C09970994 / invoice 10000

Revisit Skin

Verified: YES

HISTORY
Presenting for: 2.5 year old female dog (Staffy cross, possibly Kelpie) presented for follow-up of pruritic skin condition one week after receiving Cytopoint injection during health check
Historical Conditions: Skin samples taken last week showed no Malassezia or bacteria
Diet: Blackhawk premium lamb and chicken kibble for over 6 months, daily cooked chicken with vegetables (carrots, pumpkin, broccoli), recently added tuna
Skin: Pruritus started couple of weeks ago, currently rated 6-7/10 (previously 9/10 before Cytopoint), constant paw licking especially when settling in evenings, red flaky belly with missing fur, slight improvement after Cytopoint but not significant
Current Meds: Cytopoint injection given one week ago, topical aloe vera gel applied to affected areas
Lifestyle Risk Factors: Lives in Loch, spends most time outdoors, frequent beach visits
Other: Owner works from home and travels frequently for work, owner has been applying aloe vera gel which helps reduce licking

EXAM
Integumentary: Red, flaky skin on ventral abdomen with alopecia, erythematous raised lesions on abdomen, generalised erythema worse than previous week; plantar aspect of paws - alopecia and dry flaky skin
Diagnostics: Skin cytology from paws revealed low numbers of Malassezia (1/hpf)

ASSESSMENT
Allergic dermatitis with secondary Malassezia - Environmental allergens most likely given seasonal timing and distribution (paws and ventral abdomen), though food allergy remains possible. Secondary yeast infection contributing to persistent pruritus despite Cytopoint treatment.

PLAN
New Meds/Tx:
- Malaseb shampoo: Apply to damp skin on affected areas (paws, abdomen, armpits), lather well and leave for 10 minutes before rinsing. Use every 2nd day for 2 weeks, then every 3rd day for 2 weeks, then weekly ongoing. Prevent licking during 10-minute contact time
- Apoquel tablets: 1 tablet BID (morning and night) for 2 weeks, then reduce to 1 tablet once daily. Minimum 3-4 weeks treatment recommended. May cause mild gastrointestinal upset

Additional Discussion:
- Cytopoint less effective when secondary Malassezia present, Apoquel works on different interleukin receptors and may be more effective
- Food allergy possible despite long-term diet - would require 8-week elimination diet with novel or hydrolysed protein, then food challenge to definitively rule out
- Steroids discussed as alternative but Apoquel preferred due to skin-specific action and better side effect profile for long-term use in young dog
- Recommend avoiding beach visits temporarily until skin condition resolves due to potential irritation from salt water and seaweed
- If beach visits continue, thorough freshwater rinse required afterwards

Client Comms:
- Monitor for improvement over next 3-4 weeks with combined topical and oral treatment
- Contact clinic if any concerns or lack of improvement
- Consider food allergy investigation if condition doesn't resolve with seasonal change