Managing Hot Spots in Practice – A Sizzling Topic in Vet Med

Acute moist dermatitis, aka “Hot Spots,” is a common finding in South Florida’s tropical climate. While these lesions are often triggered by underlying allergies, they’re ultimately a manifestation of self-trauma and secondary infection. This blog offers a quick clinical refresher on diagnosis, treatment, and client communication around hot spots—plus some pro tips from fellow IndeVets in the field.

Clinical Presentation & Diagnosis

Hot spots present as focal to multifocal erythematous, moist, and often crusted areas of skin. Lesions may be painful and quite pruritic. In most cases, they are the result of self-inflicted trauma in response to pruritus—breaking down the epidermal barrier and allowing opportunistic bacteria and yeast take advantage of the skin irritation…and invade!

In South Florida, the hot, humid weather creates the perfect storm for hot spots to form. Pets with dense undercoats are particularly at risk for hidden lesions. However, all pets can develop hot spots if they have predisposing conditions such as allergies.

Predisposing Conditions

Hot spots are often a symptom of an underlying condition. In most cases, they’re secondary to other issues such as:

• Allergies: Flea allergy dermatitis, food sensitivities, environmental allergens
• Endocrinopathies: Hypothyroidism, hyperadrenocorticism
• Poor grooming or matted fur, especially in long-haired breeds
• Localized pain or discomfort (e.g., arthritic joints, otitis, anal sac disease) that can prompt licking/biting that leads to lesions

A full diagnostic workup isn’t always feasible during the first visit, but it’s helpful to plant the seed with clients that an underlying concern is worth investigating to prevent recurrence.

The Tip of the Iceberg – Setting Client Expectations

Before reaching for the clippers, take a moment to set expectations. When clients bring patients in for hot spots it is common that the hot spot they’ve seen is only partially visible through their pet’s fur. A full exam and appreciation of the extent of infection may require the veterinarian to clip away fur from a large region, potentially revealing a robust infection hidden beneath, thus an iceberg scenario. Explaining this upfront and preparing owners for a temporarily “worse looking” appearance can go a long way in building trust.

Tackling Treatment in the Clinic

A multimodal approach is warranted when treating hot spots and options may include:

Cytology: Always start with a tape prep or swab to identify cocci, rods, yeast, or parasites. This guides appropriate antibiotic or antifungal therapy.

Clipping & Cleaning: Clip generously around the lesion. Clean with dilute chlorhexidine or an appropriate antiseptic flush. Allow the area to fully dry before applying topical treatments.

Sedation: Don’t hesitate to sedate if the area is painful or the patient is fractious. A calm, thorough cleaning is better than a rushed one.

Topicals: Use antibiotic/antifungal ointments or sprays (e.g., Animax, GentaSpray, Neo-Predef).

Systemic medications: For moderate to severe lesions, systemic antibiotics (e.g., cephalexin, fluconazole, etc.) and anti-pruritics (Apoquel, Cytopoint, or steroids) may be warranted.

E-collar: Non-negotiable. Reinforce its importance to clients.

Home Care & Follow-Up

Ensure clients understand the full scope of home care, including medication schedules, the importance of the cone, and keeping the area dry. A written plan or schedule often helps with compliance. Rechecks are critical—not only to assess healing but to continue the conversation about underlying causes and long-term management. Recurrence should prompt further workup: food trial, allergy testing, endocrine screening, or skin culture for resistant infections.

Preventive Management

The key to preventing future hot spots is addressing the primary cause. Whether it’s treating allergies, managing flea infestations, or resolving a first-time skin infection, working with clients to create a long-term plan for their pets is critical. Focus on:

• Recommending monthly parasite preventions
• Addressing chronic allergies with ongoing management plans (e.g., Cytopoint, Apoquel, immunotherapy)
• Discussing routine bathing with medicated shampoos or skin barrier repair products
• Encouraging regular grooming to prevent matting, especially in thick-coated dogs

Clinical Tips from the Field

As veterinarians, we follow general principles and guidelines when managing hot spots – but the truth is, that every patient is different, and case-specific considerations must be made. Here are some thoughts on treating hot spots from some of our Associate IndeVets:

“When it comes to the treatment of hot spots, I have found a lot of success using topical antibiotic medications like Claro or Osurnia that are long-acting and have the added benefit of steroid to help with inflammation (make sure the pet has e-collar on so they don’t lick it off!). I also love to use low-level laser therapy for the cases that are refractory to healing.”

-Dr. Chelsea Smasal, Associate IndeVet
 

“I think it depends on severity. If it’s pretty superficial, I’d probably go with a topical treatment, such as Genta spray or Animax, depending on the size. If it seems like it’s been there longer or is more chronic, I would definitely reach for cephalexin in addition to topicals. Unfortunately, it’s the underlying cause that’s always the tough part. Is it a food allergy? Is it contact dermatitis or hypersensitivity, fleas, etc. If it’s a common occurrence, I would definitely recommend medicated shampoos with skin protectants.”

-Dr. Andrew Heller, Co-Founder & IndeVet #1
 

“Depends but clip and clean, and if very moist I’ll use Neo-Predef and Apoquel. Ecollar as well. If smaller area, Animax”

-Dr. Jackie Garcin, Associate IndeVet

Sources:

Cohn, Leah, A., and Etienne Côté. Cote’s Clinical Veterinary Advisor: Dogs and Cats. 4th ed., Mosby, 2019.