Chapter 1 – Intertrigo: Prevention, Work-Up, and When (Not) to Use Antibiotics (00:12) John welcomes Dr Laura Buckley (Senior Lecturer, Veterinary Dermatology, University of Liverpool) and asks what “brachycephalic” means and which breeds it covers. Laura explains shortened muzzles and broad, domed heads; the most extreme include French and British Bulldogs, Pugs and Boston Terriers, with Cavaliers, Chihuahuas and Dogue de Bordeaux also affected. (01:44) Sue notes their huge popularity in UK primary care. Laura adds that around 40% of her clinic can be French Bulldogs, with brachycephalics a very large overall share. (02:22) Sue asks which skin problems are most common. Laura explains that atopic dermatitis and otitis (externa/media) lead, with interdigital furunculosis also frequent. Cavaliers often show primary secretory otitis media. Skin-fold dermatitis (intertrigo) and muzzle furunculosis are common, and lesions can form over bony prominences where itchy dogs rub. (04:17) Sue asks what intertrigo is and why brachys get it. Laura explains shortened muzzles leave redundant skin that folds around eyes and muzzle, creating humid, low-airflow pockets that accumulate keratinous/sebaceous debris. Microbial overgrowth follows; bristly coats plus rubbing traumatises follicles and escalates inflammation. (06:04) Sue asks about prevention. Laura suggests daily fold hygiene from the start: clean away debris; consider antiseptic wipes (e.g., chlorhexidine) once or twice daily, and increase during flare-prone periods. (07:14) Sue highlights how early routines improve compliance and handling; Laura agrees it gives a “head start,” especially as atopy often appears within the first three years. (08:31) John asks how early disease presents and how to work it up. Laura explains earliest signs are diffuse erythema in the fold, then partial/complete alopecia, erosion/ulceration, crusting; severe untreated cases may progress to folliculitis and even deep pyoderma. (10:05) Sue asks about cytology. Laura explains it’s pivotal: expect keratinous debris with cocci (staphylococci) or Malassezia in overgrowth; neutrophils with intracellular bacteria indicate infection and guide therapy. (11:05) John asks if systemic antibiotics are ever needed. Laura explains they’re rarely indicated: most cases respond to topical antiseptics/antimicrobials plus strong anti-inflammatory control. Consider systemic antibiotics only for genuine deep, painful, draining pyoderma, immunosuppression, poor feasibility for topicals, or proven topical failure - always post culture & susceptibility. (14:11) John asks how she controls inflammation. Laura uses topical glucocorticoids (often in combination products). For severe inflammation, short anti-inflammatory courses of prednisolone (~0.5–1 mg/kg for a few days before tapering) can calm tissue so topicals can work. (15:07) Sue asks about long-term routines and when to consider surgery. Laura advises daily fold cleaning (once–twice daily) and twice-weekly topical anti-inflammatories (e.g., hydrocortisone aceponate or mometasone) with minimal systemic absorption; discuss surgery if medical care is impractical, or if maintenance fails with frequent relapses or recurrent infections. Chapter 2 – Viral Pigmented Plaques (VPP) (17:40) John moves to VPP and asks which brachy breeds are affected. Laura most often sees Pugs, plus Boston Terriers, Chihuahuas and French Bulldogs. (18:51) Sue asks what they look like. Laura describes numerous, heavily pigmented, slightly raised plaques that may begin flatter and become scaly, verruciform and hyperkeratotic over time. (19:28) Sue asks how to differentiate melanoma. Laura says biopsy/histopathology is the diagnostic choice; FNAs from plaques are often low-cellularity keratinocytes, whereas melanoma cytology differs. (21:23) John asks if plaques regress. Laura explains most persist or increase, likely due to a virus-specific, genetically influenced immunodeficiency in other

Chapter 1: Meet the Microbes (02:41) John opens the episode, introducing Dr Vanessa Schmidt and inviting her to share her background. Vanessa explains her role at the University of Liverpool, her PhD in antimicrobial resistance in staphylococci, and her leadership in infection control and antimicrobial stewardship. (03:38) John asks whether staph infections in pets are usually caught or part of their natural skin flora. Vanessa replies that most infections come from an animal's own commensal microbiota, which coexist harmlessly but can cause disease when the immune system or skin barrier is compromised. (05:07) Sue asks whether humans and animals share the same commensals. Vanessa explains that while many organisms are shared across species, each host also harbours unique flora. Cross-species transfer is possible but not common. (06:16) Sue asks whether different body sites have different staph species. Vanessa says this is well-mapped in humans, while in pets we know carriage is common in the nose, mouth, and perineum, but site-specific species need more study. (07:28) John asks about coagulase-positive vs coagulase-negative staph. Vanessa explains that coagulase-positive staph are generally more virulent, while coagulase-negative species can still be important, especially in immunocompromised hosts or in association with implants. (09:37) Sue asks how to interpret a coagulase-negative result on a lab report. Vanessa advises considering clinical context, immune status, culture growth level, and cytology to judge significance. (12:34) Sue emphasises the value of cytology. Vanessa agrees, explaining it's routine in dermatology and helps identify intracellular bacteria and neutrophilic inflammation.   Chapter 2: Resistance Training (14:30) John transitions to methicillin resistance. Vanessa explains MRSP carries the mecA gene, conferring resistance to beta-lactam antibiotics. It spreads clonally and is more stable than resistance in Gram-negatives. (17:40) Sue asks whether antibiotic use can switch the resistance gene on or off. Vanessa says it's about selection pressure - resistant strains survive when antibiotics are overused. (19:03) Sue shares her “rucksack” analogy. Vanessa agrees, adding that over time resistant strains adapt, carrying resistance genes more efficiently. (20:15) John asks about zoonotic risk. Vanessa confirms bacteria like MRSP can pass between pets and owners, though actual infections are rare.   Chapter 3: Less is More: Treating MRS the Smarter Way (22:33) Sue asks about managing MRSP pyoderma in practice. Vanessa outlines a tiered approach: treat the underlying disease, apply barrier nursing, and use topical therapy like chlorhexidine, aiming to avoid systemic antibiotics. (27:00) Sue raises chlorhexidine use and guideline updates. Vanessa recommends 2% or above concentrations of chlorhexidine and warns that dilution reduces effectiveness and may lead to treatment failure. (30:05) Sue mentions suspected resistance. Vanessa confirms resistance is reported and linked to bacterial efflux pumps. She uses hypochlorous acid or bleach as follow-up options in certain MRSP cases. (33:15) John asks what Vanessa avoids. She avoids systemic antibiotics in superficial MRSP unless absolutely needed, and tailors treatment to the underlying disease. Immunosuppressives are avoided if the infection arose due to immune compromise. (35:00) Sue asks about treating MRSP otitis. Vanessa explains that lower chlorhexidine concentrations are potentiated by TRIS-EDTA, so she still uses them as first-line ear cleaners. (36:40) John asks about long-term carriage. Vanessa explains MRSP can persist for months or even years. Decolonisation before high-risk surgery is common, but long-term clearance is difficult and evidence is limited. (39:42) Sue summarises the discussion: in MRSP, less is more - fewer antibiotics and more topicals. New guidelines offer hope for better resistance control.   ISCAID guidelines https://onli

Show Notes On this month's episode, Sue, John and Paul invite Darragh O'Hanlon (@thetopicalvet)  onto the pod to discuss pollen allergies. Chapter 1 – How Pollens Affect Animals (02:32) John introduces the topic of pollen allergies and welcomes guest Darragh O’Hanlon.Darragh shares how Sue’s lecture on otitis sparked his dermatology journey, and how John’s CPD also played a role. (04:09) John asks how pollens cause allergic reactions in animals. Darragh explains that pollens are airborne reproductive grains from grasses, trees, and weeds, and describes their microscopic structure and typical transmission routes.He shares the story of Mitzi the fox terrier, one of the first dogs documented with airborne pollen allergy. (06:30) Sue asks whether pollens affect more than just the skin. Darragh explains that: In dogs, pollens mostly trigger atopic dermatitis but can also affect eyes and ears. Cats may show respiratory and skin symptoms, including asthma and eosinophilic conditions. Horses show skin reactions like urticaria and, in some regions, respiratory issues like heaves. (08:45) John asks why grass pollens are so problematic over say garden flowers.Darragh notes a rising trend in grass pollen allergy and explains the volume and dispersal of wind-pollinated plants. Garden flowers are less allergenic due to heavier, insect-borne pollen; wind-pollinated plants like grasses and trees produce vast quantities of light airborne pollen. Sue discusses tree flowers and their pollen production. (11:30) Sue asks which trees cause the worst reactions. Darragh highlights birch as a major allergen in Northern Europe. He explains its cross-reactivity with other tree pollens and regional variations such as cypress (Mediterranean) and cedar (Japan). Conifers and pines, though present in air samples, are less allergenic due to their size and resin content. Chapter 2 – Seasons, Cross-Reactions, and Geography (14:20) Sue asks about pollen season overlap and the role of allergy testing. Darragh agrees and describes how pollen calendars can predict seasonal challenges.He outlines Ireland’s pollen calendar, from alder and hazel in winter through to weeds in autumn. (16:20) John asks if pollens cross-react with each other or be linked to food sensitivities.Darragh explains: Cross-reactivity is common among grasses and within trees and weeds. Birch is highly cross-reactive. Some food cross-reactions exist in humans (e.g. Mugwort-Birch-Celery Syndrome), but evidence in dogs is limited. (19:55) Sue mentions bee foraging and asks about using tape strips to detect pollens on animals. Darragh shares anecdotes and online interest in identifying pollens via tape stripping. (21:36) Sue asks about ragweed in Ireland. Darragh says it’s rare locally but problematic in the US. He discusses its introduction to Europe and control measures. (23:20) John asks how pet owners can reduce pollen exposure. Darragh shares advice: Allergen avoidance is difficult; pollens travel long distances. Regular washing, foot rinsing, and barrier-supporting shampoos help. Avoid walking dogs on freshly cut grass or on high pollen days. (26:10) John asks about environmental factors like altitude or proximity to the sea.Darragh explains: Pollen can travel thousands of kilometres. Grass pollen is more localised than tree pollen. Higher altitudes and coastal winds can reduce exposure. (29:12) Sue mentions a 2023 study on reactions to grass sap, not just pollen.Darragh reflects on cases that may fit contact dermatitis patterns seen with grass sap exposure. Chapter 3 – Testing, Treatment & Takeaways (31:14) Sue asks for practical advice on pollen avoidance and resources.Darragh recommends: Monitoring pollen forecasts (e.g. Met Office, Met Éireann). Using allergy maps from dermatology providers. Avoiding warm, dry, windy days; walking dogs after rain. Understanding how weather affects pollen counts, including the impact of thunderstorms and urban pollution. (35:15) Jo

This podcast is based upon the new 'Antimicrobial use guidelines for canine pyoderma by the International Society for Companion Animal Infectious Diseases (ISCAID)' available HERE   (00:00) John introduces the podcast with his co-hosts Sue Paterson & Producer Paul.   Chapter 1 – Understanding Pyoderma and the Need for New Guidelines   (02:56) Sue welcomes Dr. Anette Loeffler, who introduces herself and her background in veterinary dermatology. Originally from Germany, she studied in Munich and has worked in the UK for over 30 years. She is currently a dermatologist at the Royal Veterinary College (RVC) and has a special interest in Staphylococcus and bacterial skin infections and this has led her to work over the last 4 years on the new pyoderma treatment guidelines, aimed at improving antibiotic use and promoting topical therapy.   (04:30) Sue asks Anette to explain antimicrobial stewardship and why it is important. Anette describes antimicrobial resistance as a major global threat. Overuse of antibiotics leads to resistance, so it is crucial to avoid unnecessary prescriptions and focus on appropriate diagnostics.   (06:10) Sue asks how common pyoderma is in domestic species, particularly dogs and cats. Anette explains that staphylococcal pyoderma is very common in dogs due to their unique skin structure, making them more prone to bacterial overgrowth. While cats and other species can develop bacterial skin infections, it is far less frequent and usually not recurrent.   Chapter 2 – Diagnosing and Classifying Pyoderma   (08:00) John discusses evolving perspectives on pyoderma classification and asks if the traditional categories of superficial and deep pyoderma are still relevant. Anette confirms that the new guidelines still use these classifications as they help determine treatment:   Surface pyoderma (dysbiosis): Often in skin folds where bacteria and yeast overgrow due to friction and moisture. Superficial pyoderma: Involves hair follicles and is the most common type. Deep pyoderma: A more serious infection requiring systemic antibiotics.   (10:19) Sue notes that past treatment approaches lacked strong clinical evidence. Anette explains that many historical treatment protocols were based on anecdotal evidence rather than research. While deep pyoderma has more robust studies, superficial cases often lacked proper research, leading to overuse of antibiotics.   (13:04) John asks how vets can determine whether a case is surface, superficial, or deep pyoderma. Anette explains that clinical examination alone can often differentiate them:   Surface infections show redness and are in friction areas (e.g., nasal folds, hotspots). Superficial pyoderma presents with papules, pustules, and epidermal collarettes. Deep pyoderma causes swelling, draining tracts, haemorrhagic crusting, and pain.   (16:04) Sue asks how to confirm true bacterial pyoderma and rule out mimicking conditions. Anette stresses the importance of cytology, a simple and cost-effective test that can quickly confirm bacterial involvement. Cytology can also differentiate between bacterial infections, yeast overgrowth, and sterile pustular diseases.     Chapter 3 – Treatment Approaches and Key Takeaways from the New Guidelines   (19:36) John asks about traditional treatment approaches and why they need updating. Anette outlines how older guidelines recommended unnecessarily long courses of antibiotics (e.g., 3-4 weeks for superficial pyoderma, 4-6 weeks for deep pyoderma). While this was logical before antimicrobial resistance became a concern, modern research supports shorter, targeted treatments. (26:13) Anette explains the new recommendations:   Surface pyoderma should be treated topically only – systemic antibiotics are inappropriate. Superficial pyoderma should primarily be treated with topical therapy – which has been shown to be as successful as a course of antibiotics. Deep pyoderma requires systemic antibiotics but can benefit from adjunct

Show Notes This month, the Skin Flint team welcome RCVS & European Specialist Debbie Gow to the platform to explore Eosinophilic granuloma complex (EGC). (00:00) John Sue and Paul introduce the podcast.   Chapter 1 – What on Earth Is Eosinophilic Granuloma Complex?   (02:55) Sue welcomes Debbie Gow to the podcast and invites her to introduce herself. Debbie shares that she is a specialist in veterinary dermatology, working at a busy referral hospital outside Edinburgh. She describes her role in setting up the dermatology service, working with a resident and derm nurse, and her continued involvement in CPD and writing.   (04:05) Sue introduces the topic: eosinophilic granuloma complex (EGC) in cats. She jokes that it’s sometimes referred to as “eosinophilic granuloma confusion” due to its complexity and terminology. She asks Debbie to break it down explaining that EGC is an umbrella term for three lesion types: Linear granulomas: Seen on the backs of legs, chin, or in the mouth. May or may not be itchy. Plaques: Often pruritic, ulcerated, and secondarily infected. Found on the ventrum or medial thighs. Indolent ulcers: Located on the upper lip, may appear crater-like.   (07:28) Sue asks about miliary dermatitis. Debbie considers it a separate reaction pattern, not part of EGC, though also common and allergy-associated. (08:15) John asks about age, breed, or sex predispositions. Debbie explains that while any cat can be affected, young adult cats (6 months to 5 years) are most likely to develop these lesions. Females may be slightly overrepresented, but evidence is limited. (09:27) John inquires about geographical prevalence. Debbie confirms EGC is seen globally wherever cats are present and exposed to allergy triggers.   Chapter 2 – Lookalikes, Lip Lesions & Licking Cats: Sorting the EGC Puzzle (10:21) Sue asks whether EGC lesions are pathognomonic or if there are important differentials. Debbie stresses the importance of not assuming a diagnosis without investigation whilst they can have a classical appearance: Cytology is key to identifying eosinophils. Differentials include squamous cell carcinoma (particularly for lip ulcers), mycobacteria, fungal infections, and viral diseases.   (12:37) Sue asks about a minimum diagnostic approach. Debbie advises: Cytology Wood’s lamp and trichogram to rule out dermatophytosis Consideration of biopsies if in doubt   (14:08) Sue asks how to perform cytology. Debbie describes: Tape prep for dry lesions Cotton bud for moist/crusted areas Direct impression with a slide   (14:59) Sue asks how often infection is present. Debbie says: Infections are uncommon but more likely with plaques due to licking Cytology helps assess if antibiotics are needed Most cases are treated with anti-inflammatories rather than antibiotics   (16:52) John asks about allergic patterns in cats. Debbie describes four main reaction patterns: Miliary dermatitis Head and neck pruritus Ventral overgrooming Eosinophilic lesions She notes cats may display multiple patterns and also non-skin signs like conjunctivitis, otitis, or sneezing. (19:02) John asks if specific allergies present with specific signs. Debbie says it’s inconsistent. While flea allergy is often associated with miliary dermatitis and food allergy with head/neck pruritus, patterns vary and aren’t reliable for diagnosis.   Chapter 3 – Practical Approaches: From Kitchen Floor to Referral Door   (21:23) John asks what owners might notice or try at home. Debbie recommends: Observing behaviour Keeping a diary Ensuring flea control Considering recent diet or environmental changes   (23:30) Sue asks about food trial myths. Debbie emphasises: Over-the-counter “hypoallergenic” foods are not suitable for true food trials Prescription hydrolysed diets or novel proteins (e.g. ostrich, kangaroo, crocodile) are required Food trials should run for ~8 weeks She also recommends: Treat toppers to help encourage eating Short-term feeding is us

Show Notes To celebrate Pet Dental Health Month, the Skin Flints team looked a bit further afield this month, exploring gum health and Canine Chronic Ulcerative Stomatitis with Hannah van Velzen. Chapter 1 – Understanding the Oral Mucosa and Inflammation (02:53) John welcomes Hannah, who introduces herself and her journey into veterinary dentistry, from her studies in the Netherlands to her current role leading the dentistry referral service at Fitzpatrick Referrals. She highlights the small but growing number of veterinary dentistry specialists in the UK. (05:46) Sue asks for a basic overview of the oral mucosa, as it plays a key role in CCUS. Hannah explains that gingiva surrounds and seals the teeth, preventing bacteria from entering the body, while mucosa covers the rest of the mouth. The mucogingival junction marks the boundary between the two and helps differentiate between gingivitis and mucositis. She describes the different types of mucosa, including lingual (tongue), palatal (roof of the mouth), alveolar (bone covering), vestibular (cheek and lip folds), buccal (cheeks), and labial (lips). These structures vary in thickness and function, with keratinized areas like the tongue and hard palate providing protection, while thinner, non-keratinized areas aid in saliva flow and bacterial clearance. (13:24) John then asks Hannah to define common inflammatory conditions affecting the mouth, including: Gingivitis – Inflammation limited to the gingiva, without mucosal involvement. Mucositis (stomatitis) – Inflammation affecting the mucosa, which is central to CCUS. Periodontitis – Inflammation of the structures supporting the tooth, which can lead to tooth loss. Hannah emphasises the importance of accurately defining oral lesions to guide diagnosis and treatment.    Chapter 2 – What is CCUS? How Can It Be Diagnosed? (18:43) John introduces Canine Chronic Ulcerative Stomatitis (CCUS), asking how it relates to previous terms like CUPS (Canine Ulcerative Paradental Stomatitis) or contact mucositis. Hannah explains that CCUS was formerly known as CUPS, but the name changed as research showed that 40% of lesions occurred in areas without teeth, making the term "paradental" inaccurate. The condition is chronic, meaning it develops gradually rather than suddenly. (23:22) Sue asks how a primary care vet should determine whether a dog with oral ulcerations has CCUS or another condition, such as pemphigus vulgaris, lupus, or uremic stomatitis. Hannah acknowledges that many inflammatory and autoimmune diseases look similar and that no single exam finding confirms CCUS. She advises vets to follow key diagnostic steps: Perform a thorough dental cleaning and radiographs to rule out periodontal disease. Differentiate gingivitis (gum inflammation) from mucositis (mucosal inflammation). Take a biopsy if mucosal inflammation is present, as periodontal disease should not cause mucositis. Look for "lymphoplasmacytic infiltrates" on biopsy, which strongly suggest CCUS. If the biopsy findings suggest CCUS, referral to a dentistry specialist is recommended. If results are inconclusive, a dermatologist may need to investigate potential autoimmune conditions. (27:33) Sue asks whether "kissing lesions" (ulcerative lesions where mucosa touches the teeth) strongly indicate CCUS. Hannah agrees that they are a key sign, but notes that plaque build-up can also cause similar inflammation. A dental clean should be performed first—if inflammation persists despite clean teeth, CCUS is more likely. (28:31) Sue then asks if certain breeds are predisposed to CCUS. Hannah confirms that small breeds and terriers are overrepresented, particularly: Cavaliers, Labradors, Maltese, and Greyhounds. Greyhounds are prone due to poor dental health and periodontal disease. Spaniels may also be affected, though this is not yet confirmed in literature. Some affected dogs have severe gingivitis and mucosal inflammation despite excellent dental hygiene, making C

This month, Skin Flints welcomes a European and Australian boarded veterinary dermatologist, Sonya Bettenay. Show Notes (00:00) John introduces this month’s podcast, his co-hosts, and the topic. Chapter 1 – First Cut: Introducing Skin Biopsies (02:21) John invites Sonya to introduce herself, and she discusses her current work in Munich - focusing on skin biopsies, clinical practice, and teaching. Sue highlights Sonya's credentials, noting her Australian and European board certifications. Sonya explains her dermatology training in Australia and California and her involvement with the ECVD as an examiner and tutor. (03:57) Sue and Sonya discuss the challenges pathologists face in interpreting biopsy samples and the importance of taking quality samples to aid diagnosis. Sonya reflects on improvements in biopsy submissions over the years but notes that obtaining multiple samples often provides a more comprehensive picture. (05:31) John asks Sonya to explain what a skin biopsy is. Sonya describes it as a microscopic examination of the skin, providing insights beyond surface-level observation. Sonya outlines cases where biopsies are useful, such as unusual presentations that deviate from common conditions, and emphasises the need to tailor biopsy timing based on the patient's condition. Chapter 2 – Going Deeper -  Steps Before Biopsy (09:15) Sue asks Sonya whether biopsies should replace basic investigative tests. Sonya emphasises that fundamental diagnostic steps such as skin scrapes, hair plucks, and impression smears should be performed first in most cases. However, she highlights exceptions, particularly for vesicular or severe oral mucosal lesions, where early biopsy is crucial to diagnosing immune-mediated conditions. Sonya explains the importance of maintaining the integrity of vesicular lesions during biopsy to ensure accurate diagnosis. She stresses the need to take elliptical samples to include surrounding healthy tissue and avoid disrupting the lesion structure. (11:52) Sue and Sonya discuss the distinction between primary and secondary lesions. Sonya explains that primary lesions, such as pustules and vesicles, provide the most diagnostic value, whereas secondary lesions, like crusts and alopecia due to self-trauma, may offer limited insights. (15:15) John asks about choosing biopsy techniques. Sonya shares her preference for biopsy punches due to their precision and ease of use, while acknowledging the importance of elliptical excisions for fragile lesions like vesicles. She explains the technical aspects of both methods and how they can impact diagnostic outcomes. Chapter 3 – Preservation - Sustainability and Practical Considerations (19:30) Sue raises concerns about the sustainability of single-use biopsy punches. Sonya explains that while some attempts to sterilise and reuse them have been made, they often result in decreased sharpness and reliability. She advises using new punches for best results but acknowledges the need for sustainable alternatives. Sonya discusses her approach to biopsy sampling, recommending taking multiple samples to ensure comprehensive diagnosis. She suggests including normal tissue alongside affected areas for comparison. Sue and Sonya explore potential innovations for more sustainable biopsy tools, such as reusable handles with replaceable blades. (23:19) John asks if separate biopsy punches should be used for each sample. Sonya clarifies that one punch can typically be used for multiple samples unless dealing with particularly tough tissues that may dull the instrument. (23:52) John then asks who can take biopsies and Sonya notes that all vets and also veterinary nurses may be able to take samples depending on local regulations, particularly for alopecia cases. She highlights the importance of orienting samples correctly by marking the direction of hair growth to aid pathologists in accurate analysis. (27:25) Sue and Sonya discuss the need for deep biopsies in cases of hair lo

As a slightly different approach to this episode, John Redbonds heads to BVNA Congress to hear nurse's thoughts on the current lay of the land, and invites a few special guests to share their thoughts as well.   (00:00) John introduces the podcast and his co host – eLearning.vets head of education, Amelia Sherwood, looking into Veterinary Nursing in Dermatology, with conversations with Veterinary Nurses and industry people. Starting with some conversations from the British Veterinary Nursing Association Congress.   Chapter 1: VN Dermatology at BVNA congress – the challenges and the opportunities.   (02:12) John has a conversation with a couple of nurses working for a small group of practices that are involved in dermatology, without specialising. They reflect on some of the ways they have found to work more on dermatology, along with some of the challenges.   (05:49) John then speaks to two nurses working in a charity based PDSA practice, where they do the majority of dermatology work, and the cases are worked up thoroughly and fully – they reflect on why this is the case and why nurses do this more and how this shows that this is the most sensible and correct model.   (08:26) John speaks to Paris, a nurse who is interested and trained in dermatology – and sees the cases, but is unable to put her skills to use because the practice she is working at doesn’t utilise those skills.   (10:25) John speaks to someone working for a company called VN Recruitment – to discuss options which exist for nurses with an interest in dermatology to find a practice where they can use their skills.   Chapter 2: VN Dermatology Nursing in a corporate industry.   (12:45) John then speaks to representatives for the corporate groups to see if there were opportunities are present for nurses in CVS, VetPartners and IVC to progress in dermatology – and specialist centres and training programmes to exist, if a nurse pursues that route.   (17:50) John has a conversation with a nurse who had been heavily involved in dermatology work, but been made redundant by the group she worked for – with no options as a result locally to work as a vet nurse due to competition for places. Demonstrating the challenges that exist in the current landscape.   Chapter 3: VN Dermatology on the move.   (20:55) John spoke to Claire, a nurse who uses a more district nursing model to deliver her nursing skill set – showing there are ways for nurses to diversify within this landscape – and whilst she has some involvement in dermatology in partnership with her local practice, she recognised there could be more opportunity and potential for this.   (27:00) John speaks to Nicola Swales, the dermatology nurse at paragon referrals, who moved 4 hours across country to work as a dermatology nurse having worked at Langford referrals previously. Nicola shares how heavily she is involved in this process, showing just how involved nurses can be.   (34:12) John wraps the podcast by speaking to Amelia Sherwood, a veterinary nurse who has worked in wound management and the advancement in the nurse role in a large group; she shares her thoughts on where the veterinary nurse industry is currently and reflects on the challenges and opportunities there are for nurses.

Pododermatitis Paw-dcast Part 2 – A Surgeon's Perspective (00:00) Intro - this month, Sue, John and Paul invite EBVS Specialist in Small Animal Surgery, Jakub Kaczmarek onto the platform to discuss the other side of pododermatitis - from the surgeon's perspective. Chapter 1 – Feet First - A Surgeon’s Take on Pododermatitis (03:12) John introduces Jakub, highlighting Ursula's recommendation following their fruitful discussion on pododermatitis. He invites Jakub to share his background. Jakub expresses gratitude for the invitation and mentions Ursula as a mentor during his residency in Germany. He discusses their collaboration on pododermatitis, combining dermatology and surgery. Jakub shares his educational journey from Poland, a semester in Vienna, and his internship in Germany, which focused on surgery and dermatology. He currently works in Cologne. (04:55) John acknowledges Jakub's expertise in dermatology and asks how a surgeon fits into managing pododermatitis in dogs. Jakub emphasises teamwork between dermatologists and orthopaedic specialists, noting the complexity of pododermatitis. He explains that it can arise from both skin-related and conformational issues, necessitating collaboration for optimal care. (06:16) John enquires about the types of lesions found on dogs' feet. Jakub explains that abnormal weight distribution from orthopaedic conditions, like developmental elbow disease, can cause pressure on specific paw digits, leading to abrasions, inflammation, and even local pyoderma. He describes hypertrophy on the paw's plantar surface, potentially forming "pseudoballs." Chronic irritation can result in excessive licking, leading to severe inflammation, which requires both orthopaedic and dermatologic management.   Chapter 2 - Toes: Lesions and Lameness (09:25) Sue comments on the dog's paw pad structure, noting that abnormal weight-bearing can lead to skin issues. She asks if this is the pathomechanism for pododermatitis. Jakub agrees and adds that while there are many potential causes, mechanical issues may also contribute. He supports Sue's idea that malalignment and weight distribution lead to abnormal weight-bearing and related problems. Sue clarifies that some cases of pododermatitis have dermatological causes, while others stem from orthopaedic issues. Jakub agrees but points out that breeds like Labrador Retrievers and Bulldogs often have both conditions, complicating the determination of the primary issue. Sue P recalls a study revealing Bulldogs walk on their toes, which could contribute to multiple health issues. She emphasises the need for a multidisciplinary approach. Jakub references a study by Tim Nuttall involving over 160 dogs, noting that factors like body condition and hair type are significant in causing pododermatitis and interdigital cysts. Sue P agrees, linking higher body condition scores to more weight on the front limbs, thus making pododermatitis more common there. Jakub clarifies that while pododermatitis is typically seen more in front limbs, conditions like hip dysplasia can also affect hind limbs. He explains that primary dermatological issues may affect both front limbs, while orthopaedic problems often involve a single limb. Sue P sums up that multiple limb involvement likely relates to skin conditions, while single limb issues could indicate orthopaedic problems. Jakub agrees, adding that orthopaedic conditions like OCD or FCP typically show changes in the affected limb. (14:53) John revisits Jakub's "top-down or bottom-up" approach, asking how it relates to recognising orthopaedic diseases as triggers for pododermatitis. Jakub explains that common orthopaedic triggers include developmental elbow diseases like OCD and FCP, as well as shoulder OCD, which causes dogs to alter their walking to reduce pain. He notes that patellar luxation often results from underlying angular limb deformities that shift the weight-bearing axis, exacerbating dermatological issues.   Chapt

Chapter 1 – Companionship for Life on the Streets   (02:58) John asks Jade to introduce herself and her background as a vet and how she came to setup Streetvet. Jade shares her story of experiencing homelessness in London with a man called Dave and his dog brick, and using her past research on homelessness and dog owners coupled with her own experience in mental health challenges and how having a dog helped her, to drive her to want to help these dogs and their owners. She shares how she started going round with someone who who cut hair for homeless people, and used this as a launching pad for doing the same as a vet seeing the dogs of homeless people.   (10:05) Sue talks about the data showing the importance of companionship for homeless people with their pets, and Jade shares how there are papers and research showing that lots of factors from loyalty through to body heat show that they are vital, and her own experience maps onto that.   Chapter 2 – Building StreetVet: A Backpack and a Big Heart   (13:37) John asks Jade about how Streetvet started and what id does, and jade share how she and co-founder Sam Joseph set it up going out just the two of them, and calling themselves Streetvet – but they realised the size of the task and in 2019 set it up as a registered charity ad looked to grow it. She talks about how it picked up traction in the media through both the need for it – but also how the professional of vets needed it – with Vets and Nurses remaining in the profession providing this service reconnected them with their work. This was a completely unexpected thing for Jade.   (17:30) John asks how the service works and Jade shares that they go out with a backpack and do all the things they would in a consultation – so taking blood samples and urine samples etc. They look to empower the owner on feeling involved by doing this on the street – before then if they need to go into a practice and Streetvet have a network of practices that help provide inpatient services. Streetvet also started an accredited hostel scheme as less than 10% of hostels in the UK accept pets, to prevent owners from having to hose to remain on the street if they have one. She also mentions they offer boarding for times where the owner need to go into hospital for healthcare themselves and can’t take their pet with them.   (21:10) Sue asks about the management of chronic, long term illnesses in the Streetvet work, Jade shares that they have set times and set locations rather than approaching the owners on the street – so the owners come to them in those times. But this allows them to come back again, and jade has been surprised that they have been able to treat long term diseases like cushings and diabetes, in cases where the client is committed to the process – as they do keep coming back.   Chapter 5 – Tackling Skin Woes: Managing Dermatology in the StreetVet World   (27:00) John asks about specifically the management of skin disease in the Streetvet environment and Jade shares that they do treat these, but the challenges are very real. They have even had cases of clients performing a diet trial and long term management of skin disease. The challenges in the life of these people can make it very difficult for the owners to have consistency, but the clients are very good at coming for regular flea treatment and prophylactic skin care, in some way because of the social benefits to coming and sharing in the the streetvet community and this makes managing these cases easier than one may think.  Jade discussed the types of medications they have food they can help with, topical treatment and some antibiotics to help with these cases as well as steroids if needed. Then they do have access to other medications if needed which they wont carry in the backpack.   (32:35) Sue asks how this is funded and Jade again emphasises how great and supportive the veterinary profession has been – with companies supporting with pro bono products and vets and n

Pododermatitis Paw-dcast Show Notes (00:00) John introduces the podcast and Sue introduces Ursula Mayer – the guest on the show. Chapter 1 - Paw-sibilities – introduction to pododermatitis. (02:21) John invites Ursula to introduce herself. Ursula discusses her background and passion for pododermatitis, its prevalence, and its impact on dogs' quality of life. (03:33) When asked to define pododermatitis, Ursula explains that it's inflammation of the paw skin, with a particular emphasis on chronic cases, known as C-PIF. She discusses the various signs to look out for, such as excessive licking, lameness, and specific changes in paw appearance as the condition progresses. (05:31) Sue talks about the complexity of pododermatitis, and Ursula draws parallels with chronic otitis in terms of the multifaceted factors involved. She emphasises the importance of considering predisposing factors, primary causes including orthopaedic issues, secondary influences, and perpetuating factors in diagnosing and managing the condition effectively. Chapter 2 - Paw-sibilities - Orthopaedic Influences and Breed Predispositions (06:57) Sue asks Ursula to explain how orthopaedic diseases can contribute to pododermatitis in dogs. Ursula explains that pain from orthopaedic conditions alters weight bearing, causing dogs to adjust their stance and potentially rub their paws together, leading to inflammation and abnormal walking patterns. She goes on to discuss specific orthopaedic diseases, including elbow dysplasia, hip dysplasia, and arthritis affecting joints such as toes, carpus, tarsus, elbows, hips, and the back. These conditions can disrupt normal weight distribution and contribute to the development of pododermatitis. (08:35) Sue further illustrates with an example and Ursula emphasizes the importance of referring chronic cases to orthopaedic specialists for thorough examinations and imaging. She acknowledges the complexity of diagnosing older dogs with multiple affected areas, stressing the need for integrated care across disciplines to effectively manage pododermatitis. (09:56) John asks if this is just dogs and Ursula confirms that while cats can also suffer from pododermatitis, the chronic form discussed, known as C-PIF, predominantly affects dogs and not cats. John then asks about breed predispositions, particularly in relation to posture-related issues in Labradors. Ursula elaborates that certain breeds, notably larger and heavier ones like bulldogs, French bulldogs, and pugs, are commonly affected. Labradors and Golden Retrievers also constitute a significant portion of cases. The characteristics such as short, bristly coats and broad, flat paws, may contribute to their susceptibility to the condition. Ursula notes that even without orthopaedic diseases, these breeds' anatomical traits appear to play a role in the development of pododermatitis. (12:20) Sue reflects on a study involving bulldogs walking on pressure plates, noting that those without interdigital lesions tended to walk more upright. She emphasises that dogs with flatter feet and heavier builds are more prone to issues due to their posture, suggesting a correlation between anatomical features and pododermatitis. She further discusses how these factors influence investigation and treatment approaches. Ursula agrees, highlighting the significant role of allergies alongside orthopaedic diseases in pododermatitis cases. She notes the complexity in distinguishing between underlying orthopaedic conditions and inherent anatomical predispositions in certain breeds. Ursula shares a case involving a dog initially treated for allergies, later developing orthopaedic issues that exacerbated pododermatitis, illustrating the interplay between these factors. (14:47) Sue outlines the investigative process, starting with a comprehensive history and dermatological examination, incorporating orthopaedic evaluations based on findings. Ursula explains her approach, emphasising the importan

Unleashed: The Dawn of the Leishmania Intro Chapter 1: The Attack of the Sandfly 3.17 Sue introduces the topic of leishmaniasis, and Christian describes leishmaniasis as a multisystemic disease affecting humans and animals, primarily dogs. He notes its prevalence in regions like the Mediterranean and its expansion due to climate change and imported infected dogs. 5.19 Sue questions whether leishmaniasis occurs naturally in the UK or is solely imported. Christian mentions reported cases in the UK, suggesting transmission via infected phlebotomine flies brought back by travelers from endemic regions. The conversation shifts to the sandfly vector responsible for transmitting leishmaniasis. Christian describes the sandfly as small, silent, and potentially painless, emphasizing its absence in the UK but the possibility of migration due to global warming. Christian advises against using repellents on dogs in the UK due to environmental concerns but stresses the importance of monitoring the situation, given he acknowledges the likelihood of sandflies reaching the UK in the future. 7.27 John queries if leishmaniasis can be transmitted by other vectors like fleas. Christian affirms that sandflies are the primary vector for the disease, although other potential vectors are suspected but not proven. John then asks if humans can contract the disease from infected dogs. Christian explains that with the vector absent in the UK, human transmission from dogs is unlikely. However, he emphasizes the importance of isolating positive dogs to prevent transmission through blood transfusion. Chapter 2: The Haunting Symptoms and Diagnosis 9.11 The conversation then transitions to the clinical signs of leishmaniasis. Christian describes typical systemic symptoms such as anorexia, weight loss, lethargy, and mucous membrane pallor, along with some less common signs like polyuria and polydipsia. Christian also discusses characteristic skin lesions, including non-pruritic exfoliative dermatitis and erosive lesions. Sue adds her observations about the scaly appearance of affected dogs without itchiness, contrasting it with parasitic skin conditions. Christian concludes by stressing the importance of diagnostic assistance in accurately identifying the disease, especially considering its varied clinical presentations. 12.09 Sue brings up how leishmaniasis can affect nails, prompting Christian to elaborate on what clinicians might observe. He describes nails that grow unusually long and fast, resembling talons rather than being deformed. Christian notes that this sign is relatively rare in his experience, with scaly dermatitis or ulcerative dermatitis being more common presentations. 13.11 Sue then queries whether certain clinical presentations carry a better prognosis than others. Christian explains that prognosis depends on the severity of internal organ involvement, particularly kidney disease. The disease originates from the skin but can affect various body parts due to the immune system's reaction. 14.12 John asks how general clinicians diagnose it. Christian outlines that diagnosis relies on compatible clinical signs and specific clinical pathologies, notably anemia and changes in protein levels. While general practitioners can conduct serological tests, more specialized examinations may require referral to a laboratory. Christian emphasizes the importance of considering travel history and ruling out other conditions before treatment initiation. 16.40 Sue raises the issue of screening for leishmaniasis in dogs rescued from abroad, inquiring about the incubation period and when to start screening. Christian explains that the incubation period varies greatly, suggesting performing a quantitative serological test six months after returning from an endemic area. If positive, measures like using repellent and excluding the dog from blood transfusion banks are advised. Sue seeks more detail on the blood tests, and Christian elaborates on measuring

Welcome to a new episode of the Skinflint Podcast, celebrating our impressive milestone of 10,000 downloads. This episode is a deep dive into the crucial role of sustainability in veterinary dermatology, presented to you by Nextmune UK and Elearning.Vetand featuring Monika Linek.   Chapter 1: Setting the Sustainability Stage  (03:10) Sue introduces Monika to the podcast, who shares her experience as a German dermatologist and diplomat of the ECVD. Monika discusses her work in a referral practice in Germany and her involvement in "Parents for Future," advocating for climate justice and sustainability.   (05:20) Monika defines sustainability as meeting present needs without compromising future generations' ability to meet their own. It involves maintaining a balance to prevent depletion of natural resources and harm to ecosystems. Sue emphasizes the importance of sustainability in preserving the Earth for future generations. Sustainable practices ensure a lasting and enduring system for future generations.   (06:40) Sue raises the issue of sustainability in veterinary dermatology practices and asks Monika about potential improvements. Monika highlights several areas for improvement, including reducing carbon footprint from energy use, transportation, and waste management.   (07:39) Monika acknowledges the challenges of telemedicine in veterinary dermatology due to the necessity of physical examinations. However, she sees potential in remote consultations for follow-ups or initial assessments, particularly for referring practices. Finding a balance between technology and quality care is crucial. Monika also notes telemedicine's ability to reduce clients' carbon footprint by minimizing travel, a point Sue agrees with, emphasizing its role in complementing traditional consultations and promoting sustainability.   Chapter 2: Navigating Sustainable Solutions   (10:19)  John asks about areas in veterinary dermatology that could reduce carbon footprint. Monika underscores the importance of considering the environmental impact of drugs, particularly antibiotics and anti-parasitics. She notes the shift towards antibiotic stewardship and the need to rethink the use of topical anti-parasitics like chlorhexidine. Monika emphasizes the necessity of rethinking and changing practices regarding drug usage to minimize environmental impact.   (12:32) John appreciates Monika's insights and finds them encouraging, as these considerations align with responsible veterinary practices. He delves into the choice between systemic and topical treatments in dermatology, seeking Monika's opinion on their sustainability. Monika discusses the need for susceptibility testing before antibiotic use and emphasizes the benefits of combining topical treatments with antibiotics to reduce treatment duration. She advocates for avoiding systemic antibiotics when possible, relying on topical treatments alone for superficial pyoderma.   Regarding alternatives to chlorhexidine, Monika suggests hypochlorous acid as a more environmentally friendly option. Sue agrees, highlighting the importance of effective yet eco-friendly alternatives that do not compromise animal health.   (16:28) The conversation shifts to the development of technologies like photonic therapy as potential replacements for topical treatments. However, Sue acknowledges the challenge of balancing efficacy, cost, and environmental impact in private veterinary practice. Monika points out the need to address the pricing of eco-friendly products, highlighting the broader systemic issues surrounding their accessibility and affordability.   Chapter 3: Practical Sustainability   (18:36) John raises a practical question about the disposal of unused medications and antiseptics. Monika mentions new guidelines in the UK for returning unused or expired antibiotics and medicines to clinics for proper disposal. She highlights the importance of implementing better waste disposal systems for medicines in the f

Chapter 1: "The Dermatological Agent: Ross's Malassezia Mission"   02.42 - John begins by welcoming Ross to the Skinflint podcast and acknowledges Ross's expertise in "Malassezia." He asks Ross to share his background and explain what Malassezia is.   Ross introduces himself as a professor of veterinary dermatology, detailing his experience in farm practice and later transitioning to small animal practice. He pursued further studies and a Ph.D. specifically focusing on Malassezia, and so has been interested in them for more than 30 years.   03.44 - John asks Ross to elaborate on Malassezia, describing it for listeners who might not be familiar with the term.   Ross explains that Malassezia is a group of yeast found naturally on the skin of various mammals and birds, thriving in lipid-rich environments. It typically exists as a commensal organism on the skin but can become an opportunistic pathogen, leading to dermatitis and otitis in dogs and occasionally in cats and horses.   05:27 - Sue asks if Malassezia is the same across different species or if there are variations.   Ross explains that there are 18 known species of Malassezia, each potentially adapted to a specific host. He discusses examples like M. cunicui in rabbits, M. caprae in goats, and M. equina in horses. He notes M. pachydermatitis as the dominant species in dogs, which is unique as it can grow on routine culture media, unlike other species requiring lipid supplementation. In contrast, cats may have different species like M. nana and M. slooffiae, among others, leading to variations in yeast colonisation. There's a discrepancy between what's identified molecularly and what's observed in cultures, particularly in dogs, highlighting an unexplained scientific disparity.     Chapter 2: "Species Confidential: Malassezia's Breed of Intrigue"   8.44 - John asks Ross about the location of Malassezia on animals.   Ross mentions that, in dogs, Malassezia is predominantly found in web spaces (75-80%), lip fold regions (similar proportion), and ear canals (about one-third). Lower levels are detected on the trunk, axilla, groin, and dorsum due to their warm, moist nature.   10.00 - John inquires about identifying Malassezia in cytology with dermatology tests like tape strips or impression smears.   07:35.54 - Ross confirms that Malassezia has a characteristic peanut-shaped morphology, identifiable under microscopy, usually abundant in specimens obtained from areas like a friendly basset hound's ear wax or neck fold wax, which are good teaching examples.   08:17.63 - Sue asks Ross about determining the relevance of Malassezia presence in ears or skin. Ross explains breed-specific variations in normal yeast population, how certain breeds might have high yeast counts without causing issues, and that the anatomical site also influences yeast populations. He notes that there's no clear clinical cut-off for relevance; treatment response often helps assess its significance, as excessive yeast might not always correlate with clinical symptoms.   14.39 - John asks Ross about the clinical signs indicating an overgrowth of Malassezia.   Ross explains that signs like inflamed or greasy skin, particularly in folded areas, ears, neck, or groin, are indicative of a potential Malassezia issue, especially in predisposed breeds (he names some).   16.48 - Sue asks Ross about Malassezia as a primary or secondary disease and its relation to underlying issues. Ross mentions that Malassezia is a commensal yeast and when it causes disease, it's often secondary to an underlying problem, involving immune system imbalances or hypersensitivity responses. Ross confirms that even in breeds prone to Malassezia, like Basset Hounds, there's usually an underlying cause for yeast proliferation. He mentions high Malassezia colonisation in mucosal populations of Basset Hounds, indicating more than just skin folds contributing to the issue.     Chapter 3: "Fungal Intrigue and Secret Signs: Unravelli

John introduces the podcast and the co-hosts for this conversation; the guest on this episode is RCVS Specialist in Veterinary Oncology, David Killick.   Chapter 1 – Little Miss Diagnosis David's Background: 2.14 - David began in general practice in 2003 and later specialized in medical oncology at the University of Liverpool, earning a PhD at the RVC in London. He is now the professor of veterinary oncology at the University of Liverpool.   Malignant vs. Benign: 3.19 - Benign growths stay localized, mostly causing no problems during a pet's lifetime, while malignant growths can invade nearby tissues and spread. 4.49 - Approximately 40-50% of skin growths in dogs are malignant.   Investigate All Lumps 5.30 - Investigate All Lumps: Investigating all skin lumps is essential, even if no immediate action is taken. Initial investigation involves history-taking and examination, looking for signs like attachment to underlying structures or enlarged lymph nodes.   Biopsy Importance 8.05 - Diagnostic biopsy samples, including fine needle aspiration (FNA), are invaluable in veterinary medicine. FNA is minimally invasive, providing initial insights in 80-90% of cases. It may not offer a precise diagnosis but guides further steps. David suggests fine needle aspiration as a cost-effective initial diagnostic tool, emphasizing its utility in informed decision-making. Other options include incisional and excisional biopsies, each with its own considerations regarding risks and benefits. By prioritizing fine needle aspiration, veterinarians can efficiently navigate the path toward accurate diagnoses and appropriate treatment plans.   Factors Influencing Animal Skin Tumours 11.05 - Sue inquires about factors influencing susceptibility to skin tumours in animals, such as age, breed, and sex. David discusses breed-related associations with specific diseases in veterinary oncology, citing mast cell tumours in bulldogs, boxers, and retrievers. He mentions melanomas more common in Scotties and Schnauzers and highlights characteristics like rapid growth and tissue attachment raising malignancy concerns.   Identifying Common Benign Lumps Visually 13.18 - John seeks insights into visually identifying common benign lumps. David notes some, like skin tags, papillomas, and sebaceous adenomas, can be recognized by appearance. Skin tags are outgrowths, papillomas breed-specific, and sebaceous adenomas common in aging Cocker Spaniels. David advises monitoring, measuring, and fine needle aspiration for accurate identification.   Understanding Pigmented Tumours in Dogs, Especially Melanomas 16.33 - Sue asks about pigmented tumours in dogs, melanomas specifically. David explains not all pigmented tumours are melanomas. Dark or black lesions suggest melanomas, including malignant melanoma and benign melanocytoma. Skin melanomas may require removal if melanocytes are detected, with digital and oral melanomas requiring active management.   Identifying Melanocytes in Fine Needle Aspirations 18.00 - Sue questions melanocyte identification in fine needle aspirations. David notes pigmented tumours are usually melanomas, with characteristic black granules in cells. He mentions amelanotic melanomas' rare occurrence, especially in oral cases.   Chapter 2 – Introducing Mr Mast Cell Insight into Mast Cell Tumours 18.52 - John seeks insight into mast cell tumours (MCTs). David explains their origin from mast cells, which release histamine and cause itchiness and redness. MCTs may periodically change size upon palpation. They are common in dogs, especially specific breeds, potentially requiring multiple management due to recurrence.                       Using Fine Needle Aspirations (FNAs) for Diagnosis and the Role of Veterinary Nurses 22.10 - John inquires about using fine needle aspirations (FNAs) for diagnosis and the role of veterinary nurses in interpreting samples. He wonders if preliminary assessments in practice are acceptable due to budget constraints

Log this CPD with 1CPD here    (00:00) John introduces the podcast and welcomes our guest for this episode - the founder of the Dermatology Referral Service in Glasgow, Peter Forsythe.   Chapter 1 – The Ears   (02:58) John welcomes Peter Forsythe, who talks about how he got involved in dermatology and how ear disease makes up half the caseload in the referral practice he works at.   (04:41) John asks why it is important dogs have clean ears and Peter discusses the long tube made up of the auricular and annular cartilages which are lines with glandular skin which produces wax - which combines with skin cells to make up what we know as wax. He says a build-up can alter the environment on the ear canal, increasing humidity and increasing the number of microbes such as bacteria and yeast, which - whilst normally present - can develop into an overgrowth or even infection. He also talks about the concretions, or balls of ear wax which can form adjacent to the tympanic membrane or ear drum, and they are called ceruminoliths and can sit on the ear drum and damage and even perforate it. So it is important to manage this ear wax and keep the ear clean.   (07:55) Sue asks about the ‘self cleaning’ mechanism the ear called epithelial migration and Peter describes this as similar to the shedding of cells we have on our continuously growing skin cells, but in the ear these have a sliding, upward motion to them as they do this, and this slowly carries cells and wax up and out the ear like a slow moving escalator – at the speed our nails grow at.   (09:49) Sue asks if this changes with age and Peter says there isn’t information on age changes, but in cases of inflammation or disease this is affected, slowing it down and then leading to increased build up of wax. Peter says the human ear produces 2 kilos of wax in a lifetime!   (11:32) Sue asks what Peter recommends to clients in terms of ear cleaning with puppies and he doesn’t recommend routine ear cleaning in puppies if they are healthy, as the mechanism is working well; however, he does think in those breeds where they are prone to ear disease, that it is good to get them used to you handling their ears at a young age.   Chapter 2 – The Cleaning   (13:34) Sue asks about hairy ear canals or plucking ears and Peter says in his view plucking hairy ear canals in poodles and bichons for example, where the hair can trap the wax, can irritate and inflame the ear and begin ear disease, so he wouldn’t pluck them. If the dog has got ear disease (otitis) then some plucking maybe necessary – but ear phobia – where a dog has had bad experiences and they won’t let people go near their ears, is more of an issue and plucking can lead to this. He would prefer then to begin cleaning if you can see wax building up. This is the same with a dog with a pendulous (flappy outer) ear (which can also contribute to ear disease) – but he does point out too much cleaning can overly wet the ear and cause more problems – so each case must be considered carefully.     (17:15) Sue asks as a pet owner who can see so many different ear cleaners, what can help you decide and what to look for and Peter divides these into two. Firstly softening or dissolving ear wax products called cerumenolytics, containing things like propylene glycol, mineral oils, glycerine; through to secondly salicylic acid or even stronger sodium docusate (DOSS) or carbamide peroxide (which is only recommended in anaesthetised dogs) which dissolves. Sue clarifies then this depends on how waxy the ear is as to which you reach for and Peter says it is recommended to talk to the vet about it rather than purchasing straight from the internet.   (21:10) John points out it is important then for any nurse or vet to have a good understanding of the ear cleaners on their shelves and Peter wholeheartedly agrees, saying for example a more water based ear cleaner being used to dissolve and remove wax doesn’t make sense and also cleaning isn’t comfortabl

Log this CPD with 1CPD here    (00:00) John introduces today’s guest - host of another veterinary dermatology podcast The Derm Vet, Ashely Bourgeois.   Chapter 1: UK vs US Dermatology   (02:50) Sue asks Ashley how she started out in podcasts and Ashley shares her story, wanting to stay involved in dermatology whilst also raising children and not wanting to lose that knowledge base, and helping  others in that kind of position.   (04:33) John asks Ashely and Sue what the difference between the UK and US in approach to dermatology. Sue says the approach is the same, but the system is slightly different and there isn’t so much of a referral process in the US as here in the UK. Ashley agrees, saying often people will come direct, but that they have good relationships with first opinion practices in order that clients are aware dermatologists exist.   (06:45) Sue says the board certified dermatologists exist in both regions, but in the UK we have an intermediate tier of advanced practitioners which doesn’t exist in the states; therefore asking Ashley if there are any areas in the US which aren’t covered well geographically with specialists. Ashley says there are areas without specialists, and there is work to see if they can develop better coverage; including the possibility of telemedicine in for example a state that doesn’t have dermatologists.   (08:58) Sue asks if the rules around dermatology prescribing through telemedicine differs state to state and Ashley confirms this, saying in her state for example, they must see a client at least once a year whereas in other states this is possible long term remotely.   Chapter 2: UK vs US Antibiotic Use   (11:30) Ashley then asks Sue if it differs in relation to staphylococcus infections in the UK and US and Sue says it really does, and also across Europe from the UK. She points out in Scandinavia they hardly use antibiotics at all and use antiseptics much more, and this seems to really correlate to having less resistance. Sue asks for example if Ashely would use vancomycin and Ashely says whilst she hasn’t for this one she has had to use rifampin and chloramphenicol. She reflects there is a shift in the mindset with the use of antibiotics because of the number of times they will only have one or two choices left due to resistance.   (14:45) Sue asks if it is right you can buy neomycin, polymyxin, bacitracin over the counter and Ashely says you can for topicals, and said she even had a client who had fish antibiotics they were giving to their dog whenever they felt there was an infection. Sue reflects what would be available by comparison in the UK.   Chapter 3: UK vs US In Practice   (17:17) John asks whether a clients expectation would differ in terms of approach to a skin case in the states than in the UK and Ashley says there is much the same issue in terms of clients not understanding the long term nature of skin management, particularly in allergy and also the multimodal approach; where often more than one therapy is going to manage the patients skin. She is always quick to point out to owners these cases will change and even when well managed, this will change and they will flare up.   (20:14) John reflects that in the US the Vet nurses or Vet Techs as they are called there are still as important to case management as here in the UK and Ashely passionately agrees, saying they are critical to the solidification of a case management – instilling confidence in the owners to the treatment plan long term. They also catch mistakes and understand the cases very well.   (23:05) John asks Ashely about the education side in terms of the difference with logging CPD and education. Ashley says the regulations are quite strict in terms of whether she can talk off label at lectures and online and her and Paul reflect on some of these aspects.   Chapter 3: UK vs US Dermatology Top Trumps   (26:27) Sue asks Ashley for most common presentations and Ashley and Sue spend some time reflec

Ep.16 Show Notes   In this Skin Flints episode, Sue, John and Paul welcomed Dr Arielle Griffiths to the platform to discuss a very topical subject - sustainable pet food.   (00:00) Introduction   Chapter 1: “Understanding the Urgency: Why Sustainable Food is Necessary for Our Pets”   (03:44)  John welcomes Arielle to the pod, who talks about her work in the industry and in setting up the Sustainable Pet Food Association. As a GP vet she became involved in nutrition and did extensive research before also becoming environmentally and sustainably focused as a result of seeing a change in the world.   (07:31) Sue asks Arielle to clarify what is meant by obesity-based diets and Arielle says this is where owners are (through love) overfeeding their pets and potentially causing arthritis, heart disease and a number of conditions relating to the excess weight. This tipped her to realise the use of plants as a base in food can really help, which was a big factor in her  becoming vegan herself.   (09:08) Sue clarifies we are talking about people feeding too much or an imbalanced diet and the carbon footprint of that diet – and that we are discussing dogs here and not cats. Arielle says that the need for palatability in foods has resulted in an excess of protein in the diet and more meat being used than needed, affecting the sustainability. She shared that wet, meat-based diets have the largest carbon footprint, including raw lean diets – with one study in Brazil demonstrating a dog on this diet matched that of a human in that country.   Chapter 2: "Exploring the Landscape: What Constitutes Sustainable Food?"   (11:49) John asks why vegetarian or vegan food is a more sustainable option and Arielle says it is proven that animal agriculture for the use in pet food accounts for 2.5 - 3% of the entire carbon footprint of the world. This comes from deforestation to provide this food and the by-products of the food as a result of the market.   (13:40) Sue clarifies this as methane production from the animals used increasing the carbon emissions along with the deforestations. Livestock accounts for over 70% of global farming land use but only produces 18% of the world’s calories and 37% of total protein - with dog and cat food being equivalent to an entire country’s worth of production. But Arielle says the health benefits are what turned her more to vegetable based foods.    (15:29) Sue comments on the information on the human side for the health benefits, with more GPs suggesting it – she asks if there is evidence to support this on the pet side. Arielle says there is and comments on how in the 27,000 years of domestic evolution dogs have developed to require 52% of their diet to be carbohydrate due to the change in their genes over that time compared to the wolf they descended from, which only needs 1.2% carbohydrate. She also says dogs 3,000 years ago were primarily plant based.   (17:09) John asks if the theory of raw feeding being more natural for dogs is therefore unmerited and Arielle agrees, explaining that dogs obviously love eating food like this which is the success of the industry – but in terms of the environment there is significant evidence that resistant bacteria has been shown to be happening as a result of raw feeding, as well as it not being healthy for the dog. And she reiterates - a dog is not a wolf!   (19:18) John goes on to clarify Arielle is advocating a formulated dog food which is vegetable based and asks if it could be insect based. Arielle says it could and there are a number of companies for this, but she focuses on vegetable based and insects are just using another way of recycling protein and therefore whilst they are more substantiable – they are not as much so as the vegetable equivalents. She mentions how she was one of three vets speaking on the subject at London Vet Show along with Professor Andrew Knight and Dr Mike Davies - talking about animal nutrition and the evidence for vegetable based di

Ep.15 Show Notes   In this Skin Flints episode, the team were delighted to host one of the giants of the equine world - the brilliant Derek Knottenbelt (or Knotty, as he is also known).   Log this CPD with 1CPD here    Chapter one: Knotty   (03:49) Sue introduces Derek Knottenbelt who gives his background in the industry and his practical emphasis.   (05:09) Sue asks Derek "what is a sarcoid?". He describes it as a reactive skin tumour – so skin cancer is the best way to think about it and not viral as it has been before which has resulting in an incorrect approach; a multi-morphology skin tumour affecting all equid species and continuing to puzzle the scientific world.   (07:00) Sue asks whether it can be contagious given it is a tumour and Derek says that it is his contention that it is transmissible with circumstantial evidence to suggest this, but the mechanism for this is very little understood – it has some relationship with the bovine papilloma virus.   (08:06) Sue asks flies are spreading this and Derek says it is – where sarcoids occur tend to be where the skin is thin – where flies can feed with impunity – where it sweats and there is less hair and therefore where flies feed. Derek doesn’t believe it is the biting fly that transmits it – but a surface feeding fly which feeds on a sarcoid and then transfers the sarcoid element into the site of skin trauma on another horse – which could include where a biting fly had caused tissue damage.   (10:12) Sue says this would fit with periocular sarcoids as flies tend to feed there and Derek again agrees, saying wherever sarcoids occur rarely, they are always associated with wounds which further demonstrates this. Derek uses the analogy of surface feeding flies being like teenagers going to MacDonalds, where the food is greasy, warm and available at almost no cost – whereas biting flies are like Richard Branson who wouldn’t dream of going to MacDonalds but a 5 star Michelin star restaurant – before then saying sometimes the biting flies go there after and have a pub drink and transfer the sarcoid. This all fits the epidemiology of the disease – but the process of exactly how this happens and the link to bovine papilloma virus is not yet fully understood.   (12:36) John summarises the conversation so far and Derek goes on to show how in 1985 in a survey 2.5% of British horses had sarcoids, with an average of 2.5 sarcoids each. In 2018 this had risen to 8% of British horses with an average of 24 sarcoids each - so this disease is steadily increasing.   Chapter 2: Sarcoidy   (15:06) John asks if there are any breeds, ages or predispositions which are more susceptible and Derek says that whilst some studies have demonstrated this he does not think it is so simple having seen sarcoids in just about every breed that is available – he says there are genes which impart susceptibility as there have been outbreaks within families of horses. So it is very difficult to isolate. He also studied age of onset within a study of close to 30,000 horses and the numbers merely mimicked the population – so no definitive evidence, and he has seen 40 year old and 17 day old horses with sarcoids. He is more convinced of conditional, situation and environmental factors over any of age, breed, gender and colour.   (19:05) Sue asks about sarcoids themselves – what do they look like? Derek says it is often misdiagnosed as something else because of how multiformal it is. Because it is a tumour of fibroblasts and not epithelial cells often what you see bears no relation to what you would perceive as a fibroblastic tumour. This is because of the effect of the viral component on the disease and the impact this has on the surround tissues. So firstly the occult form of sarcoid is not the occult tumour – but may contain the tumour – and this must be kept in mind. He goes on to say the circular nature of this form is in effect a result of the mediators diffusing out from the centre. Then the centre

In this episode of the Skin Flint podcast, Sue, John and Paul welcome Katarina Varjonen to the platform to discuss the Scandinavian approach to responsible veterinary antibiotic usage. Log this CPD with 1CPD here Chapter 1 – A Scandinavian Success Story   (02:46) Katarina introduces herself and her experience as a dermatologist; Sue clarifies she is also the incoming president of the European Society of Veterinary Dermatology.   (04:00) Sue talks Katarina's career, working in Scandinavia, the UK and the USA, commenting on how good Scandinavia is on managing antibiotic usage. Sue then asks why responsible antibiotic use is important and Katarina says the one health consideration ties in and is really important across the profession in order to avoid using them longer than needed to prevent resistance. She feels most countries have put a lot of work into eliminating unnecessary use.   (06:39) Sue asks Katarina to outline the advanced approach Scandinavia has to this and Katarina says antibiotics are not completely off limits, but the guidelines are strict for recommendations – as well as limitations to what is available on the market. So for a number of years now fluroquinolones and 3rd generation cephalosporins are limited to life threatening situations, requiring culture tests as proof. Sue clarifies these are classed as critically important antibiotics in humans.   (08:23) John says this sounds quite extreme in comparison to what we do in the UK and asks if this would be considered a few years ahead of the UK and what is happening in the US. Katarina comments on it more as a cultural difference, feeling that the smaller industry in Scandinavia has helped to spread the message from within, along with the government and health sector working hard to spread the message to the public. As a result they don’t get pressure so much from clients to use the antibiotics in the first place.   (10:19) Sue asks if it is easier to treat a disease in Scandinavia because there is less resistance to antibiotics, or whether it is harder because you have less access to antibiotics. Katarina says that actually they still have the same access, but the big difference in the case management is that in Scandinavia they are far more keyed into preventative approach to a disease, meaning the cases are better managed in the first place and therefore cases are less severe from the outset.   (12:10) John asks if this comes at all from the owners side, with them being more in-tune with identifying issues early and Katarina doesn’t believe so – she feels this comes entirely from the veterinary side.   Chapter 2 – The Prologue to a Case   (13:52) John asks Katarina to share what things would help with that early identification and Katarina says scratching and head shaking is the early sign, and whilst the approach to these first symptoms will be the same for treatment, the conversation about underlying causes is begun at this stage, which is almost always allergy. Katarina herself describes this to owners as the dog equivalent of allergic eczema but in the ear.   (16:20) Sue asks Katarina to talk through her approach to a case. Katarina says she would start by feeling the ear canal on the outside, is it firm or soft to suggest issues – it also helps the dog to get used to being handled. Then she has a look with an otoscope down the ear if the dog tolerates - or she may sedate at this stage if not – in order to examine and perform cytology. If the canal is inflamed she will go to cleaners and anti-inflammatories to open up the canal, even before thinking about treatment of the infection.   (18:07) Sue asks Katarina to clarify what is meant by Cytology and Katarina describes this as the basic and easy to perform diagnostic tool for these cases, using a Q-Tip (cotton bud) to gather material from the upper ear canal and roll onto a microscope slide before staining with Diff Quick (or similar) to look for bacteria, round or rod shaped, yeasts or infla