Skin issues are one of the most common reasons that dogs come into the veterinary clinic for a sick visit. In fact, according to Healthy Paws Pet Insurance’s “Cost of Pet Health Care 2018 report”, skin conditions made up 22% of all dog pet insurance claims.
Despite how common they are, skin issues can be a challenging and frustrating issue for both pet owners and veterinarians alike.
When I first saw Milly in June of 2024, I had no idea that she would rapidly become one of my most challenging dermatology cases, and, thankfully, my most rewarding dermatology case. In the year that followed her initial visit, Milly underwent several rounds of testing, medication trials, and ultimately a biopsy to finally diagnose her condition. It is often shocking for many pet owners to learn that an issue as common as a skin rash can require patience and perseverance to determine the best treatment for each patient.
One of the most challenging aspects of dermatology is that many different conditions can look very similar on a physical examination. Allergies, autoimmune conditions, and skin infections can all look very similar, but they all require very different treatment. When a pet is seen by a veterinarian for a skin condition, the doctor will look at the types of lesions and where they are located on the body. The doctor will also look for evidence of parasites, like fleas. This helps to provide clues to what is causing the issue.
Sometimes, a diagnosis can be reached easily on the examination and treatment recommended; for more serious lesions, diagnosing the condition is more complicated. When Milly first came in, she had an odd distribution of symptoms.
Her owner states, “June of 2024 my son’s dog’s nails were growing like a rams horn on one paw. She also began to develop horrid scabs on her face. She looked like Godzilla.”
Her clinical signs did not fit neatly into any one category and so the search for answers began.
Diagnostic testing for skin issues is important but can sometimes feel frustrating and unrewarding. When a skin issue arises, dermatologists will recommend an initial panel of tests – a skin scrape, a skin cytology, ringworm test, and a flea combing. These tests look for evidence of bacteria, mites, yeast, or other infectious organisms within the skin. Further testing, like a culture, may be recommended as well. It is not uncommon, however, for these tests to deliver false negative results and a medication trial is sometimes recommended to help rule out different causes.
Milly’s initial testing did not yield helpful results, her initial fungal culture was negative, her cytology results were negative, and no fleas or mites were seen. Several medication trials were started for her: allergy medication, antifungal medication, laser treatments to promote wound healing, and finally a medication for autoimmune conditions. While Milly would intermittently show mild improvement, her symptoms still persisted.
Her owner states that, “…we were close to deciding on a quality of life for Milly when Dr. Collins came up with a solution.”
When a patient fails to respond to medication trials and initial diagnostic testing has not yielded answers, there is still one route that can be used to obtain a diagnosis — a skin biopsy. With the patient under general anesthesia, a surgeon can sample several pieces of tissue that are then evaluated by a dermatopathologist under a microscope. This poses some challenges, however, as patients must not be on steroid or immune suppressing medications and all secondary infections must be treated to obtain reliable answers.
Additionally, a biopsy does not guarantee a diagnosis. After discussing Milly’s lack of response to treatment and the concerns for her quality of life, it was decided to perform a biopsy on Milly. When the results came back, they provided a surprising result for everyone involved in her case: a fungal infection. The dermatopathologist even admitted that the result was surprising given the distribution of her lesions.
Despite the challenging nature of diagnosing the cause of chronic skin issues, treatment once the cause has been determined is rewarding. Fortunately for Milly, we were able to determine the cause of her symptoms and start her on the correct antifungal medication.
Milly’s family states, “Within a couple of days, Milly started to improve and heal. Today she has no scabs, and her hair is growing back.” With regards to her year-long journey, they went on to state that, “this seems like a lot to do for just an animal, but Milly is a family member. What would you do for family?”
Our entire team at Karing for Kreatures who have participated in Milly’s care are grateful to know that she is finally able to get back to her happy, energetic self.
Milly’s journey illustrates the path to resolving skin issues is complex and not always straight forward. Navigating the puzzle requires diligence, patience, and often multiple diagnostic procedures. With perseverance, these complex cases can have a happy ending.
