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Veterinary Dermatology 10 TOP TIPS you NEED to Know — Transcript

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0:02[Music]
0:05hello
0:06i'm anthony chadwick from the webinar
0:08vet
0:09do you want to become a master of emory
0:11dermatology well
0:13watch this video and by the end you'll
0:15have my top 10 tips
0:17about how to provide really fabulous
0:19care for the
0:21clients and the patients under your care
0:25for the very best veterinary tips
0:28subscribe to the channel please
0:30by pushing on the subscribe button
0:33and then click the bell to make sure
0:35that you receive notifications
0:37as we create more of these short videos
0:39for your enjoyment
0:42so my first tip is taking a good history
0:46this is so important it's fundamental
0:49it's the groundwork
0:50that gives you the best chance to be
0:53successful with the case
0:55but it's amazing how many people quickly
0:58run over it and don't pay any attention
0:59the dog comes or the cat comes into the
1:01room
1:02and immediately you want to touch the
1:04animal and find out what the problem is
1:07now many times in my career by taking a
1:10really good history
1:12i almost knew what the diagnosis was
1:14before i even looked
1:16at the dog or the cat i'll give you an
1:19example
1:21two young gps came in with a dog that
1:24very itchy had been seen by their own
1:27vets
1:28they couldn't come up with a diagnosis
1:30but by taking a careful history i found
1:32out that the gps were itching themselves
1:36by seeing where the dog was mainly
1:37itching i immediately made a diagnosis
1:40of scabies
1:41and was able to sort the dog's problem
1:43out very very quickly
1:47so histories are really important and i
1:49would encourage you to spend time
1:52finding out what the animal's diet is
1:55obviously its signalment its age
1:59looking at if there are other people in
2:01the house that are affected
2:04does the dog have diarrhoea as well this
2:07might be indicative of a food allergy
2:09with
2:09other skin signs all of these things are
2:13important
2:13spend time spend five to ten minutes
2:16taking a good history
2:18and it can save you a lot of time in the
2:20future
2:22my second tip concerns cats particularly
2:25allergic cats
2:27and it is amazing to me how often i i've
2:30seen a cat
2:31that obviously has an allergy of some
2:34description but when i
2:35ask about the flea treatment that's
2:38being given
2:38it's really not adequate and this can be
2:42sometimes because the vet has said i
2:45can't see any fleas
2:46therefore it can't be a flea allergy
2:50of course we know that cats that are fly
2:52allergic
2:53are very very effective at removing
2:56fleas from them
2:58by licking and swallowing them and in
3:00fact sometimes
3:01the best place to find a flea in a
3:05in an allergic cat is in the feces
3:09so i would encourage you always when you
3:12see
3:13a cat that is allergic even if you can
3:16see no fleas
3:17to consider that fleas are involved
3:19until
3:20proven otherwise and treat appropriately
3:26my third tip is around fleet treatment
3:32obviously over the last 25-30 years
3:34there's been an explosion
3:37in the number of products that we can
3:38use to treat fleas
3:40when i first qualified we had new van
3:43top the orange tin
3:45that hissed when you squirted it on the
3:47cat and the cat actually recognized
3:49the new van top and would be very
3:51difficult to catch
3:53it also killed pretty quickly but didn't
3:56last for very long
3:58so if two or three days later fleas came
4:01onto the cat again
4:02they wouldn't be killed by the spray now
4:06we have many products that act
4:08quickly but also last for a prolonged
4:10period
4:12and so i'd encourage you to go for one
4:14of the better
4:15veterinary recommended flea treatments
4:18obviously now there is the option to
4:20treat
4:21with spot on collars
4:25also with tablets and there are
4:28many many options out there but look at
4:31speed of kill
4:32and how long the product will last for
4:35and make sure that you follow the
4:36instructions
4:38of the manufacturers
4:43of course one of the major problems that
4:45we face
4:46and this is what i'm going to talk about
4:47with the fourth tip is
4:49antibiotic resistance i was reading a
4:52recent
4:53article about penguins in melbourne and
4:56one of the biologists has actually
4:58tested for antimicrobial resistance
5:01within the penguins who've never had
5:02antibiotics
5:04and she could find that there was
5:06antibiotic resistance
5:08to some of the bacteria that she found
5:10with them
5:11so this is a real global problem and i
5:13think we as vets need to take our
5:15responsibility seriously
5:18in large animal but also in small animal
5:20medicine
5:22and my key tip with antibiotics is that
5:25we use them appropriately
5:27very often i see people treating with
5:30a lower dose than is required for the
5:32weight of the animal
5:34and not for long enough so a dog comes
5:37in
5:38it's treated for seven days
5:41the skin looks better the vet or the
5:43client
5:44doesn't come back and the animal doesn't
5:48get the required three to four weeks
5:50that i think that you need to treat with
5:52to actually get rid of an infection
5:56obviously with mild infections we can
5:58try shampoos
5:59but otherwise we should not be afraid of
6:02treating
6:03adequately for a long enough period
6:06with the proper dose
6:12my fifth tip concerns using antibiotics
6:15and steroids concurrently
6:18i really don't recommend this when i
6:22was a young vet i experimented with this
6:25in a practice where
6:26i would just use antibiotics for three
6:28weeks whereas my colleagues often were
6:30using them for 10 days
6:32along with steroids of course after 10
6:35days the skin looked a lot better
6:37the steroids had reduced the
6:38inflammation and the antibiotics have
6:40probably killed a few bacteria
6:43but of course steroids
6:46will actually hide the real extent of
6:49the disease by removing that
6:51inflammation
6:52and will also make it very difficult for
6:54you to make a diagnosis
6:55during the diagnostic phase so i
6:59very very rarely if ever we'll use
7:01steroids and antibiotics together
7:04and yet i see this happening a lot in
7:06practice so i would encourage you
7:09to only use steroids after making a
7:12diagnosis
7:12or any of the anti-paritic
7:16drugs that are out there
7:19and then ideally not with steroids
7:22because i believe that that will make
7:25will often help to reduce immunity and
7:27and make it more difficult to control
7:30the pioderma in the first place so treat
7:33the pioderma
7:34see what you're left with treat
7:37concurrent
7:38potential allergies with food trialling
7:40and flea treatment
7:42and then quite often after three weeks
7:44you will find as i did that the dogs or
7:47that were only on antibiotics
7:50often did a lot better than those that
7:52were on antibiotics and steroids so
7:55think very carefully about using those
7:58two drugs together
7:59it is not good practice
8:04my sixth tip is about demodex
8:08we've made such strides over the last
8:10years
8:11in treating demodex again
8:14when qualifying it was a really really
8:16difficult disease to treat and in fact
8:18sometimes we had to
8:20put dogs to sleep that had demodex
8:23because they were so bad
8:25and that treatment has definitely
8:27developed over the years
8:30very much the revolution has happened
8:32with the um
8:34discovery and and the development of the
8:37isoxazoline
8:38so all of those drugs seem to have an
8:41activity
8:42against emoticosis and can be delivered
8:46you know on a monthly or or a quarterly
8:49basis
8:50and will give fantastic results i think
8:52you have to remember with demodex that
8:54there are two forms of demodex there's
8:56juvenile onset dermadecosis
8:59and there's adult-onset dermaticosis
9:03we think that juvenile onset
9:04dermatitosis is something to do with
9:06with a an immature immune system and
9:09sometimes if we can
9:10kick that immune system into place or as
9:13if the dog gets older it develops it it
9:15can sort
9:16the problem out itself whereas the adult
9:19onset dermaticosis usually means there's
9:21an underlying problem
9:23uh treatment with steroids for example
9:26could cause dermadicosis or perhaps
9:28a dog that is developing cushing's
9:30disease or hyperthyroidism so
9:33an older dog with dermadecosis needs to
9:36be
9:37really worked up to see what the
9:40underlying problem is
9:41but with a young dog then we we consider
9:45the dermatocosis to be the main problem
9:47and if we treat the
9:49and treat it adequately for long enough
9:52usually with the ice oxazolines now we
9:55will get
9:56really high treatment success
9:59prior to that of course we were using
10:01drugs like milbamycin
10:03ivamectin which were unlicensed and
10:07potentially
10:08could have side effects i think we all
10:11know about the potential for
10:13ivamectin to cause death in sheepdogs or
10:16in sheepdog crosses so it's a
10:18it's a drug that thankfully we can avoid
10:21now due to the great success of the ice
10:23oxazolines
10:25in the treatment of dermidicosis so
10:27please
10:28do use those as a first line
10:32but of course i've also seen studies
10:35where people are using
10:36isoxazolines with great results but then
10:40using the dam and messiah from that
10:43litter
10:44to continue breathing because they can
10:46sort the problem out
10:48with an ice oxazoline dose we know that
10:50this will lead to
10:52greater problems down the line so please
10:55also remember that when a dermadicosis
10:58litter is produced
11:00the diamond messiah should not be bred
11:02again
11:04my seventh tip is all about rabbits
11:07i think the key message with rabbits is
11:09please please don't use fipronil spray
11:11on them
11:12it can be a really serious issue
11:15uh rabbits have died because of being
11:18sprayed with fipronil
11:19very effective at obviously getting rid
11:21of their
11:23their fleas or their their mites or
11:25their lice
11:26but unfortunately can
11:30lead to really tragic consequences so
11:32don't use it there are
11:34other products out there like
11:35imidacloprid that you can use
11:38for fleas and obviously the other key
11:40point is always be checking your
11:42rabbit regularly particularly in the
11:44summer because we know
11:46how traumatic it can be for everybody
11:49including the rabbit when there is
11:51flight strike
11:52so carefully looking at a rabbit on a
11:55daily basis turning it over
11:57to to look for any wet patches
12:00but particularly with flea and
12:03ectoparasite treatment
12:05please don't use fipronil spray
12:12my eighth tip concerns testing for
12:15allergy we know that out there there are
12:17skin tests
12:19intradermal skin tests and blood tests
12:22which is the better one i think the
12:24first question we have to ask is why are
12:26we using the test
12:27i've seen very often that vets can use
12:30the test
12:31as a diagnostic tool to make a diagnosis
12:34of atp
12:36and actually atp is a disease entity
12:38that's diagnosed by
12:40ruling out the other issues
12:43so i think it's really important that we
12:45understand whether we use a skin test or
12:47a blood test that we're doing it
12:50to decide on what the dog
12:53or cat is specifically allergic to
12:56with a view to creating a vaccine
12:59there can be other reasons why i might
13:01skin test for example
13:03if it's a summer allergy and i know that
13:06by finding out
13:07which particular pollens the dog or cat
13:10is allergic to
13:11i can help the owner avoid those pollens
13:14so
13:15i always take the dog for a walk through
13:17this oak forest
13:18if the dog is allergic to oak let's
13:22change the walk pattern but it once
13:25we've
13:26made the diagnosis of atp and we're
13:28thinking about using
13:30intradermal vaccines to create
13:35a desensitized animal then i think there
13:38are
13:39measures and values in skin testing
13:42or in blood testing when i had my own
13:44practice i used
13:46r2 skip skin tests and i used hesca
13:50blood test that's because i thought they
13:52were the best on the market
13:55i think it's really important that
14:00you use the one that you you're best
14:02able to skin testing is very
14:04difficult to do if you're not doing a
14:06large number of them
14:07so i think it is a test that you
14:09probably leave to your dermatologist
14:12whereas a blood test using a good
14:14quality blood test that will
14:16measure properly and not create a lot of
14:19false positives
14:20is obviously open to many more vets
14:23in my own practice i often used both
14:26tests so that i had
14:27the most information i could get to then
14:32by looking at the history deciding
14:35which were most likely to be the most
14:37significant allergy so there's quite a
14:39lot of
14:39art and science in that creation of a
14:42vaccine and it's why i think that i
14:45often found this to be a very successful
14:47treatment whereas
14:49vets in general practice may find it
14:51less effective
14:53because of some of the subtle nuances
14:55that i've talked about there
14:56so both can be good
15:00you can use both together or you can go
15:04with skin
15:05or allergy testing i think the key is to
15:07use a test that you know
15:09is accurate and is not creating a lot of
15:12false positives or negatives
15:17my ninth tip is all about treating
15:20for long enough do you know often
15:25seeing referrals i was seeing seeing
15:27dogs and cats with quite chronic disease
15:29and the first thing that you almost have
15:31to do is set
15:32owner's expectations that this is going
15:34to be a long journey
15:36in some cases with allergy
15:40this is a diagnosis that you make that
15:42says
15:43we will control this dog or this cat
15:46symptoms and this will be a lifelong
15:49potential issue but with appropriate
15:52treatment we can actually keep things
15:53together
15:55obviously with things like deep
15:57piodermas it's really important to treat
16:01well beyond clinical cure so you
16:03continue with antibiotics particularly
16:05feet dermatocosis sometimes those deep
16:08piodermas that we could see could take
16:11several months to really get better
16:13because of the fibrosis
16:15getting the antibiotics into the deep
16:17tissue
16:18and actually having a clinical cure so i
16:22would encourage you with all treatments
16:23that
16:24this is also about compliance we often
16:26find that
16:28clients don't come back we don't follow
16:30them up they're lost to follow up we
16:32don't ring them to come in for more
16:33antibiotics
16:35and we end up again with a problem where
16:37we're not sorting it and of course we're
16:39more likely to create immunity
16:43you know antibiotic resistance and so on
16:46so
16:48do always think about treating for long
16:50enough with these conditions
16:53that they can be quite long lasting and
16:56will need aggressive treatment
17:02my tenth and final tip is all about
17:06using the right shampoo i am a real
17:09advocate of shampooing
17:11i think it can really help quicken the
17:14actual
17:15progression to cure but i think
17:18sometimes shampoos get a bad press
17:21because
17:22vets don't understand all of the
17:24different types of shampoos and can use
17:26the wrong
17:27shampoo at the wrong time with bad
17:29results
17:31and of course this puts them off using
17:33shampoos in the future
17:36with pioderma i think it's
17:39well recognized using an antibacterial
17:41shampoo
17:44will really help to quicken up
17:47the the cure and in fact in some cases
17:50particularly if you have an mrsp case a
17:53a methicillin-resistant staph assumed
17:55intermedius
17:56where you can't use antibiotics then
17:58chlorhexidine
18:00on its own sometimes can affect a cure
18:02so
18:03it's really good to understand how
18:07how shampoos can be used we also have
18:10the colloidal oatmeal shampoos that can
18:12be antipruritic and and can help to
18:16reduce itch particularly in those dogs
18:19that perhaps you're not
18:20giving any antiprotics to like steroids
18:24because you're about to test them for
18:26for skin allergy and so on
18:28so do look at shampoos as your friend
18:31if you've had a bad experience it's
18:34possibly been because you've
18:35you've used the wrong shampoo in the
18:37wrong place
18:39we know for example that with malassezia
18:42problems
18:42quite often shampooing once twice a week
18:46might be enough to keep that dog's itch
18:49which can be quite severe with
18:50malassezia
18:51under control so do think about
18:55shampoos as part of your treatment
18:57regime when treating
19:00dermatology cases
19:03now that you know about my top 10 tips
19:05in dermatology
19:07maybe you'd like to carry on the journey
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