Peer Reviewed VETcpd - Dermatology Scaling and crusting in dogs: Part 2 – management Treatment of scaling and crusting should be aimed at addressing underlying root causes. Secondary scaling disorders include allergies, ectoparasitic infestations, endocrine and metabolic disorders, immune-mediated diseases, and neoplastic conditions. Correction of secondary infections and treatment of underlying causes can lead to rapid clinical improvement. Topical therapy is indicated for most dogs with scaling and crusting, irrespective of the cause. Key words: Scale, crust, therapy, shampoo, secondary, primary, management.

Mark Craig BVSc CertSAD Introduction MRCVS Scaling and Emollients and moisturisers crusting are Emollients soften, lubricate or soothe the Mark Craig qualified from Liverpool common in skin, typically by reducing water loss from University in 1985. After 5 years in canine clinical the epidermis. Moisturisers increase the general veterinary practice, Mark spent practice (see three and a quarter years as resident water content of the stratum corneum, Part 1: Vet CPD the outermost layer of the skin. Examples in dermatology at the Royal Veterinary Journal, Vol 2, College, where he gained his certificate include propylene glycol, glycerin, Issue 3). For in small animal dermatology. Since colloidal oatmeal, , , sodium treatment to be leaving the college in 1993, he lactate and chitosanide. Both emollients effective in the long-term, underlying has built up Re-Fur-All Referrals, a and moisturisers are useful in hydrating causes should be identified and addressed. veterinary dermatology referral service and softening the skin and may, therefore, in the South of England and the West Dogs with scaling and crusting, irrespec- help dogs with chronic pruritus associated Midlands. tive of the cause, however, are prone with dry skin. to staphylococcal and yeast infections Mark has written and lectured which can in turn cause more scaling extensively on animal skin diseases, Antiseborrhoeics and crusting. A poorly-managed scaling translated dermatology articles and • Keratolytic agents text books from French to English, and crusting disorder can be a source Keratolytic agents reduce cohesion and presented papers at national and of discomfort to the dog and a source international dermatology congresses. of unpleasant smells and greasy debris between corneocytes thereby softening the for its owners. Fortunately, correction stratum corneum and facilitating orderly Re-Fur-All Referrals, 31 Porchester of secondary infections and manage- scale removal. Examples include , Road, Newbury, Berkshire, RG14 7QH DOGS DESERVE THE BEST CHANCE ment of underlying causes can lead to sulphur, lactic acid, , urea, Tel: 01635 35600 rapid clinical improvement (Miller et al. and at higher concentrations. 1 E-mail: [email protected] 2013 ) and reduction in smell. This article • Keratoplastic agents OF RECOVERY TOO discusses aspects of topical and systemic Keratoplastic agents assist in restoring therapy relevant to both primary and normal keratinisation and epithelialisation. secondary scaling and crusting disorders. While most dogs will happily accept oral , owners with busy lives often miss doses, dose late and even Examples include coal tar, sulphur, selenium discontinue dosing before recovery is complete.1 These dosing deviations can allow drug levels to drop below minimum The number of primary and secondary sulphide and salicylic acid. ® scaling and crusting disorders is vast, and inhibitory concentrations (MIC) and limit or delay complete recovery. Convenia , the one shot , gives you Many shampoos contain keratolytic and a full discussion of specific treatments for and your clients the confi dence that pets will receive 14 days of uninterrupted treatment of the common bacteria keratoplastic agents (Figure 2). causing canine skin, soft tissue, urinary tract and periodontal infections.2 Convenia is already a successful these conditions is beyond the scope of 3,4 treatment option for cats. Don’t dogs deserve the same? this article. Agents to promote LEARN AND EARN CPD: www.zoetis.co.uk/antibiotics/webinars.aspx restoration of epidermal barrier The epidermal barrier is altered in dogs It is prudent to reserve 3rd-generation cephalosporins for clinical conditions responding poorly or expected to respond poorly Topical therapy to other classes of antimicrobials or 1st-generation cephalosporins. Convenia use should be based on susceptibility testing. Topical therapy is indicated for most dogs with atopic dermatitis (Santoro et al. with scaling and crusting, irrespective 2015) and defective in keratinisation of the cause (Figure 1). A wide range defects, and some products are now For Dermatology Referrals in your of veterinary products is now available, marketed for maintaining and supporting area: vetindex.co.uk/derm including shampoos, spot-ons, sprays, the skin barrier. mousses, pads, and conditioners. For Lab Tests and Equipment: Moisturisers and anti-seborrhoeic agents • Phytosphingosine vetindex.co.uk/Lab Read more: www.zoetis.co.uk/antibiotics are widely used, but many products also Phytosphingosine is present in the stratum Market your referrals in VetIndex 2016! have antimicrobial, antiparasitic, anti- corneum of normal skin, has been shown 1. Owner compliance with short term antimicrobial in dogs. Barter LS, Watson AD, Maddison JE. Aust Vet J. 1996 Oct; 74(4):277-80. For further information call us on 01225 2. Convenia SPC. 3. Stethos, Convenia Diary Study, July 2014, Slides 14, 17. 4. Ipsos Forward Research, Brand Health Assessment, May 2012, Slides 16-19, 50. pruritic, anti-inflammatory, degreasing, to increase levels of ceramides (key 445561 or e-mail: [email protected] Further information is also available from the Summary of Product Characteristics, or please contact Zoetis UK Ltd, Walton Oaks, Tadworth, Surrey KT20 7NS POM-V and astringent properties. structural components of the intercellular www.zoetis.co.uk Customer Support: 0845 300 8034 Zoetis Ireland Ltd, 9 Riverwalk, Citywest Business Campus, Dublin 24 POM Use medicines responsibly (www.noah.co.uk/responsible). Date of preparation Aug 2015. AH516/15 VETcpd - Vol 2 - Issue 4 - Page 15

4223 - Convenia_Responsible Use in Dogs Ad_VET CPD_FULL PAGE_210x297_AW.indd 1 28/10/2015 14:19 VETcpd - Dermatology lipid cement in the stratum corneum), and improve skin barrier function in people when applied topically. Phytosphingosine is now included in various veterinary shampoos, spot-ons, mousses, sprays and pads (Douxo, Ceva Animal Health).

• Fatty acids A mixture of ceramides, fatty acids and cholesterol is present in Allerderm Spot- on (Virbac Animal Health). Essential fatty acids (EFAs) and essential oils are included in Essential 6 (Dermoscent Figure 1: Washing with an appropriate shampoo Figure 2: Truncal scale on a 1 year old German Animal Dermo-Care). Both spot-ons are provides many benefits for dogs with skin Short-haired Pointer with lupoid dermatosis. marketed in the UK for use in improving disorders. Antiseborrhoeic shampoos and EFA supplements or supporting skin barrier function in were helpful in managing this dog’s condition. dogs with skin problems.

• Antimicrobials Antibacterial and agents are indicated in the treatment of staphylococcal and yeast infections in dogs with scaling and crusting. Topical antimicrobial agents commonly used include chlorhexidine, povidone- iodine, ethyl lactate, , and benzoyl peroxide. A recent literature review (Mueller et al. 2012) concluded there was good evidence for the efficacy of shampoos containing 2-3% Figures 3a & 3b: Examples of scaling and crusting associated with Malassezia dermatitis typically chlorhexidine against staphylococcal respond well to topical antifungal shampoos. bacteria, and for the use of a combination of 2% chlorhexidine and 2% miconazole manufacturer’s instructions. Typically, in dogs with Malassezia spp overgrowth washing and drying a dog thoroughly (Figures 3a and 3b). Malaseb (Dechra takes 30 minutes or more and many Veterinary Products Limited), Microbex dogs do not enjoy the process! After a (Virbac Animal Health) and Adaxio (Ceva shampoo has been applied, it should Animal Health) are licensed in the UK for remain in contact with the skin for about treating Malassezia dermatitis in dogs. 10 minutes before being well-rinsed. Rinsing, which should take 2-3 times Recent additions to the UK market longer than lathering, removes debris and include PYOspot (Dermoscent Animal shampoo and helps to hydrate the skin Dermo-Care) which contains PhytoC-2, (Miller et al. 20133). a vegetable extract claimed to restore the Inappropriate shampoos or overuse can balance of the cutaneous flora and soothe increase scaling and irritation. A mild the skin by re-inforcing the skin barrier, Figure 4: Mild dorsal scale in Cavalier King Charles product should be used initially before and Douxo Pyo (Ceva Animal Health) Spaniel with cheyletiellosis. Scaling resolved with changing to a stronger one if clinical which contains chlorhexidine, appropriate ectoparasitic treatment response is unsatisfactory. For mildly flaky, and phytosphingosine. pyriproxifen, permethrin, amitraz) are dry skin, moisturising or emollient-based Antimicrobial activity has been claimed delivered in spot-on formulations or products should be used. In more severe for other topical agents such as honey aqueous solution (Figure 4). cases, shampoos containing sulphur and (Mueller, Bergvall, Bensignor and Bond, salicylic acid may be indicated. For greasy 2012), coconut oil (Kabara et al. 1972), Clinical response skin, selenium sulphide and benzoyl (Halcon and Milkus 2004) and The clinical response to shampoos of peroxide can be helpful although there is aloe vera (Shelton 1991). Further studies dogs with chronic scaling disorders is currently no benzoyl peroxide-containing are required to evaluate their usefulness in quite variable. Most patients should veterinary shampoo available in the UK. managing canine skin disease. probably be washed 2-3 times weekly Pre-washing with a non-medicated sham- until clinical improvement is noted. A poo helps to remove general debris and • Anti-parasitic agents shampoo is selected according to the allows better contact of the antimicrobial Many antiparasitic agents (e.g. fipronil, nature and severity of the lesions and or antiseborrhoeic product with the skin, imidacloprid, selamectin, moxidectin, should always be used in accordance with thereby increasing efficacy.

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