cats is Malassezia.  Unlike Candida yeast, Malassezia does not live in the intestines and is not kept under control by the gram positive bacteria in the intestines.  So all the carbohydrate and sugar restrictions and ProBiotics will not affect the Malassezia yeast living on the skin.  The carb and sugar free “anti-yeast” diets were developed for humans having problems with Candida yeast which lives in the intestines.  Unlike Malassezia, Candida does “feed” on the sugars in the intestines and is kept under control by gram positive bacteria that live in the intestines.

Diagnosis and Treatment of Atopic Dermatitis

Mary Sakai

IMG_1221.JPG

Atopic dermatitis is an allergic disease syndrome in which exposure to environmental allergens leads to an overzealous immune system response.  This results in itchy skin and ears, which dogs and cats will demonstrate by scratching, licking, rubbing, and biting at themselves.  As we talked about in the previous blog entry, common allergic triggers in the environment include dust, dust mites, pollens, environmental molds, and insects.  Symptoms of atopic dermatitis may be year round or seasonal, depending on the individual animal’s allergic triggers.

Arriving at the diagnosis of atopic dermatitis can be a long process because it is a diagnosis of exclusion.  This means we come to the diagnosis of atopic dermatitis by first ruling out all other causes of itchy skin disease.  Many times we do not arrive at the diagnosis until your pet has first undergone a 6-8 week strict elimination diet trial to rule out food allergies, a parasite treatment trial, and/or treatment of yeast or bacterial skin infections. 

“Why can’t you just allergy test my pet so we don’t have to go through a diet trial?” 

This is something we hear a lot!  Allergy testing can be very valuable, but it is not used for initial diagnosis of allergies.  For one thing, food allergy tests are notoriously unreliable and test results often do not correlate with a patient’s clinical response to foods.  Our dermatologists do not recommend food allergy testing.  Allergy testing for environmental allergies is something we perform frequently, but only after we have already come to the diagnosis of atopic dermatitis (see above).  The test should not be used as an initial diagnostic tool because as with any test, allergy tests may occasionally come back with false positive or false negative results.  For example, if you performed the test for environmental allergies on a group of pets with only food allergies (or even a group of pets with no allergies at all), a few of these pets would probably test positive for some environmental triggers.  The appropriate use of allergy test results is in creating allergen sera for immunotherapy (aka desensitization therapy).

Atopic dermatitis is a condition that is treatable, but not considered curable.  Pets with allergies will likely need some sort of allergy treatment regimen for the rest of their lives.  Mild allergy symptoms can sometimes be managed with antihistamines, topical therapies, and supplements.  There are currently four treatment options for pets with moderate to severe atopic dermatitis: long-term steroids such as prednisone, a medication called Atopica (cyclosporine, Novartis), a medication called Apoquel (oclacitinib, Zoetis), and desensitization immunotherapy.  Each treatment option has certain benefits and drawbacks- there is no perfect treatment option.

Long-term steroid therapy is the least ideal option.  This treatment option should be considered an option of last resort- to be used when other treatments have failed.  When used long-term, steroid medications have the potential to cause detrimental side effects, and may even shorten the lifespan of your pet.  Atopica is a non-steroid medication that is very effective in the treatment of atopic dermatitis.  It has been approved for use in the treatment of atopic dermatitis in veterinary medicine since 2003.  Apoquel is a brand new medication with promising initial results.  This medication was approved for the treatment of allergic skin disease in dogs in 2013, and was released for clinical use in 2014.  Soon after release, Apoquel unfortunately went on manufacturer backorder.  The backorder is expected to be lifted sometime in 2015.  The main limitation of Apoquel so far is that we have limited long-term safety data and limited experience with the medication (since it is such a new medication).  Immunotherapy, or desensitization therapy is the only non-drug treatment option that has been shown to produce significant improvement in clinical symptoms of atopic dermatitis.  Immunotherapy involves administration of tiny amounts of allergens in attempt to change the way the immune system responds to these allergic triggers.  Allergens can be administered by injection (allergy shots) or they can be administered under the tongue (sublingual immunotherapy- SLIT).  Each pet’s immunotherapy serum is unique, and is created based on the results of the pet’s allergy test.

Although diagnosis and treatment of atopic dermatitis can be time consuming and complicated, most pets can be managed successfully.  Our goals in treating atopic dermatitis are to reduce the severity and frequency of allergic flare-ups and to help your pet live a happy, comfortable life.  When your pet is diagnosed with atopic dermatitis, the dermatologists at ADA will discuss the details of the treatment options with you and help you choose the best management plan for your pet.

Allergies in Cats and Dogs

Mary Sakai

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Spring is here, and with it comes increased pollen counts and the start of another allergy season!  To start off the allergy season, we’d like to give you a general overview of allergic skin and ear disease syndromes in dogs and cats.

There are three major allergic skin and ear disease syndromes seen in dogs and cats: flea allergy dermatitis, environmental allergies (aka atopic dermatitis), and food allergies.  The primary symptom of allergies in dogs and cats is itching.  Itching manifests as excessive scratching, licking, biting, rubbing, and chewing.  Skin rashes, greasy skin and coat, bad odor, bacterial or yeast skin and ear infections are also commonly seen in allergic pets.  Since all of the allergic syndromes have similar or even identical symptoms, determining which type(s) of allergies your pet has can be a complicated process. 

Flea allergy dermatitis is probably the overall most common type of allergic skin disease seen in dogs and cats.  See our previous blog entry for detailed information on this type of allergy.

The second most common type of allergic skin disease in dogs and cats is atopic dermatitis.  In animals with atopic dermatitis, allergic skin/ear symptoms are triggered by exposure to allergens in the environment such as tree, grass or weed pollens, dust, dust mites, some insects, and molds.  Atopic dermatitis can be active year-round, or only part of the year during an individual pet’s specific allergy season.

Of the three major allergy syndromes we have mentioned, food allergy is the least common.  Twenty to thirty percent of dogs and cats with food allergy dermatitis may also have concurrent gastrointestinal symptoms such as vomiting, soft stool, diarrhea, or excessive gas.

Check our website monthly for future blog entries with more information about diagnosis and treatment options for atopic dermatitis and food allergies.

Why All The Fuss About Fleas?

Mary Sakai

Flea allergy dermatitis (FAD), or fleabite hypersensitivity, is an allergic skin disease syndrome affecting dogs and cats.  Most non-allergic dogs and cats can receive a few flea bites here and there without any significant itching, however animals with FAD cannot tolerate even the most minimal flea exposure.  Dogs and cats with FAD experience a severely itchy allergic reaction after exposure to antigens in flea saliva, when the flea bites the animal.  The exact amount of flea exposure required to trigger an allergic reaction likely varies between individual animals, but we know that it does not take a heavy flea burden to elicit signs of FAD.  In fact, owners of many flea allergic patients have never actually seen fleas on their pet.  Flea allergy dermatitis is not the same thing as flea infestation!

FAD usually shows up in dogs and cats by the time they reach middle age, however it is possible to show up later in life.  The typical symptoms of FAD include intense itching, focused mainly on the back half of the animal’s body.  This can include the hind legs, tail, rear paws, flanks, groin, abdomen, and lower back regions.  Sometimes the neck and sides of the face are involved as well, particularly in cats.  Over time, symptoms can even become generalized and involve most of the body.  With all of the scratching/licking/chewing comes hair loss, redness, and sometimes rashes, scabs, or flaky skin. 

Diagnosis of flea allergy dermatitis is mostly based on historical information and clinical symptoms, but other causes of itchy skin disease are often ruled out as part of the diagnostic process.  Yeast and/or bacterial skin infections often develop secondary to all the itchy behaviors associated with FAD, so cytology to look for yeast and bacteria will typically be performed.  Skin scrapings to look for mites may also be a part of the diagnostic workup.

Treatment of FAD revolves around minimizing flea exposure for the patient.  Cats and dogs with FAD need to be receiving  top of the line veterinary flea preventatives on a regular basis, year round!  Adult fleas can emerge from weather-resistant cocoons (pupae) any time the temperature gets above the mid 50’s (Fahrenheit).  In most areas of California these temperature conditions can occur year-round.  Also, the interior of our homes are kept at temperatures in which flea populations could thrive during all months of the year.  Another essential component of treating FAD is often overlooked… other pets in the family must also be part of the FAD treatment regimen.  Unless they are also on year-round flea preventative medication, other pets can serve as a source of flea exposure for the allergic pet.  More information on flea life cycles and environmental cleanup can be found on the following website: http://www.drmichaeldryden.com/fleas/

So, next time you hesitate in treating your itchy dog or cat for fleas, just remember that these often unseen pests can cause a huge problem for allergic animals!  All flea control medications are not created equal, and the doctors here at Animal Dermatology & Allergy can provide guidance on the best flea control choices for our patients and their families.

Bath Time!

Mary Sakai

Winter weather is here, and California is finally getting some of the rain we desperately need!  Because this is a time of year when our pets are spending more time indoors or travelling with us to visit friends and relatives, we want them to be clean, shiny, and smelling nice.  So, how often are you actually supposed to bathe your dog?  This is a question we get all the time.  There is a lot of information (and misinformation) out there about when, how, and why to bathe your dog.  Bathing recommendations for dogs depend on your pet’s lifestyle, skin health/disease status, and their breed and hair coat type.

Dogs with healthy skin and coat really do not need to be bathed that often.  Short coated dogs can often get away with being bathed every few months, or on an as needed basis- when they run through the mud at the dog park, or are smelling a little too “doggy.”  Dogs with longer coats, or breeds with continuously growing hair (such as poodles) may need more regular grooming – every 6-8 weeks is fairly typical.

Dogs with skin disease often have special bathing needs.  For some patients, it is not uncommon for the doctors here at Animal Dermatology & Allergy to recommend bathing 1-2 times per week!  We will often prescribe a medicated shampoo for your pet- the choice of medicated shampoo depends on the specific skin disease(s) we are treating.  Pet owners are sometimes concerned when they hear that we want them to bathe their pet so frequently…”Won’t this cause dry skin?”  The answer in most cases is NO.  Veterinary shampoos have really come a long way- these medicated shampoos have just as much scientific research leading up to their development as many of the human shampoos we use to wash our own hair.  Medicated veterinary shampoos are designed for frequent bathing, and many of them contain moisturizers to help replenish natural skin oils.  Additionally, pets with skin disease frequently have up-regulated production of skin oils, and so frequent bathing helps de-grease their skin and coat.

If your dog has sensitive skin or has a skin disease of any kind, you may want to avoid shampoos that contain tea tree oil or oatmeal.  For many dogs, these shampoos are just fine.  However, when our clients tell us about pets having a reaction to over the counter dog shampoos, it is often with a shampoo containing tea tree oil or oatmeal.

For pets with sensitive skin or skin disease we also recommend bathing with luke-warm to slightly cool water temperature, because heat can intensify the sensation of itch.  If you are using medicated shampoo, here are some general guidelines: wet the skin and coat first, apply shampoo, then allow shampoo to sit on the pet for 10 minutes prior to rinsing thoroughly.  Towel dry, or use a room temperature air dryer.  

With the colder weather, we do recommend that you keep pets in a warm place until they are completely dry.   If you have questions about your dog’s specific bathing needs, call your veterinarian to ask for advice.

The doctors and staff at Animal Dermatology & Allergy wish you and your pets a wonderful holiday season, filled with the joy of family, friends, good food, and good health!