Dermatology made easier: 10 common mistakes to avoid (Sponsored by Pfizer Animal Health)

Managing a pet's chronic dermatologic conditions can be frustrating to both clients and clinicians, but there are tips to making the process easier for everyone. Avoid the following 10 mistakes sometimes made in managing dermatology cases and you'll find the process considerably easier in the future.

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1. Thinking cure, rather than control: Most pet skin problems can not be cured, regardless of the medication selected, so set realistic expectations with clients early on. When discussing the management of conditions such as allergies, I tell clients that it is like managing diabetes or degenerative joint disease. We can often achieve long-term control with ongoing close monitoring and intervention, but it's unlikely that we'll be able to "fix" the underlying problem.

2. Not scheduling effectively: No one can solve a complicated dermatology case in a single visit, regardless of the appointment's duration. You can address the client's primary concerns, but be clear with the client that the pet's problems will not be solved with that single visit. The key to successful dermatology management is scheduling frequent follow-up examinations.

3. Ignoring the basics: Utilizing the basics, such as skin scrapings, cytologies, and fungal cultures, is good medicine and good business. And, if you do have something such as sarcoptic mange on your list of differential diagnoses, it is reasonable to do a parasite-control trial with selamectin—even if you don't find parasites on the scrapings.

A properly conducted dietary trial also yields a lot of useful information in the workup of a pruritic animal.

4. Expecting too much from one modality: Most dermatologists will tell you that many clients come to referral appointments with a plastic bag full of products that have been ineffective. Clients are often looking for the magic bullet, that special drug that the dermatologist has access to, but the primary-care veterinarian does not. The reality is that dermatologists rarely rely on one product to help their patients. In fact, the number of products that we dispense for clients to use all at one time is sometimes overwhelming, and can adversely affect compliance.

5. Not anticipating recurrence: Because most dermatologic presentations have underlying disorders, you should anticipate recurrence. Reaching for a stronger medication just temporarily masks the underlying problem, and clients are quick to recognize this. The answer is to start looking more intently for the primary causes. So, tell clients that you'll attempt symptomatic therapy at first with an appropriate product, but also tell them that if the problem recurs when the medication is discontinued, more investigation will be warranted before stronger medications are considered.

6. Underestimating secondary invaders: Most pets with dermatologic issues also have secondary infections (bacterial and/or yeast dermatitis) that need to be addressed. If those secondary infections are not properly managed, it may be difficult—or impossible—to assess the response to other treatments. For routine bacterial infections, consider a convenient product such as cefovecin to reliably control the infection while guaranteeing owner compliance (which is always critical in dermatology cases). Since you'll probably be dispensing a variety of products, your clients will appreciate that you took care of the infection with an injection, and they have one less thing to do at home.

7. Lacking realistic product and pricing models: Dermatology patients tend to be on medications long-term, so consider which products and pricing models work best for you and your clients to keep that revenue in your practice. It pays to stock products that are appropriately priced and have been researched, safety tested, and labeled for use in the species to which they are being administered.

8. Performing tests out of desperation: As the majority of dermatologic cases have underlying disorders, it makes sense to perform tests to try to identify them, so they may be addressed if possible. However, it is important to have a clear diagnostic plan and to proceed logically. For example, the results from biopsies are more likely to be useful if a thorough history, clinical description and differential diagnoses are provided to the pathologist (pictures are a nice touch as well).

9. Forgetting to mention referrals: The best referral happens as part of a well-conceived plan, not as an afterthought. It helps to prepare clients early on that the first course of treatment may not resolve the problem, and if so, that you may try other options or recommend the assistance of a specialist. Clients will appreciate your efforts to inform them now, rather than when they are frustrated, upset, and depleted of funds.

10. Considering clients a nuisance: you are in business to serve the needs of your clients. Due to the nature of dermatologic diseases, you will see most of your dermatologic patients and their owners many times during the year, for many years to come. These are exactly the clients that you should crave for your practice. The next time the pollen count rises and your telephone starts ringing frequently from clients with itchy pets, don't curse—give thanks! These are probably the most dedicated clients you will have in your practice.

References/notes

1.Sousa C. Glucocorticoids in veterinary dermatology. In: Bonagura, J, Twedt D, eds. Kirk’s current veterinary therapy (XIV). St. Louis, Mo: Saunders/Elsevier, 2009; 400-405.

2.The lower side of the mid-range of production (0.4 mg of the 0.2 to 1 mg/kg/day range) was used for this calculation.

3.The number (30) is used as a conservative approximation for the 36.5 mg/kg/year annual dose of endogenous steroid (cortisol) produced (0.4 mg/kg/day cortisol)x 365 days ÷ 4 (prednisone’s potency factor). It was selected based on a combination of several publications reporting the side effects of glucocorticoids as related to dose as well as based upon clinical experience.