Maltese with dermatitis

Detailed Report

Joy is a Maltese dog who lives in the garden with another dog (a Labrador) and follows a homemade diet.
The owner brings Joy in for a visit during the vaccination booster. The general physical examination is normal.
On visual inspection, there is a dermatitic lesion on the nipple (left thoracic mammary gland) characterized by erythematous and swollen skin. The nipple is enlarged, with a small ulcer at the base, while the tip is covered with yellowish scales. One vulvar lip also shows a small round, hairless, erythematous lesion. Despite frequent and proper application of antiparasitic treatments, Joy is itchy and shows this by persistently licking.
I perform a Scotch test and Wood's lamp examination, both of which are negative. Based on the symptoms, I suspect the patient may be atopic, so I recommend a leishmania test and immediately start therapy with Aloeplus Syrup and Aloeplus Dermo Spray.
At the 7-day follow-up, there is improvement in the dermatitis on the nipple and healing of the lesion on the vulvar lip.
After 18 days, Joy still shows itching with licking of the nipple, which remains swollen but less erythematous. Meanwhile, the leishmania test results are negative.
On day 28, there is a clear improvement, the itching is controlled, and the nipple remains erythematous at the tip and lichenified at the base.
On day 35, the nipple continues to improve, appearing less swollen and erythematous.
After 50 days, the itching has completely disappeared, and the nipple is no longer swollen or red. Only a small lichenification remains at the base.
I declare Joy healed and advise the owner to continue applying the Dermo Spray for a few more days.