What is the best approach to treating acute moist dermatitis (hot spots) in dogs?

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Acute moist dermatitis (hot spot) treatment centers on breaking the itch-scratch cycle, addressing the primary cause, and managing surface bacterial colonization. The condition begins as a self-inflicted skin trauma driven by an underlying trigger — fleabite hypersensitivity, lice infestation, anal sac disease, poor coat hygiene, or foreign bodies are the most common primary causes and must be identified and eliminated alongside local lesion management.1 The clinical presentation frequently progresses beyond simple surface disease before the dog is examined. Because owners commonly initiate home treatment with disinfectants before veterinary evaluation, and because the lesion's appearance changes significantly within hours of onset due to continued self-trauma, distinguishing classic acute moist dermatitis (surface bacterial colonization only) from pyotraumatic folliculitis or furunculosis is often not possible without histology.1 Clinically, the lesion may simultaneously show acute moist dermatitis and folliculitis with surrounding satellite papules.1 Predisposed breeds include Golden Retrievers, Labrador Retrievers, Rottweilers, Collies, German Shepherd Dogs, and Saint Bernards, though any breed can be affected; dense coat is the key predisposing factor regardless of breed.1 Photobiomodulation using fluorescent light energy (FLE) has been evaluated as a sole treatment for pyotraumatic dermatitis in dogs. All cases in the published series presented with a single lesion, with dermatological evaluation occurring approximately 5 days after onset.1 If the hot spot is occurring in the context of underlying atopic dermatitis, acute flare management follows the ICADA and AAHA frameworks. For mild flares where secondary infection is identified, treating the secondary issue alone is sufficient to resolve the increased pruritus.4 For severe inflammatory flares, a short course of glucocorticoids is the appropriate addition; if glucocorticoids are contraindicated, twice-daily