How to Prepare your Patient for Dermatology Referral

How to Prepare Your Patient for Dermatology Referral
Amy Schnedeker, DVM, MS, DACVD

Dermatologic diseases, especially allergies, are one of the most common conditions seen in general practice, with frequent recheck visits and relapses of clinical signs. This can make allergies a frustrating condition for both clients and us as veterinarians. Since there can be a 4-5 week wait time for Dermatology referrals, here are some steps to take to keep your patients comfortable while awaiting referral:

Cytology Early and Often to Treat Any Secondary Infections

  • Perform skin and/or ear cytology to check for secondary infections. Remember that otitis externa and superficial/deep pyoderma are significant contributors to pruritus.
  • Ear cytology is recommended at each visit to confirm the presence and resolution of an active ear infection. Diagnosis cannot be made by odor and physical exam alone. Cytology is crucial to help determine which organisms (cocci, rods, yeast) are present to prescribe the appropriate topical ear medications.
  • Skin cytology is also recommended from active skin lesions (pustules, papules, crusts, epidermal collarettes, etc.) to evaluate the presence of bacteria, yeast, or other organisms.
  • If the patient is currently on antibiotics and has new, active lesions, an aerobic bacterial culture from the skin is recommended. This is especially important if there is a history of resistant infections.

Start Topical Therapy

  • Topical therapy is an important adjunctive (and sometimes sole) treatment for pyoderma and other dermatologic skin conditions. Shampoos, mousses, and sprays can be very helpful in removing dirt and pollens as well as its antibacterial and antifungal properties.

Rule Out Parasites

  • Always consider parasites such as fleas, ear mites, Demodex, and Sarcoptic mange as a rule-out when treating your pruritic patients.
  • Diagnostics such as superficial/deep skin scrapes and a flea comb are useful to rule in/out parasites.
  • Treat with appropriate topical or systemic medication. Make sure all pets in the household are being treated.

Control Pruritus

  • It is important to start medications to help control pruritus, even while treating secondary infections, as this is the most common presenting complaint for these patients. Common anti-pruritic options include Apoquel®, Cytopoint®, low-dose steroids, Atopica®.
  • Topical therapy can also be helpful for pruritus, as most have healing ingredients that are anti-inflammatory and help support the skin barrier.

Consistency and Thoroughness is Key

  • Reinforce your recommendations with demonstrations and hand-outs when possible.

Set Expectations

  • Prepare pet owners for the potential need for long-term therapy.
  • The most common primary cause of pruritus and/or secondary infections is allergic disease (ea, allergy, food allergy, or atopic dermatitis).
  • Allergies are never cured; they are only managed. This means that most animals relapse if the primary condition is not controlled.
  • Elimination diet trials, allergy testing, and immunotherapy are all diagnostic tests that can be performed once your patient is seen by a veterinary dermatologist.

Ask for Help

  • If you are unsure how to manage your patients to keep them comfortable until their initial appointment, contact your local veterinary dermatologist for recommendations and guidance. We are here to help!

-Amy Schnedeker, DVM, MS, DACVD