th e c h a nging d y na m ic s of ve te r ina r y c a re

28072021 The changing dynamics of veterinary care

httpswwwdvm360comviewthe-changing-dynamics-of-veterinary-care 19

The changing dynamics of veterinary careJuly 14 2021Louise Grubb TriviumVet CEOdvm360 dvm360 August 2021 Volume 58

How COVID-19 prompted veterinary care to change and the new ways of the businessthat will remain in the post-pandemic world

Maria Sbytova stockadobecom

The US animal health industry has long been a global front-runner Over the past fewgenerations our pets have made the move from the backyard to the couch to ourbeds We have never been closer to our furry companions and this has been reectedacross the veterinary industry Even with the global economic impact of COVID-19 theUS veterinary industry rebounded strongly in the latter half of 2020 with industry salesdata from the Veterinary Hospital Managers Association (VHMA) reporting revenuegrowth of 45 from 2019 to 2020 But how has COVID-19 changed the verydynamics of service delivery Outlined below are the shifts that took place withinweeks of the pandemic hitting and even with reopeningrsquosmdashthe new ways of doingbusiness that are here to stay

Curb-side appointmentsmdashthe new normalAs with humans essential medical care did not diminish during the pandemic all ourfamily animals with the usual ailments needed treatment Although the purchase ofessentials such as parasiticides and wormers shifted online seeing the veterinarian inperson remained a critical element of care Given COVID-19 restrictions and socialdistancing requirements the most impressive pivot by the industry was the almostimmediate shift to curb-side appointments with staff collecting and treating pets whileowners waited in cars In a February 2021 Brakke survey 86 of vets were stilloffering this service with it accounting for 62 of visits The obvious safety andconvenience of this new trend seem set to stay even as society returns to pre-pandemic norms An interesting dynamic is that although 80 of vets believe ownerswill revert to in-clinic visits post pandemic many owners are happier with curb-sideservice

MARC Research with a sampling size of 1000 pet owners reported that 86 feltcurb-side treatment went well or very well for their pets and 28 felt curb-side carewent better than traditional in-clinic visits The most signicant data from this studypoints to the 48 of owners who would use curb-side after the pandemic has ended

1

2

3



Telemedicinemdashstruggling to gain tractionFor many years the shift to telemedicine has struggled to gain traction and althoughthe pandemic could have been the perfect storm to switch to telemedicineveterinarians and owners have been slow to embrace these services Although thesame Brakke February 2021 research reported that 39 of vets were offeringtelemedicine either via phoneFaceTimeZoom or a veterinary-specic app less than3 of clients used these services This lack of uptake might seem obvious given thelack of verbal communication from animals but it also appears pet owners need theiranimals to be examined in person by the veterinarian to feel they are receivingadequate treatment

Source Brakke Animal Health 2021 Animal Health Industry Overview

Online salesndasha must-have solution for futureveterinariansThe convenience of shopping from home continues to expand across all industriesand retail segments Online retailers have been particularly successful inunderstanding consumer behavior and tailoring marketing messages accordinglyresulting in high conversion rates Meanwhile the traditional costs of brick-and-mortarstores have been pumped into understanding and pursuing business online In 2020online veterinary product purchases by pet owners accelerated and although thehealth care requirement for essentials such as wormers and parasiticides has easilytransitioned to online purchases the more specialty prescription-only medicines havehad to follow suit This has resulted in more veterinarians writing scripts to be lled byonline pharmacies and investing in their own online ordering and delivery platforms toll this burgeoning need with over half of practices now offering online ordering

Brakke Consulting released an in-depth report in 2018 exploring online sales at smallanimal veterinary practices This Veterinary Practice Home Delivery Report compileddata from more than 1100 respondents showing that

Half of independently owned practices operate an online store or pharmacyOnline sales represent roughly 1 of the average independently ownedpracticersquos annual revenues

This highlights the major opportunity for growth in the online segment as veterinarianslearn to retain their clients and potential revenue streams within their practice albeitonline

Competition is erceWith many veterinary practices selling pet food and grooming and gifting products inaddition to their pet pharmacy category the competition has never been ercer toretain revenues and satisfy the modern tech-savvy client The rise of Chewy IncmdashanAmerican online retailer of pet food and other pet-related productsmdashis a clear signpostthat US clients want their pet products to have all the variety of choice and

4



convenience they have come to enjoy in other areas of their retail lives Chewyrsquos focuson customer experience and auto-ship of products took a leaf from the Amazonplaybook and has paid off Unlike many other companies that have suffered through2020 Chewy has seen its stock price soar as individuals have shifted more heavily toonline Since the start of 2020 Chewy shares have jumped from about $30 to morethan $67 Reporting in August 2020 the company saw net sales of $17 billion a 47increase over the same period in 2019 With myriad other online-savvy companiesfollowing suit your local vet practice will need to upskill and invest in technology tostay in this market

Industry challengesDespite industry challenges and changes the veterinarian remains central to pethealth care but practices must adapt to keep pace with the strong demand forveterinary services As most veterinary hospitals nd themselves at capacity priceincreases are inevitable and Animalytix is projecting increases of between 7 and9 A continued shortage of registered veterinarians and qualied employees willpush wages upward putting pressure on practice margins and protability Growingonline revenue streams provide an opportunity for increasing revenue and creatingpassive income that can be reinvested to develop the health care services

The futureOne thing is certain from the strong performance of the animal health industry overthe past 10 years and its ability to rebound in a post pandemic era pets are now partof the family and their health care has become a physical emotional and nancialpriority

Louise Grubb is the founder and chief executive officer of TriviumVet which wasnamed one of the top 100 start-ups in Ireland in 2020 and 2019 She has more than20 yearsrsquo experience in the veterinary and pharmaceutical industries Her previousroles include founder of NutriScience a global developer and supplier of dietary andwellness supplements for animals and founder of Q1 Scientific a firm specializing inthe stable storage of human and veterinary pharmaceutical products In 2016 shewas a finalist in the Ernst amp Young Entrepreneur Of The Year Awards while leading Q1Scientific

References

1 Veterinary Hospital Managers Association Insiders Insight Benchmark Reporthttpscdnymawscommembersvhmaorgresourceresmgrinsiders__insight_-_2021VHMA_Insiders_Insight_Januarpdf Published December 2020 AccessedJuly 9 2021

2 Brakke Consulting 2021 Animal Health Industry Overview Published February23 2021 Accessed via webinar February 23 2021

3 Animalytix LLC Lessons Learned in a Disrupted Marketplace How COVID isShaping the Veterinary Channel Published February 16 2021 Accessed viawebinar February 16 2021

4 Brakke Consulting The Veterinary Practice Home Delivery Reporthttpstodaysveterinarybusinesscombrakke-report-examines-hospitals-internet-sales Published June 2018 Accessed March 1 2021

5 Wile R Therersquos a $30 billion company in South Florida It wants to take over thepet world Miami Herald httpswwwmiamiheraldcomnewsbusinessbiz-mondayarticle246143765html Published October 19 2020 Accessed March 12021

6 Animalytix LLC Animlaytix 2021 Senior Executive Forum 2021 Key Expectationsamp Projections by Katz Sapper amp Miller Published February 16 2021 Accessedvia webinar February 16 2021

Download Issue dvm360 August 2021

5

6



Related ContentPractice Manager | Owners | Business | Client Relations amp Marketing | dvm360 August2021

Time for topicals A spot-on guide to treatingdermatologic diseases

Pet Releaf debutsprofessional product linewith Sentesa

The veterinary ally Acomprehensivecommunication solution

Time for topicals A spot-on guide totreating dermatologic diseasesJuly 27 2021Sean Stapleton DVM Fiona Lee VMD DACVD MBAdvm360 dvm360 August 2021

Topical therapeutics should be a veterinarianrsquos first line of defense against superficialdermatologic conditions Follow this rundown of the ingredients and multiple types oftreatments for skin problems

Eric Isseleacuteestockadobecom

Topicals such as pour-ons shampoos and ointments provide concentrated treatmentfor both focal and generalized skin problems while minimizing systemic adverseeffects Although there are many other antiparasitic antimicrobial otic andophthalmic topicals this article focuses on ingredients available in the United States

CytologyWith any dermatologic problem cytology is the rst step for ruling infectious agents inor out Slides stained with Diff-Quick can identify bacteria and yeast A trichogramwhich is a direct examination of hairs has some ecacy in diagnosingdermatophytosis Supercial or deep skin scrapings can detect mite infestations Ingeneral the more samples that can be obtained the better the likelihood of makinga diagnosis The authors recommend sampling from at least 2 or 3 locations ona patient to improve sensitivity These noninvasive inexpensive diagnostics cansometimes make the diagnosis or discover the next step to a more expensive andmore invasive test Veterinary technicians can be trained in obtaining and readingcytology to achieve eciency in busy clinics

Infectious agents

Staphylococcus

1 1

2 3

4



The growing prevalence of methicillin-resistant Staphylococcus species in companionanimals necessitates judicious systemic antimicrobial use in veterinary medicine andemphasizes the need for topicals as sole-agent therapeutics for supercial and localpyodermas as frequently as possible Chlorhexidine 2 to 4 is effective forStaphylococcus and comes in multiple convenient formulations including shampoossprays wipes and mousses For focal lesions twice-daily application for 10 to15 minutes of contact time would be ideal For generalized lesions bathing twiceweekly with chlorhexidine 4 shampoo has an ecacy similar to systemic amoxicillin-clavulanate administration Because the turnover of skin takes about 3 weeks thisstudy recommends the duration of topical treatment be similar to that of systemicantibiotics for supercial pyodermas a minimum of three weeks with one weekbeyond clinical resolution

Another effective treatment for supercial pyoderma is a 525 solution of bleach Ithas been shown that the minimum bactericidal concentration (MBC) may requirea 132 dilution (ie frac12 c bleach to 1 gal of water) although anecdotally a 150 dilution(ie ⅛ cup bleach to 1 gallon of water) may still be clinically effective The dilutionloses stability after 24 hours There may be limited published clinical evidence inveterinary medicine Bleach is commonly used in human medicine to decolonize ortreat resistant bacterial skin infections

Povidone-iodine can be bactericidal but it can also be drying and irritating and causestaining Benzoyl peroxide can be effective by lowering the skin pH but can bedrying To attenuate the drying adverse effects of these ingredients consider pairingwith conditioners andor emollients Mupirocin ointment can be applied to focalinfections However a concern for growing resistance has led some countries outsidethe United States to withhold it from veterinary medicine Silver sulfadiazine creamcan also help with focal infections but may best target gram-negative bacteria

Malassezia

Malassezia yeast dermatitis can be treated topically with twice-daily administration ofcombination shampoos containing 2 chlorhexidine and 2 miconazole Clinicsmay elect to carry only 3 chlorhexidine products for both bacterial and yeastdermatitis although there is less evidence supporting this as a sole agent comparedwith the miconazole-chlorhexidine combination Lotions containing antifungalingredients such as clotrimazole or miconazole administered twice daily may also beconsidered in focal infections

Demodex and Sarcoptes

In recent years infestations by either Demodex and Sarcoptes mites have often beentreated with the isoxazoline class although none is labeled specically for thisindication Many isoxazolines are oral but in the United States there are topical spot-ons of uralaner for dogs and cats and of sarolaner for cats

Benzoyl peroxide shampoos administered twice weekly can be an adjuvant treatmentfor demodicosis by effectively ushing out mites but they can be drying Weeklyapplication of a moxidectinimidacloprid spot-on has demonstrated safety but alsopotentially lower ecacy

Amitraz dips are the only FDA-approved treatment for canine demodicosis (labeledevery 14 days but perhaps more effective weekly) but their use is decreasing due totoxicity risks in both humans and animals

For cats 2 lime sulfur dips once to twice weekly have been used for both Demodexcati and Demodex gatoi but ecacy was a variable The idea of bathing cats may be anonstarter for many clients

Dermatophytosis

For dogs and cats dipping in lime sulfur (8 oz diluted in 1 gal of water) twice weeklyalong with oral antifungal administration and environmental decontamination can bethe fastest clinical resolution in about three weeks Lime sulfur must be left on for

5

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910

1

3

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3

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3

3

2



about an hour until dry and should not be rinsed off There is a rotten-egg smellassociated with this product and animals with white coats in particular man betemporarily stained yellow following administration Young or small animals aresusceptible to hypothermia during the drying process and ingestion may (rarely) leadto oral ulceration pharyngitis or gastrointestinal upset

If lime sulfur is not available or owners request a different option then biweekly use ofa shampoo containing 2 miconazole and 2 chlorhexidine may be effective but notto the same degree as lime sulfur The topical should be combined with oral antifungalmedications and environmental decontamination Chlorhexidine as monotherapy isnot effective for the treatment of ringworm For focal lesions clotrimazole andmiconazole can be considered But due to limited data on ecacy they should not beused as sole therapy There is limited in vitro evidence demonstrating some ecacy ofshampoos containing other antifungals such as climbazole terbinane andketoconazole Similarly accelerated hydrogen peroxide formulated as a leave-on rinsemay be a future adjuvant but in vivo studies are needed to conrm safetyand ecacy

Keratinization disordersDisorders of the supercial layers of the skin such as ichthyosis sebaceous adenitisor primary seborrhea can cause the skin to be either too dry or too greasy dependingon the condition resulting in a compromised skin barrier function Topicals used toaddress these problems are generally classied by their keratoplastic or keratolyticeffect Keratoplastic activity restores normal rate of keratinocyte division and skinlayer turnover whereas keratolytic activity eliminates excessive layers of skin forscale removal

When degreasing is needed once- to twice-weekly benzoyl peroxide shampoos areeffective options In the past coal tar or selenium disulde have been used but theycan cause a rebound increase in seborrhea andor skin irritation when discontinuedboth can be toxic to cats Regardless of the topical of choice long-haired dogs willneed to be shaved to have appropriate shampoo contact with the skin

For disorders leading to excessive drying emollients that soften and lubricate the skinor moisturizers that increase the water content of supercial skin layers are benecialThese are also indicated following degreasing therapy to balance and restore theprotective barriers of the skin A wide range of ingredients such as propylene glycolmineral oil lactic acid urea and glycerin can carry out these functions The authorsrsquorst choice is 01 phytosphingosine administered as a shampoo mousse andorspray Alternatively spot-on products containing essential oils can be applied to theskin between the shoulder blades once a week for 2 months then every 2 weeks formaintenance

There is some evidence that topical polyunsaturated fatty acids like omega-3 andomega-6 may restore the skinrsquos barrier However they are typically an additionalingredient in some veterinary products rather than the sole therapy for keratinizationdisorders Coconut oil may be popular among owners either as a topical or oralsupplement but is not recommended because there is no scientic evidence tosupport its use and it can aggravate secondary infections

PruritusClinicians should always address the underlying causes of pruritus such as allergy orinfection but topicals may provide short-term relief to focal and mild lesions Formoderate-to-severe or multifocal-to generalized pruritus oral anti-inammatory dosesof steroids are more appropriate The chronic administration of topical steroids likeOTC hydrocortisone or even such a soft steroid like mometasone furoate can lead tofocal skin atrophy hyperpigmentation or delayed wound healing (if applied totraumatized skin)

2

2

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Nonsteroidal agents such as colloidal oatmeal or polyunsaturated fatty acids haveonly mild ecacy in relieving pruritus They typically provide relief for 24 to48 hours do not have any antimicrobial action and should be offered only asadjunctive therapy for anything beyond mild pruritus Clinicians may consideroffering oatmeal-based shampoos for long-term maintenance Dogs with atopicdermatitis should be bathed once every other week with this shampoo which will helpremove environmental allergens and support skin barrier function

Instructing the ownerEcacy of treatment largely depends on owner and patient compliance Topicaltherapies can be more labor-intensive for owners and may not be feasible for somepatients Slow introduction and positive reinforcement is essential for any patient butparticularly for those with a history of anxiety or aggression It is important to provideclear instructions and to troubleshoot if an owner is having diculties with topicalsHere are some of the topics you should discuss with the pet owner about treatment

Contact time Many topicals need to be left on the animal for 10 to 15minutes before rinsing (chlorhexidine benzoyl peroxide bleach) or mayrequire up to one hour to completely dry on the animal without rinsing (limesulfur amitraz) Animals will need to be monitored during this time or evenwear an Elizabethan collar to prevent lickingStaining Bleach benzoyl peroxide or lime sulfur may permanently staintowels and furniture before drying Similarly chlorhexidine and lime sulfurmay temporarily stain the patientsrsquo furPet safety Owners should be instructed to avoid the animalrsquos eyes and facewhile bathing or applying topicals Lesions on the face should be treatedonly with a cotton ball or makeup pad soaked in lukewarm water to avoidburning or overheating the animal in warmer months or inducinghypothermia in colder months Drying should be done only with fans or low-temperature hair dryers as heated air may cause burns andor inactivatesome topicals like bleach

A handout from your clinic may be helpful to walk a client through the preparationsand supplies needed for bathing and the instructions for contact time rinsing anddrying

ConclusionsFor many supercial dermatologic diseases veterinarians have the unique advantageof practicing ldquoexternal medicinerdquo with topicals If owners are willing to overcome theminor cost and increased time and labor required with topicals their pets can benetfrom a safe inexpensive and often effective sole or adjunctive treatment

Reference

1 Miller WH Muller GH Scott DW Griffin CE Campbell KL Muller and Kirkrsquos SmallAnimal Dermatology 7th ed Saunders 2013

2 Moriello KA Coyner K Paterson S Mignon B Diagnosis and treatment ofdermatophytosis in dogs and cats Vet Dermatol 201728(3)266-e68doi101111vde12440

3 Mueller RS Bergvall K Bensignor E Bond R A review of topical therapy for skininfections with bacteria and yeast Vet Dermatol 201223(4)330- 41 e62doi101111j1365-3164201201057x

4 Albanese F Canine and Feline Skin Cytology A Comprehensive and IllustratedGuide to the Interpretation of Skin Lesions via Cytological Examination SpringerInternational Publishing 2018

5 Morris DO Loeffler A Davis MF Guardabassi L Weese JS Recommendations forapproaches to meticillin-resistant staphylococcal infections of small animalsdiagnosis therapeutic considerations and preventative measures Vet Dermatol201728(3)306-e69 doi101111vde12444

6 Borio S Colombo S La Rosa G et al Effectiveness of a combined (4chlorhexidine digluconate shampoo and solution) protocol in MRS and non-MRS

1213

12

13



canine superficial pyoderma a randomized blinded antibiotic-controlled studyVet Dermatol 201526(5)339-344doi101111 vde12233Hillier A Lloyd DHWeese JS et al Guidelines for the diagnosis and antimicrobial therapy of caninesuperficial bacterial folliculitis (Antimicrobial Guidelines Working Group of theInternational Society for Companion Animal Infectious Diseases) Vet Dermatol201425(3)163- e43doi101111vde12118

7 Pariser M Gard S Gram D Schmeitzel L An in vitro study to determine theminimal bactericidal concentration of sodium hypochlorite (bleach) required toinhibit meticillin-resistant Staphylococcus pseudintermedius strains isolated fromcanine skin Vet Dermatol 201324(6)632- e157 doi101111vde12079

8 Mueller RS Rosenkrantz W Bensignor E Karaś- Tęcza J Paterson T ShipstoneMA Diagnosis and treatment of demodicosis in dogs and cats Vet Dermatol202031(1)4-e2 doi101111vde12806

9 Creech CB Al-Zubeidi DN Fritz SA Prevention of recurrent Staphylococcal skininfections Infect Dis Clin North Am 201529(3)429-464 doi101016jidc201505007

10 Bond R Morris DO Guillot J et al Biology diagnosis and treatment ofMalassezia dermatitis in dogs and cats Vet Dermatol 202031(1)73-77doi101111vde12834

11 Blaskovic M Rosenkrantz W Neuber A SauterLouis C Mueller R The effect of aspot-on formulation containing polyunsaturated fatty acids and essential oils ondogs with atopic dermatitis Vet J 2014199(1)39-43doi101016jtvjl201310024

12 Olivry T Deboer DJ Favrot C et al Treatment of canine atopic dermatitis 2015updated guidelines from the International Committee on Allergic Diseases ofAnimals (ICADA) BMC Vet Res 201511210 doi101186s12917-015-0514


Related ContentRoles | Technicians | Associates | Dermatology | Clinical


News wrap up Thisweeks veterinaryheadlines plus first non-invasive pet thermometer

dvm360 product reportSmart cat water bowlplus a noninvasive petthermometer and more

Pet Releaf debuts professional product linewith SentesaJuly 26 2021dvm360 Staffdvm360 dvm360 August 2021

Hemp-based capsules that promote patient health and healing are the first product ofPet Releafrsquos Professional Line for veterinarians

Image courtesy of Pet Releaf



Pet Releaf the market-leading hemp health brand for pets has released Sentesa ahemp-based supplement featuring a triactive formula Sentesa was developedby veterinarians exclusively for veterinarians and specially made to help managecaninesrsquo inammatory response calmness joint exibility and mobility anddiscomfort according to a company release Proved safe and fast acting to guaranteeecacy Sentesarsquos triactive formula consists of cannabidiol (CBD) β-caryophylleneand caprylic acid

We knew from our veterinary partners that there is an unmet need for data-drivenproduct development in the hemp space We focused on delivering products to theveterinarian that can safely and effectively manage their patientsrsquo longterm health andwell-beingrdquo says Alina Smith CEO and cofounder of Pet Releaf in this release ldquoWe areproud to offer Sentesa as a safe effective and natural alternative to help bridge aneeded gap in pet carerdquo

Made with the highest-quality ingredients and manufactured in a cGMP (Current GoodManufacturing Practice) facility Sentesa has undergone testing in a third-partyaccredited laboratory and evaluation in clinical studies

ldquoIt can be dicult to treat pets through chronic diseases and long-term painIncorporating Sentesa into veterinary practices can help pets suffering from amultitude of ailments in a more all-natural way without the harmful adverse effectsthat may be caused by pharmaceuticalsrdquo says Joseph Rosentel DVM PhD MS vicepresident of product development and supply chain in the release ldquoWith the data-driven approach to development completed safety and PK study and an ongoing eldsafety and ecacy study we are thrilled to offer the veterinarian a new option for thetreatment of their patientsrdquo

The capsules are available in 2 sizes for small dogs (11-33 pounds) and mediumlarge dogs (33+ pounds) Sentesa for small dogs contains 10 mg of CBD 10 mg of β-caryophyllene and 10 mg of caprylic acid Sentesa for mediumlarge dogs contains30 mg of CBD 30 mg of β-caryophyllene and 30 mg of caprylic acid


Related ContentRoles | Technicians | Associates | Products | Practice Manager | Pain Management |Clinical



CityVet acquires CentralAnimal Clinic



Telemedicinemdashstruggling to gain tractionFor many years the shift to telemedicine has struggled to gain traction and althoughthe pandemic could have been the perfect storm to switch to telemedicineveterinarians and owners have been slow to embrace these services Although thesame Brakke February 2021 research reported that 39 of vets were offeringtelemedicine either via phoneFaceTimeZoom or a veterinary-specic app less than3 of clients used these services This lack of uptake might seem obvious given thelack of verbal communication from animals but it also appears pet owners need theiranimals to be examined in person by the veterinarian to feel they are receivingadequate treatment

Source Brakke Animal Health 2021 Animal Health Industry Overview

Online salesndasha must-have solution for futureveterinariansThe convenience of shopping from home continues to expand across all industriesand retail segments Online retailers have been particularly successful inunderstanding consumer behavior and tailoring marketing messages accordinglyresulting in high conversion rates Meanwhile the traditional costs of brick-and-mortarstores have been pumped into understanding and pursuing business online In 2020online veterinary product purchases by pet owners accelerated and although thehealth care requirement for essentials such as wormers and parasiticides has easilytransitioned to online purchases the more specialty prescription-only medicines havehad to follow suit This has resulted in more veterinarians writing scripts to be lled byonline pharmacies and investing in their own online ordering and delivery platforms toll this burgeoning need with over half of practices now offering online ordering

Brakke Consulting released an in-depth report in 2018 exploring online sales at smallanimal veterinary practices This Veterinary Practice Home Delivery Report compileddata from more than 1100 respondents showing that

Half of independently owned practices operate an online store or pharmacyOnline sales represent roughly 1 of the average independently ownedpracticersquos annual revenues

This highlights the major opportunity for growth in the online segment as veterinarianslearn to retain their clients and potential revenue streams within their practice albeitonline

Competition is erceWith many veterinary practices selling pet food and grooming and gifting products inaddition to their pet pharmacy category the competition has never been ercer toretain revenues and satisfy the modern tech-savvy client The rise of Chewy IncmdashanAmerican online retailer of pet food and other pet-related productsmdashis a clear signpostthat US clients want their pet products to have all the variety of choice and

4







References








5

6












Infectious agents

Staphylococcus

1 1

2 3

4






Malassezia







Dermatophytosis


5

6

57

9

5

910

1

3

35

3

11

11

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3

1

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2










2

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Reference







1213

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References








5

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Infectious agents

Staphylococcus

1 1

2 3

4






Malassezia







Dermatophytosis


5

6

57

9

5

910

1

3

35

3

11

11

11

3

1

3

3

2










2

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1

1

1

1

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Reference







1213

12

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Infectious agents

Staphylococcus

1 1

2 3

4






Malassezia







Dermatophytosis


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910

1

3

35

3

11

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1

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2










2

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Reference







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Malassezia







Dermatophytosis


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Reference







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th e c h a nging d y na m ic s of ve te r ina r y c a re

Documents