Skin Deep: Pet Skin Conditions

The differences between human and pet skin often aren’t fully understood by pet owners, and managing their pets’ skin conditions can be challenging. This represents an opportunity for veterinarians to enhance client relations.

How big of a product category is dermatology for a distributor rep calling on veterinary clinics? To put it in perspective, dermatology-related issues represent a large portion of insurance claims year after year.1

“Every single day that a veterinarian has patient appointments, they’re going to see some type of skin, ear, or gastrointestinal issue,” said Pam Mitchell, MS, DVM, Manager of Veterinary Strategic Partnerships for Dechra.

Dr. Mitchell said two things are crucial to achieving a satisfactory outcome for a patient who is being treated for a dermatological issue. The first is making the appropriate diagnosis. “When we are working up a patient’s recurrent skin, ear, or gastrointestinal problem, many times we will determine that there’s an underlying allergy, or perhaps an adverse reaction to food. These are all genuinely chronic conditions,” she said. “So, we need to treat any current infections and then manage those underlying conditions.”

The second vital component is client education. Dr. Mitchell cautions that veterinarians don’t use the word ‘cure.’ They will need to manage the client’s expectations appropriately. For instance, if a patient is being treated for an infection today, the veterinary team can treat it with an appropriate topical therapy or, in some cases, an oral antimicrobial or anti-inflammatory. The client must then come to understand that in most cases these are long-term conditions that will have to be managed for the rest of the pet’s life. Maintenance therapy to help manage these cases can include regular use of topical products, supplements, therapeutic diets, and, perhaps, immunotherapy. “We’re going to use a multi-modal protocol to ensure that we’re giving the best medicine,” Dr. Mitchell said. Guidance from a veterinarian on the use of these therapies is ideal because the veterinarian is going to make that recommendation based on a specific diagnosis.

Because pet owners are bombarded with marketing about pet health products, the information they have on a given health condition may not always be what the veterinarian would recommend or agree with. “Sometimes that marketing is wonderful and sometimes there may be misinformation,” Dr. Mitchell said. For example, if the pet has an infection, the veterinarian can investigate to determine what organism may be causing problems, and then select the active ingredients that are going to best treat that specific infection. The veterinarian is going to be able to choose from products that may only be made by reputable manufacturers.

 

 

The difference between human and pet skin

It may sound obvious, but not enough pet owners understand that shampoos developed for people are best used on people – not dogs or cats. Human skin is very different than a dog or cat’s skin. It’s a different pH, and the skin’s thickness is different. “What is good and appropriate for us to shampoo our hair with is not going to be ideal to bathe a dog or cat.”

For instance, the baby shampoo we use on infants is pH balanced to be appropriate for the acidic nature of human skin. The skin of veterinary patients has a higher pH, so pets need a shampoo that is formulated specifically for them. Baby shampoo can also be harsher than an all-purpose grooming shampoo that’s made specifically for pets, which typically has moisturizers in it, and/or ceramide complexes. Baby shampoo can actually be a very drying shampoo, Dr. Mitchell said.2

What products should pet owners consider and veterinarians recommend? The following are product categories veterinarians will need to have in their inventory for skin-related issues:

General cleansing shampoo. Every veterinary clinic needs a quality general cleansing shampoo to recommend. Preferably the shampoo is soap free, moisturizing, and appropriate for puppies, kittens, and adult patients. A general cleansing shampoo can be used on a dog or cat without any dermatology issues, or as a maintenance therapy for a patient that has some type of chronic issue. “But we want soap free so that we’re not drying the patient’s skin,” Dr. Mitchell said.

Anti-microbial shampoo. Anti-microbial shampoos play an important role in the management of dermatologic conditions in animals. These products are a critical part of a veterinary clinic’s dermatology portfolio. Effective anti-microbial shampoos frequently come with a combination of ingredients, providing both an anti-bacterial and anti-fungal effect. In some cases, these ingredients can create a synergistic effect. Anti-microbial ingredients include chlorhexidine, miconazole, ketoconazole, and others.

Anti-seborrhea shampoo. Anti-seborrhea shampoos contain ingredients to help break down the built-up debris, skin cells, and oil that can occur as a result of many skin diseases. Some of these ingredients can also help normalize the turnover of skin cells to help slow down this build-up. Anti-seborrheic ingredients include benzoyl peroxide, salicylic acid, and sulfur.

Sprays, mousses, and wipes. It’s important for veterinary clinics to have sprays, mousses, and wipes on hand so clients can use them if needed in between shampoos or as directed by the veterinarian. Spray, mousse, and wipe formulations can also help the veterinarian tailor a therapeutic regimen for clients who are unable or unwilling to bathe their pets. These products contain a variety of ingredients to mimic or complement the shampoo formulations.

Supplements. Supplements play an important role in multi-modal therapy and are a great addition to a topical therapy regimen. Products in this category can include fatty acids and palmitoylethanolamide. Working in a different manner than the topical products, these ingredients provide additional support to the health of the pet’s skin.

The importance of a proper diagnosis

When managing dermatology cases, veterinary clinics aren’t playing a guessing game. They start with taking a thorough history of the patient by asking about the pet’s home environment and diet, and exposure to other pets or wildlife.

A thorough physical exam that includes diagnostic testing and cytology of the skin is a must. With skin cytology, veterinarians can determine exactly whether microbes – bacteria or fungal organisms – are present. “Performing cytology is very important so we get an appropriate diagnosis,” said Dr. Mitchell. Deep and superficial skin scrapes are also valuable tools to identify parasitic infections.

Once veterinarians know what organisms are causing the problem, they can then choose the products with the active ingredients that are going to be most effective. “It allows us to choose the best topical therapies and if needed, systemic therapies. We know that there are many resistant organisms out there right now, so choosing the best therapy that’s most effective the first time is crucial. Topical therapy is going to be the most important component of managing skin and ear disease. We must use the proper ingredients based on the results of cytology.”

The next step in client education is on how to use the product. It’s important for the veterinary team to partner with the client to make sure they can use it. Efficacy only goes so far as proper usage. Ultimately, it’s important that clients understand treating and managing skin and ear issues is an investment in their pet’s health and comfort. “We want clients to understand that this can be a long-term, multimodal therapy; more than just a topical therapy,” Dr. Mitchell said. “It could also include systemic anti-microbials and supplements, and we may have to do other things over time.”

The distributor rep’s role

When distributor reps walk into a veterinary clinic with dermatology products as top of mind, Dr. Mitchell said they should always get as much information as possible. “Get to know everybody in that hospital: the front desk team, the veterinary technicians, and the practitioners. Everybody in the hospital has a crucial role when talking to and helping clients that have pets with dermatology issues.”

Look at what’s on their shelf. What topical therapies do they have right now? What shampoos, sprays, mousses, and wipes do they have? Reps need to know what they’re working with now.

“Ask your questions and find out if they are sending home a topical therapy with each dermatology patient,” Dr. Mitchell said. “How much client education is being done? We see so many patients and clients in a day. As crucial as education is, sometimes it can become challenging to do it as well as we’d like. Using technicians and the front desk team is very important with that. Also, are there any other client education pieces that a distributor rep may have? Or maybe you can direct them to a manufacturer’s website for resources to use if you don’t have the materials on hand.”

Distributor reps can enhance their value to the veterinary clinics by knowing the basic categories that every veterinarian should carry. “As a distributor rep, you have access to literally everything that is available,” Dr. Mitchell said. “Some products are great, some may not be so great, so it’s important for a distributor rep to know their manufacturer partners well. Which ones are reputable and helpful? Is the manufacturer rep available to them? Do they have good resources and are they ready to provide assistance? Those are important things to consider.”

 

References:

1 Skin allergies, ear infections among most common conditions that prompt veterinary visits. Nationwide. Accessed August 17, 2023.
https://news.nationwide.com/common-pet-conditions-that-prompt-veterinary-visits/

2 Srivastava M, et al. Update on use of medicated shampoo in companion animal dermatology. Journal of Canine Development and Research. 2013;9:102-11.

3 Patel A. Essential fatty acids in veterinary dermatology: do they have a place? Veterinary Practice. June 1, 2017. Accessed August 17, 2023. www.veterinary-practice.com/article/essential-fatty-acids-in-veterinary-dermatology-do-they-have-a-place

4 Noli C, Della Valle MF, Miolo A, Medori C, Schievano C. Efficacy of ultra-micronized palmitoylethanolamide in canine atopic dermatitis: an open-label multi-centre study. Vet Dermatol. 2015;26(6):432-e101. doi:10.1111/vde.12250

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Atopy Follow-up Care

Atopic dermatitis (ay-TOP-ick dur-ma-TIE-tiss) (also known as Atopy) is an allergic skin disease in dogs and cats. It is a genetically inherited, recurrent, itchy skin disease that usually begins by 1 to 3 years of age. Contrary to popular belief, it is a young dog disease that needs to be managed as needed for the rest of the pet’s life. Cats can also be affected.

 

Components of atopy therapy involve the following:

 

• Flea control is imperative, because fleas worsen the problem, especially if the pet has a flea allergy. Flea allergy and atopy can occur concurrently.
• Once any infections are resolved, barrier repair products can support skin health by providing ingredients to help maintain the epidermal barrier and provide moisturization. These products come in spot-on, mousse, and collar formulations. Crucial ingredients for barrier repair include ceramides, lipids, glycosaminoglycans, and essential oils.
• Supplements such as Omega-3 fatty acid supplements (DHA [docosahexaenoic acid] and EPA [eicosapentaenoic acid])3 and palmitoylethanolamide4 can help support skin health in atopic pets and are frequently given in conjunction with other therapies as part of a multi-modal approach.
• Immunomodulators, including glucocorticoids, cyclosporine, oclacitinib, and lokivetmab, can provide anti-inflammatory and anti-pruritic effects which can help control inflammation and itch in dogs and cats with allergies.
• There are many advantages of topical therapies such as shampoos, sprays, mousses, and wipes. They remove debris and allergens from the skin. Treating secondary bacterial or yeast infections with these products can help provide immediate relief to the pet (some contain anti-itching medications) and may aid in reducing the need for oral or injectable medications that may have unwanted side effects. Some also contain ingredients to support the skin barrier function.
• Oral anti-microbial agents to treat bacterial and yeast infections are indicated when topical therapies might not be able to address the problem quickly enough or completely.
• Allergen Specific Immunotherapy or “allergy shots” may be formulated based on the results of allergy testing. Once the pet owner and veterinarian know what the pet is allergic to, a series of allergy shots are prepared for the pet based on that information. The allergy shots train the pet’s body not to react abnormally to the allergen (the substance to which the pet is allergic). It may take up to 9-12 months to see beneficial results.
• Some pets with atopy benefit from switching to a higher-quality food, even if they don’t have a food allergy.

 

Photo credit: istockphoto.com/gorodenkoff