Adopting the mindset of a dermatologist

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Dermatology cases are most likely going to find their way to the veterinary general practitioner. Clients can bring their pets in with a wide range of conditions or secondary causes that have been rooted from some for of dermatology conditions. When they present themselves to the clinic, can you think like a dermatologist to help diagnose?

During her lecture Think like a Dermatologist, at Fetch Long Beach in Long Beach, California, Ashley Bourgeois, DVM, DACVD, shared how general practitioners can channel the mind of a dermatologist in their practices to help diagnose and manage skin diseases in canine and feline patients. Through the lecture, she highlighted, among other things, the importance of history, physical examinations, and diagnostic tools as means to help make these dermatological cases that come into your clinic easier for all.

History

According to Bourgeois, history is crucial in dermatology. For pets that are coming in itching, history will be able to begin the process of diagnosing them. Have they been itching for a month, 6 months, or even a year? Maybe even it has been happening for a young age continuously, leading to believe that maybe it is their food and a diet trial is needed or an allergy test could be the better way to go. The understanding of the history will also be able to help veterinary teams understand next steps they can take to begin working toward a diagnosis.

“So when we think about these concepts, we want to think about what would a dermatologist think? Critical thinking. When I am seeing a case as the owner is telling me the history, I kid you not in my mind, maybe it's the mom in me, but I'm like multitasking, and I'm sitting there and I'm flip flopping all the things I need to think I need to do. So they're telling me a story, and all of a sudden they're like, Well, it started when they're really young. I'm like, oh, diet trial,” Bourgeois explained to attendees.

“Maybe think about diet trial. So I'm literally listening to history, doing my exam assessment, and all of that is assessing what diagnostics need to happen. You know? What do I really need to do for that patient? I love to do lots of things in my patients.

She also wanted that when you are first starting out with dermatology, especially if you are not as confident, to do tests that are negative. She explained to attendees that 13 years later, she is not doing as many skin scrapes or DTMs as she used to because there is a reasonable chance that the client has the condition, she is testing them for. Despite that, she is still okay with a negative. This can also help the clients save money on costs. If the history is indicating a diet trial is the way to go for the canine patient presenting with a dermatological condition, and it is effective, that could save the client money on running tests and performing biopsies.

There are other things that veterinary teams should be asking when it comes to history. If this is a client who has had a patient in need of dermatology services before, were there treatments or medications that worked or did not? By being able to eliminate will continue to help teams save clients money, time, and get to a diagnosis quicker. One other part of the history she mentioned was if the pets or owners have travelled lately.

“I got the privilege of going to teach in Thailand last month. It was phenomenal, an amazing experience. But we were talking they see sporotrichosis. Weekly. Sporotrichosis, is a horrific fungal infection I have never diagnosed for process, right? So, like, it's not on my radar unless I know that the cat was maybe visiting Thailand, and they came over. So travel history is important,” she explained.

The examination

When it comes to patients, Bourgeois wants veterinary professionals to consider 2 things, where and what is the lesion. She also wants veterinary professionals to know to look beyond where the client is telling you the lesions are because you could miss others that they might have missed or did not look at the full picture of the pet. If you are only focusing on the ones, this can also be misleading diagnostic clues. She explained to attendees these commonly overlooked areas.

“So commonly overlooked anatomical areas we see in the derm space, inter digital space. So actually separating the toes and looking at those interdigital webbings, the claw folds, doing cytology of those skin folds, so your brachiocephalics, peri-vuller folds, we need to check those, the pinna and then the perianal region,” she informed attendees.

“I mentioned this earlier today with the perianal region, if they are scooting, it doesn't have to just be anal sacs. If you check those anal sacs and they are normal, you need to be looking for other causes of infection around that area, or checking the vulva folds of female dogs, because that can cause a lot of scooting as well,” she continued.

She also explained to attendees that she understands a deep and thorough exam can take up time some professionals do not have. She recommended that as you are speaking to the client, continue to do the exam. This way you can be listening to what the client is saying about their pet as you are feeling it in real time and you can save the time.

Conclusion

Following the tips and asking the questions Bourgeois has laid out can help teams ensure they are putting their dermatologist coat on and getting to the bottom of the itchy cats and dogs in the clinic. By getting a good and extensive history on top of a through physical exam, time and money can be saved, but a pet can get the treatment they need faster.

Reference

Bourgeois A. Think Like a Dermatologist. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.