When your dog’s paws seem to be severely itchy – so much that he wakes you every night with slurping sounds as he endlessly licks his paws – and the skin between his toes is red and inflammed, he’s likely suffering from a condition known as pruritic pododermatitis. Pruritic means to be itchy, podo refers to feet or paws, and dermatitis is inflammation of the skin.
There are a few causes of pruritic pododermatitis:
- Demodex mites
- Hookworm infection
- Canine atopic dermatitis (hypersensitivity, i.e., allergy)
- Malassezia dermatitis (yeast overgrowth)
While many owners are tempted to try home remedies for their dogs’ itchy paws, it’s best to have your dog seen by a veterinarian so the root cause can be treated and resolved. If only the symptom is addressed, the problem will recur again and again, putting the dog through needless distress and discomfort.
Here’s how the most common causes of pododermatitis are diagnosed and treated:
Dealing with Demodex
Demodex mites live in the hair follicles and sebaceous glands of your dog’s skin. They are usually a commensal mite; this means that they live on and benefit from your dog without causing your dog harm. Demodex mites can cause a dog to become itchy when their populations suddenly increase.
Puppies are more prone to developing pruritus caused by the Demodex mite because of their young age. Adult dogs can also develop demodicosis, but there is often an underlying immunocompromising condition that allows the Demodex mite to proliferate. Demodex mites are not contagious to other dogs.
To confirm the diagnosis, your veterinarian may want to complete a skin scrape test to look for Demodex mites.
There are several treatments for demodicosis. The only medication that is approved by the U.S. Food and Drug Administration (FDA) for demodicosis is a dip treatment called amitraz (brand name Mitaban). There are side effects to using amitraz, and the odor of the dip is quite noxious.
Other treatments for demodicosis are not FDA-approved for this purpose but are effective at treating the condition. These treatments include ivermectin (an oral medication), milbemycin (found in several heartworm preventatives), moxidectin (found in some topical flea preventatives), and the fluralaner class of drugs (found in several oral flea/tick preventatives). Discuss with your veterinarian which treatment option is best for you and your dog.
Hookworm
Hookworm can also cause pruritic pododermatitis. We often think of hookworm as being an intestinal parasite. Puppies can get hookworms from their infected mothers when they are in utero, or from their infected mother’s milk. Hookworm eggs are shed from an infected dog in its feces. The eggs develop into larvae, which infect other dogs when they are swallowed (often when the dog is grooming himself) or penetrating the dog’s skin, typically the underside of the webbing between the dog’s toes. When it penetrates the skin, hookworm causes an intense pruritus.
This parasite can be treated with several different anthelmintics (dewormers), including fenbendazole, milbemycin oxime, moxidectin, and pyrantel pamoate.
Canine atopic dermatitis (CAD, a.k.a. allergy)
CAD is a diagnosis of exclusion, which means that other causes of pruritic pododermatitis are first investigated, treated, or ruled out before concluding that a dog has atopic dermatitis. It is caused by hypersensitivities to a combination of contact, inhaled, and/or food allergens.
There are several treatment options for CAD. Some of these treatment options – like prescription medications Apoquel and Cytopoint – target a process in the body called the itch cascade. The itch cascade is a series of reactions that begin when a dog is exposed to an allergen. This series of reactions ends with the dog feeling itchy and licking or scratching at whatever is pruritic. When the itch cascade is interrupted, the dog does not reach the stage of feeling itchy.
Medications that modulate the immune system’s response to allergens – such as prednisone and Atopica (modified cyclosporine) – are another treatment option for CAD. There are potential side effects for both of these medications. Baseline bloodwork and periodic monitoring may be necessary when using prednisone or cyclosporine.
A prescription diet that addresses sensitive skin or food hypersensitivities may also be beneficial. Dogs who do not have known food hypersensitivities may benefit from a diet that promotes a healthy skin barrier and flora. This type of diet is available from both Hills and Royal Canin and can be ordered through your dog’s veterinarian.
Dogs with known food hypersensitivities may benefit from a limited ingredient, novel protein diet. Hills, Royal Canin, and Purina all have specially formulated diets that meet these criteria. Unlike limited ingredient diets that are available to purchase without a prescription, these diets are produced separately from other diets to eliminate cross-contamination with proteins that may cause an allergic reaction.
Immunotherapy is another treatment option for CAD. This involves exposing a dog to low doses of allergens to retrain how the dog’s immune system responds to exposure to those allergens. Testing is completed to determine what a dog is allergic to and how severe their response is to those allergens. Allergy testing can be completed by a blood test or by an intradermal skin test. An immunotherapy serum is created specifically for each individual dog and can be given by injection weekly or by mouth daily. Immunotherapy is continued for at least a year and sometimes longer to achieve a positive effect.
Malassezia dermatitis
Another common cause of pruritic pododermatitis is caused by an overgrowth of a yeast called Malassezia pachydermatis. Your dog’s skin naturally has yeast and bacteria growing on its surface. This population of yeast and bacteria is called the normal skin flora. It is part of the skin’s immune system and keeps yeast and bacteria from growing on the skin surface that can cause your dog harm. An infection with Malassezia is often secondary to another underlying skin condition, so it is important to complete a diagnostic workup with your dog’s veterinarian.
Pyoderma is a bacterial skin infection that can cause itchiness of your dog’s paws. Pyoderma can either be superficial or deep. Superficial pyoderma is often caused by an overgrowth of the normal flora on your dog’s skin surface but can be caused by other bacteria that are not part of the skin flora. Deep pyoderma is a bacterial infection that is within the layers of skin. Diagnosing the cause of deep pyoderma may require obtaining a small biopsy sample of the affected skin. The skin sample is submitted to a laboratory for a bacterial culture and sensitivity to identify the bacteria and the appropriate antibiotic.
Like Malassezia dermatitis, pyoderma is often secondary to another underlying skin condition. Both Malassezia dermatitis and superficial pyoderma can be treated with a combination of medicated shampoos and oral medications. Deep pyoderma typically requires a several week course of one or more antibiotics.
Don’t wait; see a vet!
Itchy paws are annoying for both you and your dog, but appropriate solutions will provide relief. Make an appointment with your dog’s veterinarian to determine the underlying cause and start down the path toward itch-free paws.
There is another cause of seriously itchy paws that is much less common than mites, hookworm, allergies, and yeast: chronic inflammatory pododermatitis. Dogs with this condition may have small swellings between their toes that rupture and drain. The underlying cause of chronic inflammatory pododermatitis is not known, but is thought to be more prevalent in dogs with carpal valgus (front paws that turn outward) and those with a deep bacterial infection of the skin or an immunosuppressive disorder. Treatment is aimed at identifying and treating the underlying cause of the condition.
