Atopic dermatitis in dogs: a long-term plan for itchy skin

Atopic dermatitis is an allergic skin reaction to environmental allergens — pollens, house-dust mites, moulds — and it is one of the most common skin problems I see in Hong Kong dogs. It usually appears between six months and three years of age and tends to worsen over time without management.

The classic signs are itchy feet (licking and chewing the paws), recurrent ear infections, scratching at the face and armpits, and reddened skin that can become infected and thickened over time. Cats can have atopic disease too, but present differently — often as over-grooming and small scabs around the neck.

There is no single cure, and any vet promising one is overselling. The goal is control, and the most effective approach layers several strategies rather than relying on one.

First, rule out the other causes of itch — fleas, mites, food allergy and skin infections all look similar and need to be excluded before settling on atopic dermatitis. A food trial with a hydrolysed diet for eight weeks is the only reliable way to rule food allergy in or out.

Maintenance combines: regular bathing with a medicated shampoo to reduce allergen load and infection, flea control (flea allergic dogs are often also atopic), and medication. Modern options — lokivetmab (a monthly injection), oclacitinib (a daily tablet), or cyclosporine — control itch far more safely than long-term steroids.

Allergen-specific immunotherapy (desensitising vaccines or drops) is the only treatment that changes the immune response rather than suppressing symptoms. It works in roughly half to two-thirds of dogs and takes months to take effect, but for severe cases it can reduce the need for other medication long-term.

Ear infections are the most common flare of atopic dogs. If your dog is shaking its head or the ear smells, do not wait — an infected ear canal narrows and thickens with each episode and becomes harder to treat each time.

A realistic plan, made with your vet, keeps most atopic dogs comfortable year-round. The skin will never be 'perfect', and aiming for that leads to over-medication; aiming for comfortable and infection-free is the right target.