Specialty Spotlight: Fall is Falling! How to Treat (not trick) Your Pruritic Patient

September 24th, 2025 | Posted in General, Medical Articles

Fall is Falling! How to Treat (not trick) Your Pruritic Patient

Amy Schnedeker, DVM, MS, DACVD

The temperatures are falling, the leaves are changing color, and kids are back in school. That beautiful time of year has returned to upstate New York…Fall! But with seasonal changes come new environmental allergens and more questions about itchy pets. I find that most flare-ups happen during the transition seasons of spring and fall, but for some reason, upstate New York has its own brand of especially flavored ragweed that makes dogs and cats severely pruritic and flare up in the fall.

The difficult part about seasonal allergies is that pollen is everywhere and unavoidable. As veterinarians, all we can do is control the pruritus and treat any secondary infections.

Schedule those patients for a recheck and consider these steps to get them feeling better:

Step 1: Is there a Secondary Skin Infection?

If there are primary or secondary lesions on the skin, perform skin cytology to check for any yeast or bacterial infection.
If mild to moderate, topical therapy is the first line of defense for infections, as we strive as veterinarians to be antimicrobial stewards and decrease the frequency of resistant infections. Medicated shampoos, mousses, or sprays containing chlorhexidine 2-4% are very effective for both Staphylococcus bacteria and Malassezia yeast. You can choose your own brand, but my preferred brand is the Douxo S3 Pyo products (shout out to CEVA). Bathing can be weekly or multiple times per week, and mousse may be used every 12 hours to resolve infection.
Systemic antibiotics may be needed if pyoderma is severe. Always consider a bacterial culture if there is a history of resistant infection or concern for resistance.

Step 2: Is there Otitis Externa?

If there is any otic pruritus (head shaking, ear shaking, ear rubbing), ear cytology is ALWAYS recommended to rule in/out otitis externa. Remember that secondary otitis will only increase discomfort and pruritus! Always perform ear cytology to diagnose AND confirm resolution of otitis externa. We cannot diagnose otitis by odor alone….both bacteria and yeast are smelly.
Topical ear medications are needed to treat otitis externa, as systemic antibiotics do not penetrate the external ear canal well. Treatment is typically every 12 hours in the affected ear(s) for at least 3-4 weeks, then REPEAT ear cytology to confirm resolution before stopping ear medications.

Step 3: Are there Parasites?

Parasites should always be ruled out in your pruritic patients, as there are multiple easy, safe options, and these things can be cured! Take it from me, it’s nice when you can cure something.
All patients should be on flea prevention, either oral and/or topical. Yes, even indoor-only cats can have flea hypersensitivity (I know I am preaching to the choir!).
Do not forget about good ‘ole sarcoptic mange, as these itchy bugs are out there here in Upstate NY! The culprit tends to be foxes or other wildlife that drop parasites in the environment, and then our patients pick them up. Many systemic flea/tick preventatives (isoxazoline family of medications) will treat sarcoptic mange and are effective in preventing re-infestation.
Sarcoptic mange is zoonotic, so make sure owners know and have any lesions evaluated with their physician.

Step 4: Treat that Itch!

Do not forget to address the pruritus of your patient, as this clinical sign is causing the most discomfort for both the patient and the clients at home. Treating infection can take time, so we want to offer relief now!
There are lots of safe, effective options for itch including Apoquel, Zenrelia, Cytopoint, and even yes…..prednisone and steroids. Options will really depend on your patient, any co-morbidities, and perhaps owner preference and budget. Do not fear steroids; they can be very effective, useful, and cost-effective for short-term relief.

Step 5: Help Wanted

Allergies and dermatologic issues are never easy or simple. Please know that referral to Dermatology is always an option. Even if an owner cannot come to UVS, we are here to support and help work through a case. Always feel free to call or email for support!

-Amy Schnedeker, DVM, MS, DACVD