General Rules Topicals for Skin Infections Topicals for Allergic Skin Disease Topicals for Seborrhea

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1 Douglas J. DeBoer, D.V.M., Diplomate A.C.V.D. School of Veterinary Medicine University of Wisconsin-Madison General Rules Topicals for Skin Infections Topicals for Allergic Skin Disease Topicals for Seborrhea Wash pet with ordinary shampoo first, to remove debris and oils. Apply medicated shampoo; allow 5-10 minutes total contact time to allow penetration Use at least twice weekly Ask about compliance Products to leave on skin may be more convenient and have more residual action Conditioner, foam, mousse, wipes, spray

2 Chlorhexidine Various formulations available 2-4% concentrations With or without Tris With or without azole antifungal Various ways to deliver Shampoo Spray Wipes Mousse or leave-on product Careful around eyes Good antiseptic Keratolytic Dissolves keratin plugs Deep pyoderma Demodicosis Drying/irritating Bleaching Iodine, ethyl lactate, triclosan - NO Mupirocin Nisin Laundry Bleach Accelerated Hydrogen Peroxide Antimicrobial Peptide

3 Antimicrobial by several mechanisms Disrupts microbial biofilms Sticky, gluelike polymer produced by microbes to help them attach to surfaces, and protect them from the environment Certain organisms are very good biofilmproducers including Staphylococcus and Pseudomonas Wound dressing gauze Bone implants Catheters Toothpaste Water purification Many consumer products Silver sulfadiazine 10 um particles with very high surface area Enables more efficient leaching of silver ion (Ag++) into local area Continuous, slow release of Ag++ Wound dressings Bone implants Catheters Toothpaste Water purification Many consumer products Should extend antimicrobial action of a chlorhexidinemiconazole shampoo Recent unpublished study: yes, this is true!

4 Should help disrupt biofilm produced by P. aeruginosa or other organisms We use as preventive maintenance treatment, 2x weekly, in dogs with history of recurrent bacterial otitis Many products Oatmeal Pramoxine Hydrocortisone Antihistamines but no evidence! BATHING HELPS! 2-3x weekly Removes organisms Removes allergens Soothing effect Use slightly warm water, not hot or cold For temporary or seasonal use in atopic dermatitis The Stratum Corneum

5 Cornification Seborrhea is: The process of division and maturation of epidermal cells to form the stratum corneum. üa disruption of cornification üa common secondary complication, especially in dogs üscaling, crusting, and a complaint of odor to the coat that can t be washed off Classical Ingredients: Coal Tar Increased mitotic rate of epidermal cells Scale and crust accumulates Change in composition of surface lipids irritation, inflammation, odor Increase and shift in bacterial flora frequent bacterial pyodermas frequent yeast overgrowth Slows mitotic rate of epidermal cells Keratoplastic helps to normalize the cornification process Drying to skin Becoming difficult to obtain

6 Classical Ingredients: Sulfur Keratoplastic helps to normalize epidermal turnover time and the cornification process Antipruritic Antimicrobial Antiparasitic Classical Ingredients: Salicylic Acid Keratolytic helps to break up or dissolve the adherent scaling and crusting Newer Ingredients Newer Ingredients: Phytosphingosine Moisturizers ammonium lactate, glycerol, urea, fatty acids Antimicrobials piroctone olamine, ketoconazole, chlorhexidine Keratoplastic - zinc gluconate Precursor of ceramides Antimicrobial Anti-inflammatory Barrier-enhancing Prevent transmission of MRSP strains to other animals in your clinic Recent visit to a veterinarian is a strong risk factor for dogs to harbor MRSP Prevent colonization of humans by MRSA

7 Handwashing and disinfection Wearing gloves when appropriate Protective clothing, frequent laundering Cleaning/disinfection of premises One room for derm cases Education of staff and owners Overall 17.5% of clothing contaminated No difference: clothing type, where laundered, cleanliness, how long worn Technicians most likely Veterinary Surgery 2013 What to use? Traditionally: phenol-based or quaterinary ammonium-based disinfectants Bleach-based Odor, possible health hazard? Newer: Peroxide-based Use the right ingredients Use the product often enough Most importantly, owner compliance is the most important ingredient! Choose products that are easy for owner to apply, to guarantee success!