Q&A: Working with a dermatologist to improve patient outcomes

Christina Gentry, DVM, DACVD, a clinical assistant professor at Texas A&M University College of Veterinary Medicine and Biological Sciences in College Station, presented a series of dermatology-focused lectures at the 2026 Veterinary Meeting & Expo (VMX) in Orlando, Florida, hosted by the North American Veterinary Community. In a dvm360 interview, Gentry discusses topics she covered at VMX, including concurrent endocrine disease, dermatologic emergencies, and what all veterinarians should know about dermatologists.

The following is a partial transcript of the interview recorded at VMX:

dvm360: What could [lecture] attendees learn about concurrent endocrine and dermatological disease?

Christina Gentry, DVM, DACVD: We [talked] about patients that have endocrine disease but also skin manifestations of that. Our main focus [was] hypothyroidism and hypercortisolism, also known as Cushing [disease], because those patients may present to either the internist for systemic signs, PU/PD [polyuria and polydipsia], lethargy, weight gain, potbelly appearance—depending on which endocrine disease it is—vs those same animals [that] could actually present to a dermatologist for the skin changes.

For hypothyroidism, for example, we get patients [with] noninflamed wear-and-tear alopecia—just the hair is not growing back. Then, with further questioning—yes, he is lethargic. Yes, they've maybe gained weight. Then, for hypercortisolism, we often see patients present [who may not be] as obvious with their PU/PD, so they don't go to internal medicine. First, they come to us for truncal hair loss, maybe thinner belly skin scaling, and secondary bacterial infections. And they often think that the dog is suffering from allergies because there is recurrent infection, and the infection is itchy. But when the infection goes away, they're not itchy, which is more consistent with endocrine disease. So we're going to talk about…who you go to first [and] how we work them up. We're also going to talk a little bit about—I think [this is] the most important thing for this talk, because I think it's the most complicated—what [to] do if you have a dog [with] secondary infection or secondary mycosis but you need to test them for endocrine diseases. What test can you still run in light of having these other inflammatory diseases, and how do you circumvent some of those issues?

dvm360: What is a key consideration about concurrent endocrine and dermatological disease?

Gentry: From my dermatology standpoint: Don't take endocrine disease off your differential list as a cause of occurred pyoderma. We know that, generally, dog [specialty and critical care, general practitioners], and [dermatologists] practice for bacterial skin infections. It's almost like it's almost always going to be allergic skin disease, but there are some that are going to come with endocrine disease. And just keep that in mind when you have dogs that just come in for recurrent bacterial infections…asking historical questions about systemic signs and see whether or not they really do have itch before the skin signs occur.

dvm360: What types of cases should be considered dermatologic emergencies?

Gentry: Dermatologic emergencies, overall—it almost sounds like a joke because dermatologists in general are the nonemergency people, but there are a few typically immune mediated diseases that can present as emergencies. The most severe ones are actually going to be drug reactions. So when animals take medications, they can have all sorts of reactions. They may feel lethargic; they may have vomiting or diarrhea and things like that. With medication discontinuation, everything is fine again, but the reactions that we're talking about specifically are things like toxic epidermal necrolysis and its sister disease, Stevens-Johnson Syndrome, where when they take a medication, their body somehow gets a signal that instead of processing the drug correctly, they should mount an immunologic response in the skin. The body sends out signals that all the keratinocytes in your skin—so all your tops of the skin—should die all at once. When that happens, that can lead to widespread necrosis, not only the haired skin but the nonhaired skin, like [the] oral cavity, paw pads, and the pinna. Those can be very serious and life-threatening, because losing large sections of your epidermis can really throw off your homeostasis.

dvm360: When is an allergic reaction to a drug or any other dermatology therapy considered to be an emergency?

Gentry: For us, when we think about reactions, hypersensitivity reactions to insect stings can be emergencies because there may be facial swelling [or] paw swelling. And facial swelling could lead to difficulty breathing. You can also have anaphylactic reactions. All of that goes outside the realm of dermatology, but the reactions that we are most interested in as dermatologist—what we're called in for—is specific allergic reactions that manifest as immune-mediated skin diseases. [These include] toxic epidermal necrolysis, Stevens-Johnson syndrome, and occasionally other presentations of immune membrane diseases such as pemphigus or crossover conditions of all the dermatology diseases, where the histopathology is kind of varied or confusing. It's most likely to be a drug reaction, because it's like your body doesn't really know how it wanted to get upset. So instead of just having one very concrete pattern that says it's definitively this, you may actually see crossover reactions of multiple immune diseases, and it'll clue you into that, because the dog was totally fine until recently, within usually a week or so, [and] a new medication was added.

dvm360: What should other veterinary professionals know about dermatologists?

Gentry: Dermatologists, in general, are here to help you. We are a specialty that loves to talk about our specialty and loves to educate. [Dermatology] is ever-changing. We have new drugs coming out every few years. We change our minds about how long we should treat bacterial pyoderma based on new information. It is a lot of information to keep up with, but we're here to help. We want to be referral partners for our [general practitioners] and our community.

There are several really awesome dermatologists [who] have platforms online where they do podcasts, webinars, and CE [continuing education] series. So if you want to learn more about dermatology, I really encourage you to check out some of the online offerings that other dermatologists have and go to as much [dermatology] CE as you can.

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