Allergic dermatitis in canines can cause quality of life issues for patients and lead to caregiver burden for pet owners. Complex cases can also be frustrating for clients and veterinary teams.

Understanding condition management frustrations and the unique experiences of patients, pet owners and veterinary teams can help guide treatment plans. In an educational session at the 

2024 Fetch dvm360 Conference in Long Beach

, California, talk, Brittany Lancellotti, DVM, DACVD, a Fear Free-certified practitioner at Veterinary Skin and Ear in Los Angeles, California, provided insights about these experiences from different perspectives.

Quality of life (QOL) can decrease for an animal with allergic dermatitis, while also elevating the pet’s fear, anxiety and aggression. Dogs with the condition have also shown a significant decrease in trainability, according to Lancellotti.

In addition to emotional behaviors, clients may observe in pets with allergic dermatitis scratching, licking, chewing, rubbing, biting, head shaking, scooting or nibbling—all of which can worsen clinical signs of the disease. Allergic dermatitis can also cause disruptions in a pet’s play behaviors, in the job performance of working animals, and in sleep, Lancellotti added.

Those effects create an important welfare issue for these animals. However, Lancellotti said that early recognition of behavioral problems that may be associated with chronic allergic dermatitis of the skin and ear can lead to improved treatment outcomes and QOL for the animal and their owner and may help minimize pet relinquishment.

“The great news is that we have a lot of different options for individual relief from allergic dermatitis,” Lancellotti said. She followed with an overview of drug therapies that included glucocorticoids, modified cyclosporine, Janus kinase inhibitors, and lokivetmab.

Veterinary teams can work with clients to ascertain the best path forward with treatment plans. For example, Lancellotti said, a client that finds it difficult to clean a pet’s ear or administer medication may need to work with the veterinary team to overcome the challenge or pursue a new treatment tactic.

“Eliciting from owners any difficulties with the treatment and where the pet might be struggling can provide an opportunity to creatively troubleshoot and overcome the discrepancy between improvement of clinical signs and improvement in quality of life,” Lancellotti said.

In the lecture, Lancellotti noted that client education about allergic dermatitis should include an explanation of 

treatments are being recommended. Veterinary teams should also allow pet owners to share their concerns about the treatment plan and offer solutions to potential problems including how an animal is responding to therapies.

“There is no one size fits all treatment for these animals. Each pet is their own special snowflake, and so we'll adjust our management plan based on how that pet is responding. That means that good communication with the veterinarian is really crucial to finding a plan that works best,” she said.

Client expectations can be managed by communicating what the condition means long-term and how a pet’s QOL may be affected. Caregiver responsibilities such as expenses associated with treatment, including costs for doctor visits, condition management products and associated therapies, as well as the time commitment needed to continue addressing the condition, should be adequately conveyed.

A survey of 283 veterinary dermatology practice clients was conducted by the American College of Veterinary Dermatology in 2019. Respondents of the study—cited in Lancellotti’s lecture—reported their dogs had dermatology conditions that included pruritus, ear problems, coat changes, and skin lesions.

Results of the survey revealed that 73% of clients had visited their primary care veterinarian more than 3 times to have their pet’s dermatologic condition evaluated before being referred to a dermatology specialist. Forty-two percent of these clients reported visiting their primary care veterinarian an average of 5 times before receiving a referral.

“Now, going [to a veterinarian] 5 times and not having an answer is incredibly frustrating. Never mind the 5 times these pets are getting packed up, poked and prodded. That's also 5 times the owner has the opportunity cost of spending their time going back and forth to the vet visit. These repeat visits are just one thing that is going to contribute to caregiver burden, and that's the strain that an owner feels from the challenges of providing care to a companion animal,” Lancellotti said.

A treatment plan for managing canine allergic dermatitis should be individual to the patient since no 2 pets will respond exactly the same way to the same plan. 

"Symptomatic treatment should be aimed at targeting pruritus and/or inflammation, depending on the individual pet,” Lancellotti said. “With proper medication selection, once you understand the individual [patient] and the tools you have available, we can help relieve what that patient is going through, but also relieve what some of the owners are going through."

Lancellotti B. Quit your itchin: managing pruritis and client frustration from canine allergic dermatitis. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.

Hanna B. Earlier dermatology referral rewards primary care practice (part 1): easing client expenses and enhancing patient care. 

. May 18, 2022. Accessed December 6, 2024. 

https://www.dvm360.com/view/earlier-dermatology-referral-rewards-primary-care-practice-part-1-easing-client-expenses-and-enhancing-patient-care

Articles

In an education session at Fetch Long Beach, presenter Brittany Lancellotti, DVM, DACVD, discussed how patient, client and veterinary care providers all contribute to improving outcomes for pet with skin condition

Using experiences to guide dermatologic care

Atopic Dermatitis

At the 2024 Fetch dvm360 Conference in Long Beach, California, Brittany Lancellotti, DVM, DACVD,  explains how managing atopic dermatitis requires a comprehensive understanding of its multifactorial nature, which includes genetics, environmental factors, and the animal’s unique microbiome. 

My name is Dr Brittany Lancellotti. I am a board-certified veterinary dermatology specialist working at Veterinary Skin and Ear in Los Angeles. I'm also the founder and host of 

, a client education podcast for pet owners.

Atopic dermatitis is very complicated. This is a multifactorial disease involving genetics, the environment, and an animal's individual microbiome. When managing this condition, we have to consider the animal's clinical presentation, their comorbidities, how the disease is presenting in them, how they've responded to previous treatments, and what the long-term goals are for their care, as well as any side effects they've experienced.

We also need to think about what the animal is dealing with in terms of non-dermatologic medical issues and take that into account when selecting medications. These are really complicated cases that involve not just the skin but the whole animal. There are so many factors to consider when choosing the therapy that will be most effective for a specific patient.

Videos

Atopic dermatitis isn’t just a skin problem—it’s a multifactorial disease requiring a holistic, patient-specific approach

The multifactorial nature of atopic dermatitis

Ansell Glove Technology

 Hey everyone, Dr. Adam Christman, Chief Veterinary Officer here at DVM360. I'm joined by Martin Jewell, Associate Director of Alternate Care of Ansell. Thank you so much for being here. 

We're going to talk today about something very important in our field and that is surgical gloves. As of December 2016, the FDA banned powdered surgical gloves and absorbable powder used for lubricating surgical gloves due to health risks for healthcare providers, patients, and other individuals. What arose of this ruling were companies like Ansell who wanted to make safe powder-free gloves. However, Ansell decided to take that a step further by developing various types of gloves to make them easier to use during appointments and also in surgeries. As a result, the market has shifted, with veterinary professionals now relying on powder-free surgical gloves while Ansell's innovative donning technology offers a solution for easier applications when needed. This commitment to safety and usability ensures a higher standard of care for both patients and healthcare providers. So, with that, let's talk about this. What sets Ansell's gloves apart from the competitors out there? 

The powder to powder-free happened in the human side almost 20 years ago. So, we had designed gloves with what we call DermaShield. It's our proprietary hand donning technology. It is a silicone that is compounded as we make the glove that allows the hand to don while it's damp. It works with emollients, it also works with sanitizers, so that you're not blocking and you're not breaking through gloves when you're donning. You have less waste, you can perform your procedure faster and better. 

Excellent. There's so much innovation and safety so how has this evolved in the types of gloves that we have today? 

Well, today is no longer just a white surgical glove with no donning. We've evolved into micro gloves, we have textured surgical gloves. We also have synthetic ranges for folks with latex allergies. So, we have neoprene, polyisoprene, and we have PI hybrid, which is a combination of neoprene and polyisoprene for those with latex allergies. But our whole range of products, one of the things that we feature on each of our gloves are the DermaShield technology and then we also have what's called sure-fit technology. That's to prevent the cuff from rolling down because you've got a slick polymer on a gown and you can have cuff roll down and then you can compromise your sterility. If you notice, we have an ergoform technology on our formers so that means less hand fatigue, less worked time off, less problems with your hands and strength. So, this particular glove that you're looking at, I don't know if you want to try to put that on, that is an Encore micro glove. 

We found that within the vet procedures, and you see how nicely that goes on, now that was a dry hand but we'll take it with a damp hand as well. That is a glove that was designed for cardiovascular, peripheral vascular surgery years ago and ophthalmics. You notice the color’s brown because folks work under light. They don't want the glare. It's 20% thinner so you can feel the small suture and the small needle as you conduct your procedures no matter how small or how fragile that procedure is. 

That's great. I'm thinking of the ophthalmology procedures too with such delicate tissue and the suture material is so fine and you can definitely feel. I have good dexterity with it so that's pretty good. I like it.

 Yeah. Then the next step from that is if you have spay and neuter procedures and you're using animals with a lot of fatty tissue, we have a fully textured very aggressive latex surgical glove. Orthopedics now are becoming more common in the veterinarian practice. So, we have thicker orthopedic gloves. Double-gloving has become sometimes a priority. So, we have an under-glove, we have a glove-in-glove double-glove system out of the poutch, the only one out of the pouch and the only one in the world. And while we do this, we keep all of the things that are so important now to environmental and safety and social governance on our packaging and our missions. We want all of our packaging to be fully recyclable. By the year 2026, we're going to reuse the water and all of our plants are employed. We own and we employ those individuals there. We have our research and development centers there and we do our own sterilization there. That's a big deal now. After seeing the global shutdowns, we have three manufacturing facilities in three different countries, each with their own sterilization ability. So that gives us a lot of flexibility in the future.

That’s fantastic. And I hear something about WEI, what does that say? 

That’s really just the whole umbrella: the worker improvement and the technology of all of our technologies combined together under our one umbrella with Ansell. So, the DermaShield is what enhances the gloves’ ability to go on a damp hand and where that really comes into play is if you're doing repetitive surgeries over and over and over and you're scrubbing and you're going back and forth and you're getting gloves on your damp hand, you don't have to stop. You don't have rips and tears, you don't have the waste, and you've got the ergo form technology on the gloves, so you've got a more comfortable feel as you go through the work day. 

 That's fantastic. So much easier for workflow. And talk to me more about the Ansell sure-fit technology that's available. 

The sure-fit technology is to ensure that when this is up over a gown, that it's a sticky band on the inside of the glove, so that it does not roll back down, and it does not compromise the surgical technique of the procedure. So, you know all of these technologies together make a better experience with using our gloves. 

 Excellent. Nice. I see that we have a lot of products over here focused on safety. Tell me a little bit about that. 

Well, this is our Sandel® safety solutions line. We have a whole portfolio of safety solution products that were designed by healthcare workers. All of these ideas for products came from healthcare workers and these are designed for never events in the OR space. We’re sharing that more now in the animal health space to make sure you're doing the correct procedure on the correct patient and on the correct body part. 

Working on the right leg and sort of the left leg and so forth, those are excellent. 

Just following more with the OSHA guidelines that are required now for the veterinary hospital. We also have a full offering of non-latex disposable examination gloves. Dental practice has become very prominent now, and so we have half sizes in our exam gloves, so that is a big thing. If you can't find your fit, we've got the small mediums, and we've got the medium and the smalls that I call this smediums. 

 Oh, that's great, I didn't know that. Wow, that's really cool. And where can we learn more? 

 for our surgical gloves and our examination gloves, and you can go to 

 Great, thank you for all the great work you and the company do. Thank you for being here. 

And thank you for tuning in here, Products360. We'll see you next time. Take care, everybody.

How Ansell's innovative surgical glove technology has been applied to the animal health world. 

The evolution of surgical glove technology

The 4 P's

At the 2024 Fetch dvm360 Conference in Long Beach, California, Kelley Detweiler and Peter Weinstein gave 4 lectures on controlled substance compliance for veterinary practices. In a pre-conference interview with 

, the pair shared how focusing on "the 4 P's"—people, processes, paperwork, and products—practices can have a simplified framework for remaining compliant and avoiding DEA violations.

Kelly and I were talking about veterinary practices and the different components of them when it comes down to controlled substance compliance, and it just felt natural to talk about people and processes and paperwork and then the products, because that's really it—it wraps around the veterinary practice. So really, the fifth P is practice, and people, products, processes, and paperwork are what you need to be in control of to remain compliant.

We take each of those areas and dive into them to help you understand what you need to do: to have your people under control, to have your products under control, to understand what products you need to be concerned about, and to recognize that paperwork will either cover your assets or kick your assets.

When it comes down to processes—and I'm a big process guy—if you learn how to do things the same way each time, every time, all the time, you can prevent problems (if you want to keep with the alliteration). From that standpoint, yep.

And I'll say that one of the key elements, keeping with the alliteration, is how Dr. Weinstein instills this concept of the Four P's. It's a perfect breakdown for replication and driving home the 4 P’s. We're just constantly trying to drive it in a memorable way, keeping it simple.

Veterinary practices can simplify controlled substance compliance by focusing on 4 essential pillars

The 4 P's of controlled substance compliance: people, processes, paperwork, and products


Microbiomes—the communities of microorganisms such as bacteria, fungi, and viruses residing in and on various parts of animals and humans and in the environment—are integral to health and disease. In recent years, significant advances have been made in understanding the human microbiome. However, a growing area of research is exploring the microbiomes of pets and the complex relationships shared with the microbiomes of their human counterparts. For veterinary professionals, this interconnected microbiome frontier holds profound implications for both animal and human health.





Human microbiomes are primarily concentrated in various body niches, including the gastrointestinal (GI) tract, skin, oral cavity, and respiratory system. These microbiomes influence numerous aspects of health, from digestion and nutrient absorption to immune system modulation and pathogen defense. Dysbiosis, or the imbalance of microbiota, is linked to a variety of conditions such as inflammatory bowel disease, allergies, and even mental health issues.


Similarly, pets, particularly dogs and cats, harbor diverse microbiomes that are crucial for their overall health. The GI tract of pets is home to complex microbial communities that aid in digestion, nutrient absorption, and immune function. Skin and oral microbiomes play protective roles against pathogenic bacteria infections,

 and maintaining homeostasis of the skin and oral cavities.

 Understanding pet microbiomes can provide insights into common veterinary conditions such as allergies, GI disorders, and skin infections.





Pets and humans share several microbiome-associated phenotypes such as obesity, gastric inflammation, and chronic kidney disease. On the other hand, there are microbiome-relevant characteristics special to each host, such as their unique nutritional requirements. For instance, companion animals do not rely on the microbiome for energy production the way humans do, and cats require more protein in their foods compared with dogs and humans, who consume more omnivorous diets.

 The microbial communities that assemble in each host environment have evolved to adapt to that host’s physiology and food intake while also playing a role in modulating host processes such as disease and metabolism. Although there are common microbial members residing in the gut microbiome of cats, dogs, and humans, there are also microbial species unique to each host.

 Some microbial species that are present in both companion animals and humans carry different genes, which may enable them to perform different metabolic or protective functions. This indicates host-specific evolution of microbes to thrive and contribute tailored functionality to each host.





Although the amount may differ from one individual to another, it is common for people in the modern era to spend more than 90% of their time indoors.

 Humans often share the same living environment with their pets, facilitating the exchange of microbes. Findings from studies have shown that pet owners often share more microbial similarities with pets in their household compared with pets in other households.

 This bidirectional transfer occurs through direct contact, shared surfaces, and even the air.

Companion animals can also be carriers of environmental microbial species, especially those who live both indoors and outdoors. One study looked at the microbial composition in the home environment in homes with dogs, cats, or no pets.

 The homes that had dogs had increased microbial diversity when compared with homes with no pets, and homes with cats fell in the middle in bacterial diversity and richness.

 This makes sense considering the vast majority of cats spend their time indoors and are not exposed to additional types of bacteria in the outdoor environment.

Often, when we think about the exchange of microbes, we think about the transmission of pathogenic strains such as Clostridioides difficile, Campylobacter spp, or Escherichia coli.

 However, the transmission of commensals, the beneficial or neutral resident microbes, between humans and pets is an emerging field of study due to the potential positive effects of microbe sharing.





Sharing microbiomes has potential health implications. Pets can contribute beneficial microbes that enhance human microbiome diversity, potentially offering protective benefits against certain diseases.

 Conversely, pets can also be carriers of pathogenic microbes. Findings from one study discovered that bacterial species causing periodontal disease in the mouth could be transmitted between dogs and humans.

 As a result, a balanced approach to pet ownership and hygiene is essential.





There is compelling evidence to suggest that early-life exposure to pets can influence the human microbiome in ways that reduce the risk of allergies, otherwise referred to as immunological priming or the hygiene hypothesis.

 Pet ownership, particularly of dogs, has been associated with a decreased prevalence of asthma and allergic diseases in children.

 This protective effect is thought to be mediated by microbiome-induced immune modulation. Children who lived with pets in the household had higher microbial diversity of their gut microbiome.

 On the other hand, children who developed asthma by the age of 7 years had a low total diversity of the gut microbiota during their first month of life when compared with children who did not develop asthma.

 Therefore, early-life exposure to pets appears to play a role in shaping the human microbiome and potentially lowering the risk of developing allergies and asthma.





The One Health concept emphasizes the interconnectedness of human, animal, and environmental health, with a growing focus on microbiome research. Scientists are investigating how our shared environment affects health, including the roles that pets play. This research holds significant therapeutic potential, such as developing probiotics, prebiotics, and other microbiome therapies such as the use of postbiotics or metabolic products, to enhance human and pet health. It also informs better hygiene and pet care practices, thereby reducing disease transmission risks and amplifying health benefits for both humans and pets. However, close human-pet contact can promote the exchange of antibiotic-resistant bacteria, resulting in hard-to-treat infections.

 This underscores the importance of careful antibiotic use in both human and veterinary medicine. By understanding these dynamics, strategies can be devised to control the spread of resistant bacteria, preserve antibiotic effectiveness, and protect the health of both humans and their pets through focused interventions.





More extensive and detailed profiles of pet microbiomes across different species and breeds are essential to understanding the full scope of their role in health and disease. Microbiome sequencing, combined with specific experiments, can answer many important questions about pet health. These include:

What external factors affect the pet’s microbiome?

How do these factors change the variety and balance of microbes?

How do different microbes move and spread between the pet and their owner?

Which specific microbes or groups of microbes are important for keeping pets and their owners healthy?


Advances in sequencing technologies and bioinformatics will be pivotal in the effort to answer these questions in our quest to better care for our pets.




Long-term studies tracking the microbiomes of pets and their owners can provide deeper insights into how these microbial communities coevolve and influence health over time. Such research may identify key microbial markers associated with disease prevention or progression.





The intricate relationship between human and pet microbiomes represents a fascinating and highly relevant area of study for veterinary professionals. This interconnected microbial world not only influences the health of pets and their owners but also opens up new avenues for preventive and therapeutic strategies. By embracing this holistic perspective, veterinarians will be able to enhance animal care and contribute to the broader understanding of microbiome health across species. The journey into the enigmatic realm of microbiomes is just beginning, and it promises to bring transformative possibilities for both veterinary and human medicine.






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The intricate relationship between human and pet microbiomes represents a fascinating and highly relevant area of study for veterinary professionals. 

Exploring the interconnected world: The relationship between human and pet microbiomes

We are seeing younger, successful owners selling their practices so what do you think is driving this trend and why is it a myth that selling your practice is only for those "older"  or "ready to retire?" 

It's a great question and we are seeing much younger practice owners looking to sell nowadays. With Transitions Elite, the youngest we worked with is 36 years old. The co-owner was 39 years old. What was really driving them was they came to the conclusion after they stood back one day and really asked themselves, "why?" They had thriving multiple locations and everything was going well. They were comfortable. They had to ask, "how much money did they need to make? How many sacrifices do we need to make? We have young families. What is our why? Is this it? Is this all we can expect for the next 20 or 30 years?" With these younger people focused on quality of life, when you say to them that with one decision you can have it all. You can still continue to be a veterinarian, but have much greater job satisfaction if you sell....Quality of life is really what is driving them.

Podcasts

Melani Seymour sits down with Adam Christman, DVM, MBA, to talk about a shift happening in younger veterinary practice owners.

