One of my pet peeves when reviewing medical records. I know someone here needed this clarification 😂

#petpeeves #medicalrecords #miamivetderm #gotitchypet #vetdermatology #dermatologiaveterinaria #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petdermatologist

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Treatment with fluoroquinolones (FQ) for the skin and ears should be based on culture. The use of enrofloxacin or any FQ for that matter for a bacterial skin infection should be avoided without a culture to support its use.

Most veterinary FQ have limited effect on gram positive bacteria, their primary activity is against gram negative bacteria. There are other classes of antibiotics, like cephalosporins, that are a better option for Staphylococcal infection than a FQ as a first line.

FQ are concentration dependent antibiotics. Their post antibiotic effect and long half-life allows for their once-a-day dosing which helps with compliance. FQ antibiotics works best at killing bacteria when used at a high dose once a day. Administering this class of antibiotics at a low dose for short duration of time increases the potential for antibiotic resistance. With that said, splitting a low once a day dose in half so twice a day dosing increases the chances of resistance and should be avoided.
There is also evidence to suggest that the use of FQ may upregulate the genes (mec-A) responsible for methicillin resistance. This means that improper use of this class of antibiotics for skin infections will not only cause resistance to FQ but also methicillin resistance.

The prevalence of MRSP infection has increased over the last decade. MRSP is not just showing resistance to beta-lactam antibiotics, it is now become a multi-drug resistant bacterium. There is now resistance to non-beta-lactam antibiotics, like FQ and potentiated sulfonamides. Due to this prevalence of multidrug resistant strains, empirically switching antibiotics when treating a staphylococcal infection that fails to respond to first line antibiotics (particularly beta lactam) NEEDS TO BE AVOIDED.

Do not reach for a big gun like a FQ just because a skin infection is not resolving. Please culture first!

Let’s use fluoroquinolones more wisely. Misuse of this class of antibiotics may lead to resistance of multiple antibiotic classes making it much harder to resolve skin infections in our pet patients.

#dogskininfections #vetdermatology #antibioticresistance #vetmedicine

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Deep pyoderma on an atopic dog’s paw.

🐾 How do I know this is a deep infection? There is nodular swelling of the skin. If you pressed on the skin, you would see discharge and bleeding.

💊 Making the distinction between superficial and deep infection is important, as deep infections need minimum 6-8 weeks of antibiotics.

🗓 Too short of a time on antibiotics and the infection may not fully resolve leading to relapse of the infection within a few days to weeks.

😧 Do not be afraid in these deep pyoderma cases to do the full 6–8-week time on antibiotic. It may seem overly long, but it is necessary. Explain this to clients too as you may get push back from them when they do not understand the necessity for the length of time. Explain to clients to keep going on the antibiotics even when the skin infection looks resolved, because there may still be infection deep inside.

✔️ Make sure to follow up. I like to see these cases back in 4 weeks to make sure the medication is working and if so, refill the antibiotic and follow up again.

#dogpaws #bulldog #bulldogproblems #miamivetderm #gotitchypet #allergies #vetdermatology #petowner #dermatologiaveterinaria #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petdermatologist

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Enjoyed this week with @indirarojas, vet student extern!!! Come back and visit us Indira and will have some cafecito ready for you 😁 #vetstudent #vetschool #vetschoollife #vetmed #vetdermatology #vetderm #futureveterinarian ...

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Como dice mi amigo @renatovetderm … estoy dermatologiando en New Orleans @navdf #vetdermatology #vet #vetmedicine #vetderm #nola ...

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I can’t believe I forgot 🤦🏽‍♀️ to share this fun podcast I did with @chatfield_show last year. You have to follow Dr Jen and Dr Jason for entertaining and informative podcasts. These two are an awesome duo! ✨✨

You can watch 👀👀the podcast on You Tube:

#vet #vetpodcast #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #veterinarymedicine #vetmed #vetmedicine #medicinaveterinaria #petdermatologist

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Here to remind you …. Don’t forget to look at the pinna during your physical exam of a patient. The pinna is skin, no different than the rest of the body, and can become significantly infected causing alot of discomfort to the pet.

Many times, if the pinna is infected the ear will be infected too, therefore, make sure to be doing your otoscopic exam.

And… don’t forget to cytology that pinna.

#dogears #pinna #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology

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Ear margin hyperkeratosis or ear margin seborrhea is not as common as nasal or digital hyperkeratosis, but it is often seen in dogs. This condition is thought to be due to a keratinization disorder. Dachshunds are a common breed affected with this disorder. For some dogs the excessive scales/skin doesn’t make them uncomfortable, in others it can cause swelling and irritation causing them to shake their heads.

I present here a case of a 5-month-old French bulldog with pinnal lesions that may have looked like a benign ear margin seborrhea, but turned out to be dermatophytosis. The diagnosis was made on biopsies. Cultures are still pending on the species of dermatophyte.

Keep dermatophytes in your differential list when you see pinnal lesions like these.

Any other differentials that you can think of for pinnal disorders? I’ll go first - see comments 👇🏼

#dogears #frenchiepuppy #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

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Pandemic put a halt to our student extern visits and foreign vet visitors.

We have decided to start allowing students and vets to come back. And the last two weeks we’ve had the pleasure of sharing our derm cases with Dr Jesus Duenas from Colombia, who practices vet dermatology in his country.

It was a great two weeks learning derm from each other. Hope to see you again Jesus!

#vetexternship #visitingvet #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

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Woke up early this morning to give a lecture to @kingsroadvetclinic in the Philippines. Their vets reached out wishing to learn more about intradermal skin testing and immunotherapy. When they said “we want to elevate the standard of care in our patients” I couldn’t resist giving my to support these veterinarians. There is no dermatologist in their area and I was happy to share my knowledge and help them help pets in their country.

#saturdaymorning #vetsupportingvets #timedifference #phillipines #phillipines🇵🇭 #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

85 8

“The Spray” that most clients mention they use on their pet…

Gentamicin/Betamethasone spray is commonly used in general practice for skin lesions and pruritus. It is important to remember that this spray has a long-acting steroid and should be used cautiously. I would advise that its application be for no more than 5-7 days.

Overuse can lead to skin atrophy, especially of thin skinned areas of the body like the abdomen/inguinal region.

This spray is labeled for superficial infections, but I would limit its use in these cases. The betamethasone will quickly improve the inflammation associated with the skin infection making the client think the infection is resolved. Only to see the lesions reappear days later. The client then sprays again, and the cycle repeats and then there is overuse. Overuse can lead to worsening of skin lesion, which makes the client think more spray is necessary and things just rollercoaster out of control from there. It is best instead to send the client with an antibacterial shampoo or spray for a superficial pyoderma.

Since the spray should only be used for a few days, there is always left over in the bottle. Make sure to warn clients that it should not be used again until you direct them to do so.

And please do not refill this product willy nilly.

Just my two cents on this product, which ends up causing more harm than good when clients use it incorrectly.
Let us do things right. Let’s use it wisely.

#miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

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Who has Depo Medrol in their pharmacy cabinet? I will admit I do!

In 2021, I used Depo Medrol two times. I do not use it often but have it on hand in case I have a FELINE case that the owner cannot administer medications orally.

Depo Medrol is methylprednisolone acetate- a repository glucocorticoid formulation.

Methylprednisolone by itself has a duration of 12-36 hours. With the addition of the poorly water soluble “acetate” it causes the methylprednisolone glucocorticoid to accumulate in tissues and slowly release over 3-6 weeks. The repository effect is the reason it should be used with extreme caution. The potential side effects of this type of glucocorticoid cannot be reversed once injected. Of concern, is its diabetogenic and cardiovascular effects.

If long-term use of a glucocorticoid is necessary for a pruritic cat, the goal should be to reach a point where the lowest steroid dose is achieved that will keep the cat comfortable without side effects. This is best done with an oral steroid. Of course, this tapering cannot be accomplished with Depo Medrol, and that is why it should be avoided for long term use.

I understand cats can be hard to medicate, but we should not assume that a pet owner is not willing to learn to give medications orally to their cat to avoid the side effects of a long action steroid like Depo Medrol.

In our practice, if a cat owner cannot pill, then we offer liquid, if liquid steroid is difficult then we consider compounding the steroid in a liquid flavored concentrated formula (so that client is only giving a small volume). Anything to avoid the use of injectable long-acting steroid.

Let us do things right and not run to Depo Medrol for every cat that is itchy. Let’s use it wisely.

#depomedrol #cats #catsofinstagram #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedicine #veterinarian #veterinario #veterinaria #medicinaveterinaria #petdermatologist

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Here is product that I am a big fan of for my atopic dogs.

It is a leave on hydrocortisone conditioner. This is one brand, but there are many others. Hydrocortisone is a mild potency steroid and the percentage in this product is low at 1% that I rarely see any reactions.

I find this product a nice adjunct to the medicated baths the clients are already doing for their atopic pets. After the medicated bath they will apply a small amount to the frequent itchy areas of the body and leave it on to dry. I especially love this product for dogs with itchy paws.

Caution to not over apply to the ventrum, like the abdomen or inguinal region, where the skin is thin. Overuse can cause atrophy of the skin. I have clients apply it once a week.

#vet #vettech #vetdermatology #dermatologiaveterinaria #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #medicinaveterinaria #miamivetderm #gotitchypet #atopy #petallergies

326 7

Lichenification is typically known as hyperpigmented leathery appearing skin. However, it can also be leathery-erythematous skin as shown in the picture.

When lichenification is present on the skin we often think of it being caused by malassezia, but quite often there is a concurrent bacterial infection or it may just be bacterial. It is important to perform skin cytologies.

Lichenification develops more readily in certain breeds like Westies and German Shepherds, in comparison to other breeds.
When lichenification is present on the body, it is more common in certain areas like the ventral neck, chest, abdomen, inguinal, perianal and muzzle.

Lichenification should be equated with chronicity… the pet has had chronic infection and constant trauma (i.e., pruritus) on the skin for weeks to months to years.

When lichenification is present on the skin it means treatment will be extensive: from weeks to months of systemic and topical therapy.

It is hard to believe, but the elephant skin can go back to normal smooth skin by treating the infection appropriately and resolving/managing the underlying cause.

#vet #vetdermatology #dermatologiaveterinaria #vetmedicine #medicinaveterinaria #dogskin #elephantskin #dogskininfection

458 5

A question pet owners will often ask is if their pet’s red eyes, or excessive tearing or ocular mucous discharge is due to allergies. Allergies in pets does not typically cause red, itchy eyes like it will in people. There are other more common conditions that can cause these eye signs and are important to rule out first. One such condition are eye lid disorders, like entropion. Look at this video of an English Bulldog with entropion. Look at how the eyelid is rolling inward causing the eyelashes to rub on the eye, it is obvious why the eye is red. This rubbing of the eyelashes can also irritate the cornea and potentially damage it. This patient needs eyelid surgery. This English Bulldog has allergies that will need to be worked up as well, but first let us fix the eyelid abnormality.

#vet #vetdermatology #dermatologiaveterinarian #vetmedicine #medicinaveterinaria #petdermatology #vetophthalmology #entropion

267 8

The Collaborative Care Coalition is an organization that aims to improve the relationship between primary care veterinarians and specialists. To carry out their goal, they have been working on studies that compare the outcomes of primary care alone versus collaborative care in various medical situations.

One of these studies retrospectively looked at the medical records of 65 dogs with otitis and compared the outcomes for the treatment of chronic otitis externa when managed by primary care alone or working together with a specialist. The results showed that dogs had better long-term outcome when collaboration with a dermatologist was initiated within 6 months of treatment. Therefore, referral or consultation is advised for patients with recurrent otitis that has been present over a 6-month period.

But, a striking finding for me in this study was that the proliferative ear canal changes improved by 91% when the patient care was teamed with a specialist versus just primary care alone at 13%. I will often talk about how chronic changes to an ear canal perpetuate infection and can eventually lead to end stage ears, and then finally total ear canal ablation surgery. This just highlights the importance of reaching out to your local dermatologist for help with those tough ear cases. Let’s work together to save those ears.

Article: JAAHA (2021) 57 (5): 212-216

#vet #vetdermatologist #dermatologiaveterinaria #vetmedicine #medicinaveterinaria #otitis #dogears

65 2

What is your favorite topical ear medication?

I am a big fan of Virbac’s Easotic. I like this product for several reasons, and no, Virbac is not paying me to say this…

👍🏼 The pump bottle makes administration easy peasy. The client just presses the pump and it delivers 1 ml of medication straight into the ear canal. No need to count drops or make sure those drops went down the ear canal. This delivery system alone makes it a great product, because as we know client compliance is always a concern with otitis treatment

👉🏼 It is a once- a- day treatment. Easy for pet owners to remember to do

🙌🏼 The bottle only has 10 ml or 10 dose treatments, so there is usually not any left -over medications that pet owners will use at a later time

✊🏼 The hydrocortisone aceponate (HCA) is a potent new generation glucocorticoid. It is 60x more lipophilic than hydrocortisone and due to this it has a rapid absorption into the targeted tissue for fast acting anti-inflammatory effects. HCA when reaches systemically is converted to weaker metabolite- hydrocortisone, therefore less systemic side effects

👏🏼 The miconazole and gentamicin are good combo of broad- spectrum antimicrobial and antifungal ingredients for treatment of simple staphylococcal and malassezia infections

Client compliance and improper treatment of an otitis can be a reason why the ear infection in a pet is not resolving. Consider using this product and see if your compliance improves and otitis cases are resolving quicker. Of course, don’t forget to look for the underlying or primary cause of the ear infection.
Who is using Easotic? What are your thoughts on it?

#vet #vetmed #veterinarydermatology #dermatologiaveterinaria #medicinaveterinaria #otitis #dogear #dogearinfections

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Severe case of superficial spreading pyoderma. A number of my patients present with skin infections that look like this, and I am sure you are seeing these cases as well. These cases appear daunting when they walk into your door, but they don’t have to be.

Things to remember, infections on the skin like this contribute to pruritus, it makes these pets uncomfortable and sometimes unsightly, it is the cause for the pigmentation, the crusts, the hair loss and odor. You can definitely make a difference in these patients by treating the infection correctly (i.e. appropriate dose and length of antibiotics and medicated baths).

It is important to discuss with clients how skin infections are secondary and why it is important to look for the primary cause. Keep allergies and endocrine disorders in mind, when investigating those primary causes. I always check for demodex mites, as well.

Eager to see what this pet looks like in a few weeks.

#vet #vetdermatology #vetmedicine #medicinaveterinaria #dermatologiaveterinaria #dogskininfections

253 6

I speak Spanish. I thank my parents for making sure I learned to read and write my native language. Actually, Spanish was my first language as a young child and then it became second when I entered grade school. I’m fortunate I can communicate the complexities of allergies to my Spanish speaking clients, a skill necessary in my community. Now … speaking to my veterinary community in Spanish is another thing- I will admit it’s daunting. I can use common terms for my clients, but medical terminology is hard because my brain only knows it in English. I know some terms are similar in both languages, like atopy in English is atopia en Spanish, but some terms are not. So next week I will be presenting a lecture in Spanish. At my ripe age of 48, I feel like I am learning a new skill. It’s kind of exciting, but also scary at the same time. I have wanted to share my derm knowledge with my Latin American colleagues for some time and I am fortunate Zoetis and @dr.calad gave me this opportunity. My parent’s legacy of language will continue to thrive. #vet #vetdermatology #vetmedicine #medicinaveterinaria #dermatologiaveterinaria ...

154 25

Seasonal flank alopecia or canine flank alopecia

This is an English Bulldog, the poster child for this condition.

The hair loss occurs in the lateral flanks, and it is typically symmetrical. The area of alopecia is hyperpigmented and irregularly shaped with well demarcated borders. There is no pruritus associated with this condition.

The cause for this disorder is unknown. However, there is an association with daylight cycle. Dogs will lose hair with a change in season and then regrow hair next season. Some dogs will skip a season and it can take time for the hair to completely regrow. It is possible in individual cases for the hair to never completely regrow.

Diagnosis is based on clinical signs and breed predisposition. Other differentials to consider are bacterial infection, dermatophytosis, demodex or endocrine disorders like hypothyroidism or Cushing’s.

This is a cosmetic condition, and it will not affect the pet. No treatment is necessary. Melatonin, a natural biochemical that can help regulate circadian rhythms, may help some pets regrow hair.

#englishbulldog #dogsofinstagram #vet #vetdermatology #vetmedicine #veterinarydermatologist #vetmed #flankalopecia

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