Facing an Excruciating Itch
Ralph’s Journey with Atopic Dermatitis
// Pet dermatolgy //
Case Study:
Ralph's Journey with Atopic Dermatitis
Patient Profile
Name: Ralph
Breed: French Bulldog
Age of onset: 1 year
Presenting Signs
Ralph was referred to our dermatology service after a two-year history of progressive, persistent itching.
Clinical signs included:
- Constant scratching and chewing at his feet
- Facial rubbing and hair loss
- Sore ears with recurrent infections
- Perianal rashes and infected anal glands
- Seasonal flare-ups, particularly in spring and summer
- His itch score was 10/10
Despite multiple treatments, including dietary changes, parasite control, and various medications, Ralph continued to struggle. His symptoms had become so severe that he wore a buster collar continuously for eight months. He felt miserable and didn’t like to be handled.
Diagnostic Work-Up
A full dermatological exam was conducted under sedation because he was so uncomfortable. Findings included:
- Extensive alopecia and crusting on the face and chest
- Ulcerated ear canals with pus discharge in the canals
- Inflamed interdigital spaces with cysts on all feet
- Infected anal gland exudate and a red tail base
- High malassezia yeast and bacterial presence on cytology
- Culture confirmed Methicillin-Resistant Staphylococcus pseudintermedius (MRSP)
A comprehensive environmental allergy panel confirmed significant sensitivities to:
- House dust mites (D. farinae and D. pteronyssinus)
- Flea saliva
- Malassezia yeast
- Timothy grass
- Moulds (including Aspergillus)
Ralph was diagnosed with Atopic Dermatitis with many secondary infections of his skin.
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Treatment Strategy
Managing Atopic Dermatitis is about reducing allergic triggers, controlling skin infections, and keeping the immune system calm. Here’s how we helped Ralph:
- Food trial
- Exclusive trial with Purina HA hypoallergenic diet to rule out food allergy.
- Medical Management
- Ciclosporin: Daily immune-modulating medication to control the allergic reaction.
- Prednisolone: Initially to control inflammation but rapidly tapered and stopped.
- Gabapentin & Pardale V: Pain relief to keep him comfortable.
- Infection Therapy
- Given MRSP has been diagnosed all treatments were topical and antibiotics were stopped.
- Malasseb shampoo twice weekly
- Clorexyderm 4% foam daily on non-bath days
- Topical ear antibiotics and steroid treatments.
- Environmental Control
- Ongoing flea control and allergen exposure minimisation though household controls.
The Outcome
Over the following months, Ralph showed remarkable improvement:
- Significant hair regrowth and normalisation of skin
- Odour-free ears with no discharge
- Itching and licking behaviours resolved
- Buster collar removed!
- He was much calmer and happier to be examined
- Skin cytology is clear of bacteria and yeast
Future Planning
Ralph is now maintained on every-other-day Cyclavance and topical therapies as needed. We may now look to commence allergen-specific immunotherapy (ASIT) during a stable period. This custom vaccine targets his specific allergens to build long-term tolerance.
Vets Summary
Ralph’s case highlights the importance of a thorough diagnostic approach and tailored multimodal treatment. With owner commitment and appropriate dermatological care, Ralph is thriving once again – comfortably enjoying life without the constant discomfort of Atopic Dermatitis.
You can explore more about our animal dermatology experience by visiting our dermatology hub via the link below:
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