Small Animals

Chronic recurrent otitis is an extremely common presentation in dogs and cats, causing pain and pruritus in our patients and significant distress in owners. A successful approach relies on the correct identification and correction of the underlying primary disease as well as the identification of secondary and perpetuating factors. Many patients also have an otitis media component that is frequently underdiagnosed due to the lack of neurological signs, yet acting as a source of perpetuation of the infection. Dr. Nuttall¹ describes the common challenges encountered when dealing with otitis cases and provides tips on how we can improve the management of frustrating cases of recurrent otitis externa.

Many of these patients have allergies as underlying disease and it can be a challenge to determine whether the trigger is an environmental allergen or a food source, as those conditions can look clinically indistinguishable. To the great frustration of owners and clinicians, there is currently no diagnostic test for allergies. So, at this time, there are no alternatives to a food trial to determine whether foods play a role in the clinical signs of our patients. Dr. Jackson² highlights the current knowledge on this topic, addressing the issue of cross-reactivities among different protein sources, the pros and cons of hydrolyzed diets, and how critical client education is for the successful completion of these trials.

For patients diagnosed with environmental allergies experiencing prolonged allergy seasons, immunotherapy is still the best option to reeducate the immune system. Dr. Mueller³ provides a systematic review of allergen-specific immunotherapy in small animals, encouraging clinicians to utilize this option to proactively decrease flares of disease in the long term.

Dr. Rosanna Marsella

Citation: Journal of the American Veterinary Medical Association 261, S1; 10.2460/javma.261.s1.s4

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Dr. Rosanna Marsella

Citation: Journal of the American Veterinary Medical Association 261, S1; 10.2460/javma.261.s1.s4

• Download Figure
• Download figure as PowerPoint slide

Dr. Rosanna Marsella

Citation: Journal of the American Veterinary Medical Association 261, S1; 10.2460/javma.261.s1.s4

• Download Figure
• Download figure as PowerPoint slide

Providing immediate relief to pruritic patients is critical for the pet and the owner. Much progress has been made in recent years on providing new treatment options. It has now been 10 years since the launch of oclacitinib in the US, and it is timely to provide an evidence-based review of what has been published on oclacitinib, what we have learned using this medication, and where we go from here. Owners and clinicians frequently ask questions about this medication so it is important to have clear and science-based information to answer their questions. A group of dermatologists with extensive clinical experience worked with me to put together this information, and we hope that you will find this review⁴ useful.

Moving from allergic diseases to immune-mediated conditions, Dr. Bizikova⁵ reviews autoimmune and immune-mediated diseases that manifest with ulcerative lesions in the oral cavity, providing guidelines on how to successfully diagnose these conditions that may look very similar to each other.

Equine

Pastern dermatitis is a common dermatological presentation in horses. As there are many etiologies for pastern dermatitis, making the correct diagnosis and successful management can be a source of frustration for clinicians and owners. Dr. Gerber⁶ provides us with a complete review of this multifactorial syndrome, highlighting risk factors, common primary causes, and options for treatment.

Pruritus is another common reason for owners to reach out to veterinarians and can represent a diagnostic and therapeutic challenge. As pruritus is not specific for just allergic diseases, identification of the correct underlying disease is critical to ensure therapeutic success. Dr. White⁷ has prepared an excellent article on how to approach pruritic horses. You will find a review of common diseases that should be considered when presented with a pruritic horse and also updates on pathogenesis of allergic skin diseases. He also highlights novel therapies targeting relevant cytokines like IL-5 and IL-31. It is indeed becoming increasingly clear that IL-31 is an important mediator of pruritus and allergic inflammation not just in dogs, but also in horses. In the hope of developing more treatment options for allergic horses in the future, Dr. Craig⁸ shares in this issue new research findings on the gene expression of IL-31 and its receptor in horses with insect bite hypersensitivity.

Livestock

Livestock species can also develop skin diseases and they can be very challenging to diagnose. Dr. Foster⁹ has prepared a valuable review on what to consider when presented with skin diseases in alpacas, goats, sheep, and pigs. He also covers an unusual condition affecting the antler velvet in reindeer. Whether these animals are pets or used for commercial purposes, it is important to know what conditions to consider and how to work up those cases. Dr. Simpson¹⁰ and her collaborators write in this issue to increase our awareness on how to recognize foreign animal diseases presenting with dermatological lesions in small ruminants. It is important to differentiate those diseases from common endemic conditions in the US: sheep pox and goat pox are currently foreign animal diseases in the US and it is critical to be vigilant to avoid introducing these diseases in the country. One common presentation in cows is ulcerative lesions on the teat. Proper diagnosis is critical to maximize comfort and minimize losses. As Dr. Virkler¹¹ highlights, there are many diseases to consider besides herpes, and in his narrative review he describes his experience with teat open lesions, identifying areas where more research is needed.

Exotics/wildlife

Skin diseases affect all species, including lizards. Nannizziopsis guarroi is a fungus that causes yellow fungus disease in bearded dragons and this condition can progress from skin disease to invasive mycosis and even death. The role of the environment as a source of infection has been investigated by Dr. Keller¹² and her research team, demonstrating that fomites play an important role in the transmission of this disease and that the environment should be disinfected when dealing with affected animals.

Dermatopathology

A frequent challenge for clinicians is when and where to biopsy skin diseases so I asked Drs. Craft and Rodrigues-Hoffmann¹³ to prepare a clinician-friendly article on lesion selection and biopsy handling to maximize the benefit of your dermatopathology submissions. Biopsying the right lesion makes a difference on whether you will obtain your diagnosis or receive a generic report that does not help you figure out the next step. Thus, this article is extremely important regardless of your species of interest.

One Health

Increasing antibiotic resistance and transmission across species is a very important issue for all of us. Whether you practice small animal or large animal medicine, methicillin resistance and multidrug resistance in Staphylococcus spp are of outmost importance, as these bacteria colonize the skin and nose of animals but are also found in meat sources and in the environment. They are shared among animals in the same household as well as their owners and handlers. Dr. Morris¹⁴ has researched this issue extensively and presents an excellent article on the history of the rise and expansion of multidrug resistance in staphylococci and Pseudomonas aeruginosa and on the current state of knowledge regarding the epidemiologic factors that underly the dissemination of these pathogens across companion animal populations.

Administration of antibiotics plays an important role in resistance. Since skin infections are very common and often require extensive courses, it is critical to use these drugs appropriately. Dr. Papich¹⁵ provides a paper on antibiotic use in dermatology covering small and large animals, pocket pets, and exotics. As our awareness of resistance as a result of antibiotic pressure increases, it is good practice to treat superficial bacterial infections topically as much as possible rather than systemically. Dr. Santoro¹⁶ provides us with an update on topical therapy for canine pyoderma and how we can select the best option for our patients.

It is my sincere hope that you will enjoy reading this issue and that you will find it informative and useful for your daily practice.

Respectfully,

Rosanna Marsella, DVM, DACVD

College of Veterinary Medicine, University of Florida