Approach to Pruritus

Pruritus is a non specific sign in dermatology thus the clinical approach to it can be complex and frustrating. It is therefore important for the clinician to develop a systematic and logical approach to it. First and most important thing to remember is that most patients presented for pruritus have, at least at first visit, a secondary infection. This infection can be bacterial or yeast. Cytology is helpful in figuring out the nature of the infection and providing some basic guidance on how to approach it. Yeasts are typically not difficult to treat and be addressed either systemically in severe cases or topically for the milder cases. Systemic treatment includes the use of azoles. Ketoconazole is a good choice for young and healthy dogs while itraconazole is preferable in cats. For patients with compromised liver function fluconazole would be a better choice. Bacterial infections are more challenging since staphylococcus is now frequently resistant and proper antibiotic choices may require a culture. Empirical choices for first time pyodermas would include first generation cephalosporines, lincomycin or clindamycin. Other more spectrum antibiotics should only be selected based on culture and sensitivity. Since most infections are cause by staphylococcus the rule is always to select a narrow spectrum antibiotic first and an antibiotic known to be effective against Staphylococcus.

Once the infection is controlled is important to note whether the underlying disease is a pruritic one or not. This lecture will be focused on underlying diseases that are pruritic in nature even once the secondary infection has been resolved. In order to rank pruritic diseases it is important to note the distribution of the pruritus as well as the presence of primary lesions such as papules and pustules. Highly pruritic diseases include flea allergy, food allergy, scabies, contact allergy.  […]