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Veterinary dermatology FAQ
What is a veterinary dermatologist?
Veterinary dermatologists diagnose and treat diseases of the skin of animals. This includes a wide spectrum of diseases, ranging from allergies and ear infections to auto-immune disease and skin cancer. Skin disease can also present as a manifestation of an underlying internal disease process. Veterinary dermatologists are therefore also trained in otoscopy, immunology, allergy, and internal medicine. Veterinary dermatologists must be board-certified by the American College of Veterinary Dermatology (ACVD). The purpose of the ACVD is to promote excellence in veterinary dermatology, oversee postgraduate training in veterinary dermatology, sponsor research, and organize scientific and educational programs for both veterinary dermatologists and general practitioners. There are currently about 300 ACVD board-certified veterinary dermatologists worldwide, including our two doctors.
Why is my dog or cat so itchy?
- Nationwide, the most common reason for itchiness in dogs and cats nationwide is ectoparasites—the creepy crawlies—usually fleas and mites. Flea bite allergy often causes hairloss and itchiness over the rump and tail area. In cats, it can be associated with a particular allergy manifestation called miliary dermatitis, which are little raised crusted bumps, usually on the trunk and neck. Fleas may not always be visible, particularly in cats, who groom them off. Mites are microscopic and cannot be detected with the naked eye. Sarcoptic mange is an itchy, contagious mite endemic in the fox population. This mite often causes crusting on the edges of the ears, elbows, and hocks, and tremendous, severe itchiness that often responds poorly to anti-itch medication. Ectoparasites particularly should be considered if the patient has no prior history of being itchy, or if they are of an unusual age to develop allergic skin disease (ie, greater than 5 years of age).
- The next most common cause of itchiness is, by far, allergic skin disease. Allergic skin disease generally manifests as itchiness and/or inflammation (red skin) of the feet, face, armpits, belly, and rear end, and typically afflicts young animals (ie, first clinical signs less than 5 years of age). It can be seasonal or year-round depending on what the patient is allergic to. Certain dog breeds are genetically predisposed, such as English and French Bulldogs, German Shepherds, Labrador Retrievers, Golden Retrievers, Labradoodles, Golden Doodles, Pit Bulls, and many terrier breeds.
- Skin infections: Bacterial and fungal infections can cause significant itchiness. While fungal infections such as ringworm can be primary infections (meaning that the infection is not caused by something else), most bacterial and yeast infections are secondary to a primary skin disease, such as skin allergies or endocrine disorders like hypothyroidism or Cushing’s disease.
- Other potential causes of itchiness are less common: immune-mediated conditions such as sebaceous adenitis (where the immune system destroys the skin’s sebaceous glands) and pemphigus foliaceus (where the immune system destroys the connection between skin cells) can both be severely itchy, as can a type of skin cancer called epitheliotropic cutaneous lymphoma.
Why does my dog or cat keep getting skin and ear infections?
Skin infections and ear infections are generally SECONDARY to an underlying PRIMARY skin disorder that is affecting the skin barrier or immune system of the skin. The most common cause of recurrent skin infections in dogs is allergic skin disease. When the patient is exposed to something she is allergic to, her skin responds by becoming inflamed. This inflammation changes the microhabitat of the skin, from one that is naturally dry, arid and inhibitory of bacteria and yeast overgrowth, to one that is moist and humid, in which the normal flora bacteria and yeast can proliferate out of control and cause infection. These infections, therefore, are not contagious—instead, they are overgrowths of the normal bacteria and yeast that are present on the skin.
The second most common cause of recurrent skin infections are endocrine disorders. Endocrine disorders occur when there are abnormal amounts of normal hormones that are important for skin health. The two most common conditions are hypothyroidism and Cushing’s disease, where the body makes too much stress hormone (cortisol). These conditions lead to suppression of the skin’s immune system, which allows the normal flora bacteria and yeast proliferate and cause infection. Endocrine disorders typically cause other clinical signs in addition to skin disease. For example, Cushing’s disease can cause excessive thirst, urination, and eating, and patients often have a pot-bellied appearance. Hypothyroidism can be associated with lethargy and weight gain.
Why is my dog or cat suffering from hair loss?
When your pet is suffering from hairloss, it’s important to determine if this is inflammatory hairloss—meaning that the involved skin is itchy and red, or if this is non-inflammatory hairloss, where the involved underlying skin appears normal and is not itchy. In general, non-inflammatory and inflammatory hairloss are caused by different diseases.
- Causes of inflammatory hairloss include: allergic dermatitis, ectoparasites (fleas, mites) infestation, infection (bacterial, fungal, viral), immune-mediated conditions (sebaceous adenitis, pemphigus foliaceus), and skin cancer (cutaneous lymphoma).
- Causes of non-inflammatory hairloss include: endocrine disorders (hypothyroidism, Cushing’s, sex-hormone associated alopecia), hair cycle arrest (conditions where the hair follicles stop cyclcing normally, including cyclic flank alopecia, Alopecia X), follicular dysplasia (structural abnormalities of the hair follicles, such as black hair follicular dysplasia or color dilution alopecia), and self-induced/behavioral hair pulling in cats (barbering).
Does my dog or cat have a food allergy?
It’s possible that your pet has food allergies, but environmental allergies are much more common than food allergies. The only way to diagnose a food allergy is with a strict elimination diet trial using a prescription or home-cooked diet. This trial comprises you exclusively feeding your pet the diet for 8 weeks. We will then evaluate a clinical response to the diet. In our experience, it is common for owners to walk into our clinic thinking that their pet has a food allergy, when in fact their pet has an environmental allergy or another undiagnosed skin condition.
How is laser surgery used in veterinary medicine?
Veterinary dermatologists are at the cutting edge of laser surgery in veterinary medicine. Today’s surgical lasers help speed up healing time by decreasing inflammation of the surrounding tissue. Our laser is a Vetscalpel CO2 laser. Documented benefits of surgery using this instrument include decreased bleeding, decreased pain, reduced risk of infection, and faster recovery time. In addition, surgical lasers offer a unique feature—they allow the surgeon to carefully ablate the diseased tissue, almost one cell at a time, which makes them the instrument of choice for conditions that involve multiple skin lesions, such as Bowenoid carcinoma in situ, a type of skin cancer in cats, ceruminous gland cystomatosis, a type of ear cysts in cats, and sebaceous adenomas/hyperplasias in dogs, where traditional removal of all of the involved sites would be difficult, if not impossible. Laser surgery can also be performed in hard-to-reach places, such as deep in the ear canal, using our video-otoscope.
Is allergy testing needed to diagnose a pet with allergies?
No. The diagnosis of allergies is based on a clinical diagnosis, which occurs when a pet has a medical history and clinical lesions typical of allergies, and other causes of these clinical signs have been ruled out. We recommend allergy testing only after the diagnosis of allergies has been made. The reason for this is that allergy tests can be positive even in animals who do not have allergies. For instance, a dog could be generating allergen-specific antibodies, but these antibodies are not leading to inflammation or itch. One common example in the northeast US is a pet with sarcoptic mange, a disease caused by an itchy contagious mite endemic to our native foxes. As another example, sogs with sarcoptic mange (“scabies”) are very itchy and are commonly misdiagnosed with allergies. Allergy testing on these patients might well reveal some positives to tree pollens or weed pollens, but once the sarcoptic mange is treated, these patients usually no longer show clinical signs of allergic skin disease. Therefore, it is strongly recommended to have a solid clinical diagnosis of allergic skin disease before performing allergy testing.
Are pet allergy tests accurate?
Allergy testing is currently only accurate for environmental allergies—for instance, allergens to pollens, trees, weeds, molds, pollens, and house dust mites. It is not currently accurate at detecting what food allergens are afflicting the pet. This is true regardless of what type of food allergy test is selected—serum (blood), saliva, or patch testing. Positive values on a food allergy test simply mean that the pet has been exposed to that allergen or something similar. The only value in performing food allergy testing is in negative values—they usually can accurately predict what the patient is NOT allergic to. Currently, the only accurate way to diagnose food allergies in dogs and cats is to perform a strict elimination diet trial using either a prescription hypoallergenic diet or a home-cooked diet. For environmental allergies, allergy testing can be accurate and helpful.
What pet allergy tests are best?
For environmental allergies, there are two forms of allergy testing that can be considered:
- Intradermal Allergy Testing: This is the gold standard method of identifying environmental allergens in dogs and cats (and horses). This test requires light, reversible sedation. Allergens such as danders, house dust mites allergens, pollens are then directly injected into the skin. The size of the allergic reaction is measured and compared to a positive control (pure histamine) and negative control (saline). This test identifies allergen-specific antibodies on mast cells inside the relevant organ, the skin. This distinct “pro” must be weighed against the potential “con” inherent with the risk of sedation and the very slight risk of an allergic reaction occurring during the procedure.
- Serum (blood) allergy testing: This test is easy to perform, as it is a simple blood draw. It aims to detect allergen-specific immunoglobulin E (IgE) to grasses, tree pollens, weed pollens, molds, and house dust mites, as well as some insects. The most important consideration with this test is the laboratory the sample is submitted to, as the accuracy of laboratories can have important differences. For example, it is crucial that the laboratory use Cross-reactive Carbohydrate Determinants (CCD) blockers. CCDs occur on many plant allergens, and animals can develop antibodies to CCDs. Because these molecules can be present across many different allergens, many false positives can be detected. By blocking the CCDs, this false positivity is prevented.
Do I need a referral to see a veterinary dermatologist?
No, you may be referred or simply make an appointment. If you are referred, it is helpful to have your veterinarian fill out a referral form. Either way, we will get your records from your veterinarian’s office and work with you primary care veterinarian.
Reviews
These reviews are pulled chronologically from our Google business profile.
Rating
As a medical doctor myself, I really appreciate when veterinary medicine is practiced to a "best-practice" standard of Excellence that any provider of human medical care would be envious of. Unleashed Veterinary Dermatology is such a place. Instead of just "managing" recurrent allergy and skin problems, Dr. Falk and her team provide prompt, attentive, thorough and thoughtful care - discussing diagnosis, options for treatment and plans for follow-up preventive care to avoid problems in the future - all with a smile and modest fees. My dog's quality of life has been dramatically improved as a result of the ongoing, superb clinical treatment that has been provided to her by the staff of "Unleashed". I was lucky to have been referred to them.
I cannot say enough good things about Dr. Falk and her entire staff at Unleashed. We used to bring our beagle, Delilah to her at her previous job in Stamford. When we heard that she was opening up a practice in Stratford, we knew we had to follow her! My partner and I are so impressed with her and her staff of their knowledge of how to treat allergies. At one time Delilah was sneezing constantly and sniffling a lot. Our regular vet said that it was no big deal and to bring her in again if it gets worse. This went on for several months. We brought her to Dr. Falk and immediately she looked in her nostrils and found that her nostrils were very swollen and we immediately were able to get her treated for it. Everyone is always friendly and compassionate. They treat Delilah as if she was their own pet, and they treat her mommies with caring, patience and compassion. Delilah loves them! Whenever she sees any of the staff (most recently Elena and Dr. Falk), she would run over to them, tail wagging, and roll over for a belly rub! I would recommend Unleashed to anyone who has a pet that has any kind of allergy. Thank you, Dr. Falk and team!
My dog loves going for his appts. His allergies are very well controlled for the past two years. Staff is absolutely amazing. Dr Faulk is thorough, every step of the plan is explained. Can’t say enough great things about going here.
There is one thing wrong here. They don’t have a general practice vet. If they have one I will move to live closer to them. Everything is perfect. Since receptionist to docs. Keep it that way.
Pricing
We believe in transparent pricing!
New-patient consultation (about 60 mins): $295.
New-patient cytology: $86. Cytology is when we take samples from your pets skin and examine it under a microscope. New patients typically need this service.
Recheck appointment: $165
Blood test at an external lab: about $200, depends on the test
Medications: We aim to set our prices to match the lowest advertised price from discount online pharmacies like Chewy. You view these prices our online refill pharmacy, Unleashed Vetmart.
What to expect: The total price for a first visit, including consultation, cytology, external diagnostics and medications, is typically $400-$1,000. The higher end of that range is for pets that require a procedure (e.g. a biopsy).
Accepted payment methods: Cash, check, credit cards, Carecredit, Scratch, Trupanion
