Give the skinny on dermatology

Whether you realize it or not, every day pets walk into your practice with skin and ear problems, says Breigh Blakley, CDT, ASVDT, veterinary assistant at Allergy, Skin and Ear Clinic for Pets in Livonia, Mich. Even though they may not be visiting for dermatologic issues, at least 40 percent of the patients you see today suffer from a skin or ear allergy, Blakley says.

With an abundance of afflicted patients, it's important for every team member to recognize the tell-tale signs of allergy and infection and be able to talk to clients about dermatology. To scratch your itch for information, Blakley explains how to answer clients' three most common skin and ear questions.

1. My pet doesn't have fleas so why does he constantly scratch himself?

Clients may be surprised to learn that fleas themselves aren't always the culprit behind skin issues, Blakley says. Allergies may be to blame. When pets inhale, come in contact with, or ingest something they're sensitive to, they'll begin to itch or rub excessively. This process changes the skin's surface and can allow for an overgrowth of bacteria or yeast, Blakley says. An overgrowth of bacteria on pets' skin or in their ears is called pyoderma, whereas an overgrowth of yeast is called Malassezia dermatitis. (Are you able to match the symptoms to the skin disease? To test yourself on four dermatologic case studies, search for "Which Itch Is Which?)

Because an itchy pet may be suffering from a food or airborne allergy, be sure to ask clients about what they're feeding the pet, where it travels, and its home environment. Also inquire about when the symptoms occur. Are they seasonal or year-round? Do they only flare up when the pet goes outdoors? Also ask about or note the location of the pruritus—or itch.

Be sure to let clients know that all this information will help the veterinarian determine which diagnostic tests to recommend, as well as help him or her identify the underlying cause of infection. You can go on to explain to clients that flea allergies typically affect the back one-third of the pet's body, Blakley says, while scabies affect the ear flaps, elbows, hocks, or lower chest area.

2. Why does my pet need these tests?

How to decrease the scratching depends on what started it. Without identifying the underlying cause of the skin or ear issue, you're fighting a losing battle, Blakley says. The current problem may resolve but it will recur.

To confirm or rule out possible triggers, veterinarians will order tests. If the doctor suspects food allergies, the pet needs to undergo a dietary trial where all edible items are eliminated except for one novel protein and one novel carbohydrate. It may take eight weeks of feeding the special diet before clinical improvement is noted, Blakley says. The doctor may call for skin scrapes or serum tests to identify airborne allergens after discarding all other diseases as the source, Blakley says.

Regardless of what caused the skin problem, to treat it, you'll need to distinguish whether you're dealing with a concurrent bacterial or Malassezia infection, Blakley says. A skin cytologic exam is needed to determine if these organisms are present. Depending on the cytologic results, appropriate medicine can be prescribed.

"Never dispense medication without examining the pet for secondary infections," Blakley says. If clients balk at the tests, explain that they're necessary to determine the best treatment for their pets. Try saying something like, "I wouldn't want you to waste time and money treating your pet's yeast infection with an antibiotic when it needs an antifungal."

3. What's the cure?

Just like with humans, there's no cure for pets' allergies, Blakley says. While the underlying cause of a food allergy can be eliminated, the allergy would still remain. With all other allergies, the offenders can only be managed across a pet's lifetime. Antibiotics and antifungals help clear an infection, but they can't prevent recurrence. That's why it's necessary for pets with skin and ear issues to get regular rechecks. "You can't emphasize enough to clients the importance of rechecks," Blakley says. "First, rechecks allow you to make sure the infection is gone. Otherwise it will continue to get worse. Also, follow-up visits let you monitor for recurrence and discuss the game plan for managing the pet's allergies."

Clients often ask why they can't monitor their pets at home, Blakley says. While clients should always be on the lookout for telling signs such as pain, redness, odor, head shaking, and itching, they don't have the proper tools or education to manage skin and ear disease on their own. For example, Blakley says many clients wrongly assume that their pets have fully recovered from an ear infection when the ear odor begins to fade. But the fact is, it's impossible to tell whether the infection is completely clear without looking through an otoscope and running some tests, Blakley says.

Cost becomes another concern for clients as recheck visits and medicines begin to mount up. Explain to clients that managing these causes when they're mild, rather than waiting until they become complicated, will decrease the overall cost. If they allow you to monitor and manage the skin or ear problem it won't get out of control or become painful, she says.

Because there are so many potential causes for skin and ear allergies, and because they usually require life-long management, clients may need to hear the points outlined above a few times during treatment and maintenance. Be patient, and work to answer all their questions—again and again.