Jason B. Pieper, DVM, MS, DACVD, shares the #1 cause for atopic dermatitis

Treatment options for mild atopic dermatitis

Atopic dermatitis can have multiple causes, with one particular allergy—and the most common one—having the ability to cause year-round issues. In this interview about his lecture on atopic dermatitis, presented at the 2025 Veterinary Meeting & Expo, Jason B. Pieper, DVM, MS, DACVD, assistant professor at Iowa State University, talks about the top cause for atopic dermatitis, as well as some of the other causes for this condition. Pieper also delves into the various treatment options for mild atopic dermatitis.

Below is a partial transcript which has been lightly edited for clarity:

 …It is tough when we talk about atopic dermatitis, I mean, there's a variety [of causes]. [The patient] can be allergic to, grasses, trees, weeds, molds as well.

The number one, actual one, though, is house dust mites, which is very similar to humans. So usually with them then it's a year-round problem. You know, it's not just a seasonal issue. It's a year-round [issue] and even for dogs that are mildly allergic when they're younger, as they get older, they tend to still develop allergies to house dust mites, so then they have [those] year-round kind of clinical signs, but that's definitely been the most common allergy that we find for atopic dermatitis.

When you sit there and kind of classify them on their clinical lesions, I guess usually, I base it on what we call this PVAS, or the Pruritus Visual Analog [Scale], and it’s zero to 10. Zero is not really doing anything; 10 is itching all the time, you know, uncontrollable, not even able to stop to eat. They have stopped that and will start itching. And so when I say there's a dog [that is] a 3 to 4 out of 10, that's where it’s considered mild disease. And you know, usually, then we're talking about adjunctive therapies, is the way I think of it.

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The recent increases in construction costs can dampen anyone’s enthusiasm for building or remodeling. Fortunately, a new or remodeled hospital is still well within reach. Today’s veterinary floor plans are smaller, and they prioritize revenue per square foot.

Design is a powerful tool. With the right techniques, you can take a smaller space and create a big little hospital. A big little hospital may be small in footprint, but it feels light, bright, airy, supportive, effective, and is easy to work in.

In the world of digital work, reception desks can be minimized. A client service team needs comfortable computer workstations, and these individual, kiosk-style stations fulfill that need by providing ergonomic seating, elbow room, and better acoustic separation. Kiosk-style desks, like the ones used by Livewell Animal Hospitals (Livewell), not only do everything in a smaller footprint but also help the lobby space feel more open. In addition, customers are better separated and can have personal, more private, face-to-face communication with the staff, which helps foster a welcoming, client-centric experience.

Livewell Animal Hospital of RiNo (Image courtesy of Southern Veterinary Partners)

Livewell lobbies are intentionally designed to minimize clutter. The hospital floor plan prioritizes exam room space, which allows the lobby to be smaller and less crowded. With fewer clients waiting, chairs can be larger and more comfortable. Livewell is also purposeful in choosing and placing artwork for a clean and professional look.

Optimizing treatment spaces with the use of islands

The smallest hospitals may require treatment stations to be placed against walls. However, lining the walls with tub tables and exam tables is a limiting design, as this leaves room for little else. If possible, to eke out more space for treatment, the design can utilize an island layout. The island in the image below incorporates a treatment table and computer workstation on each side, medical gas drops, lighting, and storage while maintaining visibility across the space. The wall behind is free for animal housing, patient monitors, and storage.

To prevent clutter in treatment, all items are hung from above whenever possible. Chairs are also tucked under counters to keep the floor space free and clear.

Livewell Animal Hospital of Sloan Lake (Image courtesy of Southern Veterinary Partners)

Environmental design techniques for big little spaces

Glass not only helps to provide visual connection and transparency between spaces in a hospital, but it also enhances a small space design. Views to the outside, as shown in the Livewell treatment area above, help spaces feel bigger than they are. Natural light also helps create a sense of well-being and connection to the outdoors.

Building a transparent veterinary practice—with glass, open spaces, and values

In the image below, the office was designed with a Dutch door to allow it to feel even more open and connected to the rest of the hospital when the doctor does not require privacy.

Raintree Animal Hospital (Image courtesy of Tim Murphy | Murphy Photo Imagery)

Transparency is important for monitoring patients to provide better care and support positive outcomes. In the small hospital intensive care unit ward in the image below, a window connects this space to the workstations on the other side of the wall. The ward itself feels bigger and more comfortable, given the window into the space from treatment, as well as the window from the outside. The outside window is not in view in this image, but light can be observed spilling into the dog run.

Lake Anna Veterinary Hospital (Image courtesy of Tim Murphy | Murphy Photo Imagery)

A big little hospital feels bigger because it is bright, with higher illumination levels, plenty of daylight (if possible, given a lease space or freestanding configuration), and a light color scheme.

Choosing lighter paints and materials helps reflect light from surface to surface and makes any space feel bigger. Clinical areas also typically want to use more light colors for a feeling of cleanliness. This overall approach does not preclude the occasional use of a bold-colored accent feature, such as on a wall behind the reception desk, to correspond with your branding or to add an element of style.

While keeping things light, avoid using bright white for heavily used surfaces, such as treatment area walls, floors, and cabinetry. Veterinary spaces are used hard, and most veterinary practices do not have the cleaning budgets of human hospitals. Strike a balance with a color scheme that feels practical, light, and cheerful.

Noise problems can ruin the result of a big little hospital design. Incorporate noise reduction materials in every space, which means utilizing a highly sound-reducing ceiling in each space except for surgery. We recommend hard ceilings in surgery for cleanliness.

Although it is tempting in a small floor plan to have all patients in the open, designate some dog housing in a separated room, if possible, to reduce sound issues throughout the hospital and reduce fear, anxiety, and stress for your feline patients.

In summary, the most important big little hospital design techniques include the following:

Minimizing the space but increasing the quality of client reception areas

Designing highly efficient, multipurpose treatment spaces

Crafting the environment using transparency, bright lighting and light colors, and incorporating noise reduction and control

We use these techniques repeatedly to get the most out of small spaces and to ensure these small spaces are still great places to work. Given the costs of construction, get the most out of your square footage with a smaller, more efficient but still highly comfortable and uplifting design.

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Maximize your hospital through these clever design tips and space-saving tricks.

Big little hospital: Design ideas to help your small spaces feel larger

Following a recall of grounding pads produced by Megadyne, a machinery industry company, the FDA is notifying veterinarians about a potential burn risk linked to the use of these devices in veterinary patients, according to a “Dear Veterinarian” letter written by the federal agency. The FDA’s Center for Veterinary Medicine (CVM) received reports of burn injuries in animals related to the use of these human medical devices in veterinary settings, stated the letter.

 The recall involves updating the usage instructions of these devices, but does not involve removing the products from where they are used or sold.

The recall, which includes the Megadyne Mega Soft, Mega Soft Dual, and Mega 2000 Patient Return Electrodes, are human medical devices that are often used in veterinary practice. The recall was issued by the CVM on January 14, 2025, and comes after the agency was made aware of human patient burn injuries, particularly among children under 12 years of age.

Megadyne Mega Soft Patient Return Electrode. (Photos courtesy of FDA)

Megadyne Mega 2000 Patient Return Electrode

Speaking of the affected animal patients, the FDA wrote, “The animal adverse event reports received by the FDA included dogs of varying weights and ages. Human medical devices are often used for animal patients in veterinary practice. FDA has regulatory oversight over devices intended for animal use and can take appropriate regulatory action if an animal device is misbranded or adulterated. However, FDA does not currently have premarket authority over devices intended solely for animals.”

Megadyne is addressing the issues with the affected grounding pads following the reports of patient burn injuries, according to the FDA. The company is directing users to not use the Mega Soft, Mega Soft Dual, and Mega 2000 Patient Return Electrodes on children under 12 years. It is also instructing users to ensure they follow the proper cleaning, placement, and setup steps to help prevent burns in patients associated with the devices.

The Megadyne grounding pads are soft pads used in electrosurgery—a procedure where an electric current is used to heat or cut tissue, or to stop bleeding. The current is generated by an electrosurgical generator and delivered to the tissue via a small, pen-like attachment. A return electrode pad is placed on the patient’s skin to direct the current back to the generator in order to lower the risk of excessive heating.

In its letter, the FDA advised veterinarians and animal owners to “report adverse experiences and product defects” linked to animal devices. These can include

Adverse effects in animals including but not limited to

Adverse effects (such as needle stick injuries, rashes, or headache or nausea secondary to product contact) in humans that had exposure to drugs and devise used in animals

Defects in products, with examples including broken product seals, leaking bottles, and more

Medication errors, like administering the incorrect drug or dose, giving a drug too often, and more

A product’s lack of effectiveness, such as a product that is not working or stops working, or one that is no longer working as well as it once did

Reports the agency receives are used to monitor the safety of products after they become available to the market.

 More information on reporting information about animal drugs and devices is available on the FDA’s “How to Report Animal Drug and Device Side Effects and Product Problems” website.

Dear Veterinarian Letter advising veterinarians of burn risk associated with the use of Megadyne grounding pads in veterinary patients. News release. US Food and Drug Administration. January 14, 2025. Accessed February 6, 2025. 

https://www.fda.gov/animal-veterinary/product-safety-information/dear-veterinarian-letter-advising-veterinarians-burn-risk-associated-use-megadyne-grounding-pads

How to Report Animal Drug and Device Side Effects and Product Problems. US Food and Drug Administration. Accessed February 6, 2025. 

https://www.fda.gov/animal-veterinary/report-problem/how-report-animal-drug-and-device-side-effects-and-product-problems

Dogs have experienced burn injuries following unsafe use of Megadyne grounding pads

FDA notifies veterinarians of animal burn risk linked to human medical devices

SPCA International’s partner Red de Apoyo Canino in Venezuela held a spay-and-neuter clinic on February 1, 2025, in a remote town in Maracaibo, El Bajo, Municipality of San Francisco. Twenty-one cats and 11 dogs were sterilized at the event.

Global animal welfare organization SPCA International has awarded $165,000 in grants to support spay-and-neuter programs worldwide in recognition of Spay-and-Neuter Awareness Month in February. These funds will provide an estimated 10,000 animals with sterilization services.

Spaying and neutering is the most effective way to prevent animal overpopulation and alleviate suffering, according to SPCA International. The recipients of organization’s grants provide critical care for animals around the world by implementing spay-and-neuter initiatives and bringing awareness to this approach to population control.

“Spay-and-neuter programs are not only the most humane solution to overpopulation, but they are, alongside vaccinations, crucial for improving the health and welfare of animals across the globe” Lori Kalef, director of programs at SPCA International, said in an organizational release. “We are proud to support and reinforce these incredible organizations and partners, who are dedicated to advancing these efforts.”

Grants were awarded to 20 animal welfare organizations. Recipients includes the following:

A canine patient at the Red de Apoyo Canino clinic

Every Life Matters Charitable Foundation in Ukraine

Fiona Animal Refuge in Mexico and the US

Help Animals - Cat Shelter Jessica in Serbia

Lake Zone Animal Welfare Organization in Tanzania

Lawrence County Humane Society in New Castle, Pennsylvania

Sterilise Our Strays - SOS Algarve Animals in Portugal

Tahira Animal Welfare Foundation in Pakistan

Voluntary Education and Relief Initiative for Tanzanian Society in Tanzania

Although spaying and neutering is widely recognized as the most effective method for controlling overpopulation, according to the SPCA International, many areas around the world still lack access to these essential services. SPCA International’s partner organizations are often working in areas where spaying and neutering is not common practice, to raise awareness about the importance of humane animal population control and implement local initiatives. Spay-and-neuter programs can also help to reduce the inhumane practice of culling of dogs and other harmful population control measures.

SPCA International’s partner organizations provide spaying and neutering services in rural villages and urban cities worldwide. Many of these organizations’ spay/neuter programs include an education component. The grants awarded by SPCA International aim to support a range of local programs, from mobile clinics to education campaigns, all focused on increasing access to spay-and-neuter services and improving the lives of animals.

SPCA International awards $165,000 in grants to global animal welfare organizations to fund spay-and-neuter programs. News release. SPCA International. January 30, 2025.

SPCA International is providing $165,000 in total funding to support spay-and-neuter initiatives and education.

Grants awarded globally to 20 spay and neuter programs

On this week's episode of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, invited Evan Antin, DVM, on the show to discuss the current state of the wildfires that are destroying thousands of acres in Southern California, including the homes of people and wildlife living on the land. Throughout the episode, Antin explains to Christman what it was like having to flee the areas impacted by the fires, what people should not do when it comes to wildlife, and more about his experiences with animal conservation.

Providing care for animals during the California wildfires

Listen, a lot of wildlife, unfortunately, they're going to lose their homes and unfortunately, a lot of them their lives...with these wildfires. But a lot more than you would think actually can survive through them because of just the way that they're equipped to deal with, you know, the nature out here and being a native animal of this part of the world of Southern California, Southwest US, where wildfires are a reality. They're equipped with, you know, being in a sense prepared for them, if that makes sense, more from an instinctual standpoint of what they need to do when those come about. And then you're going to see and hear different things too, about recommendations of, you know, putting out food or water for them or not. 

The California Department of Fish and Wildlife, they say, Don't put out food. Don't put out water. It's actually counterproductive. You're setting these animals up for more human and wildlife conflict, because they're now depending on, you know, they're going to see people as resources for their needs that they need to have met, whereas they really just need to depend on the wild habitats that they really, you know, live in. So, I mean, the food one, I think, is pretty straightforward. It's really not ideal to leave out food for these guys. We want them searching for food. We want them finding new homes where they can get food and, you know, get to areas where it's going to provide what their needs are, then, are not, you know, charred up and on fire and everything. 

And then the water thing, you know, like I said, the Department of Wildlife, they said, don't even give water. That's [tough] to do. It's like part of me wants to just, if I was backed up to nature like that, I'd want to just put out a little bowl so just they get a little sip on the way. But, the wildlife biologists and experts are saying these guys, you really need to be given the opportunity to find it on their own, and that's what's going to be best for them long term. 

Podcasts

Evan Antin, DVM, shares more on the current state of the wildfires in Southern California on this week's episode of The Vet Blast Podcast presented by dvm360

Wildfires and wildlife

Veterinary visits are too often stressful and traumatizing for patients, making the experience a challenging one for the veterinary team, patients, and clients. So, what can veterinary professionals do to alleviate a patient’s stress and fear in the clinic, and what actions can be suggested to the pet owner to help reduce their pet’s anxiety before the visit?

This January, the 2025 Veterinary Meeting & Expo took place in Orlando, Florida, with almost 30,000 participants from 86 countries attending.

 Among the educators lecturing to the multitude of attendees at VMX were Paul Bloom, DVM, DACVD, DABVP (Canine and Feline), Elite FFCP-III, adjunct faculty member at Michigan State University’s (MSU) Veterinary College; and Marty Becker, DVM, Elite FFCP-V, also known as “America’s Veterinarian,” founder of Fear Free, who presented the session 

Skin to Win: Making Derm Cases Less Stressful

The lecture focused on how to minimize patients’ fear, anxiety, and stress (FAS) during dermatology appointments using a Fear Free approach. To gain insight into how this can be done, 

 reached out to Bloom and Becker to talk more about their session.

How does FAS affect patients and veterinarians’ ability to treat these patients?

Pets are like 1-year-old children. They are a) taken against their will for healthcare (some call it ‘hell-care’), b) have 0 idea how any procedure benefits them, c) can't anticipate the relief of [FAS]/pain even if it's moments away, and d) can't flee the threat.

The vast majority of pets that don't go to a practice where Fear Free principles/protocols are implemented feel like they're going to be harmed or killed; the pet's mom or dad feel like they're hurting their pet by trying to help them (by taking them to the veterinarian). The end result is that pets a) don't receive the necessary care, or b) receive care but suffer severe, permanent psychological damage and unnecessary pain.

[FAS] makes it difficult to perform physical examinations on…pets. It also causes great distress when the owner sees their pet being fearful.

[If]…Fear Free techniques [are used], owners are more likely to bring their pets in for care. There was a study performed which found that 28% of cat owners and 22% of dog owners reported that they would bring their pets to the veterinarian more often if the visit was not associated with so much stress. So, it is great for the pets and great for the business.

It is a great practice-builder when owners go home and talk to their neighbors and tell them how happy their pet was to see the veterinarian. It’s better for the dogs to drag the owners into the clinics because [they will be rewarded] with food and praise than to have the owners have to drag them in.

Why are dermatology cases so stressful to patients?

 There are a number of reasons. One of the reasons is that the animals are very uncomfortable either with intense itching, or ear infections, or both. I think that their sleep patterns are disrupted because of these problems. This would make the animals less approachable, just like people who have their sleep disrupted. In addition, I believe many of these animals have pain associated with [their] skin disease, especially with ear problems. Anyone who [suffered] from [skin reactions] as a child probably still recalls the discomfort they had at that time. Anyone [who] does not believe [that] skin disease can cause pain has never had a severe sunburn.

Nerve-endings right on the surface of the skin [are] painful, infected areas [are] often very sensitive (face, feet, ears). Derm cases [are also] often chronic.

How are derm cases conventionally handled, and how should they be handled? What should be changed?

 I think that in the past when we had a dermatologic problem, we would go to the source…that was affected and examined [it], causing [the patient] to have discomfort, which then leads to escalation of [FAS]. A better way to approach it is to first befriend the animal, touching areas that cause pleasure. For example, scratching the chin or the cheek of the cat, or scratching the back of a dog. 

Also, during this time, we should have high value treats being fed to the animal, such as cheese, peanut butter, hot dogs, catnip, [Greenies], Purée Temptations, Tiki Cat Vet Solutions Chicken in Creamy Gravy. Once we have established a pleasant contact, we then start to examine areas that are unaffected and then progress to the less affected areas and finally save the most affected areas for last. During this entire time, the owner should be [at] the head of the pet stroking them, talking to them, and feeding [them].

What are some other things veterinary practices can do to reduce FAS in patients?

The key is to keep [FAS] levels low, from the living room, to the exam room, to the treatment room, and back to the living room. A myriad of animal handling techniques, sedation protocols, design features, and husbandry techniques help accomplish this. Also, preventing and treating pain is a priority.

It begins with a phone call where the [client service representatives] remind owners that if they have been prescribed pre-visit pharmaceuticals [PVPs], to be sure to give [them to] the pet prior to the visit. [Clients] are also told to bring their [pet’s] favorite toys, favorite food and if they have a favorite companion, to bring the companion with them. Lastly, we tell the owner…to make sure that the pets are not fed prior to the visit so they will be especially hungry, thereby more likely to eat and be appreciative of being fed.

When the owners arrive, rather than for the animal to come into the veterinary clinic immediately, it is best to leave the owner and the pet in the car until it is time to examine the pet. Interviews and history-taking can be taken over the phone.

I think it is very important not to separate the pets from the owners unless the owners request that because I think it increases the pet’s [FAS] and I think it also causes some anxiety and stress in the owners. Using [a] pheromone diffuser…in the exam room, along with playing classical music also will decrease [FAS]. Lastly, we try to have exam rooms for cats only so there is not smell of the dog in the room.

How should veterinarians handle cases in which the patient has an 

Stop! A) come back another day a different way (perhaps with [PVPs]), or b) go straight to sedation. I tell clients, "I'm not going to sacrifice your pet's long-term emotional wellbeing for the convenience of getting this done today.”

 Do not attempt to examine the animal because things are just going to escalate even more. They should either be sent home with some [PVPs] or given injectable sedation prior to the exam. Fighting the dog to do things will only worsen the FAS.

What are some things veterinary professionals can communicate to pet parents prior to their appointment to make the appointment smoother and less stressful for everyone involved?

 I think especially for cats, [clients] should leave their cat carriers out all the time and feed the cats in the cat carriers so that they [become] accustomed to the cat carrier. …Using pheromones in the car and in the carrier can improve the FAS. …Also, playing classical music on the radio can cause some relief. [Researchers] found that when classical music was played for…animals, they required 20% less propofol for tracheal intubation. They also found that [when playing] classical music, animals vocalized less often.

Get the carrier out a week before (not the night before or the morning of); start a magic carpet ride of pheromones from carrier, to car, to clinic; pre-heat or cool the vehicle, so go from 73 [degrees] in the house to 73 [degrees] in the vehicle to 73 [degrees] in the practice; don't baby-talk the pet on the ride; do play calming music; cover the carrier on 3 sides with a light sheet to reduce visual stimuli; only go into the practice when you can go right into an exam room; DON'T put the pet up on the exam room table unless absolutely needed (all animals’ #1 fear from birth is the fear of falling); use A LOT of PVPs; don't use harsh restraint (use considerate approach, touch gradient, gentle control).

Is there anything that we didn’t discuss that you would like to talk about or want the audience to know?

 I just want to stress that doing Fear Free techniques is a great practice-builder. Owners are impressed with the animals’ behavior in my clinic, [which] practices Fear Free techniques.

“America’s Veterinarian,” founder of Fear Free, has helped popularize the human-animal bond as well as the human-animal health connection. He

has authored 23 books—several of which have been New York Times bestsellers. For decades, he was a veterinary correspondent for major media, including network television. Becker also wrote a nationally syndicated pet/veterinary column for more than 20 years and serves as chief veterinary correspondent for the American Human Society.

In a correspondence with dvm360, Becker shared, “most don't know that I've owned multiple veterinary practices and still practice at age 70.”

, an Elite Fear Free Certified Professional with a Certified Cat-Friendly Veterinarian status, graduated from MSU in 1976 and became Michigan's first board-certified veterinary dermatologist in full-time private practice in 2001. He has received several honors, including the Distinguished Alumni Practitioner Award from MSU College of Veterinary Medicine in 2019 and the Philanthropist of the Year Award in 2020, the latter of whom he received alongside his wife. He is also a Fear Free Certified Professional and a Certified Cat-Friendly Veterinarian. In addition to his clinical work, he lectures internationally and has authored many book chapters. He also serves on the program committee for the American College of Veterinary Dermatology.

VMX 2025: A record-breaking celebration of innovation, education, and thought leadership in veterinary medicine. News release. North American Veterinary Community. January 30, 2025. Accessed February 4, 2025. 

https://prnmedia.prnewswire.com/news-releases/vmx-2025-a-record-breaking-celebration-of-innovation-education-and-thought-leadership-in-veterinary-medicine-302364497.html

In this Q&A, Marty Becker, DVM, Elite FFCP-V and Paul Bloom, DVM, DACVD, DABVP (Canine and Feline), Elite FFCP-III share extensive advice on how to minimize fear, anxiety, and stress in patients