Small animal dermatology diagnoses to be improved via new CVS clinical project

Eighteen CVS’ first opinion small animal practices are setting out to improve diagnoses of dermatology cases with a new clinical improvement project.

It is hoped that it will increase the number of patients having a skin microscopy work up as part of the diagnostic pathway - to arrive at a full diagnosis and in order that the correct treatment can be given. A ten-fold increase in skin microscopy has been set for participating practices.

A 2006 study found that skin complaints are the most common reason (after preventative healthcare) for companion animals to visit a vet, with over 20% of consultations related to the skin. The dominant presenting sign in dogs and cats is pruritus, an unpleasant sensation within the skin that provokes the desire to scratch. 

Using microscopy techniques in dermatology cases is beneficial. It helps to effectively identify the disease or condition, to select the right treatment, and to evaluate the response to therapy. Overall this will improve the clinical outcome and welfare for patients.

In 2022, research conducted with nearly 500 CVS practices revealed skin microscopy techniques were only being employed in less than 0.5% of its dermatology cases, reflective of the veterinary industry. Most practices were using an ‘empirical’ approach - using a vets’ experience to make a clinical educated guess on diagnosis, along with ‘stepwise’ treatment – where vets gradually increase and decrease medicine until the best balance is found. Commonly identified barriers to conducting a full skin microscopy work up were found to be a lack of confidence, limited time and a lack of perceived value by the pet owner.

The CVS dermatology clinical improvement project is aiming to introduce a skin microscopy work up at the start of all itchy cases in participating practices. Where appropriate and agreed by the owner, veterinary colleagues will seek to take skin cells from affected animals using skin scrapes, hair plucks, sellotape strips and impression smears. Samples will then undergo a microscopic evaluation in house, or if external diagnosis is needed, they will be sent to one of CVS’ laboratories. For suspected atopic dermatitis, an additional diet trial will be conducted, whereby an animal will be fed a specific diet for six weeks with regular veterinary check-ups.

To support clients, a reduced fee for an initial package of dermatology tests is being offered, so a full and proper diagnosis can be made for their pet.

Within each practice, it is being suggested that both vets and veterinary nurses are given a role in diagnosing and managing the dermatology cases. Nurses can note down the clinical history of the animal and take skin samples, whilst vets hold the first consultation, seek to make the diagnosis and select the correct treatment or next step – using the evidence collected. Practice veterinary nurses can then hold follow-up clinics with patients to conduct re-checks and to monitor patient improvements.

To upskill both vets and nurses in participating practices, a suite of resources and training has been created by CVS’ regional clinical lead team, specialist dermatologists and laboratory division. These focus on; an approach to pruritus; taking a patient’s clinical history; and a practical guide to microscopy.  Resources have included new clinical guidelines, patient history forms, and client information sheets. Whilst training has comprised two face-to-face CPD training days and online webinars. CVS’ laboratories and LED teams have also delivered microscopes and samples for the training days. A workspace houses all dermatology materials on CVS unique online learning and development platform Knowledge Hub.

Priya Puranik Regional Clinical Lead at CVS, who designed and is leading the CVS dermatology clinical improvement project, said: “When a pet gets itchy it significantly impacts their welfare and it is worrying for clients. An empirical approach can improve conditions for a period of time, but as a full diagnosis is never arrived at, symptoms often come back - especially if a pet has multiple conditions at once.

 “Dermatology is a wide-ranging veterinary subject. Pets encounter many different skin conditions and there are a huge variety of treatments on offer. So the aims of this project are to investigate skin cases using a full skin microscopy work up, get a full diagnosis first time, and give the correct treatment to the animal. Long-term this will save the pet from suffering, and will save our clients time and money.”

Participating practices are currently collating dermatology data monthly, in order that they can chart their progress.

CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with over 500 veterinary practices and referral centres in the UK and Australia. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals.