C10009131 / invoice 10000

Reason: SkinHistory: See prev for suspected allergic dermatitis. Was treated with malaseb bathing and prednisolone course, then continued on 20mg EOD - this managed the skin well, but O ran out. Weather became warmer around the same time as pred ran out, so not clear which is the main contributing factor. Before this, hair had mostly grown back. Malaseb baths done ~weekly-fortnightly. Allows 10-15min contact time. Feels this helps manage skin well. Winter is mostly okayFlares up with the warm weather. Chest, flanks, abdomen, thighs.Mostly outdoor dog - outside while Os are at workEDDU normal, no perceived PU/PD. No VDCSDiet: cooked pet mince, pasta, veg, occasional red meat. Some kibble. Examine:BAR. Muzzled prior to visit. Mostly relaxed in consult, but frets with restraint by owner (held between legs) and starts warning barks as soon as approached from behind/touched. Limited exam today. Alopecia over chest, abdomen, ventral flanks, inner HLs, lateral and caudal hocks. Same areas have moderate-marked erythema, marked lichenification - folding of skin. Hyperpigmentation. Yeasty smell. Affected areas are very warm to touch. Laboratory: Tape prep of L flank - budding yeast +++, often at least 1/hpf but some fields with 5-10/hpf. Assessment: Allergic dermatitis with malassezia overgrowthPlan: - pred course, then continue 20mg 2-3 times a week. Consider apoquel as alternative. - malaseb baths twice weekly for 2wks, then weekly ongoing. - concurrent moisturising +/- oral supplementation for skin health, especially with frequent malaseb use. - recheck 2wks. Communication: - reiterated prev discussions on likely allergic disease with secondary yeast overgrowth, requirement for maintenance treatment to prevent flare ups etc, importance of maintaining healthy skin barrier with moisturisers/oral supplements. - given previous success with oral CCS and malaseb bathing, will try this again. Given widespread disease, if poor response then may need to consider systemic anti-fungals. - rediscussed SEs of long-term CCS use, discuss apoquel as alternative. O will start with CCS, consider apoquel.    Vital Signs    Weight: 35.9;