Folliculitis is inflammation of the hair follicles. Inflammation is the body’s response to an injury or infection of some sort; when hair follicles become infected with bacteria, the body sends inflammatory cells to attack the bacteria and heal damaged tissue. In the case of foliliculitis in dogs, the original insult may have been caused by ectoparasites, a fungus, an underlying endocrine disorder, or trauma caused by the scratching and chewing that results from the itching of hypersensitivity (allergy). The condition is sometimes called superficial pyoderma; superficial refers to the hair follicles and the epidermis; pyo means pus and derma means skin.

Folliculitis can occur anywhere on a dog’s body, but is found most frequently in warm, moist areas of the dog’s skin, particularly where there is a skin fold, such as the dog’s lips, face, neck, vulva, and the base of the tail. The axillary region (or armpits as we know them on human bodies), groin region, and spaces between the toes are also prime locations for developing folliculitis.

Bacterial folliculitis begins as small, flat red circles on your dog’s skin called macules. As the condition progresses, the macules become raised bumps called papules. Papules may fill with pus, creating a small white dot in the middle of the raised red circle. When pus fills a papule on a dog, it is called a pustule; in humans, we’d call this a pimple.

Folliculitis is pruritic (itchy) and you may notice your dog scratching or licking at these lesions. Scratching or licking at papules and pustules causes them to rupture and release clear fluid from papules and pus from pustules. When that clear fluid and pus dries, the papules and pustules become covered with a crust. If your dog continues licking and scratching at these crusty red circles, the circles get bigger and develop scales or flakes along the edge. These are called epidermal collarettes.

General Treatment of Folliculitis in Dogs

Treatment of folliculitis may include a medicated shampoo to reduce the bacterial population on the skin and ease the pruritus and discomfort. Treatment will also likely include an oral antibiotic. A dog will typically need to be on an oral antibiotic until one week after all of his symptoms resolve. This may take as little as two weeks but usually requires four to six weeks of therapy.

Folliculitis in Dogs Causes and Targeted Treatment

A bacterial infection of the skin and hair follicles is almost always secondary to one of many potential problems with the skin. Successful treatment of folliculitis will depend on its original cause. These most common precipitating conditions include:

Demodicosis

This is caused by a mite called Demodex, which live in the hair follicles and sebaceous glands of your dog’s skin. They are a commensal mite; 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. (When the equilibrium between the Demodex mites and the skin microenvironment becomes unbalanced, and the mite population explodes, they are then considered a parasite, rather than a commensal.)

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.

Your veterinarian may want to complete a skin scrape test to look for Demodex mites. There are several treatments for demodicosis. The only FDA-approved medication 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 have shown good efficacy in 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.

Ectoparasites (skin parasites)

Skin parasites include mites and lice that do not belong on your dog. They include:

• The Sarcoptes scabiei mite is the cause of sarcoptic mange, aka scabies. This mite burrows into your dog’s skin and lays eggs in the tunnels they create. Dogs have an allergic reaction to the poop that mites leave behind in the skin tunnels, causing the dog to become extremely itchy.
• Cheyletiella yasguri (the cause of cheyletiellosis) is a white mite that lives on the surface of a dog’s skin. Dogs infected with Cheyletiella have dandruff that looks like it is moving. This infection is often called “walking dandruff.”
• Trombiculidae, better known as “chiggers,” are tiny, orange-red mites that attach to a dog’s skin to feed for a few days before detaching.

The treatment for all three of these mites is similar and include amitraz and lime-sulfur topical dips, ivermectin (an oral medication), moxidectin and selamectin (found in some topical flea preventatives), and the fluralaner class of drugs (found in several oral flea/tick preventatives). Moxidectin and selamectin are FDA-approved for treating sarcoptes mange but have been found effective at treating walking dandruff and chiggers. The fluralaner class of drug is not FDA-approved for any of these mites but has been found to be effective. All three mites are zoonotic – they can be transmitted between animals and humans.

• Ear mites. Otodectes cynotis are a species of mite that live in the dog’s ear canal (and thus are commonly just called ear mites). Sometimes ear mites will crawl out of the ear and reside in the skin around the ear and the face and neck, causing itchiness in those regions. Ear mites are primarily transmitted through close contact with another animal that has ear mites. Topical ear medications that contain milbemycin and flea preventatives that contains selamectin are effective treatments for ear mites. Ear mites can be transmitted between species of animals (like dogs, cats, and ferrets) but do not typically infect humans.
• There are three species of lice that can infect dogs. One species is a sucking louse that attaches to a dog’s skin. The other two species are chewing lice that eat dead skin flakes, fur, and skin secretions. Lice glue their eggs to the shafts of fur – these little white or clear eggs are known as nits. Lice tend to be species-specific – they prefer the host for whom they developed. Effective treatments for lice in dogs include topical flea preventatives that contain selamectin, imidacloprid, or fipronil.
• Ringworm. Dermatophytosis This fungal infection is best known by its common name. Ringworm is not a worm, but got its name because the skin lesions sometimes look like a raised squiggly ring that resembles a worm under the skin. Dogs can contract dermatophytosis from contaminated soil or from another infected animal or human.

Your veterinarian may want to examine your dog’s skin lesions with a special kind of light called a Wood’s lamp. One species of fungus that causes dermatophytosis will often glow the color of a green apple under a Wood’s lamp. Since not all fungal species that cause dermatophytosis will glow under a Wood’s lamp, a fungal culture may be necessary to confirm the diagnosis. Your veterinarian will brush the affected areas of skin with a new, previously unopened toothbrush to collect a sample. The sample is added to fungal culture medium and observed for 14 to 21 days for fungal growth.

Dermatophytosis is often treated with a combination of oral medication and topical ointment, shampoo, or dip. It is a zoonotic illness – this means it can be transmitted between animals and humans. Follow your veterinarian’s directions for safe handling of your dog while treating dermatophytosis and for how to clean the home.

Endocrine disorders

Hypothyroidism and hyperadrenocorticism are two endocrine disorders that can be triggers for bacterial folliculitis.

• Hypothyroidism is caused by a decreased production of thyroid hormone by the thyroid gland. Thyroid hormone plays a major role in many body systems, including the skin. Dogs with hypothyroidism may have dry, flaky skin and have a slow regrowth of fur. Fur naturally falls out over time, but when new fur is slow to grow, a dog with hypothyroidism may develop alopecia over certain areas of his or her body. The dry, flaky skin can sometimes facilitate the development of bacterial folliculitis. If your dog is also showing signs of lethargy and weight gain despite a decreased appetite, your veterinarian may order a full thyroid panel to screen for hypothyroidism. This disorder is treated with a daily medication called levothyroxine to replace missing thyroid hormone.
• Hyperadrenocorticism (also known as Cushing’s disease) is caused by an increased production of cortisol by the adrenal glands. Cortisol is a steroid hormone that also plays a major role in many body systems. Too much cortisol can cause changes to a dog’s skin that can contribute to the development of chronic and recurrent bacterial folliculitis. Other signs that your dog may have Cushing’s disease include drinking more water and urinating more than usual, having an increased appetite, symmetrical alopecia, panting for no apparent reason, or having a pot-bellied appearance. Your veterinarian may order a screening test and then one of two diagnostic tests for hyperadrenocorticism. This disorder is treated with a daily medication called trilostane to reduce the amount of cortisol the adrenal glands produce.
• Canine atopic dermatitis Another cause of bacterial folliculitis is canine atopic dermatitis (CAD). This is a diagnosis of exclusion – other causes of bacterial folliculitis 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 Apoquel and Cytopoint – target a process in the body called the itch cascade. The itch cascade is a series of reactions that begins 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.

Dogs with CAD are more likely to be allergic to fleas. This condition is known as flea allergy dermatitis. Dogs with flea allergy dermatitis become itchy when a flea bites his or her skin. Using a high-quality flea preventative as directed will help to minimize the role that fleas play in CAD.

Immunotherapy is another treatment option for CAD. This involves exposing a dog to low doses of allergens to retrain how their 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.

Proper diagnosis necessary

No matter what the precipitating cause, folliculitis can become serious if left untreated. Make an appointment with your dog’s veterinarian to determine the underlying cause and appropriate treatment.

Anxiety, and the behavior problems stemming from it, is increasingly common in our companion dogs. If you have one of these dogs, you know how heartbreaking and disruptive this can be. Anxious dogs are not comfortable. They can’t relax. Sometimes they are downright panicky. This can lead to dangerous destructive behaviors, house-soiling, and even aggression. Luckily, there are many safe and effective anti-anxiety medications for dogs that can help your quivering canine.

The trick is to find the right ones, at the right dose, and the right combination. Take detailed notes of your dog’s behaviors, and response or lack of response to any drugs and dosages tried. Your veterinarian will use this information to tweak your dog’s protocol until the desired result is achieved. It’s a process that can take some time, so be patient and work closely with your veterinarian.

What medication can and cannot do for your dog

It’s important to mention that medication alone is not likely to be a magic bullet, miraculously turning your anxious dog into a calm, confident, well-mannered one; however, it drastically enhances the effectiveness of desensitization to triggers and behavioral modification – the mainstay of treatment and long-term management of anxiety-associated behavior issues.

Many highly anxious dogs fail to show the kind of progress in training that is typical for dogs without anxiety; that’s because anxiety, fear, and panic impair a dog’s ability to focus and learn. Anxiolytic (anxiety-reducing) medications ease the symptoms of anxiety, fear, and panic, allowing your dog to absorb and learn during desensitization and behavior modification exercises. The combination of medication and behavior modification, under the direction of a force-free trainer and veterinarian or veterinary behavior specialist, is the gold standard for treating canine anxiety.

Types of Anti-Anxiety Medications for Dogs

There are several classes of drugs used for anxiety in dogs. Some are long-acting and meant to be used daily. Others are short-acting and meant to be used situationally as needed, although they can be used daily in combination with a long-acting medication.

Most of the drugs used for anxiety in dogs are prescribed off-label, meaning the U.S. Food & Drug Administration (FDA) has not determined the safety and efficacy of the medication for the intended purpose.

Don’t let off-label use be a deal-breaker for you. These medications have been used safely and effectively in veterinary medicine for decades. Your veterinarian should have a conversation with you regarding off-label drug usage so you can give informed consent, and you’re ready to get started.

When multiple medications are necessary to achieve the desired result, drugs from different classes can be safely combined. This enhances their beneficial effects without doubling up on side effects. Never use two drugs from the same class at the same time.

We’ll take a look at each of the main classes of drugs used for anxiety in dogs, which are:

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Tricyclic Antidepressants (TCAs)
• Benzodiazepines
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
• Alpha-2 Agonists
• Anticonvulsant/neuropathic pain relievers

Selective Serotonin Reuptake Inhibitors (SSRIs)

The drugs that belong to this class and are commonly given to dogs are:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Sertraline (Zoloft)

Serotonin is a neurotransmitter highly involved in mood and emotions. It is known to produce calm and lessen overactive responses to normal stimuli. SSRIs decrease the reabsorption of serotonin, resulting in increased amounts circulating in the brain, which helps manage anxiety, aggression, and obsessive-compulsive behaviors (e.g., self-mutilation by licking or chewing, flank sucking, tail chasing, pacing/circling, incessant barking) in dogs.

SSRIs are long-acting medications that are prescribed for dogs with generalized anxiety issues needing help on a daily basis. They generally take four to six weeks to reach full effect, so shorter-acting anxiolytic medications are usually prescribed with them in the beginning.

Never use an SSRI with a TCA, nor use two SSRIs at once, as this can result in serotonin syndrome (see sidebar). If you don’t see the desired result from the first SSRI medication you try, your vet should guide you through tapering your dog off the first medication before prescribing another.

Tricyclic Antidepressants (TCAs)

The drugs that belong to this class and are commonly given to dogs are:

• Clomipramine (Clomicalm)
• Amitriptyline (Elavil)

TCAs affect several different neurotransmitters, including serotonin, resulting in increased calm and dampened panic responses. They are long-acting medications given daily to help manage anxiety and obsessive-compulsive behaviors in dogs. They do not work for aggression. TCAs usually take three to four weeks to maximum effect. Do not use with an SSRI, and never use more than one TCA at a time. Do not stop abruptly. Always taper off these medications.

Benzodiazepines

The drugs that belong to this class and are commonly given to dogs are:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Lorazepam (Ativan)
• Diazepam (Valium)

Benzodiazepines are fast-acting (60 to 90 minutes), short duration (4 to 12 hours), anxiolytic medications that promote calm by increasing the effects of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the central nervous system. They can be used alone or in combination with other classes of behavior-modifying drugs. They can be used “as needed” for situational triggers, or included as part of a daily multi-drug protocol.

Benzodiazepines are federally controlled drugs (meaning there are legal limits on their prescription).  Physical dependence with increasing dose tolerance is unfortunately a possibility when benzodiazepines are used long-term. To avoid withdrawal symptoms (confusion, vocalization, tremors, twitching, seizures, and death), always slowly taper off these medications after long-term use.

Serotonin Antagonist and Reuptake Inhibitors (SARIs)

Only one drug belongs to this class that is commonly given to dogs:

• Trazodone

Trazodone is pretty much the only SARI used in veterinary medicine. SARIs keep more serotonin circulating by both decreasing its reabsorption and blocking its receptors. SARIs have both anxiolytic and sedative effects. They are rapid-acting (30 to 90 minutes), have a short duration (4 to 8 hours), and are non-addictive. They can be used alone, as needed for situational anxiety, or included daily as part of a multi-drug regime.

Trazodone has a wide dosage range so it will typically be started low and ramped up from there. Because SARIs increase serotonin, combining them with SSRIs and TCAs comes with a slight risk of serotonin syndrome. However, trazodone is routinely used together with SSRIs in dogs, with few reports of this.

Alpha-2 Agonists

The drugs that belong to this class and are commonly given to dogs are:

• Clonidine
• Dexmedetomidine (Sileo)

Alpha-2 agonists inhibit the release of norepinephrine (adrenaline) in the central nervous system. As inhibitors, they really work only if given before your dog gets upset. Once he’s upset, adrenaline has already been released along with its “fight or flight” response, and it’s too late.

Alpha-2 agonists are given prior to stressful situations known to invoke fear in your dog (such as veterinary visits or any situation that tends to trigger your dog’s separation anxiety, noise phobia, fear aggression, or leash reactivity). Onset is rapid (30 to 90 minutes), duration is short (2 to 4 hours), and they are safe to use with most other anxiolytic medications. As such, they can be added to a daily multi-drug regimen.

Anticonvulsant/neuropathic pain reliever

Only one drug belongs to this class that is commonly given to dogs:

• Gabapentin

Gabapentin is frequently used in combination with other anxiolytic medications for its mild sedative effect. It works by blocking certain biochemical channels in the brain, which calms overstimulated neurons, helping lessen feelings of anxiety. Gabapentin takes effect within 1 to 2 hours and lasts 6 to 8 hours. There is a wide dose range. Your veterinarian will likely start with a low dosage and increase the dose as needed. It can be used situationally, often in combination with trazodone, or it can be added to a daily multi-drug regime.

For more information about gabapentin, see “Gabapentin for Dogs: What You Should Know,” WDJ April 2021.

Be persistent when finding the right anti-anxiety medication for your dog

Finding the right medication (or combination of medications) and the right doses for your dog’s anxiety can be challenging. If a medication is not working well enough and maximum dose has not been reached, sometimes simply increasing the dose may work, assuming the side effects aren’t too bad. Other times a different drug from the same class will work better. Combining medications from different classes is often the ticket. And remember, SSRIs and TCAs take weeks to reach full affect, so adding a short-acting drug in the beginning is always helpful.

Here are some examples of how a case may be managed:

A dog with separation anxiety might be started on fluoxetine daily, with alprazolam as the short-acting medication for the first 4 to 6 weeks. If this isn’t working, the veterinarian may add gabapentin, or discontinue alprazolam and add trazodone. At 6 weeks, if the desired effect has not been achieved, the vet may increase the dose of fluoxetine and add clonidine. If this doesn’t work, fluoxetine may be tapered off and a different SSRI or TCA started as the long-acting daily medication.

A dog with generalized anxiety who is also reactive on leash (see “On-Leash Aggression)” may do well with a daily SSRI or TCA, and clonidine given an hour before going for walks.

Trazodone combined with gabapentin is frequently used for fear and anxiety associated with veterinary visits. If this isn’t enough, clonidine or dexmedetomidine may be added.

Fortunately, no matter what your dog’s issues are, there are many possible medications and medication combinations available to try, with the simple goal of finding what works best for your dog with the least amount of side effects.

Most Commonly Prescribed Medications for Dogs with Anxiety

Choking puts otherwise perfectly healthy dogs at an imminent risk of dying – within minutes – if first aid is not successful.

Choking is the inability to breathe due to an obstruction of the upper airway (trachea or windpipe) that blocks air flow. In dogs, choking is usually caused by foreign objects like balls or bones. Note: Trauma and swelling in the throat can also block air flow but require immediate veterinary help. The techniques below are used to remove the object stuck in the dog’s throat.

What to Do When a Dog Is Choking

If you encounter a choking dog, the first thing to do is ascertain if the dog is really choking. “Blocked air flow” is key here. If a dog can cough, there is airflow. So, if your dog is coughing, as harsh, uncomfortable, and scary as that may be, he is not choking. If coughing persists, he needs to see a veterinarian for sure, but you can relax and leave your superhero coat in the closet for now.

Signs of Choking in Dogs

Signs of choking in dogs include:

• Obvious distress
• Pawing at the mouth
• Gagging
• Trying to cough
• Producing no sounds, or just faint whistling sounds
• Salivating
• Tongue and gums turning blue
• Collapse

How to Save a Choking Dog

1. Do a Finger Sweep Inside the Mouth

If you can safely put a finger in the dog’s mouth without being bitten, try a finger sweep first. If you can’t safely do this with a still conscious, panicking dog, it is the FIRST thing you do when they become unconscious. Be careful not to push anything you may feel at the back of the mouth deeper into the throat. If you feel something thin enough to grasp with your fingers, you may be able to retrieve it and clear the dog’s airway.

If you have a hemostat in your first-aid kit, you may be able to grasp the object. (A hemostat is a surgical tool normally used for clamping blood vessels, but its blunt end and grasping characteristics make it perfect for grabbing something heading down your dog’s throat.) If you feel something but can’t grasp it, your next move is to try to dislodge it by compressing the chest.

2. Chest Compression

With the dog standing, stand over him facing the same way and with both hands simultaneously push on his rib cage. Strong, forceful, repeated thrusts will likely be required. If this is unsuccessful, move on to the Heimlich maneuver.

3. The Heimlich maneuver

The way to do a Heimlich maneuver depends on the dog. The key is to use repeated, forceful, upward thrusts with a fist underneath the dog behind where the rib cage ends. Place yourself over the dog in whatever position allows you to place your hand/fist right below the rib cage and apply a maximum pressure gradient force from the abdomen/chest up toward the throat.

For small dogs, this position might be holding them with their spine against your body while applying the force.

For larger dogs, the Heimlich can be performed with them standing up on their hind legs, facing away from you (as is done with a human), or lying on their sides or backs if you can’t hold the dog up.

4. Rescue Breathing

If you successfully dislodge the object, but your dog is not breathing, you must perform rescue breathing – like CPR for humans, as you’re administering artificial respiration – to get the dog breathing. Close the dog’s mouth, extend the neck, place your mouth over both nostrils to create a seal, and breathe hard enough into the dog to see the chest rise and fall. Wait a few seconds for a response and repeat as needed.

Prevent Choking in Dogs

Be careful with what you allow your dog to chew on and always supervise chewing sessions.

Choking occurs most commonly during play, especially with balls. Make sure your dog only plays with a safe type and size ball. A ball that is too small for the dog could easily make its way to the back of the throat and choke the dog. This is especially important in large exuberant dogs.

If the ball is compressible, like a tennis ball, it might be easier to retrieve if it becomes lodged. Balls with holes in them are even easier to grasp.

Warning: NEVER, EVER LET DOGS PLAY WITH LACROSSE BALLS! These balls are hard and dense and the most difficult, if not impossible, to retrieve when stuck in the back of the dog’s mouth.