The Skin Flint Podcast

• Episode 30 - Understanding The New ISCAID Pyoderma Guidelines

  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 adjunctive topical treatment.   (32:40) Sue asks about helping vets communicate these new approaches to pet owners. Anette explains that the guidelines include tables, visual aids, and quick-reference guides to support busy practitioners.   (33:28) John asks about when systemic antibiotics are still necessary. Anette explains that systemic therapy is still essential for deep pyoderma or when topical treatment alone is impractical (e.g., large dogs, owner limitations). In such cases, culture and susceptibility testing should guide antibiotic choice.   (38:15) Sue asks which antibiotics should be the first choice if empirical treatment is necessary. Anette recommends clindamycin, lincomycin, cephalexin, or co-amoxiclav as first-line choices, with fluoroquinolones reserved for resistant infections.   (42:32) Sue asks Anette for her top five takeaways from the guidelines:   Read the dog, not just the textbook. Diagnose based on clinical lesions and determine if the infection is surface, superficial, or deep.   Use cytology whenever possible. It’s quick, inexpensive, and helps confirm bacterial involvement.   Always look for the underlying cause. Pyoderma often recurs due to allergies or hormonal conditions.   Prioritise topical therapy. Topical antimicrobials alone are effective for many skin infections, reducing antibiotic use.   Use systemic antibiotics responsibly. Empirical choices should be limited to first-line drugs, and culture should guide second-line therapy.   (45:45) Sue mentions that the full guidelines will be available online via: WSAVA, ISCAID, and WAVD. Sue also mentioned a  WAVD webinar Anetta hosted, which is a must watch. The guidelines are currently available HERE   (47:29) Outro – As always, Sue & John wrap up before John asks his co-hosts a light-hearted question to end on

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• Episode 29 - How Complex is Eosinophilic Granuloma Complex?

  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 usually nutritionally safe Veterinary nutritionist input for longer-term plans   (28:43) Sue asks how to start a food trial if a cat is self-traumatising. Debbie uses concurrent systemic treatment (usually steroids) to control inflammation during the trial, tapering meds over 4–6 weeks if possible. (30:05) John asks for the first steps as a guide for primary care vets. Debbie recommends her first steps would be to rule out ectoparasites with full household flea control, possibly whilst beginning topical/systemic treatment as needed for comfort (32:10) Sue asks what to do when left with suspected environmental allergy. Debbie describes: Referral approach: Intradermal testing and immunotherapy if cost allows (40–75% success rate) Primary care approach: Use steroids at the lowest effective dose Importance of prioritising flea control and food trial first as they are often curative   (36:50) Sue and Debbie have a healthy debate on the relative benefits of allergy testing when immunotherapy is not being considered as an option.  (41:08) John wraps up the episode, thanking Debbie for simplifying a complex topic and helping listeners better understand eosinophilic granuloma complex in cats. John asks Paul and Sue another probing - if not questionable - question.

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• Episode 28 - Gum On Down!

  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 CCUS harder to recognise. (31:33) John asks how easy biopsies in the mouth are Hannah stresses that biopsies should always be done under general anaesthesia for pain control and a thorough oral exam. She typically uses a punch biopsy, ensuring a portion of normal tissue is included to help distinguish inflammatory from autoimmune causes. She highlights the importance of sending clear photos and case details to assist pathologists in interpreting results. Additional tests like immunohistochemistry may sometimes be useful.   Chapter 3 – Treating CCUS: What Are the Options? (35:44) John asks how CCUS is treated and whether treatment varies by severity. Hannah explains that CCUS treatment is multi-step and includes: Dental Cleaning & Plaque Management: Full dental cleaning is the first step. Extractions are considered only for teeth that contribute to inflammation. In mild cases, cleaning + home care (brushing, antiseptics) may suffice. Home Management & Pain Control: Some owners can maintain oral hygiene, others cannot. Pain relief options include NSAIDs, paracetamol, gabapentin, or amitriptyline. Feeding tubes may be used in extreme cases for pain-free nutrition. Medical Management for Severe Cases: Two main protocols exist: Cyclosporine + Metronidazole (immune modulation & bacterial control). Doxycycline (low dose), Pentoxifylline (ulcer management), and Niacinamide (vitamin B3). The choice depends on vet preference and patient response. Long-Term Management & Research Gaps: Some dogs may eventually stop medication once inflammation is controlled. More research is needed to determine which cases respond best to which treatments. Avoiding full-mouth tooth extractions remains a key goal. (45:14) Sue highlights the lack of published research on CCUS and urges vets to seek specialist advice before extracting all teeth.

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• Episode 27 - Packing The Perfect Punch in Skin Biopsies

  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 loss or deeper inflammation and introduces the concept of shave biopsies as an alternative for delicate areas like the inner pinna. Chapter 4 – Packing a Punch - Sample Handling and Labelling (30:50) John asks about the best practices for preparing biopsy sites. Sonya advises against using any antiseptics or alcohol, explaining that preserving surface elements such as bacteria and crusts is crucial for accurate diagnosis. She recommends minimal shaving in the direction of hair growth to retain valuable diagnostic material. (33:20) John asks about labelling the samples - firstly Sonya provides guidance on handling biopsy samples, emphasising the need for quick placement in formalin to avoid tissue degradation. She recommends gently dabbing samples before immersion to preserve tissue integrity. Regarding labelling, Sonya highlights the importance of clear sample identification. She discusses techniques such as using coloured dyes or marking sutures to help orient samples and provide context for pathologists. Sonya also discusses the benefits of using dyes for sample orientation and how different colours can indicate specific sites. Sonya explains how proper labelling ensures better interpretation and helps guide future treatment decisions. (39:33) John and Sue wrap up the discussion, thanking Sonya for her insights and expressing interest in having her return for further discussions on histopathology. (41:12) John wraps up the discussion, previewing podcasts to come and asking his co-hosts another odd question.

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• Episode 26 - SkinFlint from the field – The Future of Veterinary Nursing Dermatology

  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.

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