DERM DIALOGUE Editor: Norma White-Weithers, MS, DVM, DACVD Veterinary Allergy & Dematology Consultant, Baldwin, NY 11510 Work: 646-329-4719 | Fax: 631-694-3401 | E-mail: nweithers@yahoo.com Assistant Editor: Tim Strauss, DVM Frederick,CO 80516 | E-mail: drtim@comcast.net
FALL 2018
FROM THE PRESIDENT Dear Colleagues, Mahalo to all the many individuals who were involved in planning a successful NAVDF in Maui and to all of you who travelled to learn, meet colleagues and adopt the Hawaiian lifestyle for a few days! At the AAVD business meeting in Maui, it was my distinct pleasure, as the AAVD president, to present the Frank Kral Award for Achievements in Veterinary Dermatology, most deservingly, to Dr. Valerie Fadok.
Dr. Outerbridge
I would like to thank Dr. Norma White Weithers for all of her expertise and hard work as the chief editor of the Derm Dialogue for many years now. The Derm Dialogue first began as the AAVD newsletter in 1978, so now in its 50th year; it is an important publication, which provides the only record of the NAVDF roundtable discussions. On behalf of the AAVD Executive Board, I want to thank Norma for all of her efforts and commitment to ensuring that the Derm Dialogue has remained an important and valuable benefit of being an AAVD member. The Academy continues to support research in veterinary dermatology and this year made another 15,000 contribution to the American College of Veterinary Dermatology Research Fund. These funds are awarded as the ACVD/ AAVD Research Award. An ACVD committee evaluates all grant applications for the award. The AAVD is continuing to sponsor awards for senior veterinary students who excel in clinical dermatology during their senior year. The AAVD student award provides the recipients with a $200.00 cash award and 2 years of free membership in the Academy. We have awarded 24 student awards in 2018. The board is working on the details to offer an AAVD scholarship to members that would allow the recipient to gain clinical veterinary dermatology experience working with boarded dermatologists. Be sure to check out the updated academy website and log in to check that your information is correct. Members can log in and securely pay their AAVD dues on line, and update or modify their contact information. AAVD dues have not changed and remain at $100.00 annually for DVM members with a reduced fee for technicians and students. Membership dues reminders will go out both by email and US mail this fall. For those members that obtain their reduced subscription to veterinary dermatology through the AAVD you can still access your subscription through the website. If you have colleagues, or work with technicians or students who have a passion for continued on page 3
ROUNDTABLE SUMMARIES Cytopoint Moderator: Anthea Schick, DVM Welcome and introductions of participants. Participants. Larry Klenofsky, Debbie Simpson, Andrea Meyer, Andrea Gonzales, Larry Downs, Svenja Victe, Janet Waciechausks, Steven White, Robyn Baldwin, Sheryl Scolnick, Kathy Tater (VIN), Rose Miller Dana Liska (Zoetis), Christine Rees, Alberto Martin Cordero, Andy Hilier (Zoetis), Nao Hensel, Rob Schick, Duncan Graham, Mahalani Fadul, Laura Wilson, Kimby Lo, Becca Mount, Allison Foster, Toni Anns, Teresa Koebke (Virbac), Beasley Mason, Diana Simoes, Charlotte Frank. Duration and efficacy of Cytopoint: • 3-8 weeks duration of effect is most common • Seasonality component is important and can effect duration • Underlying dx (+/- food allergy) and concurrent treatment (topicals, etc.) can effect duration • One person had a patient whose Cytopoint lasted 8-9 months • One person thought the more they give Cytopoint, the shorter the duration of effect • One person feels that efficacy is ~ 80% w/ 10-20% loss of efficacy over time • Several persons have observed good results with repeated injections (given w/in 4 weeks time), especially if there’s been lack of efficacy with the first injection • Several persons (3-4) dose it q3 weeks • One person may see/possibly longer duration in larger dogs compared to small breed dogs Dosing of Cytopoint: • In New Zealand and Europe, Cytopoint is dosed at 1mg/kg so sometimes injections are repeated sooner than 4 weeks due to lack of efficacy • Someone accidentally gave a higher dose and saw a much longer duration than before • If a low dose does nothing, then a higher dose may not do anything either • It’s not just about the dose, but about the duration of effect too • Doesn’t seems to work well in dogs w/ pyoderma • Rechecks: when Cytopoint stops working. One person sees pets coming in for a rash but not itchy b/c it is controlled w/ Cytopoint. However, the pyoderma has gone untreated Usage of Cytopoint: • Two persons feel that Cytopoint works great for atopics w/ pododermatitis • Several persons did not feel Cytopoint works as well for otitis cases • One person has successfully used Cytopoint with cutaneous lymphoma + atopy (worked well), • One person uses Cytopoint at the beginning of diet trial which can be risky b/c it may muddy the diagnosis due to variability of duration of treatment. • The same thought was expressed with sarcoptic mange • One person has used Cytopoint for acral lick granulomas w/ good success • One person thinks it doesn’t work well for food allergy (Apoquel works better) Concurrent drug therapy: • Several/many persons use Cytopoint with immunotherapy • Several persons use corticosteroids for flare-ups between Cytopoint injections • Several/many persons use Apoquel prn as Cytopoint stops working • One person uses steroids + Cytopoint simultaneously in Shar Peis Adverse events: • One person had a GSD develop TEN the day after getting Cytopoint and was euthanized (reported it) • One person had a dog that got Cytopoint at home and developed hives at injection site w/in 5 min after receiving it (reported it) • In D4A questionaire of 18 dermatologists, the following were reported as side-effects seen in their own patients: lethargy (6), vomiting/diarrhea (4), lack of efficacy (3), urticaria (2), ITP (2), IMHA (1), flare up of Shar Pei fever (1), and several dermatologists have had second-hand reports from local internists describing: IMHA, ITP, profound sudden neutropenia, polyarthropathy • Very important to report all adverse events!
2
ROUNDTABLE SUMMARIES
Patients with immune mediated disease and Cytopoint usage: • Most persons AVOID Cytopoint usage in patients with history of immune mediated disease • One person does use Cytopoint for immune mediated disease b/c they’ve often been referred from internists for management • One person wonders about Cytopoint usage in blood donor dogs Client communication and education regarding Cytopoint • Several persons feel that it is one of the safest treatment options we have, and tells us that out of 500 maybe 5 will have no efficacy or pyoderma as most common side effects • One person tells owners there’s probably a slight risk, < 1% chance, that ADR could occur • One person gives owners the Cytopoint pamphlet to read • One person touts the difference between providing owners with the most common side effects but legally not being required to describe rare side effects Who sends Cytopoint home: • One person does NOT send it home because owners may give it incorrectly and lose the drug • There was a brief discussion on storage concerns and stability of drug (temperature is important, drug must be kept at 4 to 8 degrees C, consider fluctuations in fridge door versus inner shelves, etc.) • One person is concerned about adverse events happening at home • A couple of persons have dispensed it for at home use due to specific owner circumstances Effects of Cytopoint on dermatology and referrals: • One person thinks she is less busy and has less patients due to Cytopoint • One person does less allergy testing and immunotherapy, having to shift and find alternative niches like cryotherapy, laser, surgical strategies, VO, etc. • One person sees a change in her patients with an older subset of pets, harder to manage (not seeing younger patients as much and thus losing the opportunity to intervene w/ ASIT) • One general veterinarian doesn’t refer as much anymore because Cytopoint works so well and didn’t see the need • Brief discussion on the importance of allergen immunotherapy, especially in younger patients, even if they’re well controlled with Cytopoint/etc. • It is important that dermatologists educate clients and GPs on the value of allergen immunotherapy • One person will recommend to owner that they get pet insurance if they’re suspecting a young dog may be atopic (before making the diagnosis)
FROM THE PRESIDENT continued from page 3
dermatology please invite them to become AAVD members. The new website has membership application forms that can be completed online, which allows contact information to be securely entered directly into the AAVD database. Our next AAVD business meeting will be at the NAVDF in Austin, Texas from April 10 -13, 2019, and we hope to see many of you there. The NAVDF Program Committee along with the NAVDF Organizing Committee and the NAVDF meeting planner Jill Senior have been working hard to ensure that we have another great meeting. Check out the NAVDF website for more information about the city of Austin; from its live music scene, places to go hiking or great places to eat, it looks like it will be an interesting city for the meeting. You can now make reservations at either of the two meeting hotels, further information is on the NAVDF website. I would also like to thank the AAVD Executive Secretary Libby Dietrich, Rebecca Doctrow, and Melissa Harper for all they do to support the academy. I extend my heartfelt thanks for the commitment of Dr. Jeanne Budgin as the AAVD representative to the World Association of Veterinary Dermatology and all of the work my co-board members this past year: Dr. Rod Rosychuk as past president, Dr Lenny Jonas as Vice President, Dr. Klaus Loft as Treasurer, Dr. Rose Miller as Member-at-Large, and Dr. Andrew Mills as Member-at-Large. The Executive Board welcomes Dr. Verena Affolter as our third Member-at-Large. It is with sadness and deep appreciation for all of his contributions that the board has accepted the resignation of Lenny Jonas. He has served the AAVD for many years and having retired from clinical practice he felt it was time to step down. We ALL thank him for all he has done for the AAVD and wish him well. Warmest Regards.
Catherine Outerbridge, DVM, DACVD, DACVIM AAVD President
ROUNDTABLE SUMMARIES
3
Dermatology in Academia Moderator: Sandra Koch, DVM, MS, DACVD Participants: a diverse group including general veterinarians, interns, residents, faculty and clinical instructors from different private practices and academic institutions from the USA, Canada and Europe, including Sandra Diaz, Adam Patterson, FrÊderic SauvÊ, Ross Bond, Dayle McClintock, Selene Jones, Andrew Bodenstein, Mary Labato, Jennifer Schissler, Klaus Loft, Laura Udraite Vovk, Annette Petersen, Jason Pieper, Lauren Bessey, Millivoj Milosevic, Paul Bloom and Catherine Outerbridge. A. How are we teaching dermatology competencies and skills to our undergraduate students? Are we doing a good job? There was a general consensus that we are preparing our students well but that we could do better. Some of the attendees mentioned that their colleges are making major reviews in their veterinary curriculum, including dermatology; however, a big concern shared among the group was that there is lack of mandatory dermatology clinical rotation in most Universities and everyone in the group agreed that dermatology rotations should be mandatory, mainly considering that dermatological conditions are among the most common problems seen in general practice. One person mentioned that we should teach more shelter medicine. Also, there is lack of standardization regarding the duration of the clinical rotations. Most places from the individuals in the group offer only 4-5 days rotations, others offer 2-3 weeks. One general veterinarian in the group expressed concern of not being able to participate in dermatology rotation in his institution, despite the desire to do so, and that individual felt like he did not get prepared to deal with dermatological cases as he should have and believes this is an issue. The group felt like we should at least guide our students to have dermatology externship at private institutions. The group also discussed that general veterinarians are trying to work up dermatological cases in short time, such as 15-20 minutes, which affects how they apply their knowledge and practice dermatology. The group also discussed ideas to teach students basic otoscopic exam as that is often a challenge. Some people offer minilabs, two of the attendees use an ear models developed with the goal to teach otoscopic exams, which was quite interesting. Some people ask students to bring their pets, some encourage students to examine the ears in every dog and cat, in addition to sedated animals, some people use video otoscope or hand-held camera based otoscope. In general, we are all trying to do our best to teach our students to practice dermatology; but are we doing a good job? Are we teaching the necessary competencies for their practice? Ideas for improvement include: 1. Dermatology rotations should be mandatory to small animal veterinary students 2. Partner with other institutions or private practices to add dermatology rotation for island students 3. We should all look into the basic dermatological skills and competences we want them to learn and try not to teach everything; we are not teaching them to be dermatologists 4. Set up goals with students and check at the mid and end of the rotation 5. We should provide more continuing education for veterinarians 6. We need surveys from the veterinarians we teach 1-2 years post-graduation to find out how they feel about their dermatology knowledge and skills 7. We also need to teach students to own their education, cultivate a sense of dedication and responsibility to their work 8. Ideally we should have a working group to write some teaching consensus or guidelines to help faculty and clinical instructors teach dermatological skills to the students 9. There was not enough time to discuss different ways to teach basic skills and everyone agreed that having an email or online group to share ideas about creative and fun activities or different ways we can teach our students dermatological skills should be helpful B. Are we training our residents and junior faculty in pedagogical practices? Any veterinarian in this group have had formal educational training before their residency, during their residency, or after they accepted a university position? Only two individuals from the group had some sort of formal educational training during their residency. One individual from an academic institution said that their dermatology residents are enrolled in a master program and have to take at least one teaching course and the other individual from another academic institution had seminar workshops as a junior faculty that is also offered to residents. Some people fell that the decision to offer teaching education has to come from the organization’s administration.
4
ROUNDTABLE SUMMARIES
C. Should we train residents to teach? If so, how? Although not all residents will be in academia, many private institutions work with students, interns and residents and some kind of formal teaching skills should be thought. One intern in the group and many faculty did not think educational training should be optional, that it should be a requirement for all residents. Residents should also have some training in communication skills with clients and students. NOTE: Possibly, we could offer more round tables on this topic and maybe offer a few lectures at the NAVDF regarding teaching and education in dermatology. We should have a discussion among mentors and the ACVD and Education committee about teaching our residents how to teach to discuss ideas. 1. Dermatology internship positions (“Skinternship”) What are the advantages and disadvantages for the intern? Advantages: It can be a great option for nonmatching residents, it prepares the individuals for a residency program and in a way it mimics a residency without as much pressure. Disadvantages: The main disadvantage or concern from the group is that interns may be used as “cheap labor” and get “burned out”. It would be great if mentors could come up with some guidelines for internships. One individual from the group shared some published guidelines from other specialties and that could be used as a frame for us to write up internship guidelines for dermatology. What are the advantages and disadvantages for the mentors and/or institutions? Advantages: Having an intern prepares better for a residency program, facilitating the entry into a residency program at the same or different institution. Disadvantages: A few people mentioned that some mentors feel like some interns learn “bad habits” and these mentors want to select people that have not been thought much dermatology yet. Most people in the group did not agree with that and actually believe that having residents with different perspectives can be helpful during their residency. Some interns may have expectations to become residents and that may not reflect mentor’s expectations. Most people in the group felt like that expectations should not be necessary to hire and should be clear prior to the beginning of the internship. 2. General Comments: There was great participation and interest in the presented topic. Unfortunately, there was not enough time to discuss more ideas regarding teaching students how to practice dermatology skills and residents how to teach. Additionally, it would have been nice to discuss other interesting academic topics such as job satisfaction in academia and recruiting dermatologists for academic positions. Everyone in the group felt like we should have more roundtables and possibly lectures (such as communication skills) on this topic at future NAVDF meetings and upon proposition form the host, everyone seemed interested to be part of a social media or email group to discuss more issues and share ideas and documents about teaching students and residents, and be a support group for each other for any academic or mentorship related issues. It would be nice to seek support or endorsement from the ACVD and AAVD leadership.
AAVD Executive Board President Dr. Catherine Outerbridge Davis, CA Immediate Past-President Dr. Rod A. Rosychuk Ft. Collins, CO Vice President Dr. Leonard Jonas Wheat Ridge, CO Treasurer Dr. Klaus Loft Weymouth, MA Members-at-large Dr. Rose Miller Salt Lake City, UT Andrew Mills Shoreview, MN Dr. Verena Affolter Davis, CA WAVD Representative Dr. Jeanne Budgin Riverdale, NJ Executive Secretary Ms. Libby Dietrich 1.877.SKINVET (754-6838) info@aavd.org
ROUNDTABLE SUMMARIES
5
Photography Roundtable Moderator: David Duclos, DVM Things participants wanted to know: 1. What cameras to purchase 2. How to get images connected to medical records 3. How to store images and not run out of space 4. How to process photos, and organize them for better retrieval 5. How to share images a. Pathologists need photos from vets so they can better understand the lesions, pictures are better than words on paper b. Pathologists needed tips to give to their vets sending photos on how to take better photos c. Pictures for teaching d. Pictures for social media Things participants have questions or problems with: 1. Many of the cameras are too heavy for the technicians to hold 2. Taking pictures with a camera takes more time than with a smartphone a. 30% of the participants are using smartphone exclusively, most use them frequently b. Photos taken on smart phones are good for sharing between each other but for good quality photos, a camera is needed. 3. It is more about the lens rather than what camera you purchase a. Lighting – for macro phots need ring flash too give the best light and remove any shadows b. Macro lens – the large number 105 mm lens means you can be farther away from the lesion to take the picture. A 40 mm macro means you will be very close to the lesion. Often a camera cannot be in the surgical field so having a larger mm macro lens allows you to take photos of a close up but have the camera out of the surgical field. Answers to some of these questions: 1. Backing up is very important. Photos, videos and files that are stored in only one place, your camera, memory card, phone or laptop are files you don’t care about. If they are not backed up it is only a matter of time until theft, loss, damage or failure separates you from your data. a. Cloud storage is widely available – some mentioned are i. Google Photos ii. One drive iii. Dropbox iv. iCloud b. Google photos is one of the best because it will automatically sort your photos for you. 2. Post processing tips a. PhotoMechanic software for Mac or PC will upload your photos from your camera card in an organized manner and will automatically embed into each photo information you tell it to add to the photos i. Names each photo according to what you decide – e.g. Pet’s name – {number} Owner name or date – Pet name Client name, etc. many different possibilities ii. Categories iii. Key word iv. Many other types of data b. Adobe Lightroom i. Very useful in editing photos – color balance, contrast, etc. ii. Also very useful in retrieving photos based on the keywords, or categories in the photos c. Having an organized method for moving photos from the camera card to your computer storage is essential i. Have a dedicated computer for uploading photos, editing and storage ii. Have a work flow – for example 1. Take photos 2. Upload from camera card – using PhotoMechanic 3. Burn to DVD 4. Edit – using Adobe Lightroom 5. Save as JPEGS to a hard drive on the computer 6. Back up this Hard drive in one or more places ( external HD and Cloud) 3. How to get images to medical records is an area not well served by the software companies that make veterinary medical software a. Some suggested having folders on the cloud with Client-Pet name and all photos for this pet would be in this folder
6
ROUNDTABLE SUMMARIES
b. One person had medical software that allowed easy ways to put photos in the record c. Some people say photos can be in the record but not easy to retrieve in the records 4. Local camera stores in your area are very good at offering classes on photography and have staff that are very knowledgeable about what cameras to purchase 5. Cameras mentioned by the group, not strong recommendations for any one. Each person needs to choose their own style of camera a. Nikon D90 – old version not made any more b. Nikon D500 – higher end camera c. Nikon B700 – a nice light weight, High Definition, good quality photos d. Sony Alpha 6000 mirrorless e. Canon Ftd with a macro lens f. Canon EOS 5D Mark III g. Smartphones 6. There are many good camera manufactures – the main 2 are Canon and Nikon others include: a. Olympus b. Sony c. Pentax d. Panasonic Summary: This round table covered a lot of questions people have about photography, most of which was not answered. Topics such as how to organize, and share photos, what cameras to purchase, lighting, printing, and how to process photos once taken are all topics that the program committee might consider getting someone to come and teach at future meetings.
MEMBERS’ ONLY LOGIN
We now have a members’ only log-in section of our website. Visit it to pay your dues online each year!
www.aavd.org
Welcome New AAVD Members! ACVD Members Naomi L. Rich, DVM ESVD Members Regina H. Ruckert Ramadinha, PhD Student Award Members Danielle Bartulewicz Gabriel Benoit, DVM Caitlin Conner, DVM Lexis Goellner, DVM Kimberly Kalosy, DVM Rebecca Karrels, DVM Marguerite Kissel, DVM Mariel K, Knox, DVM, MPH Megan Korpita, DVM
Megan Macleod, DVM Kalie Marshall, DVM Ashley Mealey, DVM Sarai Milliron, DVM Emilee Mitchell, DVM Mary Nelson, DVM Danielle Nolitt, DVM Dustin Ong, DVM Melissa Pinto, DVM Steven Rapp, DVM Harrison Reid, DVM Lane Robinson Torrington, DVM Rebecca Rosenblatt, DVM Allison Ruicker, DVM Tyler Spriggs, DVM
Veterinarian Members Autumn Davis, DVM Blair Dingler, DVM Cassie Hanks, DVM Alissa S. Rexo, DVM, CVA Emily C. Strzok, DVM Kara A. Wolf, DVM, BASc Veterinarian Student Members Andy Hsueh Veterinarian Technician Members Shilo A. Anderson, LVT, VTS Leah Spiering, RVT Affiliate Members Kennedy K Mwacalimba, BVet. Med, MSc, DLSH
ROUNDTABLE SUMMARIES
7
Feline Eosinophilic Diseases Moderator: Michelle Woodward, DVM The discussion primarily focused on eosinophilic granuloma complex (EGC) with mosquito bite hypersensitivity also being mentioned. Most participants agreed that the diagnosis of EGC is clinical, with cytology being used to support the diagnosis if necessary. One participant mentioned a case in which EGC was diagnosed with biopsy, but the patient was not responding to glucocorticoids. A repeat of the biopsy with special stains identified Sporothrix. Possible misdiagnosis of Pythium was also mentioned. Participants generally agreed that eosinophilic plaques, especially those on the abdomen, are the most symptomatic and pruritic for patients. Symptomatic therapy with glucocorticoids was discussed at length. Most participants primarily use oral short-term steroids, while a few will use longer acting injectable steroids in some cases. Topical steroids appeared to be less popular, especially in cats with extensive lesions (typically abdominal/inguinal). One participant mentioned giving a long acting injectable steroid and starting oral daily cyclosporine at the same time, which allows the cyclosporine to alleviate symptoms as the steroid wears off. There was also discussion of oral compounded liquid methylprednisolone (4 or 8 mg/ml), which allows for smaller volumes of liquid to be administered versus the commercial human liquid prednisolone (3 mg/ml) that is available. Participants rarely treat EGC with antibiotics alone. Most participants agreed that the first primary therapeutic/diagnostic step for symptomatic patients (especially those with seasonal disease depending on the geographic location) is institution of good flea control. The actual products favored by participants varied, with different products being used more commonly in different regions of the country/world. For some particularly difficult cases, “staggering� of different products every few weeks was mentioned. If the clinical signs are not seasonal, or if improved flea control alone is not successful for EGC, then food trials were a typical next step for many participants. Challenges of elimination diet trials in cats were discussed, and these included patients refusing to eat, multi-cat households, indoor/outdoor/hunting cats, and the lack of truly novel protein diets. Many participants use hydrolyzed diets, but struggle with palatability. Diets from Rayne Clinical Nutrition were mentioned by several participants as working well. Many participants are commonly performing environmental allergy testing on cats with EGC, with both intradermal skin tests and serum testing being utilized. Several participants are also using IV fluorescein with the intradermal allergy test to facilitate interpretation. Multiple participants feel that cats with EGC respond well to allergen specific immunotherapy and successfully encourage owners to use it. Mosquito bite hypersensitivity was briefly discussed due to its eosinophilic nature. Participants agreed that bringing the patient inside is key. There were no commercial products discussed that seemed to be completely successful in eliminating this syndrome in outdoor cats.
Flea Control Hot Button Issues Moderator: Michael W. Dryden, DVM DRYDEN: Goals of this roundtable. Perception on resistance, lack of efficacy, regional differences, perception of differences. DRYDEN: Do any of the attendees have the clinical impression that they are experiencing a reduction in performance any of the modern flea products? ATTENDEES: In Houston, Fipronil no longer effective or the OTC version of Frontline plus. The same in Israel, fipronil not working. In Georgia, selamectin seems to be less effective than previously. In New Zealand Advantage not working. In Ohio we always try to assess the flea burden and how compliant they have been. But typically it is the Fipronil and Advantage clients that come in and say they are still seeing fleas even with adequate flea product administration. DRYDEN: So, we get in to this discussion. If resistance is real, there are several things that likely occur that is directly impacted by the decay curves of these compounds. (1) You are going to compromise the residual nature of the compound and its speed of kill. So that we should see more fleas than previously towards the end of the application period. In other words, specifically, the percent of animals that have fleas should go up towards the end of application period. (2) We should start having trouble with a product like that in its ability to manage Flea allergy dermatitis. The fleas are going to be living longer, feeding longer, and injecting more salivary protein causing an immunological reaction. (3) Ultimately, if the product is compromised enough, these fleas should live long enough to lay eggs rapidly causing a continuation of the infestation. There should be a step life process that causes erosion into the decay curve. In that regard, are we seeing more fleas, difficulty managing FAD, difficulty eradicating any flea infestation. Some people have made comments about products not working as well specifically in regards to that point. As dermatologists, are we seeing the difficulty in managing FAD with those type of products?
8
ROUNDTABLE SUMMARIES
ATTENDEE (Virginia area): Comment to the contrary. I think local veterinarians have mostly gone to the oral medications because they feel the topicals not working, but that inefficacy may well be a myth. Been using Fipronil for 20+ years on our own pets every single month and no flea outbreak. Feral cats in neighborhood and definitely environmental with animal colonies with influx of new animals and rescue groups. Households not on flea control and only have the one pet suspected of FAD on prevention. Part of it is they are not doing enough. Part of this is mythological with the resistance problem. Would like to see if you all are seeing that to say that flea bomb these house and get some environmental treatment in the household, use your topical; then tell me there is a resistance. Not going to believe it until I see it. ATTENDEE (Southern California): So I would concur. I would say that I do not think I see flea resistance but OTC products not being used as regularly as if they are getting something prescribed by a veterinarian. I think it is more of a compliance issue with OTC product versus a resistance to a generic. DRYDEN: Could be a number of issues related to compliance; no doubt about that. A comment was made about the household with the cats and feral cats. ATTENDEE (Israel): I think there is an issue here. Feral cats cause issues with dogs going for walks in affected areas and always have fleas. I tell them they cannot go in the grass; they have to go on the pavement.
NAVDF Program Committee Dr. Mitchell Song, Co-Chair Dr. Sandra Koch, Co-Chair Dr. Petra Bizikova Dr. Paulo Gomes Dr. Marci Murphy
NAVDF Organizing Committee Dr. Jeanne Budgin, Chair Dr. Dana Liska, Co-Chair Dr. Marcia Schwassmann, Treasurer AAVD/ACVD Dr. Klaus Loft, Social/Sponsorship Liaison Chair Dr. Christina Restrepo, Past Chair and Social/Sponsorship Liaison
DRYDEN: Another issue I hear is that the flea product seems to work well until the fall of the year. In many areas the fall of the year has the worst flea problems. Is the issue truly resistance or speed of kill? Are we are just not killing the fleas fast enough with the topicals to manage that pruritic animal?
Dr. Catherine Outerbridge, OC Member (AAVD)
ATTENDEE: In Southern California I think it is a Fall thing. A story I tell clients: Clients see a flea in June, by the time the put the medicine on, the flea has already laid eggs in their house. Then, they go through a 3 pack in June, July, and August. Then they perceive it is “no longer flea season”, but fleas are emerging and jumping back on the dog. We see the most fleas on dogs in October.
Dr. Kristin Holm, OC Member (ACVD
DRYDEN: There are several studies in the United States that have investigated and documented widespread resistance to the older classes of insecticides, pyrethroids, organophosphates, carbamates etc. But other than the long term imidacloprid susceptibility monitoring project, there is little resistance data on the modern classes of insecticides. DRYDEN: What are your perceptions on the new oral systemics and their ability to manage FAD. ATTENDEE: Comfortis changed things for our clients for Atopic and FAD patients. We recommend to give Comfortis every 2 weeks because clients often forget to give with food. A comment was made that Credelio may have the same problem. In Phoenix and California, recently using Bravecto with good success. In Europe we have found it is a game changer to add heartworm to a flea product like Stronghold Plus (Simparica-selamectin). ATTENDEE: Comfortis did not take care of ticks so did not use. DYRDEN: Yes, product selection may be based on the importance of tick control in a given area. DRYDEN: Why did we so readily move from topicals to oral meds? ATTENDEES: 1) Experience seeing topicals failing, 2) Clients trying to save money due to having to apply topicals with increasing frequency. Every 3 months to give Bravecto, improves compliance, 3) Topicals being affected by bathing, 4) Messiness of applying topicals and perception of harm, 5) In California, client perception of putting a pesticide on their dog, 6) rapid speed of flea kill with the orals.
Dr. Lenny Jonas, OC Member (AAVD)
Dr. Allison Kirby, OC Member (ACVD)
2019 FRANK KRÁL AWARD Nominate a colleague for the 2019 Frank Král Award for Achievements in Veterinary Dermatology! For more information on the Award, its criteria, or the nomination form, visit https://www.aavd.org/ frank-kral-award.html. Nominations are accepted until November 30, 2018.
ROUNDTABLE SUMMARIES
9
World Association for Veterinary Dermatology Update Jeanne Budgin, AAVD representative to the WAVD This is my first report for Derm Dialogue after assuming the position of AAVD representative to the WAVD from Dr. Phil Roudebush following the WAVD-AC meeting in February of 2017. As your representative, I attended the WAVD-AC annual meeting on 2-3 June 2018 in London, England. WCVD9 (Sydney) – 2020 The 9th World Congress of Veterinary Dermatology will be held from 20-24 October 2020 in beautiful Sydney, Australia. The Executive Organizing Committee includes Dr. Mandy Burrows as President and Dr. Rusty Muse as Secretary. The North American Veterinary Dermatology Forum will not be held in 2020. Please visit www.vetdermsydney.com for more information. WCVD10 - 2024 The bid process for WCVD10 in 2024 began at the WAVD meeting in London this past June with final site selection occurring at NAVDF 2019 (Austin). The meeting cycle will bring the Congress to North or South America. Peter Ihrke Scholarships The WAVD established a scholarship to honor the life and career of Dr. Peter Ihrke. The scholarships provide individuals from areas of the world where veterinary dermatology training is limited to complete an externship with the veterinary dermatology service at the University of California, Davis. The first two recipients have completed the program - Dr. Sabrina Costa (Brazil) and Dr. Veronica Pereja (Ecuador). The feedback from both the UC Davis staff and the recipients has been outstanding! Clinical Consensus Guidelines The WAVD has established expert committees to develop and publish clinical consensus guidelines (CCGs). The first two CCGs were published – dermatophytosis and methicillin-resistant staphylococcal infections in Veterinary Dermatology in May of 2017. Demodicosis (Dr. Ralf Mueller, chair) and Malassezia dermatitis (Dr. Ross Bond, chair) were presented at the NAVDF in Maui on 3 June 2018 and will also be introduced at the ESVD-ECVD Congress in Dubrovnik this September with the intention of publication by the end of 2018. The manuscripts are currently available on the WAVD website (wavd.org/continuing-education/consensusguidelines/) and open for constructive comments. Future topics may include immune-mediated therapy, canine and feline otology and equine hypersensitivity with draft reports in 2020 and presentations occurring at the WCVD9 in Sydney. Many thanks to Drs. Wayne Rosenkrantz and Catherine Outerbridge who serve as co-chairs, as well as the entire subcommittee, for their hard work on the CCGs. WAVD Website and Social Media The new and improved WAVD website (www.wavd.org) will launch very shortly! Drs. Stephen White and Brett Wildermuth, with support from the subcommittee, have also been expanding the WAVD’s presence on social media - Twitter and LinkedIn are coming soon! Be sure to like and follow the WAVD on Facebook!
2019 CALL FOR ABSTRACTS
2019 call for abstracts
The program committee of the 2019 North American Veterinary Dermatology Forum (NAVDF) is calling for contributions for Free Communications (Original Research, Clinical, Resident, and Poster abstract sessions) to be presented at next year’s meeting in Austin, Texas. You can find more information at www.navdf.org/abstracts.html. Abstracts are accepted until December 1, 2018.
10
WORLD ASSOCIATION FOR VETERINARY DERMATOLOGY UPDATE
Wish you were here
Australia – the destination we all dream about visiting… Make that dream a reality. Join us at the 9th World Congress of Veterinary Dermatology in the friendly, vibrant and cosmopolitan city of Sydney, one of the world’s most beautiful natural harbours and gateway to the unique culture of Australia. From practical tips for practice to cutting edge research with a multi stream program combining lectures, workshops and wet labs not to mention a unique and exciting social program, we are confident WCVD9 will be an inspiring and memorable experience.
Take a few extra days to explore the city – from its iconic modern architecture to its historic colonial past; stroll on a golden sandy beach or bushwalk in a rugged country park.
Ready for a challenge? Climb the famous Sydney Harbour Bridge or learn to surf at Manly Beach.
The new purpose built Convention Centre in Darling Harbour is centrally located within the heart of the city, within easy walking distance of a range of hotels and accommodation, and restaurant options to suit every budget and taste, from elegant harbourside dining to bijou cafes and a diverse range of ethnic cuisines. So many choices. The only one to make right now is to be at WCVD9 in Sydney from 20th–24th October 2020. Follow our website page for updates www.vetdermsydney.com
Enjoy a leisurely tour of the Hunter Valley, tasting award winning Australian wines or marvel at the breathtaking splendour of the Blue Mountains.
Got a few more days? Why not dive on the Great Barrier Reef, or go crocodile spotting in the Daintree forest? Enjoy the nightlife of the Gold Coast, or the serenity of Uluru?
WORD CONGRESS OF VETERINARY DERMATOLOGISTS
11
Introducing the Academy of Dermatology Veterinary Technicians Kim Horne, AAS, CVT, VTS (Dermatology) Charter Member Rose Miller, DVM, DACVD As all veterinarians know it takes many dedicated people to run a veterinary office, support the clients and most importantly help the patients. An instrumental person on this team is the veterinary technician. This is especially true in the field of dermatology because the technicians spend so much time working closely with the owner and the doctor to facilitate, often lifelong, treatment. Frequently, the technician does not get the recognition they deserve. Luckily, this has been changing over the last couple decades. The National Association of Veterinary Technicians in America (NAVTA) developed a Committee on Veterinary Technician Specialties (CVTS) in 1994 due to a desire of veterinary technicians to achieve recognition for having an advanced skill set and knowledge level in specific disciplines. The Committee provides a standard list of criteria and guidelines for groups interested in attaining Academy status and is recognized by the American Veterinary Medical Association. The proposed Academy of Dermatology Veterinary Technicians (ADVT) formed an organizing committee and worked for many years to submit a petition to CVTS that met their criteria. Provisional recognition was granted with the first petition submission in 2015! ADVT continues to submit annual reports to NAVTA CVTS as their governing body in order to continue this recognition. The organizing committee members include: Kim Horne – NAVTA liaison, ADVT President, Examination Committee Chair Sandy Grable – ADVT President-Elect, Continuing Education, Social Media and Sponsorship Committees Chair Carol George – ADVT Treasurer, Financial Affairs Committee Chair Jennie Tait – ADVT Secretary, Public Relations Committee Chair Jackie Davis – ADVT Member at Large, Credentials Approval Committee Chair Missy Streicher – Nominating Committee Chair Nina Toebe – Appeals Committee Chair Chantelle Hanna – Re-certification Committee Chair This group of dedicated technicians has worked very hard as active participants in many committees to get the Academy up and running! They became Charter Members of ADVT after the first examination was offered in 2017. Since August 2015, ADVT has received 34 applications from technicians/nurses in the US, Canada, and Europe. Currently there are about 25 applicants actively working on their credentials packet (which consists of case logs, skills and knowledge list, case reports and 40 hours of dermatology continuing education). ADVT has offered the exam at NAVDF in 2017 and 2018 and have welcomed 3 new members to their group. This is a rigorous process and a huge achievement for these individuals. The newest members are: Shilo Anderson Juliann London Amanda Friedeck ADVT encourages their applicants to become associate members of AAVD and to attend NAVDF to obtain the most current continuing education to better prepare them for the exam. ADVT is very thankful that so many Diplomats have been willing to speak at the half day technician session and have delivered outstanding lectures to our group! The exam committee invites anyone interested in submitting examination questions to contact Kim Horne at horne003@umn.edu.
12
INTRODUCING THE ACADEMY OF DERMATOLOGY VETERINARY TECHNICIANS
www.navdf.org NAVDF 2019
April 10-13 HILTON AUSTIN
ANNOUNCEMENT
13