Jason B. Pieper, DVM, MS, DACVD talks about what goes into the diagnostic process for atopic dermatitis

Diagnosing atopic dermatitis

The diagnostic process for atopic dermatitis—one of exclusion—can be challenging. In an interview with 

on his lectures presented at the 2025 Veterinary Meeting & Expo (VMX), Jason B. Pieper, DVM, MS, DACVD, assistant professor at Iowa State University, goes into detail about this process. In this video, Pieper discusses one of the first causes of pruritus that are usually ruled out first in the diagnostic process and talks about what should follow.

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

Diagnosing atopic dermatitis is a matter of just ruling out all other causes of itching, which can be somewhat difficult at times. But one of the big things that we typically start to rule out is parasites, looking you know, whether it's fleas that could potentially be causing flea allergies. Also other parasites, like Demodex, scabies, things like that, that can cause pruritus, so that's a big one.

The other big ones we're always ruling out is infections. So secondary infections, whether it's bacteria, fungal, whether it's Malassezia or dermatophytes, those are other causes of pruritus.

Then we get to other kind of aspects of autoimmune diseases, keratinization disorders, endocrinopathies, that can also cause actually pruritus but then, you know, be kind of subsequent to that of causes. But once you rule out those, then the other aspect that becomes a little bit more difficult is ruling out food allergies. And once you rule out food allergies, you know, based on either clinical criteria or doing a good diet trial for them, then once you do that, you actually back yourself into a corner to say, ‘Yes, this dog has atopic dermatitis now,’ and you feel comfortable with that.

With food and environmental allergies or atopic dermatitis, you know, some of it can be ruled out honestly just from the history alone. If the animal is highly seasonal, that pretty much tells you it's not a food allergy, unless they [client is] feeding [them] something seasonal. So that's probably one of the things, just from the history alone, you can kind of rule out food allergies and make it easier on yourself as a you know, a veterinarian and a diagnostician.

Videos

Pinpointing atopic dermatitis in patients

Zoetis has updated the US label for Librela (bedinvetmab injection), following its submission of a supplement to the FDA, according to the company. The updated labeling is based on post-approval experience with Librela in the US since the product launched domestically in October 2023.

Librela is indicated for the control of pain associated with osteoarthritis (OA) in dogs. It is a once-monthly injectable monoclonal antibody that is administered by veterinary professionals.

“Pets are at the center of everything we do at Zoetis, and we are constantly working to support veterinarians and pet parents in ensuring they have the resources to make informed decisions for the animals in their care,” Richard Goldstein, DVM, DACVIM, DECVIM-CA, global chief medical officer and head of medical affairs for Zoetis, said in the release.

Label updates for pharmaceutical products are not uncommon, often occurring in the first few years after a launch and with real-world drug experience data gathered, according to Zoetis. The company has been working with the FDA to review real-world drug experience data and its own pharmacovigilance monitoring for safety and efficacy.

Adverse events with Librela have been reported by veterinarians and pet owners. In January 2025, the FDA alerted animal health professionals about adverse events in dogs treated with bedinvetmab injection, in a “Dear Veterinarian” letter listing neurologic signs as well as excessive thirst, urination and death.

In a public statement, Zoetis said the “Dear Veterinarian” letter was an informational update rather than a warning. “This agency review of reported adverse events is part of the FDA’s standard process following approval of any product. FDA’s communication to veterinarians is designed to inform and educate professionals and pet owners, supporting transparent and meaningful discussions about treatment decisions. The data shared with veterinarians by the FDA aligns with our own ongoing monitoring of Librela’s safety and efficacy. At Zoetis, we work closely with the FDA and other global regulatory agencies to provide context to reported events,” the statement noted.

In a recent letter about the Librela label updates sent to veterinarians and shared with 

, Goldstein noted there is no change to contraindications, warnings or precautions. However, this label update includes the addition of a client information sheet, a post-approval experience section, a section of information for dog owners, and a statement in the dosage and administration section regarding the client information sheet and potential adverse events.

The client information sheet includes medication information, monitoring guidelines and when to consult a veterinarian, according to the letter. The client information sheet is available on 

 and is being shared directly with veterinarians. The updated label and client information sheet will also be included in future distributions of the drug.

The company and Goldstein expressed continued confidence in the safety and effectiveness of Librela.

 “Every medicine has potential benefits and risks, and it’s important for pet owners to work closely with their veterinarians to weigh those appropriately and maintain an open dialogue about their pets’ experiences…We stand firmly behind Librela, and the positive impact it is having on dogs that suffer from osteoarthritis pain,” Goldstein said.

Since it was approved by the FDA in May 2023, the drug has been used to treat more than one million dogs in the US. The implementation of the label update will be immediate, according to Zoetis.

The product was first launched 4 years ago in Europe and nearly 25 million doses have since been distributed globally, according to Zoetis. In a release, the company has said no individual adverse event signs have been reported at a rate higher than “rare” under European Medicines Agency (EMA) standards, with less than 10 occurrences per 10,000 doses.

 have also stood by the drug’s safety and efficacy. Although some post-injection adverse effects such as itching, loss of appetite, and head tremors were reported in some cases, they saw no serious adverse effects in these patients, while quality of life was noticeably improved.

Zoetis is continuously providing veterinarians with resources that include data, research and access to leading OA experts, according to the company. More than 1000 medical education webinars have been hosted by Zoetis in the past year to support veterinarians’ knowledge and understanding of how to use its products. The company has also held frequent Librela ‘office hours’ with Goldstein to address questions from veterinarians, and has field veterinarians assigned to regions in the local markets it operates in to provide additional support.

Zoetis announces US label update for Librela (bedinvetmab injection), a treatment to control canine osteoarthritis (OA) pain. News release. Zoetis. February 4, 2025. Accessed February 4, 2025. 

https://investor.zoetis.com/news/news-details/2025/Zoetis-Announces-U.S.-Label-Update-for-Librela-bedinvetmab-injection-a-Treatment-to-Control-Canine-Osteoarthritis-OA-Pain-2025-iu22I1cCqp/default.aspx

Bautista-Alejandre A. FDA notifies veterinarians of adverse events linked to canine osteoarthritis treatment. 

. January 8, 2025. Accessed February 4, 2025. 

https://www.dvm360.com/view/fda-notifies-veterinarians-of-adverse-events-linked-to-osteoarthritis-treatment

Zoetis statement on the safety of Librela. Zoetis. December 18, 2024. Accessed February 4, 2025. 

https://news.zoetis.com/press-releases/press-release-details/2024/Zoetis-Statement-on-the-Safety-of-Librela/default.aspx

Coppock K, McCafferty C, Yankowicz S. Animal health company assures veterinarians that OA drugs are safe. 

. April 16, 2024. Accessed February 4, 2025. 

https://www.dvm360.com/view/animal-health-company-assures-veterinarians-that-oa-drugs-are-safe

Articles

Librela (bedinvetmab injection) is a monthly injectable monoclonal antibody, for which real-world drug experience data has been collected in the past year.

Drug label is updated for pain management therapy

Lindsay Starkey, DVM, PhD, DACVM (Parasitology) explains the common misconceptions pet owners can have about feline parasite prevention

interview with Dr Lindsay Starkey

According to the American Heartworm Society, only 5% of cats are on year-round heartworm disease prevention.

 Although there can be many reasons that these patients are not being given year-round heartworm disease prevention, one thing veterinary teams can do to help is discuss common misconceptions with clients. But what are they?

In this video with dvm360 prior to her lectures at the Veterinary Meeting & Expo (VMX), Lindsay Starkey, DVM, PhD, DACVM (Parasitology) shared the common misconceptions she hears when it comes to heartworm prevention in feline patients.

Linsday Starkey, DVM, PhD, DACVM (Parasitology): 

So there are a couple of big misconceptions about just vectors and vector control in general when it comes to cats, and they kind of center around the same thing, that the cat is at little to no risk for interactions with vectors because they live an indoor, or predominantly indoor, lifestyle, so fleas and mosquitoes and ticks can't come inside, therefore my cat is safe. Absolutely not true. I catch mosquitoes in my house routinely, and they can even bite through the screen window. If you have a cat that likes to sunbathe and press its body as closely to the outside as possible in that window, fleas obviously just reside indoors just fine. 

So if you get that infestation started, it could absolutely be a problem. In my own personal cat, when I was in veterinary school, [my cat] got a flea infestation because I got a dog and he was on good flea control, but [my] cat wasn't, and so [the] cat turned into the flea reservoir in the house. And then ticks too can hitch a ride indoors. Some ticks actually do survive indoors. And then that indoor only cat is rarely indoor only. They like to try to go outside and escape on you, or maybe they actually do have a Catio, or go on leash walks, or just get to go outside, but predominantly spend their time inside, and therefore the owner classifies them as indoor only because of the way we phrase that question. 

Take 5 on Feline Heartworm Disease. American Heartworm Society. Published 2025. Accessed February 3, 2025. https://www.heartwormsociety.org/resources/vet/infographics/632-take-5-on-feline-heartworm-disease

During this interview with dvm360, Lindsay Starkey, DVM, PhD, DACVM (Parasitology), shares some of the common misconceptions she hears surrounding feline heartworm prevention

Feline heartworm prevention misconceptions

Jen Sheehy, DVM, BCPA, discusses research on heartworm surveillance presented at the 2025 Veterinary Meeting & Expo.

Analyzing heartworm surveillance

Jenifer Sheehy, DVM, BCPA, medical lead, canine parasiticides at Zoetis, presented recent research on heartworm surveillance at the 2025 Veterinary Meeting & Expo (VMX), hosted by the North American Veterinary Community. She also discussed research insights from a new study in an interview with 

The following is a transcript of the video:

: With changes in micro climates, natural disasters, and dogs and cats being transported widely, we hope that more practices will be willing to participate in the future surveillance studies, not only for heartworm, but also for ticks and other vector borne diseases.

The biggest takeaway for us is that resistance is spreading geographically. The study found that resistant markers were as far north as Michigan, as far east as New Jersey, as far west as Kansas, and everywhere in between. So resistant isolates have now been identified quite a far distance from the Lower Mississippi River Valley, and in regions with endemic heartworm, every unprotected dog becomes a potential reservoir for resistance. 

I think it's really, really important that we all start to think of ourselves as shepherds for surveillance. This is a great opportunity for us to participate in the lessons that we can learn and in the information that we can share with each other.

Jenifer Sheehy, DVM, BCPA, presented new research on heartworm surveillance at the 2025 VMX event, and discussed study insights in an interview with dvm360.

For as long as I can remember, I wanted to be a veterinarian. In 10th grade, when I heard there was a position tailored for high school students interested in veterinary medicine at the emergency veterinary hospital in my area, I jumped on it. This hospital was like nothing I had seen before: triage rooms, in-patient wards, oxygen cages, and I knew that this opportunity would be life-changing for me. There, I would also go on to witness the first euthanized dog in my career.  After my interview, I was offered a hospital assistant position, where I ensured documents were filed properly, laundry and dishes were clean for patients, rooms and treatment tables were cleaned, and medical supplies were stocked. However, that was just the beginning of what I would do there.

Walking into a veterinary hospital to work at 16 years old was surreal to me; it was a moment I had always dreamed of. Prior to working there, I had no knowledge of how a veterinary hospital ran. I would keep to myself at the start, only asking questions to the other hospital assistants who were training me. As I got more comfortable in my role, I began slowly talking to the technicians, asking them about the procedures they were doing, supplies they were using, and what I could do to help. These small interactions opened a door for me into this field; my coworkers and doctors began to know my name and talk to me about veterinary medicine.

I worked as a hospital assistant for 2 years, and in that time I gained various responsibilities that were not in my traditional job title due to being curious and asking questions. By the end of my time in this position, I was answering phones, aiding in triage by taking patient history during emergency situations, walking and feeding patients, setting up kennels, and processing end-of-life care. As I got more involved in patient care, the doctors began explaining to me what they were doing and why it was needed. 

Once I turned 18 and finished my first year of my undergraduate education, my supervisor asked me if I wanted to apply to be an animal care assistant (ACA), where I would be working directly with the patients, triaging emergency cases, assisting with procedures, taking vitals, administering and filling medications. In this role, I got to experience the next level of veterinary medicine! I now could begin to gain clinical skills that I had observed over the prior years. One of the most beneficial parts of working at the hospital in a different position was that I already knew the veterinarians and technicians, so they wanted to teach me new skills. This position is where I gained most of my experience leading into veterinary school as I began to learn differentials, diagnostics, and treatment plans for common emergencies.

This hospital is where I met my veterinary mentors who wrote my letters of recommendation for various internships and veterinary school. The experience I had at this emergency hospital would never have happened if I had not taken an opportunity that pushed my boundaries at 16 years old.

Every milestone that a pre-veterinary student, veterinary assistant, and veterinary student has can be intimidating to begin, and I am still experiencing this being in my first year of veterinary school. However, this experience showed me how to comfortably push my limits and be curious and ask questions. Beginning as a hospital assistant showed me all the work that has to be done to keep a hospital running, and I took that with me in my position as an ACA. As a veterinarian, I want to ensure that all employees feel valued. I also want to be a mentor to them, as my veterinarians did for me during these years. In addition to the clinical experience I gained, I think the most important thing I learned is the kind of veterinarian I want to be. The years in these positions shaped me as a person and showed me the kind of veterinarian I strive to be.

Paige Varney is originally from Rochester, NY. She is a first-year student at Tufts University Cummings School of Veterinary Medicine in North Grafton, Massachusetts. She earned her Bachelor of Science in animal science at SUNY Cobleskill in New York. She is interested in pursuing a career in internal medicine after graduation.

dvm360 student ambassador Paige Varney shares how an early veterinary hospital job led to a wealth of experiences and opportunities

My experience in emergency medicine

Susan E. Little, DVM, PhD, DACVM, shares one of the most important things veterinarians should recognize regarding the surge in tick populations, and more

About the recent boom in tick populations

, Susan E. Little, DVM, PhD, DACVM, Krull-Ewing professor of parasitology at the Center for Veterinary Health Sciences at Oklahoma State University in Stillwater, talks about her lecture 

, presented at the 2025 Veterinary Meeting & Expo (VMX). Little discusses the boom in tick populations over the last decades, as well its driving factors and the risk of tick-borne diseases in pets.

The increase we've seen in tick populations in the last few decades has just been incredible. I mean, I think it was beyond what anybody's estimations were in terms of what the tick explosion was going to look like, and so we've got more ticks, more places. They've moved up in latitude, up in altitude. The geographic spread has just been phenomenal, and there's a number of reasons for that. We've certainly seen habitat change and increased wildlife host populations, right? So that leads to increased ticks and ticks [in] more places.

We've seen introduction and establishment of new species, and so those have taken off because they found a welcoming environment with the habitat and the host there to feed them. And then we're also dealing with the effects of climate change, and so we've got earlier springs, later falls, milder winters. I know it doesn't feel like it right now, but on average, our winters are much milder than they've been historically. And so with that increased temperature, the ticks have really taken advantage of that. It gives them more degree days to be out there, finding a host, feeding on a host, and if they find a dog or a cat that's not protected with tick control, they're going to take advantage of that.

Susan E. Little, DVM, PhD, DACVM, shares important things veterinarians should recognize regarding the surge in tick populations, and more 