Skin Deep: Dermatology Care

November 19, 2025 9 AM - 6 PM.

Today, I spent the day with Krystle, my LVT, in dermatology. She showed me their microscope setup and explained that they only use 10x and 100x with immersion oil to examine slides. Interestingly, they only heat-fix nail and ear slides—something I hadn’t realized before. It was fascinating to see how focused dermatology labs are on the details!

Case 1: Cooper – Labrador with Paw Pad Nodules 🐾

Cooper, a Labrador, presented with nodules on his paw pads that had ruptured and bled. The dermatologist started him on Apoquel to manage inflammation and itching, and added methylprednisolone, a steroid, to help with the more severe lesions. Cooper’s owner was instructed to monitor his pads and bring him back in 4 weeks for a recheck. It was interesting to see how the dermatologist balanced systemic therapy with ongoing topical care.

Case 2: Sterling – Pitbull Mix Recheck/Consult 🐕

Sterling, a 10-year-old neutered male pitbull mix, hasn’t been seen by dermatology in over 2 years. He has a history of seasonal allergies, currently managed with as-needed Apoquel and immunotherapy. Today, his dad brought him in because the clinic had declined immunotherapy due to the long absence. On examination, Sterling wasn’t itching and only occasionally licked his paws (likely due to mild OCD). The dermatologist reviewed his history and approved restarting his immunotherapy, noting he is doing well on his current regimen. It was great to observe how dermatologists incorporate both behavior and long-term treatment history into their recommendations.

Case 3: Lucy – Doodle with Chronic Ear Infections 🐶👂

Lucy, a Doodle with a history of chronic ear infections, had recently had her oral steroids abruptly stopped by her owner. The veterinarian carefully explained the risks of suddenly stopping steroids and why a washout period is necessary before initiating another steroid or NSAID. It was a good reminder of how careful medication management is crucial in dermatology patients with chronic inflammation.

After finishing the morning cases, I got to see even more fascinating dermatology patients and learn about immunotherapy preparation with Eden, another LVT.

Case 4: Cooper – Doodle with SLO (Symmetrical Lupoid Onychodystrophy) 🐶

Cooper, a Doodle, presented with brittle, painful nails caused by Symmetrical Lupoid Onychodystrophy (SLO), an autoimmune disease where the dog’s immune system attacks the nail bed. Because his nails are so fragile, he requires sedated nail trims each time to prevent pain and further injury.

The dermatologist recommended an 8-week strict diet trial using a hydrolyzed protein diet. A hydrolyzed protein diet is formulated so that the protein molecules are broken down into tiny components, called peptides, that are less likely to trigger an immune response. The strict 8-week period is non-negotiable because even a single exposure to non-hydrolyzed protein can interfere with the trial, making it impossible to determine whether the diet is helping the autoimmune condition.

Case 5: Cora – Ittie Bittie Pittie on Cytopoint 🐕💉

Cora received Cytopoint 3 weeks ago to help with her itching, and her dad was happy to report she is doing much better. She still occasionally chews her toes, which her dad believes is OCD-related rather than allergic. The dermatologist would like to perform an allergy test, but it requires anesthesia. Because Cora has a heart murmur, her dad wants to have her evaluated by a cardiologist for an echocardiogram first.

Case 6: Austin – Allergy Pittie 🐾🩺

Austin has chronic skin infections, especially between his toes (interdigital), which are red from excessive licking. He also has a lick granuloma. Last year, he had a flare at the base of his tail that required antibiotics. This visit, Austin’s dad consented to an allergy test, and the plan is to start immunotherapy tailored to his specific allergens.

Case 7: Demo – Black Lab with Chronic Scratching 🐕‍🦺

Demo has been scratching his ears incessantly and licking his paws, on top of being a hyperthyroid dog on Levothyroxine. His mom reports that immunotherapy has been helping significantly, and his overall skin condition is improving. It was encouraging to see such a positive response to therapy and see how management of multiple conditions can overlap.

Immunotherapy Prep with Eden: Customizing Allergy Treatments 🧪🌿

Since the day’s appointments wrapped up early, Eden showed me how they prepare immunotherapy vials. They test for 59 different allergens, and after a patient’s allergy testing, the veterinarian and technicians know exactly which allergens the patient reacts to.

Using this information, they formulate a custom “concoction” for each patient to increase tolerance to allergens over time. For example, if a canine patient is allergic to cats and lives with feline companions, the doctor may increase the amount of cat allergen in the immunotherapy mixture. The goal is to gradually desensitize the immune system, reducing clinical signs like itching, redness, and infections, while tailoring treatment to the patient’s environment and exposures. It was really cool to see how precise and personalized dermatology care can be!

Immunotherapy Preparation

Dermatology is truly a blend of science, observation, and client communication. Today, I learned so much about:

• Autoimmune diseases and diet trials (like SLO and hydrolyzed protein diets)

• Managing chronic allergies with Cytopoint and immunotherapy

• How precise lab techniques and allergen testing help craft personalized therapies

• The importance of client education, especially when managing chronic diseases and medications

  
  

It was fascinating to see how small details—like behavior, environmental exposure, and past medical history—directly influence treatment decisions. Krystle and Eden were amazing guides, demonstrating both the technical and compassionate sides of dermatology care. 🩺💖