As a general practitioner, you see itchy, infected pets all day long. But, when do you decide to make the referral to a dermatologist? Every veterinarian is going to have a different comfort level with managing chronic, allergic pets. Every client is going to have a different threshold for getting a specialist involved with their pet. However, there are some basic guidelines that can be used when referral can fit into your recommendations. These are discussed in more detail in episode 93 of The Derm Vet podcast.
- When recurrent infections start occurring
- One of the hardest things we deal with in veterinary dermatology is the rise of multi-drug-resistant bacteria. Whether we are seeing cases of Pseudomonas sp. otitis or methicillin-resistant Staphylococcus sp. pyoderma, cultures are showing more and more limitations for antibiotic options. Alternatives such as dilute bleach have to be used in really difficult cases, which can be a big-time commitment for the owner. A frustrated owner can benefit from hearing another veterinarian talk through their pet’s long-term management.
- Those not-so-typical lesions
- Not every itchy pet is allergic. Hints that you might be dealing with a non-allergic case include a depigmented nasal planum, ulcerated mucous membranes, and cutaneous nodules. These can be indications you may be dealing with an autoimmune or neoplastic skin process. Many of these diseases will initially improve with the use of corticosteroids. An appropriate diagnosis is necessary to assure appropriate therapies (such as azathioprine or mycophenolate) are started if needed.
- Proactive owners willing to pursue allergy testing and allergen-specific immunotherapy (ASIT)
- ASIT consists of administering gradually increasing quantities of an allergen extract to a patient to improve the signs associated with subsequent exposure to the allergen. ASIT can take several months or up to a year for full effect. Implementing ASIT at a young age can help prevent the progression of allergic signs.
- Challenging allergy or pyoderma cases where more than one anchor therapy required
- Some allergy and recurrent pyoderma cases can be difficult. If more than three infections are occurring a year or an allergic case is no longer controlled by anti-pruritics, referral can be a great suggestion. If a single antipruritic or anti-inflammatory therapy is not controlling allergic signs, then dermatology referral is a great way to allow a fresh view on the case. This may include pursuing ASIT, epidermal barrier therapies, nutritional support, etc. Also, a dermatologist can help ensure that there are not numerous allergies present or a non-allergic disease that may be complicating things.
Develop a relationship with your local dermatologist because many cases need to be co-managed. Also, you can discuss cases before referring them to maximize diagnostic results upon initial examination. If you don’t have a dermatologist in your area, there are telemedicine companies (VetNOW, Televet, etc.) available that provide consultation options regardless of your location.
1. DeBoer, D.J. (2017), The future of immunotherapy for canine atopic dermatitis: a review. Vet Dermatol, 28: 25-e6. https://doi.org/10.1111/vde.12416
This podcast was sponsored by Zoetis. Zoetis is dedicated to changing the way we approach canine pruritus to protect the bonds between the pet, the owner, and the veterinary team. Visit ScienceofStrongerBonds.com for more information.