{"id":1344,"date":"2013-03-01T17:05:58","date_gmt":"2013-03-01T17:05:58","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1344"},"modified":"2022-02-17T19:16:02","modified_gmt":"2022-02-17T19:16:02","slug":"how-to-avoid-the-five-most-common-mistakes-in-veterinary-dermatology","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dermatology\/how-to-avoid-the-five-most-common-mistakes-in-veterinary-dermatology\/","title":{"rendered":"How to Avoid the Five Most Common Mistakes in Veterinary Dermatology"},"content":{"rendered":"

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Lori A. Thompson, DVM, Diplomate ACVD<\/em><\/span><\/p>\n

Discover the five pitfalls most commonly encountered by practitioners when diagnosing and treating dermatologic conditions in dogs and cats, while learning how to fine tune your approach to history taking, biopsies, skin scrapings, and antibiotic selection.<\/p>\n

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Practicing medicine is called “practicing” for a reason. Typically, there is no ONE correct route of reaching the appropriate diagnosis. Many of us find the answers by traveling along our own path, sometimes multiple paths, with a few detours along the way.<\/span><\/p>\n

Veterinary dermatology focuses on the management of chronic diseases and, therefore, is subject to errors because of judgment calls and assumptions. This article focuses on common diagnostic pitfalls seen in veterinary dermatology, with an emphasis on spotting opportunities for improvement.<\/span><\/p>\n

PITFALL 1: FAILURE TO OBTAIN A COMPLETE HISTORY<\/b><\/span><\/h2>\n

In veterinary medicine, the history often plays an essential role in helping us formulate a list of differential diagnoses. Obtaining a thorough history is CRITICAL and one of the most important parts of the dermatologic examination.<\/span><\/p>\n

Two ways to ensure that a comprehensive history is obtained are:<\/span><\/p>\n

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  1. Have clients fill out dermatologic history forms. <\/span><\/li>\n
  2. Train your technicians to help obtain information.<\/span><\/li>\n<\/ol>\n

    By having clients fill out history forms and training technicians to ask questions about potential dermatologic issues, the practitioner can narrow the diagnosis. For example, if the owner told the technician that the pet is itching, ask the following questions (these questions can be applied to many dermatologic conditions):<\/span><\/p>\n

    <\/b>When did the itching start?<\/b><\/span><\/h3>\n

    If pruritus started at less than 6 months of age, ectoparasites or other infectious causes, along with cutaneous adverse food reaction, jump to the top of the list (as opposed to atopy). <\/span><\/p>\n

    <\/b>Are any other animals in the house affected? Has a new pet been brought into the home?<\/b><\/span><\/h3>\n

    If the answer is yes, then again, ectoparasites rise to the top of the differential list. Consider the atopic dog that was managed well with allergen-specific immunotherapy, but develops intense pruritus and alopecia on the dorsal rump a few weeks after a new kitten joins the home\u2014there’s a good chance that flea allergies are playing a part in the dog’s signs. <\/span><\/p>\n

    Sometimes the addition of a new pet means adding another food source, such as puppy or kitten food that includes a protein or carbohydrate source that may affect a food-allergic pet. A pet in the house with food allergies that manages to “snack” on the new puppy or kitten’s food (or manages to get into the kitten’s litter box) may experience a surge in pruritus.<\/span><\/p>\n

    Keep in mind that dogs and cats have individual thresholds for pruritus and their responses to various triggers may vary in intensity. <\/span><\/p>\n

    <\/b>Are people in the house affected?<\/b><\/span><\/h3>\n

    Beware of the owner that “just has a rash from working outside.” This owner’s pet most likely needs treatment for parasites prior to further allergy workup.<\/p>\n

    <\/b>Are the clinical signs seasonal or nonseasonal?<\/b><\/span><\/h3>\n

    In many regions of the country, there are variations in seasonal pollen levels. A dog that is pruritic each year from June through August is much more likely to be atopic versus having a cutaneous adverse food reaction (which would be present year round).<\/span><\/p>\n

    <\/b>Have the clinical signs changed or have they remained the same?<\/b><\/span><\/h3>\n

    Consider the geriatric patient that has always been treated in the spring and summer for allergies; however, this year, the pet is presented for recurrent infections with minimal pruritus. Focus on changes in behavior, drinking, appetite, urination, and appearance of skin and hair coat. Occasionally, geriatric dogs with chronic atopy become less pruritic after developing an endocrinopathy, such as hyperadrenocorticism, due to increased levels of endogenous cortisol.<\/span><\/p>\n

    <\/b>Has the patient been treated in the past? If so, when, with which medications, and what was the response?<\/b><\/span><\/h3>\n

    Patients that have been treated with several different antibiotics yet still exhibit generalized pyoderma may be infected with drug-resistant bacteria. These pets require culture and sensitivity in order to determine the bacteria present and their antimicrobial sensitivity, allowing the clinician to select the appropriate antibiotic.<\/span><\/p>\n

    <\/b>Additional questions include:<\/b><\/span><\/h3>\n