Some patients may be able to be maintained on just topicals once the problem has been resolved, others require maintenance ketoconazole. In dogs or cats with recurrent yeast nailbed problems, a search for underlying disease such as hypothyroidism, hyperadrenocorticism, or food or inhalant allergy should be undertaken. This ranges anywhere from chewing the nails to licking the dorsal or ventral aspects of the foot sometimes to the point of maceration. Intact, non-macerated skin has an inherent ability to fight off infection but once the skin is macerated from constant licking this ability is lost and the area actually attracts yeast and bacteria. Certainly this would hold true to occur in the non-haired areas of a dog or cat such as the feet which are in constant contact with allergens be it dust mites in carpeting or outdoor pollens.
Foot licking in atopics can begin at a very young age, perhaps younger than previously published.
In our practice some owners report the onset of foot licking in their atopic dogs occurring as early as 8 weeks of age. Unfortunately when some young dogs are skin tested or in vitro tested for inhalant allergy, the test results can be false negative until they become a few months older. In mild atopics, some patients may have their symptoms controlled by treating the secondary yeast only. Dogs experiencing nonseasonal foot licking would certainly warrant a hypoallergenic food trial since food allergy is typically nonseasonal. Since intradermal skin testing and in vitro testing has not been proven to be accurate in diagnosing food allergy, the most reliable method of diagnosis is a cooked or commercially prepared hypoallergenic diet.