Veterinarians certainly see a number of dermatological cases in their practices. After all, such issues as ear infections and skin allergies are among the most common reasons people bring their dogs and cats to the office.
“”It’s hard to get real estimates but up to 40 percent of visits for dogs and cats are for skin-related issues,”” notes Dr. Lowell Ackerman, a board-certified dermatologist, author and veterinary practice consultant. “”Of all the organs, the skin is the most visible and susceptible to problems.””
Many veterinary practices, though, may be missing the mark when it comes to skin- and allergy-related issues. “”It’s like anything else,”” Dr. Ackerman says. “”Some practices do an extremely thorough job, and some prefer to deal with the immediate concerns of the client. It’s not unusual, however, for skin conditions to be long-term and require long-term solutions. That’s especially true with allergies because pets typically don’t outgrow their allergies. That may be a common misconception among pet owners who think pets are like children who do often outgrow their allergies. To treat allergies successfully over the long term, you need to see the pet regularly, monitor their progress and clinical signs, and tweak their therapeutic treatment as needed.””
Dermatological cases represent a large component of cases for Country Club Animal Hospital in Miami, FL, says Dr. James Bogdansky. “”We have a systematic approach to evaluate and design a therapeutic program to treat the primary and secondary conditions,”” he says.
Part of the comprehensive program is to get a complete history of the pet, including any environmental concerns and issues, Dr. Bogdansky says. That’s not always easy, either. As an example, he says a family recently visited with their dog and the father, mother and son each gave differing opinions on their dog’s symptoms and situation.
The key in Country Club Animal Hospital’s approach is communication and compliance, Dr. Bogdansky says. The communication is crucial to tailor the appropriate treatment. It’s also a big step in ensuring compliance with the prescribed treatment.
Fortunately, there have been advances in dermatology, notes Dr. Bogdansky, who has been a practicing veterinarian for 18 years. Country Club Animal Hospital uses topical lines such as Virbac shampoos to address many issues, as well as Epi-Otic® Advanced Ear Cleanser and ResiKetoChlor® Leave-On Lotion.
Country Club Animal Hospital uses Virbac’s shampoos exclusively at all three of its facilities, Dr. Bogdansky says. “”The shampoo line is amazing. Their technology is superior for animals with or without significant skin lesions. They have a whole line of products made for specific conditions. These topical treatments give us the right therapy to address the specific need of the pet.””
Dr. Bogdansky says Virbac’s glycotechnology has come a long way in addressing dermatological problems. The anti-adhesive glycotechnology utilizes a unique combination of monosaccharides and an alkylpolyglucoside that reduces bacterial and yeast adhesion to the stratum corneum. This action physically disrupts microorganism colonization on the skin surface and may delay onset of irritation due to topical bacteria or yeast.
Such anti-adhesive properties go a long way in fighting infections. “”We’ve seen much less chronic infections,”” Dr. Bogdansky notes. In particular, he points to ear infections, major issues for both dogs and cats. Virbac’s Epi-Otic® Advanced Ear Cleanser prevents microbial attachment. “”That really helps prevent the adherence of yeast to the lining of the ear canal.””
The encapsulated delivery system used in the shampoos also provides a slow release after application. “”This allows us to treat the problem with remedies that need to be applied less frequently,”” Dr. Bogdansky says.
Success with such topical treatments and less frequent applications goes a long way in ensuring compliance by pet owners, he adds. “”We have new tools to make therapy much more successful. When clients see results, it makes it much easier for them to comply with therapeutic treatment plans.””
Dr. Bogdansky and his partners at Country Club Animal Hospital also are adamant about tailoring dermatology and allergy treatments to each pet. They then spend time with every client so they have realistic expectations, understand the importance of compliance and follow-up with visits to ensure the treatment plan is on track.
Experts note that Country Club Animal Hospital’s approach is right on target about providing individualized care.
“”The old paradigm in veterinary practices was that all dogs and cats were pretty much alike, and had similar medical concerns and needs,”” Dr. Ackerman notes. “”The reality is that each pet has unique needs, based on species, age, breed, genetics, lifestyle and environment. It may not be practical, at present, to completely customize a medical program for each pet, but there’s a lot we can do to assess pets on the basis of risk factors, clinical presentation and owner awareness to make a real difference in the lives of pets and their owners.””
Dr. Douglas DeBoer, a professor at the University of Wisconsin-Madison’s School of Veterinary Medicine, researcher and specialist in dermatology, concurs. “”Over the last five years or so, our thoughts have changed on these issues,”” Dr. DeBoer says.
“”In general, in the past we taught that here is the disease and here are the treatment options ” pick one. Now, especially in the case of allergies, it’s extremely complex. There is no one size fits all. We’ve gone away from single modalities toward customized combinations,”” Dr. DeBoer says. “”You must individualize the treatment program by exploring the five, 10 or 15 options available, and find the best combination for that pet and owner.
“”There’s no magic pill,”” Dr. DeBoer notes. “”There’s no cookbook. Some tests will aid you in making decisions but we still depend highly on clinical acumen and experience in diagnosing the problem and then finding the appropriate treatment.””
Counseling pet owners shapes the heart of a sound dermatology program, Dr. Ackerman says. “”Most effective practices start counseling owners from the time their pets are puppies and kittens,”” he says. “”You really need to address risk factors in specific pets and inform pet owners about what to expect, and for the early warning signs they might observe that would warrant attention. That requires an understanding of the long-term implications of certain problems and conditions, and the need to address issues at an early stage for optimal resolution.””
Many practices that gather such information can then use this to better care for their patients, as well as improving their business, Dr. Ackerman says. “”Addressing problems early and keeping them manageable long term improves the quality of life for pets, the acceptance and compliance of owners, and has additional positive effects on the bottom line of practices, so everyone wins. This is the way of the future.””
Counseling also is critical in ensuring long-term compliance and treatment success, Dr. DeBoer says. “”There’s an expression that ‘dermatology cases never get better, but never die.’ They are controllable but not curable. Pet owners typically have no problem complying for the first two or three weeks, but clients must realize that a critical part of long-term success is dependent on their persistence in administering treatment.””
Dr. DeBoer also preaches education as a way for veterinary practices to improve their dermatology programs. Many veterinarians who graduated longer than just a few years ago may not have received a thorough understanding of today’s issues and treatment options. “”You can make a big difference if you are better trained. Many veterinarians will go to a continuing education course and spend a half day in dermatology lectures. They have scratched the surface but it’s not the quantum leap that is necessary in order to truly improve their understanding and abilities.””
Instead, Dr. DeBoer strongly recommends an intensive five-day immersion course with lectures, labs and case studies. “”Those that take an intensive course come out of sessions and realize how much more they understand. It also boosts confidence.”” It certainly represents an investment, but one that pays in good medicine and better business.
