294. How to NOT feel guilty using steroids

We have so many wonderful non-steroid options to manage itch and inflammation in veterinary dermatology. HOWEVER, there is still a time and place that steroids are necessary. It is important to not be afraid of steroids, but now when and how to use them appropriately.From stenotic ears to cost concerns, check out the situations where, even as a boarded dermatologist, I lean on steroids on this week's episode of The Derm Vet podcast!00:00 Intro01:00 Taking away guilt for steroid use02:04 Scenarios where steroid use is considered03:07 Severe Inflammation05:05 While waiting for a slower medication to work07:27 Stenotic Ears9:11 Management of autoimmune diseases11:14 Cost Concerns13:10 Sometimes nothing else works14:56 Summary/Outro

Tom Lewis, DVM, DACVD is back on the podcast! Last year, Dr. Lewis joined the podcast last year to discuss the release of Zenrelia. One year later, he is back to discuss his experience with having this medication for a year and the relief it has provided for hundreds of his canine patients. Also, we discuss the recent change to the US boxed label warning which removed the vaccine induced disease portion of the label.Learn more on this week's episode of The Derm Vet podcast!Studies mentioned in podcast: Recent study regarding vaccine booster response in dogs receiving Zenrelia: Fent, G.M., Jacela, J., Plazola-Ortiz, R. et al. Immunologic response to first booster vaccination in dogs treated with zenrelia™ (ilunocitinib tablets) at up to three times the recommended therapeutic dose compared to untreated controls. BMC Vet Res 21, 481 (2025). https://doi.org/10.1186/s12917-025-04929-zRecent study regarding safety of Zenrelia: S. Forster, C. M. Trout, S. Despa, A. Boegel, D. Berger, and S. King, “ Efficacy and Field Safety of Ilunocitinib for the Control of Allergic Dermatitis in Client-Owned Dogs: A Multicenter, Double-Masked, Randomised, Placebo-Controlled Clinical Trial,” Veterinary Dermatology (2025): 1–13, https://doi.org/10.1111/vde.70009.Timestamps00:00 Intro02:46 Zenrelia box label warning change08:14 What does the box label warning change mean and why it's only in the US?12:10 Looking at every patient as an individual17:00 How comfortable do you feel using Zenrelia long-term?22:14 Outro

Otitis is a common thing for veterinarians to treat. Commonly associated with underlying allergies, we can see other things cause ear infection such as ear canal masses, endocrinopathies, etc. When you are busy in the clinic, it can be hard to think about every aspect of ear canal disease. In an attempt to make things a bit easier, I put together the top 5 mistakes I recognize in management of otitis cases. Let me preface with the fact that I have also made these mistakes in the past! Learn more on this week's episode of The Derm Vet podcast!00:00 Intro01:49 Mistake #1: Not performing ear cytology05:18 Not implementing appropriate ear flushing protocol07:46 Fail to control inflammation09:45 Don’t recheck progress12:14 Not identifying the underlying issue14:49 Recap / Final Thoughts16:27 Outro

As always, you bring the best questions for these grab bag episodes. Today, we cover dog autoimmune diseases (though cats find their way to make it in a bit). How do you tell the difference between DLE and PF?What if an owner can't biopsy the case?How do you treat SLO? Sebaceous adenitis?Find the answers to these questions and more on this week's episode of The Derm Vet podcast!00:00 Intro01:30 SLO & sabaceous adenitis09:40 Steroids and Autoimmune diseases12:23 What to do when owners can’t biopsy the case15:12 Pemphigus foliaceus in Dogs16:05 Pemphigus foliaceus in Cats17:07 Autoimmune Disease vs Allergies18:31 Differentiating between DLE and Pemphigus Exfoliation in dogs21:48 Outro

Hyperbaric Oxygen Therapy is the use of supplemental oxygen in a chamber under increased pressure so the blood oxygen concentration increases which facilitates healing. There are not many veterinary practices that have HBOT for pets. However, we are lucky enough to have Trenton Ewing, DVM, DACVD back on the podcast to discuss HBOT since his practice (Animal Dermatology Clinic in Pasadena, CA) has had HBOT available for years!Learn what diseases he has used this therapy to treat, what a typical HBOT "dive" looks like and how this therapy works! Not only can you check out our conversation on traditional podcast apps, but check out the YouTube channel which includes pictures and videos!00:00 Intro01:12 Hyperbaric Oxygen Therapy with Trenton Edwards02:34 What is an HBOT?04:36 Common cases referred to HBOT07:15 Typical HBOT Dive Protocol09:00 Issues doing it long-term?12:15 How stressful is it be for pets?14:12 Training for HBOT16:28 Contraindications19:56 How available is HBOT?23:12 Downsides24:00 Final Thoughts/Outro

It can be scary to have a dog that goes through a life-threatening reaction to a honeybee sting. Often, these dogs are young and active. Though owners can take preventative measures, it is impossible to guarantee 100% avoidance of these venomous insects. So, what can be done?Trenton Ewing, DVM, DACVD joins the podcast this week to discuss a very effective way to manage these cases. Dr. Ewing practices at Animal Dermatology Clinic in Pasadena, CA and has previously done research on venomous insect testing and desensitization. We discuss a typical history in these patients, how testing is performed and the success rate of long-term desensitization. Enjoy this unique topic on this week's episode of The Derm Vet podcast!00:00 Intro00:25 Venomous Insect Testing with Trenton Edwards01:49 What spiked your interest in venomous testing?05:08 Typical history that a dog presents to Trenton as an initial exam09:27 Testing process14:27 Most common culprits15:40 Desensitizing 20:39 Faster protocols22:29 How long do we do monthly injections?25:10 What do you send them home with and what is the expectation?28:27 Outro

It is back to school season! For this episode, I review the four things I have learned to implement as a dermatologist. Even as a specialist, I like to progress and grow into how I am practicing!We will go over how to use supplement and skin supportive diets, venomous insect testing, improving immunotherapy and proactive skin management.00:00 Intro02:15 Being more thoughtful in recommending skin supplements or skin diets07:02 Venomous Insect Testing09:33 Improving immunotherapy12:48 Proactive, not reactive with allergy management16:53 Summary

Skin damage and cutaneous wounds can be frustrating and difficult to manage. With a growing world of antibiotic resistance and difficult cases of skin repair, alternative solutions are needed. Zarasyl combines the natural power of silica to optimize the wound healing environment. The product helps to moisturize while being semi-occlusive to allow oxygen through the barrier.Julia Miller, DVM, DACVD is a frequent guest of the podcast and joins once again to discuss her experience with Zarasyl in dogs, cats and horses. This episode provides comedic relief with discussion of being a hand model and Labubus. But, most importantly, you will learn additional ways to treat wounds and manage dermatology cases with Zarasyl.00:00 Intro00:25 Dr. Julia Miller02:16 Zarasyl05:04 Using non-antibiotics when possible07:41 What is Zarasyl?10:54 How and when to use Zarasyl13:20 Can it safely be used long-term?18:04 Top diseases where you're using Zarasyl19:50 Horses22:36 Lessening the duration of antibiotics26:40 Zarasyl's scientific support29:14 Final thoughts about Zarasyl31:58 Outro

I love getting your questions and answering them on the podcast. This week is one of my favorite topics: cytology! What tips do I have for direct impression smear vs. tape prep?How do I know the appropriate treatment based on quantity of infectious organisms?What is the difference between superficial pyoderma and deep pyoderma?Get your questions answered on this week's episode of The Derm Vet podcast!TIMESTAMPS00:00 Intro01:22 What advice do you have for collecting tape prep versus collecting direct impressions?03:47 Tape prep07:06 How to stain tape prep08:43 How can we get better at sampling interdigital spaces?11:16 Dry Lesion vs Wet Lesion14:15 How do you interpret the number of Malassezia or bacteria on skin or ear cytology?17:13 How do you differentiate between a deep pyoderma and a superficial pyoderma?20:00 How many organisms do you consider 1 plus, 2 plus, 3 plus?22:20 Thoughts on AI/Digital cytology machines24:34 Outro

Back again! Fred Wininger, VMD, MS, DACVIM (Neurology) rejoins the podcast to talk about cats! Do clinical signs differ from dogs with neuro disease? What about the dreaded feline hyperesthesia syndrome? Should advanced imaging be considered?Check out this week's episode of The Derm Vet podcast to jump into the world of cat neuro/derm!00:00 Intro00:25 Dr. Fred Wininger and cats02:13 Otitis Media in cats06:44 Next step for treating13:20 Treating concurrent sinusitis rhinitis15:20 Feline hyperesthesia19:15 Toxoplasmosis25:38 Outro