Start with a fast-acting isoxazoline. Rule out fleas, Demodex, and Sarcoptes before proceeding with allergy workup.

Use the 0–10 scale at every visit. Target: < 2 for controlled AD. Tracks response objectively over time.

Is the patient mostly pruritic, or pruritic with concurrent inflammation? This distinction drives your drug selection.

Ideal for dogs with pruritus accompanied by little to no inflammation. Targets the itch pathway only. Onset by day 3, lasts 4–8 weeks. Clean safety profile, no drug interactions.

Fast acting and flexible for short or long-term use. Zenrelia offers once-daily dosing with no loading dose, supporting cost-conscious care.

Use cytology to select appropriate medication. Without cytology, choose a responsible first-line antibiotic, antifungal, anti-inflammatory combination. If recurring, assess for underlying allergy.

Topical therapy first per 2025 guidelines. Systemic only when topical is insufficient. Address pyoderma as a core feature of AD, not just a complication.

Target cytokines signaling inflammation (IL-2, 4, 6, 13, 31) plus pruritus (IL-31). Fast relief for itch and red, irritated skin. Try monotherapy first.

Effective long-term option for chronic control. 4–8 weeks for maximum efficacy. Use veterinary formulations first. 65–83% success rate. GI effects common initially.

Fast, affordable relief for acute flares. Consider dexamethasone or Temaril-P beyond prednisone. Match treatment intensity to disease severity.

PVAS is the gold standard for tracking response. Exhaust monotherapy before combining drugs. Goal: PVAS < 2. Management, not cure.