Nutrition is re-entering the dermatology workup

Nutrition is moving back toward the center of veterinary dermatology conversations. Recent coverage from dvm360 and Veterinary Practice News highlights a simple but consequential message for clinicians: diet is not just supportive care in skin cases, it can be a hidden driver of disease, a confounder in allergy workups, and, in some patients, part of the treatment plan itself. (dvm360.com)

What’s driving the renewed focus is partly a shift in feeding behavior. Robert Ward, BVM&S, MSc, MRCVS, DACVD, said on dvm360’s Vet Blast Podcast that while true nutritional deficiencies became less common as commercial pet foods improved, homemade and raw diets have brought those deficiencies back into clinical view. He specifically pointed to zinc-responsive dermatosis, hepatocutaneous syndrome, fatty acid-related skin barrier issues, and food allergy workups as areas where nutrition can materially affect the dermatology differential. (dvm360.com)

That framing aligns with broader guidance from veterinary nutrition organizations. WSAVA’s Global Nutrition Guidelines position nutrition assessment as a routine part of care and provide tools such as diet history forms, body condition charts, and pet food selection resources for the veterinary team. AAHA’s nutrition guidance similarly treats nutrition as a core clinical assessment and notes that nutrition conversations need both sound recommendations and effective communication. (wsava.org)

The clinical rationale is strong. Veterinary Practice News recently argued that a complete feeding history should be part of every dermatology visit because dull coat, scale, and shedding may signal nutritional imbalance, impaired barrier function, or early allergic disease. In food allergy cases, diet serves as both a diagnostic tool and a long-term management strategy, but only if trials are conducted strictly and confirmed by rechallenge. That point is supported by recent literature, including a 2025 blinded food challenge study in dogs with atopic dermatitis and adverse food reactions, and by survey data showing many homemade elimination diets prescribed in practice are not nutritionally adequate for adult maintenance. (veterinarypracticenews.com)

There’s also a cautionary backdrop to Ward’s comments about alternative diets. Multiple published analyses of home-prepared, vegetarian, vegan, raw, and homemade-style diets have found nutrient shortfalls or imbalances, commonly involving zinc, calcium, copper, selenium, vitamins, or Ca:P ratios. One analysis of 106 published home-prepared recipes found every diet deficient in at least one nutrient, while a 2023 evaluation of homemade-style dog foods found frequent mineral inadequacies despite products marketed for routine feeding. Those findings don’t mean every noncommercial diet is inappropriate, but they do support the need for nutritional assessment before and during dermatology management. (pubmed.ncbi.nlm.nih.gov)

On the evidence side, the role of nutritional intervention in allergic skin disease is promising but measured. A 2010 systematic review of randomized controlled trials in canine atopic dermatitis found that one high-quality trial showed oral essential fatty acid supplementation reduced prednisolone use by about half. ICADA’s updated treatment guidelines also include increasing essential fatty acid intake among measures that may support chronic canine atopic dermatitis management. More recently, a 2024 review concluded that diet plays a large role in canine atopic dermatitis, especially when food allergy is involved, but said evidence for probiotics, fatty acids, vitamins, zinc, vitamin D, or cannabinoids as adjuncts remains limited. (pubmed.ncbi.nlm.nih.gov)

Industry and practice commentary suggests one barrier is not clinical uncertainty alone, but communication. A recent JAVMA survey of 561 small animal veterinarians in the US and Canada found that pet parent preconceived notions about nutrition were the most commonly reported barrier to nutrition conversations. The most commonly identified solutions were direct but compassionate conversations, specific recommendations, and discussing what veterinary professionals feed their own pets. Today’s Veterinary Practice highlighted that study as a call for more proactive, structured in-clinic nutrition discussions. Pet Nutrition Alliance and WSAVA both offer tools that can help teams operationalize those conversations. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary teams, this is less about turning every skin case into a nutrition consult and more about avoiding blind spots. If a diet history is incomplete, clinicians can miss deficiency-related dermatoses, mismanage elimination trials, or overlook modifiable contributors to barrier dysfunction and chronic pruritus. In a practice environment where pet parents are increasingly interested in homemade, raw, and other alternative diets, dermatology and nutrition are becoming harder to separate. (dvm360.com)

What to watch: The next phase is likely to be more protocol-driven use of diet histories in dermatology appointments, more referral collaboration with boarded nutritionists, and more scrutiny of how alternative diets affect both skin disease presentation and the quality of elimination trials. (wsava.org)