https://www.vetsurgeon.org/f/clinical-questions/29097/itchy-skin---steroids-vs-apoquel-vs-topical-treatment-other As a new grad, I&#39;m trying to do a proper work-up for skin dermatological cases, sometimes even getting the clients to fill in a dermatology questionnaire. Every now and then, clients also opt for skin scrapes and some more thorough investigations,en-USTelligent Community 10https://www.vetsurgeon.org/thread/222582?ContentTypeID=1Thu, 14 May 2020 11:24:24 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:2ccc81f5-00ee-4644-af3b-9598ffc70267David Scarff<p>The general plan would involve good history and clinical examination, differential list then diagnostic tests.&nbsp; In likely atopic dogs I usually try to identify secondary infection (especially in skin folds; ears, feet lip folds) and would try to reduce this first, whilst also considering other differentials such as ectoparasitism.. Whilst the early use of drugs like Apoquel can be useful if severely itchy, it can make secondary infection worse, even if secondary to atopic dermatitis. If Apoquel is used and apparently is ineffective, owners may reject this as a treatment later when it might help.&nbsp;</p> <p>Once the secondary infection is under control and parasites have been ruled out, if pruritus persists then consider a food trial which may go hand in hand with a core treatment such as Apoquel or Cytopoint.</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/222571?ContentTypeID=1Thu, 14 May 2020 10:02:56 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:f9556e02-eff7-44b5-8c92-6ce417956cdeMark Craig<p>Hi Lulia. You are not alone. Derm cases are challenging. It is not possible to lay out in one reply on VetSurgeon.org (excellent though Arlo&#39;s website is) a complete guide to handling derm cases. However,&nbsp;there are some excellent&nbsp;CPD articles in journals such as Vet CPD, Companion Animal (UK Vet) and In Practice. There is much we do not understand about skin conditions. Preventing the problem from recurring should always be the aim, but it is important to set expectations at a realistic level, for both owner and ourselves as vets. Taking a thorough history, providing a careful examination, performing skin scrapings, altering the diet where appropriate, and improving the dog&#39;s environment and lifestyle can reduce the need for systemic medication. If you know you have a derm case booked in, set aside a good length of time to investigate fully. Some owners want only a quick fix, but many others really appreciate time and interest invested in their pet.</p><div style="clear:both;"></div>