Hi everyone and welcome to another special edition WCVD 9 podcast as part of the Siva symposium, and I am delighted to welcome Doctor Kiara Nolly to today's episode where we will focus on the impact of the management of atopic dermatitis in dogs. Now, Doctor Nolly. Is coming to us all the way from Italy, and the joys of these digital symposia and these events is that we can bring people together from all over the world.

She's a dermatologist, specialist working in referral practise in northwest Italy. She lectures around the world and is author of several articles and 3 texts. And is co-editor of the book Veterinary Allergy.

She's currently the vice president of the European College of Veterinary Dermatologists, so Doctor Noley, thank you so much for joining us. It's really interesting, isn't it, because atopic dermatitis is of course one of the most common conditions that we see in practise, and it's the management of it is so varied. Depending on where you are in the world, what drugs you've got in your practise, what things you've been taught and what cases you've seen personally, but to you obviously as a, as an expert in the field, what sorts of things have you seen going on in in the sector around sort of the manage of atopic dermatitis over the last sort of months and years?

Thank you for inviting me. First of all. Well, the atopic dermatitis is quite a complicated disease because there is no dog that is similar to another dog, and there is no owner that is similar to another owner.

And so, in fact, the therapy of this disease is quite a multimodal and can be based on On different options. And luckily, in the last years, there have been some that came to the market that are really interesting. And mainly, they address the problem of the burden that the owner has while treating opid dermatitis.

This is a lifelong treatment. And some of these new drugs. Give a visible efficacy and are easy to use, and they really relieve the burden of this lifelong therapy.

For example, there are some drugs that you only have to give once a month, or there are some shampoo protocol where you only have to shampoo once a month or twice a month. Because products are effective and safe, and they are easier to use, and this is, of course, very important. It's a help for us veterinarians when we prescribe these products in owners that have to use these products for the whole life of the dog.

Yeah, and of course, you know, when you're looking at things, it, it is commonly that conversation that we have with, with pet owners where, you know, you're saying to somebody, look, you know, this is something that we're not going to cure, this is something that is going to take life management for that animal, but of course one of the things that we're very reliant on as clinicians is pet owner compliance and. I think it's safe to say that we probably have a hit and miss success rate with that in that some owners will be completely diligent and and do everything that they're told and and really focus on the attention. Some will be a little bit more off piste with their management of their pet's condition.

And, you know, why is it so hard with those owners to get good compliance sometimes? Well, first of all, we have to say that good compliance is pivotal for the success of the therapy and also decreases the amount of relapses. Compliance is also a multifactorial process.

So, it will depend on the disease and chronic diseases like ectopic dermatitis are associated with a lower compliance because you have to treat them. For a long period of time, and after a while, some owners will be just tired of treating their animals. They will have other nicer things to do.

Complaints depends on the products we choose. If we ask our owners to peel a cat twice a day for the rest of the cat's life, that will not be easy for most of the owners and most of the cats. So, the choice of the product is also very important when you think of a lifelong treatment.

And then compliance relies also on the owner and on the veterinarian. And it is really our top. To try to understand which type of owner we have.

Is it the owner that is always in a hurry, has lots of things to do? This owner will not be able to shampoo the animal twice a week as we would like him to do. And so we have to try to find some therapeutical option that the owner will be able to carry on for a long period of time.

And lastly, it is our responsibility to explain everything very well. So that the owner will understand the disease, will understand why he has to do the therapy, and he also will understand what happens if I don't do the therapy or if I don't do it well. So, in fact, improving compliance in these chronic lifelong diseases that need this long-lasting therapies is mostly in the hands of the vet, in the choice of the product.

In teaching the owner how to use these products and why, and in monitoring therapy and sending them reminders for the checkups. And I think, you know, there's obviously it's so important and like you say, to identify that different clients from different backgrounds will have, you know, different capabilities. And I think unfortunately as clinicians, we are often all about the, you know, the sort of one shoe fits all and you know, this is how we treat atopic dermatitis and I think what's really fascinating there is how you've you've.

Personalised that that sort of management strategy to the individual owners and and it's about working with them and and very much shaping the treatment protocol to to suit them. Now of course we all know that, you know, even the best managed atopic cases will occasionally suffer from, from flare-ups. And, and of course as an owner.

Sometimes the perception of that might well be, well, the medications you've given aren't working, or that sort of thing it's not necessarily a great understanding as to why these flare-ups occur, but how as, as vets can we look at managing these flare-ups in a, in a way that's friendly to owners and in a way that they can get on board with and understand? Well, certainly we have to explain the owner that this is a disease that needs permanent treatment and that can actually undergo flare-ups. That's normal for this disease.

So this is a concept that we have to explain to the owner. And there are some clinics that organise classes for owners with dogs with ectopic dermatitis in order to teach them. How to manage this disease and teach them about this disease.

And the second concept is that it is a new trend now in allergology in dermatology, even human dermatology is to avoid the occurrence of flare-ups. So, we do treat the flare-up, but then we need to continue some sort of low tier treatment that we avoid the recurrence of the flare. And it is very important that we explain the owners that It is much better not to treat each time flares because they get worse and worse and the disease progresses, but it's better to do what we call proactive therapy after having treated the first flares so that the disease will not recur.

And this proactive therapy is actually a constant therapy that needs to be easy to perform and it needs to be safe because you have to give it practically every day. It could be an anti-inflammatory mousse. It could be some, some, an anti-inflammatory spray or something like that, or, or a supplement with essential acids.

Something that will inhibit the relapse of the flare. And if you explain the owners how important this is and take the time to talk to the owners, not just prescribe something and then next, the next owner. I think that they will understand better and, and they will cope better with possibly some, some rare flares that can, that can occur.

Yeah, and of course, you know, you're going into all of this er content at the symposium in in greater detail, but I just wonder, you know, for those who are, are attending your lecture, you know, obviously virtually and digitally at the Siva symposium, what, what would you like them to take away from, from listening to your talk? Well, there are some key concepts, and the first one is that atopic dermatitis is a chronic disease, which is associated to low quality of life of owners and dogs, and that needs a lifelong therapy. This therapy is often multimodal that can be systemic and topical therapy complicated, and because it is a lifelong chronic disease, this is associated with low compliance.

I think that they should really appreciate that compliance is key for the success of the therapy and for the avoidance of, of relapses, of relapses of flares like we have just said. And so we have to choose products that the owners would be willing to use for a long period of time. And particularly topical products.

And it is important that these products show to be efficacious, safe, and they are pleasant to use so that when the owner sees visible results on the disease lesions and on the skin, on the coat, sees how nice. The code, and if the owner knows that these products don't contain controversial ingredients because the people are really worried sometimes on the safety of the products that they use. And then they have practical formulations, they have pleasant products to use with a nice odour.

Maybe they have practical protocols, they will really be more motivated to continue this therapy. They see the results, it's nice, and I think the choice of the products in this difficult situation of having a chronic disease with the risk for a low compliance is really very important. I mean, dermatology is, is a section of veterinary medicine that that moves at a real pace and it's great to see that, you know.

We, we look at how we manage our clients and how we treat our patients and, and that is something that is constantly evolving and for me as a vet that's really exciting to know that we're constantly striving to manage these cases better. But, but what trends have you seen, if you could summarise quite quickly in dermatology in sort of recent times that, that, you know, that excite you. Oh dear.

Well, first of all, there are new concepts in the ingredients. We have now new drugs such as biologicals that are coming to the market, not only in dermatology, also in other, in other, parts of veterinary medicine. And that is really exciting.

And we have interesting formulations. We have drugs that you only need to use once a month. There are some ontological, some antipyretic drugs that make things easy for the owner.

Now we have owners that are busier and busier. They don't even have children because they don't have time and they take animals as substitutes to the children, and they really want to look after these animals, but they don't have a lot of time. So they are willing to buy excellent drugs like the ones that are coming to the market, but they need to be easy to use.

And so, and of course, our owners now, they are also more concerned about sustainability and they want products that are safe and environmentally friendly, and I see that this is also something that is more and more addressed by the pharmaceutical companies, the safety and the sustainability of some products. So, I think these are the main directions in veterinary medicine. That's fantastic.

Doctor Noley, thank you so much for joining us, and I know that I for one, am certainly looking forward to your talk at the symposium. I think it's such an exciting topic that we can all take learnings from and constantly evolve our approach to in practise, so I know that that your, your wisdom is gonna be really, really well received by everybody who listens to your talk at the Siva symposium. So thank you very much for your time, and yes, good luck for your talk.

Thank you.