Why topical therapies fail, according to a veterinary dermatologist
Rusty Muse, DVM, DACVD
Hitting a brick wall with your dermatology patients? If your recommendations for topical therapies are going nowhere, make sure youre not inadvertently doing anything on this list.
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No doubt, topical therapy is critical in providing the best care and management for most dermatology cases you see in veterinary practice. However, if not used appropriately, you're going to hit a brick wall. Things get frustrating for you and your clients, and ultimately remain miserable for your patients. No good. Here are five common reasons topical therapies fail-and advice on what to do about it.
1. Using incorrect products. There are multiple different topical products available to veterinarians but, of course, not all products work on all cases of skin disease. The key to a successful topical therapy regimen is appropriate product selection. Knowing when to choose specific products for maximum efficacy takes experience, logic and thought. Here's one winning approach.
2. Unclear or inexact directions. There's no substitute for clear and concise but very detailed discharge instructions when recommending topical therapy. Most veterinary clients will follow your instructions if they know what is expected of them. With skin disease, it's imperative that pet owners continue topical therapy until remission or control of the condition has been achieved. Then, a long-term management plan can be instituted during a follow-up visit.
3. Not using multimodal therapy. Most skin diseases-especially atopic dermatitis-require multimodal topical therapy. Shampoos, sprays, mousses, wipes and lotions may all be indicated for the same patient to treat different areas of the skin with different requirements. There may be bacterial overgrowth in one area, while other areas have Malassezia overgrowth and other areas require anti-pruritic therapy. A therapy that is effective in one area may be completely ineffective or even contraindicated in another. Here are great tips on multimodal therapy for atopy, specifically.
4. Failing to communicate the protocol for product use. The frequency and length of topical therapy recommendations often vary depending on the severity of the pet's condition or the current level of control. Initial therapy may need to involve product administration multiple times weekly (once daily to thrice weekly), while once the condition is under control, weekly therapy may be sufficient. Long-term use of topical therapy will be determined by individual circumstances, and no single recommendation will be effective for every patient. (Is that you sighing in defeat? Don't worry, you're not a magician.)
5. Not managing the primary condition. The most common reason for failure of topical therapy is not diagnosing or managing the primary disease responsible for the clinical signs present. In most cases of skin disease in the dog, topical therapy is an adjunct therapy, while additional therapy focused on the primary disease will be required for optimal management.
Successful treatment of dermatologic conditions in pets can definitely help your practice strengthen the human-animal bond. Before you hit a wall, remember that your clients will feel a special bond to you and your team when you successfully manage their pet's skin condition, together.
Dr. Rusty Muse is a veterinary dermatologist at the Animal Dermatology Clinic in Tustin, California.