Diagnostics to help define the problem beyond simple allergy include thyroid testing, cytology (examining smears of the skin and nail beds under a microscope for infectious agents) and skin scrapings with microscopic exam to rule out mites. Blood or skin testing can be done to specifically identify offending allergens, thus allowing an owner to decrease exposure if possible.

Bacterial cultures may be needed when bacteria are suspected based on cytology or biopsy results and antibiotics don't clear up the problem. Culture of the bacteria allows sensitivity testing to determine which antibiotics are likely to give the best results. This can be especially important in chronic cases in which long-term treatment may be needed.

Trial courses of medications can also be used once it is deemed safe. As with allergies in humans, the situation can be complex and may require trying several different medications to find the best drug or combination of drugs.

Treatment will vary depending on the specific diagnosis. Dogs with low thyroid results (hypothyroidism) should be supplemented. Specific infections should be treated. This treatment might include orally administered medications and/or topically applied medications, dips, scrubs and soaks. I have found that scrubbing the feet two or three times weekly with antibacterial/antifungal shampoos can be extremely helpful4 percent chlorhexidine is my favorite active ingredient. The feet should be dried well afetr scrubs.

Allergens identified on testing should be avoided or eliminated from the dog's environment whenever possible. Keeping the dog inside more and avoiding walking in grass, weeds or brush may also help, reducing topical and oral exposure to potential allergens. Some dogs may need desensitization injections; the ingredients should be chosen based on allergy testing and likelihood and duration of exposure. Flea control needs to be nearly perfect in allergic dogs.

Dogs with atopy (inhalant dermatitis) may require further anti-inflammatory treatment. This is where corticosteroids such as prednisone come into the picture. It is important to realize that steroids are not inherently "bad" medications; in fact, they are essential in the short-term and emergency treatment of many patients. The itch relief gives damaged and infected tissues a chance to heal by breaking the lick cycle. Long-term reliance on steroids and failure to pursue other causes of the itching should be discouraged. Unfortunately, a few dogs need steroids for sustained allergy relief. Even in these individuals, efforts should be made to use the steroids only intermittently and at the lowest possible dose, and to spare the need with other medications and supplements whenever possible.

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