The Skin Flint Podcast

Episode 33 - Bulldogs, Pugs and Plenty of Folds; A Deep Dive into Brachy Skin

Chapter 1 – Intertrigo: Prevention, Work-Up, and When (Not) to Use Antibiotics
(00:11) John introduces the podcast episode and the hosts.
(02:39) John welcomes Dr Laura Buckley (Senior Lecturer, Veterinary Dermatology, University of Liverpool) and asks what “brachycephalic” means and which breeds it covers. Laura explains shortened muzzles and broad, domed heads; the most extreme include French and British Bulldogs, Pugs and Boston Terriers, with Cavaliers, Chihuahuas and Dogue de Bordeaux also affected.
(04:00) Sue notes their huge popularity in UK primary care. Laura adds that around 40% of her clinic can be French Bulldogs, with brachycephalics a very large overall share.
(04:33) Sue asks which skin problems are most common. Laura explains that atopic dermatitis and otitis (externa/media) lead, with interdigital furunculosis also frequent. Cavaliers often show primary secretory otitis media. Skin-fold dermatitis (intertrigo) and muzzle furunculosis are common, and lesions can form over bony prominences where itchy dogs rub.
(06:15) Sue asks what intertrigo is and why brachys get it. Laura explains shortened muzzles leave redundant skin that folds around eyes and muzzle, creating humid, low-airflow pockets that accumulate keratinous/sebaceous debris. Microbial overgrowth follows; bristly coats plus rubbing traumatises follicles and escalates inflammation.
(08:06) Sue asks about prevention. Laura suggests daily fold hygiene from the start: clean away debris; consider antiseptic wipes (e.g., chlorhexidine) once or twice daily, and increase during flare-prone periods.
(09:15) Sue highlights how early routines improve compliance and handling; Laura agrees it gives a “head start,” especially as atopy often appears within the first three years.
(10:08) John asks how early disease presents and how to work it up. Laura explains earliest signs are diffuse erythema in the fold, then partial/complete alopecia, erosion/ulceration, crusting; severe untreated cases may progress to folliculitis and even deep pyoderma.
(11:48) Sue asks about cytology. Laura explains it’s pivotal: expect keratinous debris with cocci (staphylococci) or Malassezia in overgrowth; neutrophils with intracellular bacteria indicate infection and guide therapy.
(12:57) John asks if systemic antibiotics are ever needed. Laura explains they’re rarely indicated: most cases respond to topical antiseptics/antimicrobials plus strong anti-inflammatory control. Consider systemic antibiotics only for genuine deep, painful, draining pyoderma, immunosuppression, poor feasibility for topicals, or proven topical failure - always post culture & susceptibility.
(15:47) John asks how she controls inflammation. Laura uses topical glucocorticoids (often in combination products). For severe inflammation, short anti-inflammatory courses of prednisolone (~0.5–1 mg/kg for a few days before tapering) can calm tissue so topicals can work.
(16:48) Sue asks about long-term routines and when to consider surgery. Laura advises daily fold cleaning (once–twice daily) and twice-weekly topical anti-inflammatories (e.g., hydrocortisone aceponate or mometasone) with minimal systemic absorption; discuss surgery if medical care is impractical, or if maintenance fails with frequent relapses or recurrent infections.
Chapter 2 – Viral Pigmented Plaques (VPP)
(19:33) John moves to VPP and asks which brachy breeds are affected. Laura most often sees Pugs, plus Boston Terriers, Chihuahuas and French Bulldogs.
(20:25) Sue asks what they look like. Laura describes numerous, heavily pigmented, slightly raised plaques that may begin flatter and become scaly, verruciform and hyperkeratotic over time.
(22:00) Sue asks how to differentiate melanoma. Laura says biopsy/histopathology is the diagnostic choice; FNAs from plaques are often low-cellularity keratinocytes, whereas melanoma cytology differs.
(23:43) John asks if plaques regress. Laura explains most persist or increase, likely due to a virus-specific, genetically influenced immunodeficiency in otherwise healthy, often young dogs. For treatment, Laura notes most are cosmetic, but very rarely plaques can transform to SCC, so monitoring matters. Limited numbers can be removed surgically or with laser; for numerous lesions consider systemic/medical options (e.g., azithromycin, interferon, retinoids, vitamin A, topical imiquimod) with variable success.
(25:35) Sue summarises a primary-care approach: monitor unless numerous, pruritic, function-limiting or rapidly changing. Laura agrees; schedule regular reviews.
Chapter 3 – Seasonal Flank Alopecia (SFA)
(26:30) Sue introduces SFA and asks what it is and why it happens. Laura explains it’s a localised cyclic follicular dysplasia linked to photoperiod and melatonin; predisposed breeds include Boxers, Affenpinschers, British Bulldogs, Staffies and Chihuahuas.
(29:40) John asks about geography. Laura notes seasonality is more marked away from the equator where day-length swings are greater. Sue recalls light-box data suggesting equal photoperiod may prevent SFA; both agree the pattern fits a light/melatonin mechanism.
(30:18) Sue contrasts the clinical picture with endocrine alopecia. Laura explains SFA shows sharply demarcated, bilateral flank patches (± hyperpigmentation). Endocrinopathies tend to be diffuse, affect coat quality and other sites (e.g., tail).
(32:27) Sue asks differentials and work-up. Laura highlights hypothyroidism and Cushing’s; use signalment and systemic signs, then haematology/biochemistry ± T4/TSH and targeted endocrine tests as indicated.
(33:03) Sue asks about monitoring. Laura expects regrowth in spring within 1–4 months as day length rises, though a minority become permanently alopecic.
(35:45) John asks about treatment. Laura reassures it’s cosmetic once endocrinopathies are excluded; many owners opt to observe. For those wanting intervention, oral melatonin and increased light exposure are reasonable.
(37:30) John thanks Laura and invites her for episode 2!

Episode 32 - Resistance is Futile! Managing MRS in Practice

Chapter 1: Meet the Microbes
(02:41) John opens the episode, introducing Dr Vanessa Schmidt and inviting her to share her background. Vanessa explains her role at the University of Liverpool, her PhD in antimicrobial resistance in staphylococci, and her leadership in infection control and antimicrobial stewardship.
(03:38) John asks whether staph infections in pets are usually caught or part of their natural skin flora. Vanessa replies that most infections come from an animal's own commensal microbiota, which coexist harmlessly but can cause disease when the immune system or skin barrier is compromised.
(05:07) Sue asks whether humans and animals share the same commensals. Vanessa explains that while many organisms are shared across species, each host also harbours unique flora. Cross-species transfer is possible but not common.
(06:16) Sue asks whether different body sites have different staph species. Vanessa says this is well-mapped in humans, while in pets we know carriage is common in the nose, mouth, and perineum, but site-specific species need more study.
(07:28) John asks about coagulase-positive vs coagulase-negative staph. Vanessa explains that coagulase-positive staph are generally more virulent, while coagulase-negative species can still be important, especially in immunocompromised hosts or in association with implants.
(09:37) Sue asks how to interpret a coagulase-negative result on a lab report. Vanessa advises considering clinical context, immune status, culture growth level, and cytology to judge significance.
(12:34) Sue emphasises the value of cytology. Vanessa agrees, explaining it's routine in dermatology and helps identify intracellular bacteria and neutrophilic inflammation.
 
Chapter 2: Resistance Training
(14:30) John transitions to methicillin resistance. Vanessa explains MRSP carries the mecA gene, conferring resistance to beta-lactam antibiotics. It spreads clonally and is more stable than resistance in Gram-negatives.
(17:40) Sue asks whether antibiotic use can switch the resistance gene on or off. Vanessa says it's about selection pressure - resistant strains survive when antibiotics are overused.
(19:03) Sue shares her “rucksack” analogy. Vanessa agrees, adding that over time resistant strains adapt, carrying resistance genes more efficiently.
(20:15) John asks about zoonotic risk. Vanessa confirms bacteria like MRSP can pass between pets and owners, though actual infections are rare.
 
Chapter 3: Less is More: Treating MRS the Smarter Way
(22:33) Sue asks about managing MRSP pyoderma in practice. Vanessa outlines a tiered approach: treat the underlying disease, apply barrier nursing, and use topical therapy like chlorhexidine, aiming to avoid systemic antibiotics.
(27:00) Sue raises chlorhexidine use and guideline updates. Vanessa recommends 2% or above concentrations of chlorhexidine and warns that dilution reduces effectiveness and may lead to treatment failure.
(30:05) Sue mentions suspected resistance. Vanessa confirms resistance is reported and linked to bacterial efflux pumps. She uses hypochlorous acid or bleach as follow-up options in certain MRSP cases.
(33:15) John asks what Vanessa avoids. She avoids systemic antibiotics in superficial MRSP unless absolutely needed, and tailors treatment to the underlying disease. Immunosuppressives are avoided if the infection arose due to immune compromise.
(35:00) Sue asks about treating MRSP otitis. Vanessa explains that lower chlorhexidine concentrations are potentiated by TRIS-EDTA, so she still uses them as first-line ear cleaners.
(36:40) John asks about long-term carriage. Vanessa explains MRSP can persist for months or even years. Decolonisation before high-risk surgery is common, but long-term clearance is difficult and evidence is limited.
(39:42) Sue summarises the discussion: in MRSP, less is more - fewer antibiotics and more topicals. New guidelines offer hope for better resistance control.
 
ISCAID guidelines
https://onlinelibrary.wiley.com/doi/10.1111/vde.13342?af=R&utm_campaign=Nextmune%20-%20Nextmune%20UK%20Updates&utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--e1aa7hsXEupaiUzNH8tbxLSDEH8s4jALF4ScLWjefX83QJvKt5H20n5xE--r0sn9CVwFI
 
Protect Me guidance from BSAVA
https://www.bsava.com/Resources/Veterinary-resources/PROTECT-ME/

Episode 31 - Son of a Birch! The Pollen Predicament

Show Notes
On this month's episode, Sue, John and Paul invite Darragh O'Hanlon (@thetopicalvet)  onto the pod to discuss pollen allergies.
Chapter 1 – How Pollens Affect Animals
(02:32) John introduces the topic of pollen allergies and welcomes guest Darragh O’Hanlon.Darragh shares how Sue’s lecture on otitis sparked his dermatology journey, and how John’s CPD also played a role.
(04:09) John asks how pollens cause allergic reactions in animals. Darragh explains that pollens are airborne reproductive grains from grasses, trees, and weeds, and describes their microscopic structure and typical transmission routes.He shares the story of Mitzi the fox terrier, one of the first dogs documented with airborne pollen allergy.
(06:30) Sue asks whether pollens affect more than just the skin. Darragh explains that:
In dogs, pollens mostly trigger atopic dermatitis but can also affect eyes and ears.
Cats may show respiratory and skin symptoms, including asthma and eosinophilic conditions.
Horses show skin reactions like urticaria and, in some regions, respiratory issues like heaves.
(08:45) John asks why grass pollens are so problematic over say garden flowers.Darragh notes a rising trend in grass pollen allergy and explains the volume and dispersal of wind-pollinated plants. Garden flowers are less allergenic due to heavier, insect-borne pollen; wind-pollinated plants like grasses and trees produce vast quantities of light airborne pollen. Sue discusses tree flowers and their pollen production.
(11:30) Sue asks which trees cause the worst reactions. Darragh highlights birch as a major allergen in Northern Europe. He explains its cross-reactivity with other tree pollens and regional variations such as cypress (Mediterranean) and cedar (Japan). Conifers and pines, though present in air samples, are less allergenic due to their size and resin content.
Chapter 2 – Seasons, Cross-Reactions, and Geography
(14:20) Sue asks about pollen season overlap and the role of allergy testing. Darragh agrees and describes how pollen calendars can predict seasonal challenges.He outlines Ireland’s pollen calendar, from alder and hazel in winter through to weeds in autumn.
(16:20) John asks if pollens cross-react with each other or be linked to food sensitivities.Darragh explains:
Cross-reactivity is common among grasses and within trees and weeds.
Birch is highly cross-reactive.
Some food cross-reactions exist in humans (e.g. Mugwort-Birch-Celery Syndrome), but evidence in dogs is limited.
(19:55) Sue mentions bee foraging and asks about using tape strips to detect pollens on animals. Darragh shares anecdotes and online interest in identifying pollens via tape stripping.
(21:36) Sue asks about ragweed in Ireland. Darragh says it’s rare locally but problematic in the US. He discusses its introduction to Europe and control measures.
(23:20) John asks how pet owners can reduce pollen exposure. Darragh shares advice:
Allergen avoidance is difficult; pollens travel long distances.
Regular washing, foot rinsing, and barrier-supporting shampoos help.
Avoid walking dogs on freshly cut grass or on high pollen days.
(26:10) John asks about environmental factors like altitude or proximity to the sea.Darragh explains:
Pollen can travel thousands of kilometres.
Grass pollen is more localised than tree pollen.
Higher altitudes and coastal winds can reduce exposure.
(29:12) Sue mentions a 2023 study on reactions to grass sap, not just pollen.Darragh reflects on cases that may fit contact dermatitis patterns seen with grass sap exposure.
Chapter 3 – Testing, Treatment & Takeaways
(31:14) Sue asks for practical advice on pollen avoidance and resources.Darragh recommends:
Monitoring pollen forecasts (e.g. Met Office, Met Éireann).
Using allergy maps from dermatology providers.
Avoiding warm, dry, windy days; walking dogs after rain.
Understanding how weather affects pollen counts, including the impact of thunderstorms and urban pollution.
(35:15) John asks about immunotherapy and vaccine formulation.Darragh explains:
Allergen-specific immunotherapy aims to desensitise.
Earlier intervention is better.
Cross-reactivity helps simplify formulations.
(38:36) Sue stresses that vaccine components must reflect relevant, local allergens.Darragh notes the importance of seasonal coverage and discusses challenges with mixing mould and pollen extracts.
(41:05) Sue shares an anecdote about a mismatched allergy vaccine and wraps up with thanks to Darragh.
Useful Links:
Nextmune – Veterinary allergy diagnostics and immunotherapy.
https://nextmunelaboratories.co.uk/

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

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.

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.

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.

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.

Episode 25 | Pododermatitis Paw-dcast P.2 – A Surgeon's Perspective

Pododermatitis Paw-dcast Part 2 – A Surgeon's Perspective
(00:00) Intro - this month, Sue, John and Paul invite EBVS Specialist in Small Animal Surgery, Jakub Kaczmarek onto the platform to discuss the other side of pododermatitis - from the surgeon's perspective.
Chapter 1 – Feet First - A Surgeon’s Take on Pododermatitis
(03:12) John introduces Jakub, highlighting Ursula's recommendation following their fruitful discussion on pododermatitis. He invites Jakub to share his background. Jakub expresses gratitude for the invitation and mentions Ursula as a mentor during his residency in Germany. He discusses their collaboration on pododermatitis, combining dermatology and surgery. Jakub shares his educational journey from Poland, a semester in Vienna, and his internship in Germany, which focused on surgery and dermatology. He currently works in Cologne.
(04:55) John acknowledges Jakub's expertise in dermatology and asks how a surgeon fits into managing pododermatitis in dogs. Jakub emphasises teamwork between dermatologists and orthopaedic specialists, noting the complexity of pododermatitis. He explains that it can arise from both skin-related and conformational issues, necessitating collaboration for optimal care.
(06:16) John enquires about the types of lesions found on dogs' feet. Jakub explains that abnormal weight distribution from orthopaedic conditions, like developmental elbow disease, can cause pressure on specific paw digits, leading to abrasions, inflammation, and even local pyoderma. He describes hypertrophy on the paw's plantar surface, potentially forming "pseudoballs." Chronic irritation can result in excessive licking, leading to severe inflammation, which requires both orthopaedic and dermatologic management.
 
Chapter 2 - Toes: Lesions and Lameness
(09:25) Sue comments on the dog's paw pad structure, noting that abnormal weight-bearing can lead to skin issues. She asks if this is the pathomechanism for pododermatitis. Jakub agrees and adds that while there are many potential causes, mechanical issues may also contribute. He supports Sue's idea that malalignment and weight distribution lead to abnormal weight-bearing and related problems. Sue clarifies that some cases of pododermatitis have dermatological causes, while others stem from orthopaedic issues. Jakub agrees but points out that breeds like Labrador Retrievers and Bulldogs often have both conditions, complicating the determination of the primary issue. Sue P recalls a study revealing Bulldogs walk on their toes, which could contribute to multiple health issues. She emphasises the need for a multidisciplinary approach. Jakub references a study by Tim Nuttall involving over 160 dogs, noting that factors like body condition and hair type are significant in causing pododermatitis and interdigital cysts. Sue P agrees, linking higher body condition scores to more weight on the front limbs, thus making pododermatitis more common there. Jakub clarifies that while pododermatitis is typically seen more in front limbs, conditions like hip dysplasia can also affect hind limbs. He explains that primary dermatological issues may affect both front limbs, while orthopaedic problems often involve a single limb. Sue P sums up that multiple limb involvement likely relates to skin conditions, while single limb issues could indicate orthopaedic problems. Jakub agrees, adding that orthopaedic conditions like OCD or FCP typically show changes in the affected limb.
(14:53) John revisits Jakub's "top-down or bottom-up" approach, asking how it relates to recognising orthopaedic diseases as triggers for pododermatitis. Jakub explains that common orthopaedic triggers include developmental elbow diseases like OCD and FCP, as well as shoulder OCD, which causes dogs to alter their walking to reduce pain. He notes that patellar luxation often results from underlying angular limb deformities that shift the weight-bearing axis, exacerbating dermatological issues.
 
Chapter 3 - Surgical Solutions: From Lasers to Collaboration for Better Outcomes
(17:30) Sue asks Jakub to elaborate on triggers, noting that predisposed breeds and age of onset play a role, citing Labradors as an example. Jakub confirms that Labrador Retrievers exhibit these issues, with signs of orthopaedic problems appearing as early as five to six months, and severe cases at four months. He mentions common large breeds prone to orthopaedic problems.
(18:59) Sue asks about the timing of pododermatitis relative to orthopaedic diseases, questioning if lameness in young dogs could precede pododermatitis. Jakub notes that pododermatitis and orthopaedic diseases usually present in older dogs, around two years of age. He hasn't observed significant changes in younger dogs, suggesting it takes time for pododermatitis to develop due to malalignment and weight redistribution. Sue P agrees, noting that in her practice, older dogs often present with pododermatitis alongside a history of earlier orthopaedic problems. She suggests a compensatory mechanism may lead to conditions like interdigital cysts. Jakub agrees, highlighting that dermatological conditions like pododermatitis are painful due to inflammation, which can lead to chronic discomfort. He asks Sue if Labrador owners ever report lameness when presenting dermatological issues. Sue P mentions that owners usually don’t report pain, necessitating probing for details. She reflects on referring a three-year-old Labrador with recurrent interdigital lesions to an orthopaedic surgeon to assess joints. If swelling or crepitus is present, she recommends CT scans and emphasises early intervention. Jakub recalls Sue's 2012 publication linking interdigital lesions with elbow issues. He has observed that treating elbow conditions often leads to improvement in lesions, suggesting that combining orthopaedic corrections with topical treatments could yield better outcomes.
(25:18) John asks Jakub to elaborate on surgical approaches for pododermatitis, including techniques like webectomy and podoplasty. Jakub notes he has not performed podoplasty but has seen it used successfully in severe cases. He prefers laser ablation, as it is quicker and effective when collaborating with a dermatologist who has tried conservative treatments. He recounts streamlining procedures significantly, reducing time from 1.5 hours to 30-35 minutes. Sue adds context, explaining webectomy and podoplasty. She contrasts her cold steel surgery experience with the benefits of laser surgery. Jakub explains that CO2 lasers are more precise and cause less collateral damage than diode lasers. He emphasises the advantages of laser treatment in sealing vessels, which minimises bleeding and post-op pain. He mentions a colleague who leaves wounds open post-surgery, but he prefers using honey treatments for healing.
(34:06) John concludes by praising the collaboration between Jakub and dermatologists like Ursula, highlighting the importance of a multidisciplinary approach in managing complex cases like pododermatitis.
Outro
(37:07) Final thoughts John puts another bizarre question to Sue and Paul.

Episode 24 - Companions on the Streets: How StreetVet is Changing Lives

Chapter 1 – Companionship for Life on the Streets
 
(02:58) John asks Jade to introduce herself and her background as a vet and how she came to setup Streetvet. Jade shares her story of experiencing homelessness in London with a man called Dave and his dog brick, and using her past research on homelessness and dog owners coupled with her own experience in mental health challenges and how having a dog helped her, to drive her to want to help these dogs and their owners. She shares how she started going round with someone who who cut hair for homeless people, and used this as a launching pad for doing the same as a vet seeing the dogs of homeless people.
 
(10:05) Sue talks about the data showing the importance of companionship for homeless people with their pets, and Jade shares how there are papers and research showing that lots of factors from loyalty through to body heat show that they are vital, and her own experience maps onto that.
 
Chapter 2 – Building StreetVet: A Backpack and a Big Heart
 
(13:37) John asks Jade about how Streetvet started and what id does, and jade share how she and co-founder Sam Joseph set it up going out just the two of them, and calling themselves Streetvet – but they realised the size of the task and in 2019 set it up as a registered charity ad looked to grow it. She talks about how it picked up traction in the media through both the need for it – but also how the professional of vets needed it – with Vets and Nurses remaining in the profession providing this service reconnected them with their work. This was a completely unexpected thing for Jade.
 
(17:30) John asks how the service works and Jade shares that they go out with a backpack and do all the things they would in a consultation – so taking blood samples and urine samples etc. They look to empower the owner on feeling involved by doing this on the street – before then if they need to go into a practice and Streetvet have a network of practices that help provide inpatient services. Streetvet also started an accredited hostel scheme as less than 10% of hostels in the UK accept pets, to prevent owners from having to hose to remain on the street if they have one. She also mentions they offer boarding for times where the owner need to go into hospital for healthcare themselves and can’t take their pet with them.
 
(21:10) Sue asks about the management of chronic, long term illnesses in the Streetvet work, Jade shares that they have set times and set locations rather than approaching the owners on the street – so the owners come to them in those times. But this allows them to come back again, and jade has been surprised that they have been able to treat long term diseases like cushings and diabetes, in cases where the client is committed to the process – as they do keep coming back.
 
Chapter 5 – Tackling Skin Woes: Managing Dermatology in the StreetVet World
 
(27:00) John asks about specifically the management of skin disease in the Streetvet environment and Jade shares that they do treat these, but the challenges are very real. They have even had cases of clients performing a diet trial and long term management of skin disease. The challenges in the life of these people can make it very difficult for the owners to have consistency, but the clients are very good at coming for regular flea treatment and prophylactic skin care, in some way because of the social benefits to coming and sharing in the the streetvet community and this makes managing these cases easier than one may think.  Jade discussed the types of medications they have food they can help with, topical treatment and some antibiotics to help with these cases as well as steroids if needed. Then they do have access to other medications if needed which they wont carry in the backpack.
 
(32:35) Sue asks how this is funded and Jade again emphasises how great and supportive the veterinary profession has been – with companies supporting with pro bono products and vets and nurses fundraising.
 
(34:19) Sue asks about the size of Streetvet and Jade says they are on 24 locations in total, and over 400 volunteer vets and nurses. And Sue asks how people can be involved – Jade mentions the website where you can get involved in volunteering, whether a vet, vet nurse or someone wanting to help in some other way – or fundraising as well. Or follow on Facebook and Instagram.
www.streetvet.org.uk
https://www.facebook.com/streetvet
https://www.instagram.com/streetvetuk_/
 
(37:02) – John, Sue and Paul wrap up the podcast.