TOPICAL THERAPY

Karen L. Campbell, DVM, MS, DACVIM, DACVD Professor Emerita, University of Illinois Clinical Professor of Dermatology, University of Missouri Introduction

• Advantages of Topical Medications • Directly delivers active ingredients to skin • Minimizes systemic side effects (e.g. corticosteroids) • Decrease dependence on systemic antibiotics and thereby decrease risk of developing antibiotic resistance Introduction

• Indications • Cleansing • Antibacterial • Antifungal • Antiparasitic • Antipruritic • Antiseborrheic • Keratolytic • Keratoplastic • Degreasing • Otic Agents Introduction

• Types of products • Shampoos • Powders • Rinses • Sprays • Lotions • Creams • Ointments • Mousses • Spot-ons • Wipes Principles of Shampoo Therapy

• Proper shampoo selection • Thorough application • Regular application • Appropriate contact time • Thorough rinsing Characteristics of the Ideal Shampoo • Lathers well • Rinses freely • Removes soil/exfoliated cells • No residue • Nonirritating • Client-pleasing fragrance and texture (“elegance”) • Leaves natural oils/moisturizes • Leaves hair soft, shiny, easy to comb Factors in Shampoo Selection

• Purpose of shampoo • Species • "Elegance"—color, odor, taste, consistency • Product cost and size of animal • Acceptability to owner • Other treatments being given • Consider that rotation may increase effectiveness of products Preparation of Animal for Bath

• Clip mats, long hair • Soak 10 to 15 minutes. • Water temperature 95 to 100 F • Shampoo contact time of 5-15 minutes (read a book chapter, clean pet’s ears, empty anal sacs) Differences in Human, Dog and Cat Skin

• Dog—3 to 5 epidermal layers, 22 day turnover, pH 7.5 • Cat—3 to 5 epidermal layers, pH 6-7 • Human—10 to 15 epidermal layers, 28 (or longer) day turnover, pH 5.5 Dry Shampoos

• Absorbent powders • Mild alkali • Static electricity may build-up (negative electrical charges = "flyaway hair”) Rinse-Free Shampoos

• Apply foam to hair coat soaking hairs • Allow to dry then brush out • Contains cleaning extracts from plants and essential oils to eliminate odors and moisturize skin and hairs Soap Shampoos

• Sodium salts—hard soaps • Potassium salts—soft soaps • Require soft water to avoid leaving Ca-Mg deposits on hairs • An acidic rinse is useful to remove residue from hairs Detergent Shampoos

• Salts of lauryl sulfate • Additives combat drying • Glycerol • Lanolin • Oils • Fatty alcohols “Hypoallergenic Shampoos”

• Soap free • Moisturizing/cleansing • Examples • Allergroom • DermaLyte • HyLyt EFA Moisturizers

• Humectants • Glycerin • Propylene glycol • Urea • Emollients • Glycerol esters • Lanolin • Lanolin derivatives • Oils • Fatty alcohols Antibacterial Topicals

• Sulfur • Benzoyl peroxide • Chlorhexidine • Hypochlorous acid • Iodophors • Hexachlorophene • Selenium • Triclosan • Ethyl lactate • Acetic acid • Silver Sulfur

• Keratolytic • Keratoplastic • Antifungal • Antibacterial • Antiparasitic • Antipruritic • Odoriferous • Staining Benzoyl Peroxide

• Antibacterial • Antiyeast • Keratolytic • Follicular flushing • Antipruritic • Degreasing Chlorhexidine

• Antibacterial • Antifungal • Binds to stratum corneum Hypochlorous Acid

• Weak acid formed when chlorine dissolves in water • Oxidizers – bleaches, deodorants, disinfectants • Dakin’s solution kills a broad range of micro- organisms (bacteria, yeast, viruses) Iodophors

• Antibacterial • Antifungal • Staining • Irritating • Sensitizing • Inactivated by organic debris Hexachlorophene

• Antibacterial • Toxic to cats • Sensitizing • Systemic absorptionseizures • Embryotoxic • Do not use metal buckets or metal dispensers (damages metal) Selenium

• Keratolytic • Antibacterial • Anti-yeast • Degreasing/drying • Irritating Triclosan

• Antibacterial Ethyl Lactate • Hydrolyzed to ethanol and lactic acid • Antibacterial • Follicle flushing

Colloidal Silver • Reported to have antibacterial and antifungal properties Acetic Acid

• Antibacterial • Anti-yeast Antifungal Shampoos

• Miconazole • Sulfur • Chlorhexidine • Benzoyl peroxide (yeast only) • Iodophors • Ketoconazole • Selenium (yeast only) • Acetic acid (yeast only) Miconazole

• Antifungal • Most effective for yeast Clotrimazole

• Malassezia • Microsporum canis Ketoconazole

• Antifungal • Effective for dermatophytes and yeast Antiparasitic Shampoos

• Sulfur • Pyrethrin • Pyrethroids • Carbamates • Lindane Antipruritic Shampoos

• Moisturizing shampoos • Colloidal oatmeal • Diphenhydramine HCl • Pramoxine HCl • Hydrocortisone • Sulfur • Benzoyl peroxide • Menthol • Aloe vera Colloidal Oatmeal

• Moisturizing • Binds antigens • May have anti- cyclooxygenase activity (anti-inflammatory) Diphenhydramine HCl

• Antihistamine Pramoxine HCl

• Topical anesthetic Hydrocortisone

• Corticosteroid • Anti-inflammatory • Short-acting Menthol and Witch Hazel

• Cooling agents • Raise pruritic threshold Aloe Vera

• Moisturizer • May aid wound healing • Antibacterial • Antifungal Antiseborrheic Shampoos

• Keratolytic • Keratoplastic • Degreasing • Moisturizing Keratolytic Shampoos

• Sulfur • Salicylic acid • Tars • Retinoids • Benzoyl peroxide • Propylene glycol • Lactic acid Salicylic Acid

• Keratoplastic • Keratolytic • Antipruritic • Bacteriostatic • Synergistic with sulfur Tars

• Toxic to cats! • Keratolytic • Keratoplastic (antimitotic) • Antipruritic • Antimitotic • Degreasing • Anti-inflammatory • Some may be carcinogenic Retinoids

• Available as gels, creams, ointments • Most commonly used is Retin-A • Keratoplastic • Keratolytic • Decrease sebaceous gland secretions • Anti-inflammatory • Activity against some cutaneous tumors Propylene Glycol

• Humectant • Keratolytic • Ceruminolytic • Nephrotoxic • Irritating Lactic Acid

• Keratolytic • Ceruminolytic Keratoplastic Agents

• Retinoids • Tars • Sulfur • Salicylic acid Degreasing Shampoos

• Detergents • Benzoyl peroxide • Selenium sulfide • Ethyl lactate Otic Medications

• Ceruminolytics • TrizEDTA • Antibacterial • Antifungal • Drying agents • Anti-inflammatory agents • Parasiticides Miscellaneous Products

• Oligosaccharides • Chitosanide • Phytosphingosine • Zinc gluconate • Vitamin B6 • Hydrolyzed proteins • Topical calcineurin inhibitors • Mupirocin • Silver sulfadiazine Oligosaccharides

• Anti-inflammatory • May decrease bacterial colonization

Allermyl Shampoo L-rhamnose D-mannose D-galactose Chitosanide

• Biopolymer produced from chitosan in crustacean shells • Forms a protective film • Acts as a skin moisturizing agent Phytosphingosine

• A pro-ceramide • Repair of epidermal permeability barrier • Facilitates normal structure of epidermis • Anti-seborrheic activity • Anti-inflammatory activity • Anti-microbial effects Zinc gluconate

• Zinc is co-factor in many enzyme systems • Facilitates normalization of keratinization • May down-regulate sebum production Vitamin B6

• Synergistic with zinc in normalizing keratinization • Synergistic with zinc in down-regulating sebum production Hydrolyzed proteins

• “Repair split ends” by binding to hair keratins • Moisturizing Topical calcineurin inhibitors

• Tacrolimus • Picrolimus • Potent anti-inflammatory agents • Block T cell function • Useful in treatment of immune-mediated skin diseases • Have caution label for humans—may predispose to cutaneous tumors Mupirocin

• Topical antibiotic • Blocks the activity of isoleucyl-tRNA synthetase thereby blocking protein synthesis (unique mode of action) • Polyethylene glycol base is nephrotoxic therefore do not use over large areas of body • Not approved for use on cats • Used intranasally to eliminate/reduce carriage of MRSA • Readily penetrates into dermis Silver Sulfadiazine

• Topical antimicrobial with activity against many species of bacteria and against yeast • Does not interfere with wound healing • Very popular choice for preventing infections following burns • Dilute 1:1- 1:10 to make otic solution Leave-on Formulations

• Powders • Dips • Sprays • Mousses • Lotions • Creams • Gels • Ointments Summary

• Wide spectrum of products available for topical use • Understanding goals and mechanisms of action will facilitate product selection • Be sure owners understand the goals and how to use products Thank you to Dechra for sponsorship!

NAVDF provides up-to-date Dermatology CE (NAVDF.ORG) 2019 meeting in Austin, TX

WCVD9 in Sydney, Australia– an experience of a lifetime! (October 20-24, 2020) Karen L. Campbell, DVM, MS Diplomate, American College of Veterinary Internal Medicine Diplomate, American College of Veterinary Dermatology

University of Missouri Veterinary Health Center—Wentzville 1092 Wentzville Parkway Wentzville, MO 63385

(636) 332-5041 (636) 327-6400 fax [email protected] [email protected]