Canine atopic dermatitis: Survey reveals how financial constraints shape veterinary decision-making

Canine atopic dermatitis (CAD) is incurable, relapsing, and responsible for an average of 16 allergy-related veterinary visits over an affected dog’s lifetime. Despite the clinical burden, relatively little is known about how North American veterinarians navigate diagnostic and therapeutic decisions surrounding the condition, particularly when client finances enter the picture.

A new survey study published in April in the Journal of the American Veterinary Medical Association aims to change that.

The findings, drawn from the largest survey of its kind conducted among North American veterinarians, revealed that financial constraints are pervasive in atopic dermatitis caseloads—and that although most clinicians are adjusting their recommendations accordingly, significant gaps remain in antibiotic stewardship, awareness of newer treatment options, and how often veterinarians provide clients with estimates of the annual cost of managing the disease.

Led by Christina M. Gentry, DVM, DACVD, of Texas A&M University College of Veterinary Medicine and Biomedical Sciences, the study surveyed 718 Veterinary Information Network member veterinarians between July 15 and August 15, 2025—the largest survey to date on North American veterinarian opinions, diagnostic processes, and prescribing behavior for CAD. The majority of respondents were small-animal exclusive (79%) or predominant (15%) practitioners.

Using direct questions and case scenarios, the survey examined how financial constraints shaped recommendations across diagnostics, therapeutics, antibiotic selection, diet trials, and referral.

Clients’ financial constraints are the norm

Of the 713 respondents who quantified their client base, 58% reported that at least a quarter of their clients had substantial financial constraints, defined in the survey as the inability or difficulty obtaining veterinary care solely due to a lack of financial resources. Nearly 29% reported that half or more of their clients fell into this category.

Most veterinarians said they act on this knowledge: 76% reported almost always or often using a client’s financial status to guide diagnostic and treatment recommendations, and fewer than 10% said they rarely or never considered it.

The authors found that “veterinarians are routinely considering a client’s financial status when prioritizing diagnostic tests and treatments,” consistent with the spectrum-of-care model of providing evidence-guided care matched to client resources.

Diagnostics, treatment, and where the gaps show up

Skin cytology ranked as the most important diagnostic test in both financially constrained and unconstrained scenarios, followed by skin scraping. Isoxazolines were the dominant ectoparasiticide choice in both groups, with fluralaner selected as first choice by 90% of respondents without financial constraints and 49% with constraints.

For allergy control in a known atopic patient, oral corticosteroids led in financially constrained scenarios, with oclacitinib (Apoquel; Zoetis) and ω-3 fatty acids rounding out the top 3. In unconstrained scenarios, oclacitinib moved to first, followed by lokivetmab (Cytopoint; Zoetis) and allergen-specific immunotherapy. The newer Janus kinase inhibitor ilunocitinib (Zenrelia; Elanco) ranked below both oclacitinib and lokivetmab regardless of financial scenario—a finding the authors attributed to its recent market entry and package insert warning.

Antibiotic selection for methicillin-sensitive pyoderma showed cephalexin as the clear top choice in constrained scenarios, with cephalexin and cefpodoxime nearly equal in unconstrained ones.

Several respondents ranked fluoroquinolones among their top 3 empiric antibiotic choices for superficial pyoderma, and a subset selected amoxicillin—both choices the study flagged as problematic given resistance patterns and efficacy limitations.

Knowledge gaps, referral barriers, and the cost conversation

More than half of respondents (58%) were unfamiliar with research describing the use of prednisolone to shorten an elimination diet trial to approximately 6 weeks, a gap the authors attributed in part to those findings appearing in specialty journals not routinely read by general practitioners. Most respondents preferred hydrolyzed prescription diets for elimination trials regardless of financial constraints.

Two-thirds of respondents reported offering dermatology referral, but 81% believed clients declined due to financial constraints.

The authors note that most veterinarians reported rarely or never providing clients with estimated annual costs of CAD management.

“We wonder whether presenting a financial estimate of the yearly cost of managing atopic dermatitis flares could better enable clients to understand the cost-effectiveness of various interventions, including dermatology referral, to reduce the number of atopic dermatitis flares,” the authors wrote.

So, although veterinarians are already practicing across a spectrum of care, targeted education efforts in antibiotic stewardship, emerging treatment options, and proactive cost communication could meaningfully strengthen that practice.

Reference

Gentry CM, Rey L, Rishniw M, Tater K, Teller L. Multiple factors, including client financial constraints, play a role in clinician decisions for canine atopic dermatitis: spectrum of care in a chronic and relapsing disease. J Am Vet Med Assoc. Published online April 22, 2026. doi:10.2460/javma.25.12.0845