In a dog with chronic pruritus, what is an appropriate stepwise diagnostic plan?

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Chronic pruritus in dogs is best addressed with a stepwise, least-invasive diagnostic approach that targets common, treatable causes first. Begin with history and a thorough physical exam to narrow down potential sources of itch and its pattern, then use skin cytology to check for secondary infections or inflammatory signs. A flea comb provides a simple, low-cost check for fleas or flea-related dermatitis that can explain itching or contribute to it. A supervised diet trial is essential to evaluate for food allergy, a frequent contributor to chronic itch, and can guide elimination of offending proteins. Allergy testing can be considered as a later step if other causes are addressed and atopy remains a strong suspicion, helping plan long-term management or immunotherapy. This sequence avoids unnecessary invasive procedures and focuses on identifying reversible causes through noninvasive testing and therapeutic trials. Immediate biopsy without prior steps is not ideal, and treating only for parasites or skipping diet assessment risks missing major culprits. Starting antibiotics without addressing underlying allergic issues may control secondary infection temporarily but won’t resolve the root cause of itch.