306. Preventing pyoderma in your allergic patients

Welcome to the Durant Vet Podcast where PET skin is always in. I'm Dr. Ashi Buzwa, board certified veterinary dermatologist, skin nerd, and your go-to guide for everything itchy, smelly, and inflamed. I'm here to take the itch out of your day and make Durant more fun than frustrating. Grab your microscope and let's focus in. Welcome to another episode of the Durant Vet Podcast. I am recording this the first like week back to normalcy after holidays and our kids being on winter break and they go back to school tomorrow. And I don't know about the rest of you who are parents who have juggled the last few weeks. It's exhausting for everybody but I know I am exhausted. It is a lot. You know, holidays are wonderful. I bird days right around Christmas. I love celebrating, you know, New Year's and spending time in the mountain, which is what we usually try to do around that time. But the reality is getting back in routine is good. So as I we are getting back today before our kids go back to school tomorrow at the time I'm recording this podcast. My husband took them to Piano Lessons and I said you know my priority is making sure I get this podcast recorded for you guys. So you are kind of my kickoff into getting back in the routine which is good for those of us in the United States. The beginning of the year is always a bit busy because it tends to be like some of the heavy conference season for us speakers. So I but I am ready for it. I am ready. Have some new content for the years. As I mentioned last week, really big plans for the podcast coming in the next probably month or two. And I'm just like, we're in to go. So I hope for all of you, you had a great time. But as we're in this first week, kind of back at it, you know, you find the joy in what you do day to day and having some of that routine back. So with that, I thought it would be a great episode of the podcast to kind of go over a basic topic like allergies. One of the most frustrating things that we deal with is the recurrent pyoderma. So I wanted to go over my five ways to prevent pyoderma or at least significant pyoderma in your allergic patients. So number one is a simple one. It's an obvious one, but we're going to start with that. Get our minds into it and throw it out there. And that is make sure you're working up the underlying allergies. So we have to go through these steps, even as dermatologists, just like you guys do. So we need to start with, you know, working it up. What's the history? Is it because they pets atopic? Is it because the past of flea allergies? It because the past food allergy? Is it not allergies at all? Is there something else causing the pyoderma like hypothyroidism? Do we have multiple allergies, which I think is one of the biggest difficulties is when we have patients with multiple allergies. And I mentioned this a lot. And even as a specialist, it gets really hard for me sometimes. When I have those patients who are like food allergic and atopic, we get through that diet trial and certain things are better, but if they're not fully better, you know, do we continue on that diet or not? So it's not always super clear cut, but I do have lots of patients where, you know, they don't fully respond to the diet trial. So then the owner will focus on atopic. The owner will want to get off the food, which I totally get because a lot of these diets are more expensive. But then we're really struggling with the pyoderma. And so sometimes I'll kind of take a step back and say, well, I know your pet has environmental allergies because the food didn't completely control everything. But I'm a bit concerned they could have multiple allergies, right? Like we always want them on good flea control. In case there's also a flea allergy there. And if I'm really struggling, sometimes I go back to the food and say, I know they have environmental allergies, but in case they also have a food allergy, because all of a sudden we're just dealing with these recurrent pyoderma issues again or ears. Let's re-get back on that diet and just kind of see where we end up. And those are sometimes the difficult ones because those pets get really expensive for owners, right? Sometimes they have all three of flea allergy, food allergy, and environmental allergies. But dealing with nasty recurrent, you know, metastel and resistant pyoderma is expensive and not fun for the patient either. So sometimes it is very gray and not black and white with these patients. But make sure we're going through those steps just like you guys are. So using these allergy medications is wonderful and we use them all the time too. But we still need to go through this steps to figure out what the underlying allergies are so that we can prevent pyoderma happening as often in these patients and prevent them from becoming resistant in these patients. So number one, work up figure out the underlying allergies. Number two, way to try to prevent pyoderm on your allergic patients, support the skin barrier. And we have many times talked about this on the podcast, but it is really important that we support the skin barrier. So many different ways to do that, right? We're so lucky in all the different options that we have to manage patients. I mean, we have a lot of options in dogs, not as many in cats, but there are still some. So it's really important that we consider what it's going to be successful for that patient. So one aspect could be obviously topical therapy, which we're going to dive into a bit more in one of the other tips. But of course, topical therapy, right? Getting stuff that actually has ingredients that have been proven to help the skin like ceramides or a feature. You know, there's so many biosphere and there's so many different options. But getting things that we know have good research and literature behind them, topically, that can help restore the skin. So that's number one. Number two would be supplements. And I've talked about this many times. I'm really cautious of supplements. I used to not really use them much at all because a lot of my owners would come in and they were already using supplements that did not have any good scientific proof behind them. Sounded nice, really colorful fun packaging that had no scientific proof behind them. And I've even had companies who've approached me about lecturing or putting information out there. My first question is what literature, what research, what proof do you have? Because allergies are so complicated and are so expensive for owners, I'm all for it if it works. But if it doesn't, then I'm not going to put my name behind it as a doctor. So really make sure you have good supplements. But there are good ones out there. Redinal ultra bi-decra, derma-quin by Neutromax. I mean, they actually have studies that show they can be effective and derma-quin has the option to use it in cats as well. So supplements as long as they've got good literature and scientific proof behind them, right? Like fatty acids, we know that fatty acids can be helpful, things like that too. And then of course nutrition. So there's some diets that have really been focusing not on food allergy, necessarily as the sole purpose of it, but for skin barrier. So Hill's Derm complete being a good one. Royal Canaan skin topic obviously has been one that we've talked about that has some good studies behind it as well. And I know there's various others once out there. But those are kind of the bigger ones in the veterinary world that have good proof behind them that they can repair the skin barrier for atopic patients. And sometimes it's a mix and match in those, right? Like, you know, we are maybe doing topicals into diet or topicals into supplement, whatever makes sense, whatever that owner is able to do. Number three way to help prevent pyidermat in your patients with allergies, adjust your topical therapy accordingly. What I mean by that is we have to remember why we are using certain topical therapies. Sometimes it is not with an allergic patient. Success will not just be measured by they never get a pyiderm again, but success can be measured by they don't get them as often or as severely. And so it is really important to know why you're using certain topical therapies. So it might not be a goal for me with an allergic Frenchie as a dermatologist to say you're never going to have a crusty pyidermat ever again, but a great goal could be we're going to use this topical therapy when your pet's doing well as maintenance. And we don't need antiseptic things. We don't need chlorhexidines. We don't need these all in it, but it's just good for their skin barrier. Kind of like we talked about tip number two. But as soon as you start to notice a little redness, a little inflammation, a little hair loss, a little crossing, a little scaling, you're going to jump on to this topical therapy so that we can try to get ahead of that pyidermat when it's more mild. So you don't end up having to either see me or how the pet go on systemic antibiotic. And that is a win. You know, if we go from spring was always I need a cephalosporin a couple different times because I struggle and no matter what you do with my allergy therapy, I struggle versus hey, I watch for those little things in spring because I know that tends to happen in my pet. And I can get on top of it by switching to the chlorhexidine based product. And then when we get through that season and I'm not seeing those signs anymore, we go back to my maintenance product. Great. I mean, that is a wonderful way to manage these patients. So by adjusting topical therapy, we might be able to catch these infections earlier so that they don't have to go on systemic antimicrobials. And I love that. And a lot of times it's what they actually do in the human field is they'll kind of have the maintenance plan and then, you know, the proactive plan, like when there's a flare plan. And sometimes my discharges will actually have that. Here's what we're doing right now for maintenance. Your pet's doing great. I'm going to spread out the rejects. But if you see these signs, you know, this is the plan we actually switch to. So you can try to do that. And if that doesn't work, then they need to come in and see me. So just giving them those options that they can do. Our clients are very smart. If you set up a plan where you know that they can follow through with that, you explain why and that it might be able to save them, right? To visit cytology fee, they're going on antimicrobials. You know, if they know the reason, a lot of them will be really committed to doing that, you know, not all. But I mean, certainly I forgot my own dog's bath and she's broken out. But it's just a really great way to see if we can be proactive with managing those cases long term. So number three, adjust your topical therapy accordingly. Number four, recognize historical patterns. So this is mostly with patients that have atopic dermatitis. But recognizing historical patterns, we talked a little bit about this with topical therapy, right? So adjust your topical therapy when you start to notice mild signs of infection. But the other thing is getting owners to help recognize historical patterns or looking through the history of when you see these patients so that you can kind of make sure the owner knows, hey, I can tell your pet is on immunotherapy and they do great a lot. But you often have to see me early spring for an infection or a flare. So why don't we make a plan that as soon as early spring hits, that's when we start the jack inhibitor or that's when you need to be on the lookout. So as soon as you notice a little bit of itching that's increasing, you bring them in for a side of point injection. So it's really important that we make sure that we recognize those patterns because that can be really helpful. Sometimes you can just adjust topical therapy, but sometimes the plan isn't that we're always going to have the exact same medications year round. We can do okay on this for a good chunk of the year. But when we have a season that we know is a struggle for them, like this may be the medication we need to be on for that month, two months, three months. And that's often what we do with things like immunotherapy. It's great when patients don't need anything else, but often they still need a little help in certain times of the year, but it makes it so we don't always have to be on a traditional medication. So recognizing those, looking to see, hey, you always get an ear infection in March, you know, you always break out in the fall. So this is how we're going to change your plan proactively, whether they want to do it as soon as that month hits or if they just want to be the lookout and more aware at that time, I've had owners actually set like calendar reminders, like we hit October where falls always a bit tough for them and they'll say like, you know, be on the lookout for itch or schedule a side of point injection, whatever works for that pet. So recognizing those those historical patterns give me super, super helpful because if we clinically manage their allergies or hope is they don't get a pyoderma and it's usually a marriage of both of those, the adjusting copical therapy, if they do notice minimal, minimal signs, we can do that with and recognizing historical patterns of when they tend to struggle so that we can from a whole sense manage that, that patient effectively. So they're comfortable and so that they don't get pyodermas readily. And then the last one is referring these allergic patients early, right? We're just focusing on allergies here. So we're not even talking about the fact that allergic patients can have other things that can cause pyoderma like endocrinopathys or various immunosuppress, causes of immunosuppression. But when we see these patients and we need to refer them early, it's really important to get them into a dermatologist of the can because if we can allergy test them early, if we can get ahead of their disease, which is a progressive disease over time, we're going to hopefully minimize them breaking out, which is why we're such huge advocates for immunotherapy and allergy testing, even if they're not complete disasters and train racks. If we allergy test them and desensitize them earlier, we're hopefully saving them some heartache in the long run. So the top five things that I want you guys to think about to prevent are minimize pyoderma in allergic patients. Number one, work up the underlying allergy, especially if there's multiple allergies that are there. Number two, support the skin barrier, whether it's topical, supplements, or nutrition. Number three, have an adjustment to the topical therapy plan that your owner knows about that they can do in early signs of pyoderma. Number four, recognize historical patterns, especially for your patients that have environmental allergies. And number five, if you're able to refer these cases earlier so we can try to desensitize them and prevent these issues from happening as aggressively as they can in some of these patients long-term. So as we kick off, being in 2026, hopefully that is helpful. It gets you excited to manage some of these allergy cases I know for us. Spring is not that far away. It feels like, well, just winter just started. But man, March in those spring polons come rare and faster than I ever realized every year. So we want to be on the lookout. We want to think about these allergic patients now. We want to educate owners about them now. And I can't wait to see how you guys put these into practice in your own clinic. And I can't wait to bring you some new exciting things to the YouTube and to the podcast over the next month.