Spring into Skin: Supporting your clients

We’re coming to the end of our “Spring into Skin” season now, and we thought this might be a great place to recap some of the key points that have come up from Sarah’s webinars. Remember, allergic skin disease is a marathon, not a sprint; and maintaining both the patient’s and the client’s quality of life is the key. So, what messages are there for our clients in this?

Allergic skin disease is never one-size fits all

This is a complex disease, with multiple causative factors. Genetics, lifestyle, environment, dysbiosis and flare factors combine with skin barrier dysfunction and a failure of tolerance to mean that every animal’s allergies are, to a greater or lesser extent, unique to them. We may even find acute and chronic disease coexisting in different parts of the same patient.

However, it is increasingly clear that skin barrier failure leads to skin inflammation, which leads to skin barrier failure… a really vicious cycle. So management of both dermal inflammation and skin barrier dysfunction are important common pathways for managing any allergic skin disease patient.

Client compliance is key – but for good compliance, you need good concordance

With such a complex disease, inevitably some clients will lose patience, or mistake natural waning of symptoms for a miracle cure. Many of the drugs we use have very long lead times before effects become apparent – a 9-12 month course of immunotherapy is recommended, for example, and 6-8 weeks for essential fatty acids, before effects become significant.

As a result, keeping the client “on-side” is essential if we are to manage the patient’s condition effectively. And that means that they have to understand the issues, the costs and benefits… and that we have to listen to them about the limitations and problems they face. So make sure your clients are fully prepared for a long haul… and schedule plenty of follow-ups, face to face if possible.

While atopy is a clinical diagnosis, patient-side laboratory techniques are invaluable

While allergic skin disease is a clinical, not a laboratory, diagnosis, allergy tests (both skin-prick and IgE) definitely have their place, especially in terms of determining allergen avoidance strategies and immunotherapy. However, even “basic” cytology for yeasts and skin bacteria are invaluable tools that should not be neglected.

The treatment plan can, and will, change!

There might be a flare up; there might be a change in allergens as the seasons roll round; it might be that the patient doesn’t respond well to a particular drug. So don’t be rigid, be prepared to reassess and change the plan.

Every patient needs their own, personalised and tailored, treatment plan

Of course, clients (rightly!) want the “cure”. But the more we learn, the more we realise that what works for one dog or cat, may be ineffective for another. But for the vast majority of patients, there is an effective cocktail of interventions – anti-pruritics, immune modulators, immunotherapy, allergen avoidance, and rescue therapies. It’s just a case of finding out what will work for that individual.

Allergic skin disease is becoming more common

6 out of 10 of the most popular dog breeds are predisposed to allergic skin disease. While, historically, we would expect to see 10-15% of the canine population suffering from some form of allergic skin disease, it’s probably more like 15-20% now. This isn’t a problem that’s going away.

Anything we can do to reinforce the skin barrier is likely to be helpful

Essential fatty acids with the correct balance of omega-3 and omega-6 fatty acids, while not a panacea, are invaluable in reinforcing the skin’s barrier function. They may also have anti-inflammatory properties, aiding the restoration of normal skin integrity.

Supporting a client whose pet has allergic skin disease can’t be just one person’s job

From the receptionist taking the history, or getting an update on how the patient is getting on, to the nurse staining and examining cytology slides, to the clinician managing the case: it’s all hands on deck. A true team approach can really help to pull these cases together, resulting in a happy owner and a happy, comfy dog.

And if you need an update or a refresher – check out the recordings of Sarah’s webinars.

References and further reading…

Watch the webinars! [link]

Hensel, P., Santoro, D., Favrot, C. et al. (2015), Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification. BMC Vet Res 11, 196.

Wilhem, S., Kovalik, M. and Favrot, C. (2011), Breed‐associated phenotypes in canine atopic dermatitis. Veterinary Dermatology, 22: 143-149.