Sandy
Monday, August 4, 2025 at 1:23 PM
Subjective
Chief Complaint
Sandy, a canine patient, was presented for a dermatology recheck due to chronic pruritus and alopecia. The owner reports ongoing licking, biting, and scratching, which have been present since approximately two years of age.
History
- Sandy has historically been managed with Cytopoint injections, with improved response noted at higher dosing intervals (every 25–35 days).
- Previously trialed on hydroxyzine, discontinued several weeks ago due to limited effect.
- Currently on a prescription hydrolyzed diet, though occasional table scraps are given.
- Sporadic history of otitis externa, but not recurrent.
- Simparica administered monthly for ectoparasite control.
- Proviable probiotic was previously used for intermittent diarrhea.
- Owner reports persistent alopecia with some slow regrowth in affected areas.
- Anal glands may require expression.
Objective
Vital Signs
- Temperature: WNL
- Weight: WNL
- Heart Rate: WNL
- Respiratory Rate: WNL
- Capillary Refill Time: WNL
- Body Condition Score: BCS 4-5/9
Primary Lesion
- Macule: not appreciated on examination
- Patch: not appreciated on examination
- Papule: no papular lesions identified
- Pustule: no pustules evident
- Plaque: not present
- Vesicle: not identified
- Bulla: absent
- Wheal: not observed
- Nodule: no nodular formations palpated or visualized
- Tumor: no mass lesions detected
Secondary Lesion
- Scale: no scaling noted
- Crust: no crusting present
- Epidermal Collarette: none appreciated
- Ulcer: no ulcerations noted
- Erosion: mucocutaneous and cutaneous surfaces intact; no erosive lesions
- Scar: no cicatricial tissue identified
- Fissure: no fissuring appreciated
- Excoriation: no active or healing excoriations present
- Lichenification: mild, localized to ventral abdomen, consistent with chronic pruritus
- Callus: no hyperkeratotic callus formation noted
- Alopecia: patchy alopecia present over flanks and ventrum, with partial follicular regrowth observed
- Erythema: no erythematous areas detected
- Hyperpigmentation: mild hyperpigmentation noted in areas of chronic alopecia
- Hypopigmentation: not detected
- Comedone: none visualized
- Cyst: no cystic lesions palpated or visualized
- Abscess: no evidence of abscessation
Pruritus
- Severity Level: moderate, currently well-controlled with ongoing lokivetmab (Cytopoint) therapy
- Eyes: periocular region free of erythema or excoriation
- Ears: mild erythema of right external ear canal; no exudate or malodor noted
- Face: facial skin grossly unremarkable
- Feet: occasional interdigital licking reported; no erythema, crusting, or interdigital cysts present
- Axilla: cutaneous surfaces within normal limits
- Inguinal Area: no erythema or lichenification
- Ventrum: alopecia with mild lichenification and hyperpigmentation; no active inflammation
- Rump: no abnormalities noted
- Perianal Area: mild bilateral anal sac distension; expression performed
- Dorsum: unremarkable on inspection and palpation
Additional Dermatology Findings
- Epilation: negative — no abnormal follicular retention or hair fragility noted
- Skin Thickness: dermal thickness within expected parameters; no areas of dermal fibrosis or induration
- Other Findings: anal sacs expressed manually; moderate, non-purulent material expressed without evidence of infection or impaction
- Parasites: no ectoparasites visualized on gross examination; no flea dirt or lesions consistent with flea allergy dermatitis
Dermatology Tests
- Laboratory Tests: no hematologic or biochemical testing performed at this visit
- Skin Scraping: negative — no mites, keratinaceous debris, or neoplastic processes identified in interdigital region
- Impression Smear: not performed
- Tape Prep / Cytology: not performed
Assessment
Sandy is a patient with chronic allergic dermatitis manifesting as moderate pruritus and alopecia, with
clinical improvement on higher-dose Cytopoint injections. No evidence of secondary bacterial or fungal infection at this time. Alopecia appears non-scarring, with some hair regrowth. No active otitis or parasitic involvement observed. Perianal gland expression is likely needed.
Plan
- Continue Cytopoint injections every 25–35 days at the effective higher dosage.
- Emphasize strict adherence to the prescription hydrolyzed diet; avoid all table food, treats, or flavored supplements.
- Express anal glands today, and monitor for signs of scooting or licking.
- Continue monthly Simparica for flea control, as flea allergy can contribute to pruritus.
- Re-evaluate the need for topical therapy or oral antihistamines if pruritus increases;
Apoquel may be discussed as an alternative/add-on if Cytopoint response declines.
- Recommend routine dermatology recheck in 6–8 weeks or sooner if clinical signs worsen.
- Discuss possible seasonal variation in symptoms and adjust treatment accordingly.
Client Discharge Note
Thank you for bringing Sandy in today. It was a pleasure to meet her and discuss her care.
Summary
Sandy has been experiencing licking, biting, and scratching issues since she was about two years old. Her primary treatment has been cytokine injections, which have shown some improvement, especially when administered every 25 to 35 days at a higher dose. She has also been on a hydrolyzed diet, though adherence to strict dietary restrictions has been inconsistent. Sandy has had a couple of ear infections in the past but does not currently show signs of infection. Her skin appears healthy, with no redness or visible signs of infection, and her hair is regrowing, albeit slowly.
Key Topics We Discussed
Cytokine Injections:
Continue administering the cytokine injections every 25 to 35 days. This schedule seems to provide the best results for Sandy's symptoms.
Dietary Management:
- Strictly adhere to the hydrolyzed diet. Avoid giving Sandy any table scraps or additional food items outside of her prescribed diet.
- If Sandy is reluctant to eat her food, avoid mixing in other items. Instead, consult with we for alternative strategies to encourage her to eat.
Hydroxyzine:
Discontinue the use of hydroxyzine as it has not shown significant effectiveness in managing Sandy's symptoms.
Skin and Coat Monitoring:
- Continue observing Sandy for any signs of licking, biting, or scratching. If these behaviors increase, please contact the clinic.
- Monitor her hair regrowth and overall skin condition. While hair regrowth can take time, any significant changes or concerns should be reported.
Probiotics and Supplements:
If Sandy experiences digestive issues, you may continue using probiotics like Proviable as needed.
Flea and Tick Prevention:
Maintain her monthly Simparica treatment for flea and tick control.
Anal Gland Care:
If Sandy shows signs of discomfort, her anal glands may need to be expressed. Your daughter or the clinic can assist with this as needed.
Follow-Up:
Schedule a follow-up appointment if Sandy's symptoms worsen or if there are any concerns about her treatment plan.
Thank you for entrusting us with Sandy's care! Please do not hesitate to contact us if you have any questions or concerns.
— Dr. Moki Griffie