Updates in veterinary dermatology, from WVC to Fetch Kansas City 2024

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It’s not easy to stay at the forefront of research in veterinary dermatology. That’s why, at Fetch Kansas City 2024, an all-star team of dermatologists assembled to discuss what they learned after attending WVC this year. The panel included: Joya Griffin DVM, DACVD, Ashley S. Bourgeois DVM, DACVD, Jason B Pieper DVM, MS, DACVD, and Cristiano von Simson DVM, MBA. They shared their thoughts on what they learned, antibiotic resistance, and how topical therapies can be effective treatment strategies while promoting good antimicrobial stewardship.

Antimicrobial resistance is a growing concern

One of the key topics the panel discussed was the ongoing issue of antimicrobial resistance and antimicrobial stewardship, especially in dermatology. Panelists emphasized the importance of adhering to updated guidelines for antibiotic use. "We all know we have [antibiotic] resistance—it's everywhere," said Pieper. "The big thing is choosing the right antimicrobial agents based on updated guidelines and understanding when to escalate to culture-based treatment." He added that it is vital to choose the right antibiotics empirically and emphasized the necessity of performing cultures when initial treatments fail. The shift towards using topical treatments before systemic antibiotics was also noted as a significant change in practice, reflecting a global trend towards better antibiotic stewardship.

A shift toward topical therapies as a first-line defense

The panel also discussed the important role topical therapies can play in managing skin conditions, particularly in the face of increasing antibiotic resistance. They talked about rethinking the traditional approach of relying heavily on systemic antibiotics, especially for superficial skin infections, and are instead advocating for the use of topicals as a first-line treatment. This shift is driven by concerns not only by antibiotic resistance, but also the desire to minimize side effects of using systemic antibiotics. For instance, the use of chlorhexidine-based shampoos and other topical agents has shown significant promise in managing infections, sometimes even resolving conditions without the need for oral medications, the group said.

Bourgeois told the audience about a case that involved a dog with a resistant staph infection. Despite delays in antibiotic treatment due to logistical issues, the infection improved dramatically with the use of a 3% chlorhexidine shampoo alone. The team was planning on putting the dog on antibiotics, but there was a 2-week delay in the medications arriving by mail. In the meantime, the pet parent used a 3% chlorhexidine shampoo while waiting for the antibiotics. “By the time the antibiotics arrived at the door, the dog was better,” she said.

Long-term maintenance

The discussion also touched on the role of topicals in long-term maintenance, particularly for allergic dogs prone to recurrent infections. Regular use of topical treatments can help manage these conditions, potentially reducing the frequency and severity of flare-ups. I always have my patients on a bathing routine, even when [clients] don't want to do it,” said Griffin. You can switch to the maintenance shampoos that we're talking about that don't contain chlorhexidine. The importance of that, whether it's weekly or bi-weekly, is that we restore allergens from the skin, restore skin barrier functions, and keep [clients] vigilant and looking at the skin.”