Multiple factors, including client financial constraints, play a role in clinician decisions for canine atopic dermatitis: spectrum of care in a chronic and relapsing disease

Objective: To understand the current opinions, diagnostic process, and prescribing behavior of North American veterinarians for canine atopic dermatitis. A secondary objective was evaluating how treatment recommendations were guided by client financial limitations and veterinarian knowledge of canine atopic dermatitis. Methods: A Veterinary Information Network online survey was available from July 15 to August 15, 2025, to veterinarians who practiced in North America, saw canine patients, and consented to participation. Questions about frequency of owners with financial constraints, diagnostics and therapeutic recommendations, and referral to specialists were asked by either direct questioning or case scenarios. Results: 718 respondents provided sufficient data for inclusion; 57% of respondents stated ≥ 25% of their clients had substantial financial constraints, while 28% of respondents stated ≥ 50% of clients had financial constraints. Most respondents always or often used financial status to guide recommendations. Respondents considered skin cytology followed by skin scraping the most important diagnostic tests regardless of financial constraint. Respondents preferred cephalexin for methicillin-sensitive pyoderma when there was financial constraint. Most respondents knew of the recommendation to use sole antiseptic topical therapy for methicillin-resistant superficial pyoderma, and most recommended aerobic bacterial culture before antibiotics with suspected methicillin-resistant pyoderma. Conclusions: Substantial financial constraints of clients do not always alter diagnostic and treatment recommendations for canine atopic dermatitis; however, clinicians' recommendations do not always align with consensus guidelines. Clinical Relevance: A better understanding of veterinarians' diagnostic and prescribing behavior can improve veterinary education on spectrum-of-care decision-making for canine atopic dermatitis.