Managing canine atopic dermatitis: Addressing financial barriers, antibiotic stewardship, and the long game

Canine atopic dermatitis (CAD) is one of the most common and complex conditions veterinary teams face—allergies are the leading cause of veterinary visits, and the average allergic dog accumulates 16 allergy-related appointments over its lifetime. Yet until recently, little research had examined how real-world factors, especially client financial constraints, shape the diagnostic and treatment decisions veterinarians make every day.

That gap motivated a new survey study published in the Journal of the American Veterinary Medical Association. Led by Christina M. Gentry, DVM, DACVD, of the Texas A&M University College of Veterinary Medicine and Biomedical Sciences, and co-authored by Lori Teller, DVM, DABVP, the study asked 718 North American veterinarians about their opinions, diagnostic processes, and prescribing behaviors for CAD. Gentry and Teller sat down with dvm360 to discuss what they found.

A lifelong disease that keeps changing

CAD typically emerges in young adulthood—usually between 1 and 3 years of age—which means patients live with it for a decade or more. “Because it starts so young, these patients are going to have this condition for their entire lives,” Gentry said. It's also often progressive, escalating from a few seasonal lesions to a year-round condition requiring topical, oral, and injectable therapies together.

That trajectory collides with a reality many practices underestimate: cost. In the study, roughly half of respondents said at least 25% of their clients would have difficulty affording routine, emergency, or illness care. “That's hard for any veterinarian to deal with for an acute problem,” Gentry said. “But that becomes a lot harder when you have a disease that is forever.”

Notably, the veterinarians surveyed were already practicing across a spectrum of care, choosing lower-cost drugs more often for flares in financially constrained cases rather than defaulting to the same protocol every time.

Setting cost expectations early

Most veterinarians, the study found, rarely give clients an estimate of the annual cost of managing CAD. Gentry argues that upfront framing changes outcomes. “If the injection worked for four weeks, that's the expectation—would you be okay if we spent $107 on this injection for the next year?” she said. Some clients are relieved; others reveal a ceiling that lets the team explore alternatives before frustration sets in. In primary care, that annual estimate may not be possible until there's enough history to know whether a case is seasonal or chronic.

Where antibiotic stewardship falls short

The clearest opportunity for improvement was antibiotic selection. Topical therapy works just as well as oral antibiotics for superficial pyoderma, Gentry noted, and when systemic drugs are needed, first-line options are first-generation cephalosporins, amoxicillin-clavulanic acid, and clindamycin. Most veterinarians chose cephalexin appropriately for cost-conscious cases. But in non-constrained cases, many shifted to cefpodoxime, a third-generation cephalosporin favored for once-daily dosing, a choice that may drive resistance. Some respondents also reached for fluoroquinolones without culture or for amoxicillin alone, which most staph are now resistant to.

“Amoxicillin is great for first-line UTIs in a female dog—not good as the first-line antibiotic in skin infections,” Teller said.

The referral conversation and the team's role

Both experts urged earlier specialist referrals. With allergies affecting an estimated 10% to 20% of dogs, dermatologists can't see them all—and early intervention prevents end-stage complications like ear canal scarring. Teller frames it plainly for hesitant owners: “Just go one time, hear what the dermatologist has to say.”

Success ultimately hinges on honest communication and delegation. Teller hands detailed bathing and medication instructions to trained technicians, freeing clinicians while deepening client education. Gentry added a reminder not to overlook corticosteroids—inexpensive and useful for calming flares early, particularly during diet trials.

Their bottom line was encouraging. “Our study shows that in general, veterinarians are rocking it,” Gentry said. “They are doing the best they can across the spectrum of care.”

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