October 11, 2018

ACVC 2018: Strategies for Success With Your Derm Cases

A lot goes into diagnosing skin conditions. Here’s what you should know.
By American Veterinarian Editorial Staff
Dermatology To be successful with your dermatology cases, said Jennie Tait, AHT, RVT, VTS (Dermatology), you need to get a jump early. “Like it or not,” she said, “a very large portion of what is seen daily in general practice is dermatology.”

Dermatology cases are not easy, Ms. Tait said during her Tuesday morning session at the 2018 Atlantic Coast Veterinary
Conference®. They require a lot of investigative work, and they often have long convoluted histories in which the pet owner has been to several practices without finding success or the right treatment to manage the pet’s condition.

But they do have an upside, at least for Ms. Tait. “One of the things I like best about my job as a veterinary technician specialist is that I get to think like a detective and piece together all the pieces of the puzzle,” she said before laying out several strategies for success with these tricky cases.

Set Yourself Up for Success
“You can’t possibly get a handle on a dermatology case in 20 minutes,” she explained, “let alone conduct diagnostic tests and have the veterinarian come up with a treatment plan.” Because it’s important to block out the appropriate time for dermatology appointments, Ms. Tait recommended booking 2 time slots for these cases. “There’s more to [go] through with the pet owner than a 20-minute appointment will allow,” she said.

If booking 2 time slots is not an option, Ms. Tait advised asking the client to fill out a detailed questionnaire that can be completed and provided to the practice prior to the patient’s appointment. This allows the veterinary team ample time to review the responses thoroughly before an in-person examination. “Having an accurate history is of paramount importance,” she stressed, before laying out some of the key aspects a proper history should include (Box).

Examine Your Patient From Stem to Stern
Patient History for DermatologyA dermatologic examination should always be 100% thorough, Ms. Tate said. Remember to check these areas:
  • Eyes
  • Nasal planum and dorsal muzzle
  • Lip margins and lip folds
  • Ear canals and pinnae
  • Facial, neck, and tail skin folds
  • Coat and skin over the entire dorsum and ventrum
  • Claws, claw beds, and interdigital spaces
  • Genitalia, anus, and perianal region
  • Tail

Look for Patterns and Describe Any Lesions
While Ms. Tait conceded that practicing good veterinary dermatology is not rocket science, she did again liken it to being a detective. This is especially true because so many dermatology cases present with the same visible symptoms, but have varying causes and different management criteria. This is where being able to spot repetitive trends comes into play. For instance, if you are seeing Fluffy the cat for the sixth time for her ears, stop and ask why—why is the patient experiencing
these repeat infections? “When you are able to identify the problem,” Ms. Tait said, “you can get started on the solution.” If you see a pattern, stop and ask yourself why. If you can describe the pattern or the lesion you’re seeing, she noted, the diagnosis may come easier.

Are the face and feet affected? Does the patient have lymphadenopathy? Consider demodicosis. Is the animal younger than 1 or older than 5 years of age? Consider food allergies. Do the patient’s pustules span more than 1 hair follicle? Consider an immune-mediated skin condition.

Ms. Tait also advised taking breed into consideration, as commonalities might provide the clues you’re looking for. Dobermans, for example, are prone to hypothyroidism, while boxers often have food allergies.

Perform Cytology on Every Patient
DermatologyThe near-instant results offered with cytologic testing are invaluable in guiding the treatment plan for dermatology cases, Ms. Tait said, noting that many of her clients are amazed the staff can take samples and have answers for them in just a few minutes. Cytology brings in extra income for your clinic and puts smiles on your clients’ faces. “Don’t waste your patient’s time and your client’s money by guessing,” she said. “Take 10 minutes to do some cytology and know what
you’re dealing with.”

Consider Your Clients
Having a compliant owner gives you the best chance for treatment success, Ms. Tait said, which means you need to take the time to make sure the client can perform any treatment at home. Is bathing an unrealistic option? Consider using topicals such as sprays, pipettes, or wipes. Will the owner be able to administer oral tablets? If not, consider injectables, oral liquids, or once-daily medications. “This all sounds like it’s very basic,” Ms. Tait explained, “but it’s often missed, leaving everyone frustrated and, worst of all, leaving the patient uncomfortable.”

Conclusion
Finally, Ms. Tait said, put everything in writing and follow up. Written information gives the pet owner something to refer to when a question arises or to share with other family members who are caring for their pet. Contacting the owner the day after the visit allows for additional questions and shows that you are concerned about the pet’s and client’s welfare.

Dermatology cases don’t have be frustrating, Ms. Tait said. Use some of these strategies for success the next time one walks into your practice. “The key to managing these cases is to know what your patients are trying to tell you,” she said.
 

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