Wyatt is a 3.5-year-old castrated male golden retriever weighing 77 lb (35 kg).
Wyatt is a long-term patient of yours in which you diagnosed seasonal atopic dermatitis 1.5 years ago. He has been receiving weekly allergen-specific immunotherapy injections for the past 13 months, and his owners have been pleased with his progress. However, the owners have presented Wyatt because he has become progressively more pruritic over the past few weeks.
Wyatt usually sleeps in the same room with the owners and has recently been banned because of his now constant scratching (sides and ventral abdomen) and head shaking. His owners rate the pruritus at 10/10 (escalated from 3 to 4/10). He also has an odor. The owners have tried over-the-counter shampoos for itching with no improvement.
Wyatt spends time indoors and outdoors and goes to doggie day care one day a week. Wyatt has not exhibited vomiting, diarrhea, coughing, or sneezing and has no other previous medical problems. He receives a monthly oral flea and heartworm preventive (spinosad-milbemycin). No other animals are in the household.
Physical examination findings
- Temperature = 102.1 F (38.9 C), pulse = 70 beats/min, respiration = 16 breaths/min
- Gums are moist and pink; mild dental tartar noted
- Weight = 78 lb (35.4 kg)—weight unchanged since last visit three months ago
- BCS = 4/9
- Mild serous nasal discharge
- Mild to moderate partial alopecia along the lateral trunk with occasional excoriation noted
- Moderate papular, pustular dermatitis affecting the ventral abdomen and medial thighs
- Moderate interdigital erythema of front feet; hind feet unaffected
- Otic examination reveals patchy erythema of concave pinnae, erythema of vertical canals with moderate, dark-brown, ceruminous debris; horizontal canal and tympanic membrane appear normal
- Mild malodor noted from skin and ears