How do you treat a dog that compulsively licks its paws and scratches its ears and what could be causing these symptoms?
Original Question: Hello Dr. Greenway, I listen to your show on Saturdays but because I am at work I’m not able to call. I have a 4-year-old Cavapoo female who’s 21 lbs. About 8 months ago she started incessantly licking her paws and is now scratching at her ears. Our vet suggested that this could be allergies and we did 3 weeks of steroids followed by Royal Canin hypoallergenic food which she likes and is still on however there have been no results positive results. She is still gnawing at paws and scratching. My only issue with the vet is that every time we go in we see a different vet. There seems to be no consistency in our treatment or diagnosis. I am giving her Reactin now at their suggestion with limited success. Can you suggest anything that we could pursue? Thank you. - Ron
The most important thing here is to stop guessing. We need to start determining what’s going on. The first thing I want you to do is visit your veterinarian and have a skin scraping performed. This is a quick inexpensive test where they scrape the top layer of the affected skin and look at it under a microscope. A skin scraping is a common test that can help diagnose certain skin inflammations, fungal infections, and skin cancer and is quite effective in determining the presence of mites. This way we do away with all the guesswork and this needs to be done before any discussion of diet is entered into.
I have seen many patients with itchy paws like this that actually have a yeast infection and have been misdiagnosed as having allergies. I would recommend that you have a veterinarian do extremely thorough skin scrapings to determine if yeast is present. You may want to consider seeing a veterinary dermatologist to perform this so that you can be certain and start with the right diagnosis.
If yeast is present, then you can start shampooing daily with an anti-fungal shampoo. Leave the shampoo on for 10 to 15 minutes before rinsing it off. You’ll have to do this for a number of weeks because yeast is very stubborn. If this doesn’t work, which can be confirmed by repeating a skin scraping to be done at the end of treatment, then you can discuss with your veterinarian about giving anti-fungal oral medication as an alternative. This type of medication can be a bit hard on the liver so your veterinarian may want to do some blood testing before starting the medication and also during the treatment.
If the skin scraping reveals bacteria is also present, I would recommend that you use an antibiotic concurrently. The shampoo may help resolve this as well. If the bacteria is still present on a repeat skin scraping then I would recommend your veterinarian perform a culture and sensitivity on her skin sample. This is a test that will grow the bacteria that are present and will determine what type of antibiotic will kill it. I’m seeing more and more cases of skin infections caused by resistant bacteria.
You’ll notice in my answer so far that I have not mentioned diet at all. Stop thinking about diet at this point and get a confirmed diagnosis first. The diet only comes into play if we’re dealing with allergies. You cannot be certain about allergies in anyway at this point until the infections are identified and eliminated.
For the ears, I would also recommend you perform a culture and sensitivity test. This will identify the bacteria present and the right antibiotic you need to eliminate it. I strongly recommend that you have cytology performed on the ears to see if yeast is present there. It’s common for yeast to be on both the paws and in the ears. When the ears have a yeast infection, the debris and wax that you remove from them often has a dark brown to black appearance.
If after the infections are resolved and you are still seeing some redness, inflammation and itchiness, then I would consider allergies. I would recommend that you look at our resource about allergies, ‘Dealing with Your Pet’s Allergies‘ for more in depth information.
I hope this was helpful.
Dr. Clayton Greenway
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