Author: vetstream

Laryngeal paralysis

Laryngeal paralysis causes respiratory (breathing) noise and exercise intolerance in medium and large breeds of dogs. The disease is very slowly progressive and may start very subtly, so by the time you notice significant breathing noise or inability to exercise it might be quite far progressed. If you notice these changes in your dog you should seek veterinary advice and have a vet check your dog for possible associated problems or diseases.

The larynx is the voicebox, but it has many other functions than producing sound. All of the functions of the larynx require the vocal cords to open and close. Tensing of the vocal cords during air movement produces sounds. When your dog breathes in, the vocal cords open to allow more air in, the harder the breathing, the more open the larynx is to maximize air flow.

The larynx also stops food and liquids from entering the windpipe (trachea).  During swallowing or vomiting, the vocal cords move together to completely close the opening of the larynx. If any food, water, or irritant reaches the larynx, trachea, or lungs, coughing occurs to force foreign materials out of the larynx or airways.

Just before coughing, a deep breath is taken to completely fill the lungs, and the larynx opens wide to let that large amount of air in. During the cough, the larynx closes partially, making the air move rapidly at a high pressure, pushing out the abnormal material.

Laryngeal paralysis is lack of function of the larynx due to damage or degeneration of the nerve supply to the laryngeal muscles. Loss of the nerve function leads to loss of muscle contraction. The end result is a larynx that cannot open and close normally.

If the vocal cords cannot move out of the larynx, the larynx does not open wide enough to allow maximum airflow. If this happens your dog will not be able to exercise normally and can even progress to episodes of collapse, or passing out.

Laryngeal paralysis is typically a disease of larger breed dogs (such as setters and Labrador retrievers) and some medium breeds (Brittany spaniel). In most cases the nerves degenerate over time as part of a general disease of the nerves. Because the nerves degenerate slowly the signs of disease are not seen until dogs are quite old, usually more than 9 years old.

However some dogs have other diseases that cause laryngeal paralysis and may be affected at less than 1 year of age. In most affected dogs the signs really only affect the larynx but some dogs may have diseases affecting other nerves in the body and these may show signs of regurgitation (inability to swallow food properly) or difficulty in walking.

The first sign of laryngeal paralysis may be a subtle change in bark. Slowly progressing, the condition then results in noisy breathing, especially during panting. The noise is usually much worse during activity, when maximal air flow is required. Since the vocal cords cannot move, they sit in the airway and vibrate as the air flows by, resulting in the noise that we call “stridor.”

If the condition progresses, your dog may not be able to move sufficient air through the larynx panting (in hot weather) or during exercise, resulting in a blue tinge to the tongue and lips. In hot weather your dog may be at risk of developing heat stroke as efficient panting is the dog’s main cooling mechanism. The worst clinical signs are those of collapse, passing out, and potentially death.

Your vet will listen to your dog’s breathing and can recognise the stridor, or noise, as being more prominent during inhalation, or when you dog breathes in. They will also carefully listen to the lungs in an attempt to diagnose aspiration pneumonia. Other conditions can also cause coughing and exercise intolerance, such as heart disease, so listening to the chest with a stethoscope is very important.

An ultrasound machine can be used to look at the vocal cords during breathing but the best way to diagnose laryngeal paralysis is to look directly at the larynx. In order for your vet to do this your dog will need to have a very mild general anaesthetic so that your dog will allow the vet to look into your dog’s throat.

Although it is uncommon to find an underlying cause for laryngeal paralysis your dog should be tested for the conditions that can cause laryngeal paralysis. If one is missed, the condition could lead to more signs in the rest of the body, such as the regurgitation or difficulty walking. Since the larynx cannot close to protect against aspiration pneumonia, chest X rays are important. They also allow the heart size and shape to be evaluated for potential heart disease that could cause coughing and exercise intolerance.

Your dog’s general health should be assessed prior to general anaesthesia required for laryngeal examination, so blood and urine samples are usually tested. If your vet has any concerns about other specific diseases they may want to perform other tests.

Once nerve and muscle function are lost they cannot be recovered. If the laryngeal paralysis results in a decreased quality of life, a surgery can be done to permanently tack one side of the larynx in an open position and allow better airflow past the vocal cords. A vet with experience with this type of procedure should be able to perform the surgery with minimal difficulty. Your vet may want to refer your dog to a specialist surgeon for the operation.

Laryngeal paralysis is a slow, progressive disease. You may not notice early changes, as you are with your dog every day and mild changes are hard to recognise. Changing your dog’s activity level and keeping them in a cool environment may help and your dog may be more comfortable wearing a harness rather than a collar.

If the condition is affecting your dog’s quality of life, you can consider surgery. Surgery may never be done or can be done early in the course of the disease. The most important thing is to know what you and your dog like to do for a happy quality of life and to know the potential outcomes after surgery.

The strict answer to this question is no because laryngeal function cannot be restored. The surgery restores the ability of air to move past the larynx, relieving the problem of obstruction of air flow. Thus, most dogs have less noisy breathing, can be more active, and are at a reduced risk of overheating. You should notice an immediate improvement in your dog’s ability to exercise, but do not let them overdo it early on!

For an experienced vet the surgery is rapid and relatively straightforward. After surgery you must keep your dog quiet for a couple of weeks to ensure that healing has occurred. If the stitches break during this period then the vocal cords will flop back into the larynx.

After surgery one vocal cord is always in an open position, so the ability to protect the airways and lungs is permanently lost. Your dog may cough or clear its throat more frequently, especially when eating, drinking, or exercising because material may contact the larynx and first part of the trachea.

Your dog will always be at risk of developing aspiration pneumonia after surgery. Some dogs never get it, some get it once and respond to treatment, some get it repeatedly, and rarely a dog dies of aspiration pneumonia. Early detection and treatment are key to minimising the affect of aspiration pneumonia.

Coupage for dogs

If you think your pet has a respiratory condition that might benefit from coupage, seek advice as soon as possible from your veterinary surgeon or veterinary physiotherapist.

Coupage is a form of chest physiotherapy that when performed correctly can be beneficial in loosening and removing excess secretions from the lungs. Many respiratory conditions result in an accumulation of secretions (also called mucous, phlegm, sputum) within the lungs that the patient cannot easily clear. This can result in difficulty breathing, poor gas exchange, collapse of lung segments and infection.

The lungs naturally produce mucous as part of their natural defence mechanism. When there is a chest infection, and occasionally with other conditions, the mucous increases and becomes thick and sticky. In the normal situation, these secretions are removed by coughing, but if the animal has lung disease or weakness, this is not always possible. The use of antibiotics can control any infection but they do not remove the secretions. Some will be absorbed naturally into the body but some will remain within the lungs.

Excess secretions provide a good environment for infection to develop as well as causing breathing difficulties. They block the airways and prevent the passage of oxygen from the inspired air to the blood stream, so having a detrimental effect on gas exchange. It is important therefore to remove the secretions to allow more effective and efficient breathing and increase the amount of oxygen getting into the body.

It is certainly possible for you to perform coupage on your pet as long as you have received training from an appropriately qualified veterinary professional. Coupage is a specialised technique. However, veterinary professionals will be adequately trained to perform it. In particular, chartered physiotherapists will have undergone extensive training in all chest physiotherapy techniques.

In many cases, coupage is more effective when used in combination with other techniques such as postural drainage and vibrations, and if appropriate you will also be advised about these.

  • Hands should be formed into a ‘cup’ shape (with your fingers and thumb held closely together).
  • Keeping your wrists loose you should flex and extend them whilst you gently pat your pet’s chest wall in a rhythmical manner. Your hands should pat the chest alternately, moving around the area being treated. Do not use too much force when performing this technique as the momentum developed in your wrists is sufficient, and too much force can be uncomfortable and may be detrimental to your pet.
  • The coupage technique sends shock waves to the lungs which loosen the secretions and allow their transfer from the small airways to the larger airways where they can be cleared by coughing.
  • Coupage can be performed using a one-handed or two handed technique and at a slow or fast speed, but you should be taught the correct technique for your pet by your veterinary professional.
  • The technique should be performed through a sheet or thin towel to prevent too much stimulation to the skin. If your pet is small you can perform the same technique with 2 or 3 fingers from one hand.
  • In most cases, coupage should be continued for 30 seconds to one minute. You should perform the technique continually during the advised time period.
  • The hands are positioned on the chest wall over the affected part of the lung, and the chest is vibrated. During each vibration the hands gradually move towards the head end.
  • Vibrations are only carried out whilst your pet is breathing out (during the expiration phase), so each vibration lasts for approximately 3-6 seconds.
  • Generally 4-6 repetitions are carried out before allowing the animal a short rest period and then resuming coupage.

Postural drainage involves getting your pet into the best position to allow secretions to drain from the affected part of the lung. There are positions appropriate to all parts of the lung, and if appropriate you will be taught the postions that should be adopted for your pet.

When the techniques of coupage, vibrations and postural drainage are used in combination, the optimal chest physiotherapy regime is as follows:

Your pet should be positioned in its postural drainage position for 10-20 minutes, during which time the following should be carried out as in the example below:

  • Coupage for 30 seconds to 1 minute
  • Vibrations for 4-6 expirations
  • Rest period of 1-2 minutes to allow drainage of the now loosened secretions
  • Repeat several times over the 10-20 minute period*

*The number of repetitions, times, etc. will be determined by your veterinary professional (treatment is individual for the patient).

Coupage dislodges the secretions, vibrations move them towards the large airways, and the postural drainage position then allows the secretions to drain during the rest periods. Your pet may cough during its treatment, thereby clearing some of the mucous from its airways. It is common however for animals not to cough during treatment, but to cough 15-20 minutes later once they are walking around. Sometimes the secretions are swallowed rather than being coughed up, but at least they are out of the lungs.

Chest physiotherapy should never be done straight after a meal or drink, and you should wait at least one hour before starting the treatment.

Chest physiotherapy treatment involving coupage, vibrations and postural drainage should only be carried out when excessive secretions are known to be present. This may be once a day or it may be 4-5 times a day, but you will be advised on this. It is often more beneficial to do it after periods of rest (e.g. first thing in the morning) when the animal has been relaxing and the secretions have been draining naturally.

Performing these techniques on animals that have no secretions can be detrimental to that animal’s overall condition. Your pet should therefore be reassessed regularly during the treatment period, so you can receive updated guidance from your veterinary professional as to the appropriateness of continuing this therapy.

Coughing in dogs

It is not uncommon for dogs to cough occasionally. However, if your pet is coughing frequently or has persistent episodes of coughing then you should seek veterinary advice. There are many causes of coughing and many of these can be treated successfully. Some dogs occasionally cough when they get excited or pull on their lead. Many causes of coughing if left untreated, can progress over time causing severe consequences for your pet. If your dog develops a constant cough, an intermittent cough that does not get better after 2 weeks or becomes at all unwell then you should make an appointment to see your vet.

The trachea (also known as the wind pipe) is a tube that runs from the throat down into the chest where it branches to form the major airways in the lungs. The normal trachea is a soft tube that is held open by numerous rigid rings of cartilage. Coughing is the result of irritation or inflammation of the sensitive lining of any part or the airways or the lungs, and is an important protective mechanism allowing the removal of foreign material and mucus from the airway.

In young animals coughing is more likely to be caused by an infection, as a result of the dog inhaling a foreign body (such as a grass awn) or irritation due to smoke or other irritants. Some dogs have a congenital problem with their trachea which can allow the trachea to collapse and obstruct their airway so that they cough every time they get excited or pull on their lead. Brachycephalic dogs (those with short noses like pugs) may have long term respiratory problems that cause persistent or intermittent coughing.

In older animals other causes of coughing, such as heart disease and tumours, become more common. However, chronic bronchitis and other long term diseases reflecting damage to the respiratory tract over a lifetime can also develop in later life. A cough associated with chronic airway disease may be persistent but not get worse and your pet may remain bright and well otherwise.

Older dogs may also develop damage to the nerve controlling the vocal cords and these can obstruct their airway causing coughing particularly after eating, drinking or swimming if food and liquids pass into the airways instead of the oesophagus (the food pipe or gullet).

If your dog is coughing it is really important to get your vet to check them over to identify any possible causes that require treatment or to reassure you that nothing more serious is going on.

Some dogs with a cough may be completely normal in other respects, but this depends entirely on the underlying cause of the cough. In a young, otherwise healthy dog, kennel cough (infectious tracheobronchitis) is the most likely cause of cough. This usually gets better without treatment in 1 to 2 weeks but if coughing is persisting beyond this time or your pet is unwell you should seek veterinary advice. If you are taking your dog to the vet and think there is any possibility your dog may have kennel cough then it is advisable to leave you dog in the car until the vet has examined your dog, rather than risking potentially passing it to other dogs in the waiting room.

Dogs with pneumonia may have a fever, be off their food and feel pretty miserable. Nasal discharge may be present and this can be clear or snotty. Dogs with heart disease or lung problems may also have breathing problems and be unable to exercise normally. If laryngeal paralysis is present the changes to the vocal cords can cause changes in the tone of a dog’s bark (generally sounding hoarse), and exercise intolerance with some dogs developing blueness of the membranes (cyanosis) in their mouth or even collapse after exercise.

When presented with a coughing dog your vet will first want to establish some information which may help then localise which part of the respiratory tract is affected. Questioning you about the nature of the cough (whether it is dry or moist, intermittent or always present) will provide valuable information so it is important you think about the circumstances in which your dog coughs before you attend the veterinary visit. If you are able to take a video clip of your dog coughing on your mobile phone this may help your vet further. Your vet will want to examine your pet and look for any other signs of illness such as fever which may give a clue as to the cause of the cough. By listening to your dog’s chest with a stethoscope your vet will be able to assess heart and lung health. There are many diseases that can cause chronic coughing and your vet will want to rule out the more serious causes of coughing before a final diagnosis is made.

Investigation of coughing involves X-rays of the trachea and the chest and your vet may want to pass an endoscope (a small tube with a camera on the end) through the trachea and down into the lungs to take some samples; these are usually washes to look for inflammatory or cancerous cells, and to provide material for culture.

The treatment of coughing varies greatly depending on the cause. In some cases, if the cough is not too severe, no treatment may be necessary. Medical treatment may be available for coughing related to heart disease and infectious causes of cough. Rarely, if more sinister disease such as cancer is present, other treatment options willbe considered. It is important not to administer human cough medicine to your dog without veterinary advice.

Collapsing trachea

If you have a small dog that coughs every time it gets excited or pulls on its lead it may be suffering from tracheal collapse. Tracheal collapse results in narrowing of the airway and, if left untreated, can progress over time causing severe consequences for your pet. If your dog develops a cough that does not get better after 2 weeks you should make an appointment to see your vet.

The trachea (also known as the wind pipe) is a tube that runs from the throat down into the chest where it branches to form the major airways in the lungs. The normal trachea is a soft tube that is held open by numerous rigid rings of cartilage. In some dogs the tracheal rings gradually weaken over time so that they are not sufficiently rigid to hold the tube open and the walls collapse inwards narrowing the airway.

Tracheal collapse is mostly seen in toy breeds (e.g. Yorkshire terriers, Pomeranians and Poodles) but has also been reported in some larger dogs. In many toy breeds of dog there is a tendency to have softer tracheal rings which makes development of tracheal collapse more likely. Most dogs are middle-aged (around 7 years of age) when they develop signs but occasionally a congenital form is present from birth and can cause clinical signs in animals as young as 4 months of age. Animals with tracheal collapse that are overweight are more likely to show signs of coughing.

Dogs with tracheal collapse initially develop a classical cough which may persist for months or years before owners seek investigation. The cough associated with tracheal collapse is described as ‘goose honking’ as it supposedly sounds like the noise made by geese. The cough often comes on when the dog is excited or has been pulling on the lead and once an affected dog has started to cough they may have a prolonged bout during which they cannot stop coughing. Affected dogs may faint during a coughing spell. Severely affected animals may be unable to exercise normally and may even turn blue when they are excited or stressed.

Your vet will probably suspect a diagnosis of tracheal collapse based on the history and by listening to your dog cough. However, there are other diseases that can cause chronic coughing and it is important to make sure these are not present before a final diagnosis is made. Investigation of the condition involves X-rays of the trachea and the lungs and your vet may want to pass an endoscope (a small tube with a camera on the end) through the trachea to see if collapse is occurring.

In many cases it is possible to control the condition initially with simple changes to management. Weight loss in overweight animals will always help and, since coughing is exacerbated by exercise or pulling on a lead, exercise reduction and fitting a harness instead of a collar should help reduce the cough. Any respiratory diseases should be treated and environmental triggers such as pollens and cigarette smoke should be avoided.

Medical treatment may also be required to control the signs. Steroids can be used to reduce the irritation in the airways; sometimes these are given using an inhaler (similar to that used by asthmatics) as this reduces the side effects of steroids on other parts of the body.

Other drugs that may help to reduce coughing are cough suppressants, airway dilators and drugs to dry up secretions in the airways. Your pet may also need courses of antibiotics from time to time to reduce bacterial infections in the airways. Most animals cope reasonably well on medical management for years after diagnosis.

In some cases medical treatment alone is not sufficient and if this is the case it may be wise to talk to your vet about possibilities for surgery. The aim of surgery is to help improve the structure of the trachea to limit collapse as much as possible; this helps to improve airflow, but will not completely resolve other signs such as coughing.

An operation is available to place artificial rings around the trachea to hold it open; this technique can work very well, however this operation is very challenging as often the collapsing portion of the trachea lies within the chest so the procedure is not without risks. More recently techniques to provide internal support to the trachea using stents have had promising results. A tracheal stent is a flexible metallic tube, usually made of a special metal called nitinol (a nickel titanium alloy), which is designed to stay within the lumen of the trachea and hold it open.

Stents are placed under general anesthesia using fluoroscopy (real time movie like X-rays) to assess positioning. The stent needs to be carefully measured so that it is the correct size, but once in position, they are very well tolerated to the extent that the tracheal membrane will grow over the inert surface of the stent and they stay in position lifelong. Stent placement is much less invasive compared to open surgery with very encouraging long term results.

Surgical treatments of tracheal collapse should be performed by a specialised veterinarian with experience and specialist training in the technique, so your vet may make a referral to a specialist centre for the procedure. It is important to remember that the aim of surgery is to help improve airflow and that longer term medication will be needed after both artificial ring and stent placement to limit coughing and prevent inflammation.

Anal furunculosis (perianal fistulas)

Anal furunculosis (also called perianal fistulas) is a distressing condition commonly affecting German Shepherd dogs and occasionally other breeds. The problem is one of chronic deep infection, inflammation, discharges and ulceration around the tail base and anus. The condition may progress to involve a large area around the back end of the dog. It can be very difficult to cure or control but recent advances in treatments are proving encouraging.

No-one really understands what causes the condition to develop. It is more common in dogs with the broad tail base and low tail carriage typical of German Shepherds. This conformation may result in poor ventilation and increased humidity of the anal area. Faecal bacteria may persist in this environment increasing the risk of infection of hair follicles and hormone glands in this area.

Underlying problems with the immune system may also play an important role. The disease has also been linked to inflammatory bowel disease and colitis. If your dog has diarrhoea they may be at more risk of developing anal furunculosis.

Anal furunculosis is very irritating and dogs with this condition will frequently lick their hind end. You may notice that your dog shows discomfort or difficulty when passing faeces. Other signs of illness such as weight loss irritability or depression due to pain are seen in severe cases.

The tell-tale signs are of matted hair, odour, bleeding and discharges from the anal area. However your dog may not let you look closely if the condition is very painful. It should be possible for your vet to make a diagnosis of anal furunculosis from looking at the diseased area (but they may need to sedate your dog for close examination). In a few cases biopsies are needed to be certain of the diagnosis.

This is a difficult disease to treat and although several types of treatment are available none is 100% effective. The diseased tissue can be removed at surgery – often, extensive treatment is needed and this may need to be repeated. If extensive surgery is performed there is a risk of nerve damage which can result in incontinence. Some surgeons advocate amputation of the tail to improve ventilation or removal of the anal sacs.

Recently, encouraging results have been achieved using drugs designed to alter the function of the immune system, and this may prove to be a very effective treatment for anal furunculosis.

Yes, check with your veterinary surgeon first, but many dogs with anal furunculosis are greatly helped by hydrotherapy. This involves the use of a shower attachment or garden hose to direct water over the affected area under the tail once or twice a day. The water should be lukewarm or cool, under moderate pressure.

Start gradually and gently and build up as your dog gets used to this treatment. For this to be effective, each session should last at least 15 minutes. A tail bandage applied to the tail will stop this getting too wet. This treatment can have a very good effect if carried out diligently every day.

Controlling symptoms is a long-term process in many cases. New treatments are being developed, but relapses may occur and permanent treatment can be needed. Anal furunculosis is well known as a difficult and sometimes frustrating disease to treat. Recent treatments have shown encouraging results but euthanasia may need to be considered if your dog is very seriously affected or if your dog’s temperament makes home treatment difficult. More than most diseases, this one calls for a high level of commitment and extreme vigilance on the part of owners. Bear in mind that long-term treatment can prove expensive.

Whilst anal furunculosis can be a frustrating and difficult condition to treat it is important to seek help as soon as possible. If the condition becomes widespread it can be impossible to control. As there are a number of different treatment options it is important to discuss your dog’s problem with your own vet so that you can work out the most appropriate course of action for you and your pet.


Living with an itchy dog is no fun – but being an itchy dog must be worse! Atopy affects around 1 in 10 dogs to some degree. In dogs the condition can cause a variety of signs: skin disease, runny nose, itchy eyes and (very rarely) asthma. If your dog persists in licking its feet or has recurrent ear or skin infections, it may have atopy. As a general rule itchy skins do not resolve without treatment; so if your dog is scratching an early visit to your vet is advisable. Itchiness is not normal, nor is it a habit.

Atopy or ‘atopic skin disease’ is a genetically-predisposed tendency to develop an allergy to environmental allergens. The most common allergens are house dust mites, storage mites, pollens (grass, weed and tree), moulds, skin dander and less commonly dietary proteins. In allergic animals, the immune system over-reacts to contact with these foreign substances causing inflammation that leads to itchiness. Dogs display this irritation by rubbing, licking, chewing, scratching and biting themselves or scooting along on their backside.

Dogs with atopy are born with the potential tendency to develop significant allergic responses. As the dog comes into contact with more and more allergens in its normal life, these allergies start to develop. Most dogs with atopy start to show signs between 1 and 3 years of age. It would be very unusual for a puppy younger than 6 months to develop signs of atopy. If your puppy shows signs of itchiness before this age it is most likely that there is another reason for it.

Some breeds of dog are far more likely to develop atopy than others and if there is a history of atopy in your dog’s family then they are more at risk of developing signs.

Your dog may have atopy if it suffers with recurrent ear or skin infections that clear up with treatment but then come back some time after when treatment stops. The body sites typically affected in dogs with atopic dermatitis are:

  • the face and ears
  • between the pads of the feet
  • in the armpits or groin area.

If your dog is forever licking at or rubbing one or more of these sites, even if you cannot see any skin lesions, make an appointment to see your vet. Typically dogs with atopy start off with seasonal disease. However, in subsequent years the skin disease will often start earlier and last longer.

If you can answer yes to the following questions there is a high chance that your dog may have atopy.

  • Was your dog younger than 3 years old when it first showed signs?
  • Is the dog mostly kept indoors?
  • Was the itchiness present before you noticed skin lesions?
  • Does your dog have reddened front paws and are the inner surface of the ear flaps affected?
  • Are the margins of your dog’s ear flaps unaffected?

Your vet should also begin to suspect that your dog has atopy based on a history of recurring skin or ear infections, particularly if these clear up over the winter and come back the following year. Atopic dogs with light-coloured coats often have brown, saliva-stained fur in sites where they lick constantly.

If your vet thinks it is likely that your dog has an allergic skin condition they will want to do some other tests. But firstly your vet should ensure that regular, prescription, ectoparasite control has been used and they may prescribe treatment to clear up any secondary skin infections.

If the symptoms are not seasonal, then your vet must recommend a strict, food elimination trial for several months. Feeding your dog a specific, truly hypoallergenic diet helps to rule out a food reaction as the cause of the itchiness.

If your dog is still itchy after all this treatment, and the diet trial, then referral to a specialist dermatologist for intradermal skin testing should be offered. Under light sedation, an area of skin over the body wall is clipped and prepared. Tiny volumes of allergens are injected into the skin and your dermatologist will monitor the reaction to these allergens in the skin to decide which are likely to be causing itchiness. Depending on the intradermal test results it may be possible to treat the condition with allergen-specific immunotherapy.

Yes. The main priority for treating atopic dermatitis is to reduce all the factors that may cause the skin to be inflammed. It is very distressing for a dog and owner when a dog is scratching all the time. The management options currently available are listed below and the combination that works for your dog needs to be tailored specifically for individual conditions:

  • It is often possible to reduce the dog’s overreaction to allergens by the use of allergen specific immunotherapy (desensitising vaccines). These injections must be given over a period of some months and in over two-thirds of dogs these help to reduce the severity of the allergy. If you are considering desensitisation you will have to be patient – improvement may not be seen for around 9 months after the course of injections starts. Following that monthly lifelong injections are required, and it is rare for the condition to be controlled without the need for other managemental or medical interventions.
  • It will be important to take particular care in preventing parastic infection. Atopic dogs are prone to sarcoptic mange infection and also more likely to become allergic to fleas.
  • Complete diets, with higher levels of essential fatty acids, may assist with control of skin conditions. Of course it is important also to avoid any dietary allergens that were implicated during the food trial.
  • Regular cleansing of the coat, ears and paws to mechanically clear surface allergens, assist wth natural skin cell shedding and improved skin barrier function will be beneficial.
  • Common recurrent yeast and bacterial infections must be controlled – ideally with regular medicated washes and ear cleaners.
  • Anti-inflammatory medications, both systemic and topical (sprays, gels, shampoos and rinses), should be employed when necessary on top of all the above strategies.
  • Other drug therapies may also be needed – steroids are cheap, but potentially have many side effects. Cyclosporin A has few significant side effects though is comparatively expensive. Antihistamines are usually cheap, with few side effects, but are invariably ineffective.

It is very rare for dogs with atopy to be cured or grow out of the problem. In fact they generally have more severe episodes each year. However, in most dogs the condition can be controlled by careful, diligent management.

If it has been possible to identify the specific allergens involved in your dog’s case, by intradermal and/or serological testing, then it may be possible to avoid things that are likely to cause reactions in your dog. For example, if your dog is allergic to pollens it may help to keep them inside when the pollen count is high or when you are mowing the lawn.

Elimination of house dust mites is difficult but regular hot washing of the bedding plus annual environmental spraying can help kill mites. Dogs with house dust mite allergy may benefit from preventing access to bedrooms, soft furnishings and carpets.

If you have any concerns about our dog contact your own vet for further advice.

Hot spots (wet eczema, pyotraumatic dermatitis)

Sometimes dogs develop a sore spot on the skin which oozes and irritates. Often this develops over the space of just a few hours. The critical step in managing these spots is to stop the dog worrying them but veterinary attention should be sought to ensure there is no underlying condition that needs treatment. In most cases early treatment results in a rapid resolution of signs.

Wet eczema is also known as ‘hot spots’ and your vet may refer to it as ‘acute moist dermatitis’ or ‘pyotraumatic dermatitis’. It is caused by infection in the surface of the skin. Bacteria are present on all dogs’ skin but in order to cause infection they must break through the skin barrier. This can occur when there is damage to the skin either through changes in the skin itself or scratching by the dog.

Once the skin barrier is penetrated the bacteria can grow and this infection causes intense itchiness and the dog scratches the site resulting in further damage and spread of the sore.

It is normally clear when a dog has wet eczema. The sores are usually obvious as they most often develop on the face and the flanks. The skin sores in this condition are extremely itchy and affected dogs are unable to leave them alone. You will see your pet continually licking or scratching at the same site on their skin. The skin sores look red and ‘angry’ and exude a moist clear discharge which has a very unpleasant smell. If the sore is left alone then the exudates may dry and crust on the surface.

Some breeds of dog (especially Labrador retrievers and St Bernards) appear to be prone to developing wet eczema. However, it can be seen in any breed. Younger dogs also appear to be at greater risk of developing wet eczema, although once a dog has had one episode of wet eczema they are likely to be prone to subsequent episodes later in life too. Wet eczema is more common in summer months and particularly if dogs have dense or matted coats.

Wet eczema is triggered by an underlying skin problem and often it is caused by the dog scratching due to itchy skin. The itchy skin condition can be due to allergy (e.g. atopy), fleas, ticks or other parasites, irritation from an ear disease or anal sac disease or from the presence of a foreign body in the skin, e.g. a splinter, grass seed or thorn.

Irritation by a drop-on anti-flea treatment or other liquid that the skin was exposed to either intentionally or unintentionally is sometimes a cause. Continual wetting from bathing, swimming or drooling are possible causes. Damage from blades during clipping is also a consideration.

Wet eczema is usually caused by another skin disease so your vet will want to identify any potential cause – the condition will not clear up unless the underlying disease is properly treated. Your vet will check to see if an underlying disease is present and if so this can be treated at the same time as the wet eczema.

Sometimes, other skin diseases such as burns, deep bacterial infections, ringworm (dermatophytosis), calcinosis cutis or some tumours can have the appearance of wet eczema and so it is important to confirm the diagnosis in case a different treatment is needed. Clipping the surrounding fur, skin scrapes and cytological examinations and full-thickness skin biopsies are all useful tests that may often be helpful. Further tests are necessary in some situations.

The most important factor in management of wet eczema is to stop further trauma to the skin. The dog must be prevented from licking or scratching at the site – depending on the site of the sore a Buster or Elizabethan collar may be necessary. If the dog is scratching at the sore then bandaging the foot may help to reduce the amount of damage done. However, the affected area should be left open to the air whenever possible as this drying effect is very beneficial in the healing process.

Hair should be clipped from the sore skin and from the area surrounding the sore patch. Often the sores are much more extensive than they appear initially but clipping should be expanded continue until the whole affected area is exposed. The skin can then be bathed and dried.

Your vet may prescribe some antibacterial shampoo or cream to rub into the wound. but in most cases this is not necessary. However, in more severe cases, (particularly if the underlying skin disease is difficult to control), steroids or antihistamines may be required to reduce itchiness and antibiotic tablets given to control infection.

If your pet has had wet eczema it is quite likely that this will recur. Risks can be reduced by keeping the coat short and clean with regular bathing. Extra attention should be paid to flea control. Regular grooming will allow you to identify any skin diseases or wet eczema lesions early.

Skin fold pyoderma

Pyoderma means bacterial infection within the skin. Usually this occurs within the top layers of the skin (superficial pyoderma), and is a common medical problem in dogs. Deep pyoderma, when infection penetrates further into the skin, is much more serious and may take months of intensive treatment to cure.

Skin fold pyoderma is a common, usually superficial, infection which occurs where two layers of skin fold over one another, creating a warm, moist environment where bacteria can flourish. Pockets of skin are very prone to infection due to the closed environment. Once infection takes hold, it tends to progress rapidly due to poor ventilation and the problems encountered in keeping the area clean. Food residues and bad teeth may compound the problem around the mouth.

This type of skin problem occurs commonly in certain breeds of dogs, particularly those with lots of loose skin, e.g. Sharpei, Spaniel, Bassethound, Pekingese and Boxers. Certain body areas are more commonly affected especially around the face, feet, lips, tail-base and vulva. Obese animals are more likely to suffer with the condition due to excess tissue folds.

Dogs with an infantile vulva – a small vulva in a relatively ‘tucked up’ position – commonly get skin fold pyoderma in the surrounding area. This may be difficult to see without close examination and may be very painful to examine in the conscious dog. Infantile vulva may be more common in bitches spayed at a very young age.

In some animals areas of moist, reddened skin with discharge and unpleasant odour are easy to see. But, often the condition may not be visible until the fold of skin is stretched open, revealing the infected skin within. Dogs may also show other signs:

  • Pain and discomfort
  • Irritability
  • Pawing at the mouth
  • Rubbing the face
  • Licking at the feet
  • Excess rubbing and licking at the bottom area

Medical treatment, using drugs of various types, often leads to an initial improvement in the condition. However because the skin pockets remain, future recurrence is quite likely. Drug treatments used include:

  • Antibiotics
  • Antiseptic washes applied to the area
  • Anti-inflammatory drugs/painkillers
  • Topical creams and ointments.

The condition is often difficult to control – it may not respond well to medical treatment or come back as soon as treatment is stopped.

Since the problem is caused by abnormal anatomy or conformation surgery can help to correct this. Surgical treatment is recommended when there is frequent recurrence. The skin folds/pockets are surgically removed, opening up the area and allowing proper ventilation of the skin and a reduction in the likelihood of recurring bacterial infection. Operations of this type include cheiloplasty (on the lips), nasal fold resection (in Pekingese) and vulvoplasty (at the vulval area). In dogs with bad teeth and skin fold pyoderma at the mouth, your vet may also recommend dental treatment.

Keeping affected areas clean certainly helps. Daily bathing with a salt solution (1 tbsp in a pint of water), followed by drying, may help prevent subsequent infection. Other antiseptics, unless supplied by a vet, should not be used.

There is variation between individuals of the same breed, so some animals may be more severely affected than others. Responsible breeders should not breed from dogs which are severely affected to reduce the risk of problems being passed to the next generation. However, a great many Sharpeis have this condition to some degree due to the characteristics of this breed.

‘Walking dandruff’ (Cheyletiellosis)

Cheyletiella infection is a form of mange that is also known as rabbit mites and walking dandruff. This is an itchy skin condition caused by small parasites living on the skin surface. The mites can be found on many animals including dogs, cats and rabbits and can be transmitted from pets to people. Early recognition is important as the condition can be simply treated.

The condition is caused by infestation with a small mite. This mite lives its whole life on the skin of a furry animal. Although the mites are small they can just be seen with the naked eye or a magnifying glass and may appear like small white flakes of skin that can move – hence the name ‘walking dandruff’.

Most healthy animals seem to have some immunity to infection and the majority of affected animals are old, young or unwell. It is most commonly seen in puppies bought from pet shops or breeding centres. Boxer dogs and Cavalier King Charles spaniels appear to be more at risk than other breeds. Puppies most commonly become infected from their mother in the first few weeks of life.

Often the first sign noticed by owners is excessive scurf or dandruff formation on their pet’s skin. This may be accompanied by scratching and later small spots can develop. Occasionally owners are more severely affected than their pet and may themselves have itchy red patches or spots on their skin.

The mites causing cheyletiellosis can move between animals and can cause itchy red lesions on people as well as pets. Lesions in people are generally very itchy and tend to affect arms, neck, chest and abdomen. Infection is most easily spread to people from cats and rabbits rather than dogs. If infection is controlled in pets the lesions on people will settle down after a few weeks with no specific treatment.

The condition is relatively easy to diagnose because the mites can easily be seen under a microscope. Small samples of skin or hair can be examined and mites and eggs will be seen in an active infection. The mites feed on the skin surface and eggs are laid on the hairs or skin surface. The previous application of flea sprays or drops may reduce the number of mites making diagnosis more difficult in dogs.

Mites can be killed by the application of topical drops that kill parasites. Your vet will be able to prescribe this for you and tell you how to use it effectively. Since the infection can spread between animals, all animals that have regular contact with the infected individual should be treated at the same time (even if they are not showing any signs of disease). A number of treatments may be required over several weeks.

There is no product specifically recommended to kill any mites in the environment, e.g. pets’ beds and carpets, but an environmental flea spray may help in this respect.

Disease risks when travelling to continental Europe

An increasing number of owners are taking their pets with them on holiday when they travel to continental Europe. This factsheet provides information on the more important novel diseases that your dog may come into contact with abroad.

There are a number of protozoal diseases found in continental Europe that can be transmitted to your dog. These diseases include Babesiosis, Leishmaniosis, and Ehrlichiosis. These diseases are rarely seen in the UK and, consequently, British dogs are unlikely to have developed any protective immunity to them. Your dog may also be exposed to a number of parasitic worms including the heartworm Dirofilaria and the tapeworm Echinococcus granulosus. There also exists the small possibility of your dog being exposed to rabies.

All the protozoal diseases mentioned above are transmitted by insects. Babesia and Ehrlichia are carried by ticks and Leishmaniosis by a small biting fly called the Sand fly. The heartworm is transmitted by biting mosquitoes. Echinococcus can be caught by eating the tapeworm egg, usually in uncooked meat. Rabies is most commonly transmitted following a bite from a rabid dog or other animal.

All of these diseases, with the exception of Echinococcus, are potentially life threatening. British dogs are unlikely to have any natural resistance to these diseases and may therefore be particularly badly affected.

The areas where these diseases may be found is constantly enlarging. Some of these diseases are more common in certain places, or at particular times of the year depending on the distribution and feeding activity of the vectors (ticks and biting flies).

Canine Leishmaniosis occurs in most of the countries surrounding the Mediterranean basin, including:

  • Albania
  • Bosnia-Herzegovina
  • Croatia
  • Cyprus
  • France
  • Greece
  • Italy
  • Malta
  • Portugal
  • Spain

The sand fly season stretches from May/June to September/October.

Babesiosis is widespread in France and constantly evolving; it has been reported both in the South West and, more recently, in Normandy and Paris. There is a peak of disease both in the Autumn and Spring, with the condition almost disappearing during the months of July and August.

Monocytic Ehrlichiosis is an important disease of dogs in southern Europe and other areas of the Mediterranean basin.

British dogs holidaying on the continent should be protected from tick bites:

  • Dogs should be treated with a product that kills ticks before they have started feeding (within 24h).
  • This treatment should be repeated at the prescribed interval(s) for tick prevention. You may need to apply the product more often than you would if you were treating your pet for fleas.
  • A daily check should be made of your dog to identify any ticks – any ticks found should be removed immediately. You can take your pet to a veterinary practice to have this done but it may be useful to obtain training in the removal of ticks from your dog prior to travelling.

British dogs holidaying on the continent should be protected against biting flies and mosquitoes:

  • Spray your dog regularly with a licensed fly repellent.
  • Treatment with the fly repellent should be repeated at the prescribed interval(s).
  • Dogs should be kept indoors during the evening and night time to further minimise the risks from biting sand flies.

Use of a deltamethrin collar (Scalibor, Intervet) provides 5-6 months protection against ticks and sand flies.

If making regular visits to the continent you may want to have your dog vaccinated against Babesiosis. A vaccine is available in France for this purpose.

Treatment with a wormer containing praziquantel is required before returning to the UK in order to eliminate infection with Echinococcus tapeworms.