• DVM360_Conference_Charlotte,NC_banner
  • ACVCACVC
  • DVM 360
  • Fetch DVM 360Fetch DVM 360
DVM 360
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
By Role
AssociatesOwnersPractice ManagerStudentsTechnicians
Subscriptions
dvm360 Newsletterdvm360 Magazine
News
All News
Association
Breaking News
Conference Coverage
Education
Equine
FDA
Law & Ethics
Market Trends
Medical
Politics
Products
Recalls
Regulatory
Digital Media
dvm360 LIVE!™
Expert Interviews
The Vet Blast Podcast
Medical World News
Pet Connections
The Dilemma Live
Vet Perspectives™
Weekly Newscast
dvm360 Insights™
Publications
All Publications
dvm360
Firstline
Supplements
Top Recommended Veterinary Products
Vetted
Clinical
All Clinical
Anesthesia
Animal Welfare
Behavior
Cardiology
CBD in Pets
Dentistry
Dermatology
Diabetes
Emergency & Critical Care
Endocrinology
Equine Medicine
Exotic Animal Medicine
Feline Medicine
Gastroenterology
Imaging
Infectious Diseases
Integrative Medicine
Nutrition
Oncology
Ophthalmology
Orthopedics
Pain Management
Parasitology
Pharmacy
Surgery
Toxicology
Urology & Nephrology
Virtual Care
Business
All Business
Business & Personal Finance
Hospital Design
Personnel Management
Practice Finances
Practice Operations
Wellbeing & Lifestyle
Continuing Education
Conferences
Conference Listing
Conference Proceedings
Resources
CBD in Pets
CE Requirements by State
Contests
Veterinary Heroes
Partners
Spotlight Series
Team Meeting in a Box
Toolkit
Top Recommended Veterinary Products
Vet to Vet
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us

© 2023 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Advertisement
By Role
  • Associates
  • Owners
  • Practice Manager
  • Students
  • Technicians
Subscriptions
  • dvm360 Newsletter
  • dvm360 Magazine
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us
  • MJHLS Brand Logo

© 2023 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Managing difficult dermatological cases in pets

March 17, 2022
Ciara Vollaro, DVM
dvm360, dvm360 March 2022, Volume 53, Issue 3
Pages: 30

Dealing with a patient that is constantly itching, licking, or shaking its head can be frustrating. Here are some helpful ways to manage these difficult cases.

hen it comes to difficult dermatology cases, owners are usually looking for an immediate and permanent fix. As veterinarians, we wish there were a “magic shot” that would offer relief to our patients and make our clients happy. However, before we reach for the imaginary magic shot, we must make sure to go back to the basics in terms of diagnosis and treatment.

It is easy to fall into the same conversations by offering medications such as lokivetmab (Cytopoint; Zoetis) and oclacitinib (Apoquel; Zoetis) for immediate relief, but we cannot forget to start at the beginning. Some owners walk into our exam rooms saying that they have tried everything. Sometimes this is true, but this is often not the case. We must remember to start with obtaining a thorough history. Begin by asking simple, open-ended questions that can sometimes lead to an easy diagnosis or direct us to diagnostics that are needed to help treat these cases.

Once you feel comfortable with the obtained history, you should next perform a thorough exam using an otoscopic examination. Remember, the ears are an extension of the skin. During the physical exam, you should start mentally creating a list of recommendations that include the basics, such as ear cytology, skin scrape, skin cytology, and/or tape preparations. These simple diagnostics can give us immediate answers to underlying issues. Furthermore, keep in mind that not all dermatology cases are secondary to allergies. Any case with chronic skin changes should have complete blood work with thyroid testing and urinalysis performed to rule out underlying endocrine issues.

Although in-house testing is relatively simple, quick, and less expensive, further diagnostics are needed to help determine the best course of treatment. There are several different types of cultures that can be used to identify specific microbial pathogens. For instance, dermatophyte test medium fungal cultures are used to isolate and identify dermatophyte organisms. Bacterial and fungal cultures are essential for prescribing appropriate topical and/or oral medications. Generally, any deep cellulitis-like lesions and/or draining tracts should be cultured for bacterial and fungal organisms. Aside from cultures, there are cases where we can obtain a lot of information from skin biopsies.

To improve diagnostic accuracy for the dermatopathologist, it is best to take 3 to 5 samples from a variety of lesions. Do not completely shave or aseptically prep the area. Use a 6-mm or 8-mm punch biopsy, rotate the punch biopsy tool in one direction to get the best cut, and be gentle—no crushing—with tissue forceps when transferring the sample to the formalin jar. Other diagnostics to consider are allergy testing, trichograms, polymerase chain reaction assays, or immunohistochemistries.

Advertisement

Because owners are looking for an immediate solution to their pets’ itching, lokivetmab and oclacitinib can be great medications to use while waiting for laboratory results. Oral antibiotics have the potential to create bacterial-resistant infections, we must be cautious with immediately prescribing oral antibiotics. We often forget that there are excellent topical medications, such as shampoos, mousses, wipes, and sprays, on the market that can help manage these cases while we wait for culture results. There are many benefits with the use of topical medications, which include physically removing allergens, reducing bacterial and yeast populations, repairing epidermal barrier defects, and antipruritic effects of cool water on hot, inflamed skin when bathing.

For patients in whom parasites and external causes have been ruled out, an elimination diet trial can be helpful. A proper food trial will be successful only if owners understand their pets must strictly adhere to the specific elimination diet. You will need to select a limited ingredient or hypoallergenic diet based on the diet history and the preferences of clients and patients. If a patient was given access to any other food or treats, the trial must start over. This includes rawhides, chew toys, flavored chewable medications, vitamins, and treats. An elimination diet trial for 8 weeks should be long enough for most patients that have a cutaneous adverse food reaction.

It can be easy to get tunnel vision when trying to diagnose and treat these cases, and we may forget there are specialists we can reach out to. Patients with skin conditions may be referred to a dermatologist at any time. If owners are willing to consult with a dermatologist, remember to contact their office before you refer the patient so you can discontinue medications that can interfere with diagnostics they would like to pursue. If owners decline a consult with a dermatologist or there is not one in your area, utilize teleconsultation.

In the end, we will not be successful with treating these cases if we do not take the time to educate clients. Managing difficult dermatological skin diseases takes time and clients must be on board with the cost of diagnostics, medications, food, and recheck appointments. Giving clients the tools and knowledge to better understand their pet’s skin problems will give them the power to know they can make a difference with their pet’s quality of life.

download issueDownload Issue: dvm360 March 2022

Related Content:

Dermatologydvm360 March 2022
Dermatology expert explains the PSPP system when dealing with ear disease
Dermatology expert explains the PSPP system when dealing with ear disease
FDA approves generic drug for managing allergic dermatitis in cats
FDA approves generic drug for managing allergic dermatitis in cats
Expert shares pet care tips for springtime
Expert shares pet care tips for springtime

Advertisement

Latest News

Morris Animal Foundation appoints new chief program officer

CDC issues warning over cat-transmitted sporotrichosis

An AI solution is speeding up insurance claims processing

3 categories of inappetence in dogs

View More Latest News
Advertisement