My dog has fleas and hot spots. What do I do?

‘Tis the season of the flea! Although we have fleas year-round in Southern California, the flea burden is highest in the warmer months; that coupled with seasonal allergies and other factors, makes May a great month for fleas, and an itchy one for our best friends.

Flea bite wounds outlive the fleas that caused them by about 3 weeks. The reason is that most dogs that develop wounds are allergic to flea saliva, and flea saliva stays in the dog’s skin for about 3 weeks after the bite. Here is a guide on how to heal the wounds, from start to finish:

1. Kill all current fleas, and prevent any new ones from infesting the dog. This is done by using an effective topical or systemic flea medication. Personally, I prefer topical applications because the dog doesn’t have to ingest the medication for it to be effective. Be careful, as there are many over the counter copy-cat or generic products that may not be effective. Make sure you use something that is recommended or sold by your vet. As a rule of thumb, you should be spending $10-15 a month (per dose) on flea treatment/prevention, whether topical or oral.
2. To heal the skin, your vet may have to send home either a) oral antibiotics if the skin infection is severe, or b) a topical antibiotic shampoo. Topical is preferred when we can get away with it (in cases of mild infection), as again it avoids medicating your dog systemically.
3. Skin heals, but not overnight (3 weeks remember), so we must protect it while it is healing. Whether the treatment of choice is antibiotic pills or shampoos, neither will work unless your dog stops creating new wounds by scratching or biting. For this reason, we must mechanically stop him from doing so with an Elizabethan collar. Weekly baths with mild shampoo are also soothing.
4. The skin will remain itchy for up to 3 weeks due to the flea saliva even after all the fleas have died! For this reason, shampoos and conditioners containing antihistamines or corticosteroids can be very helpful. In more severe cases, your vet may prescribe steroid pills or administer a long-lasting injection. Steroids are very effective at stopping the itching but can cause side effects, so it’s best to prevent getting to this point in the first place.
5. Finally, once the infection on your dog is under control and the skin is healing, we must prevent future bites. Ongoing flea treatment (monthly) is recommended because just one future bite can elicit a similar outbreak in allergic dogs. In mild climates like Southern California, fleas can remain in the environment year-round, so you really should not be “letting up” on the prevention. This also includes treating the environment with sprays and powders as 95% of the flea’s life cycle is spent in the environment (not on the dog). Fleas larva and eggs live in dark areas like under the furniture, dog bedding, or in the closets.