Vet Dermatol 2017; 28: 266–e68 DOI: 10.1111/vde.12440 Diagnosis and treatment of dermatophytosis in dogs and cats. Clinical Consensus Guidelines of the World Association for Veterinary Dermatology Karen A. Moriello*, Kimberly Coyner†, Susan Paterson‡ and Bernard Mignon§ *Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive West, Madison, WI 53706, USA †Dermatology Clinic for Animals, 8300 Quinault Drive NE Suite A, Lacey, WA 98516, USA ‡Department of Veterinary Dermatology, Rutland House Referral Hospital, Abbotsfield Road, St Helens, WA9 4HU, UK §Department of Infectious and Parasitic Diseases, Veterinary Mycology, FARAH (Fundamental and Applied Research for Animals & Health), Faculty of Veterinary Medicine, University of Liege, Quartier Vallee 2, Avenue de Cureghem 10, B43A, 4000 Liege, Belgium Correspondence: Karen A. Moriello, Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive West, Madison, WI 53706, USA. E-mail: [email protected] Background – Dermatophytosis is a superficial fungal skin disease of cats and dogs. The most common pathogens of small animals belong to the genera Microsporum and Trichophyton. It is an important skin disease because it is contagious, infectious and can be transmitted to people. Objectives – The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs. Methods – The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. Conclusions – No one diagnostic test was identified as the gold standard. Successful treatment requires concurrent use of systemic oral antifungals and topical disinfection of the hair coat. Wood’s lamp and direct examinations have good positive and negative predictability, systemic antifungal drugs have a wide margin of safety and physical cleaning is most important for decon- tamination of the exposed environments. Finally, serious complications of animal–human transmission are exceedingly rare. Clinical Consensus Guidelines Clinical Consensus Guidelines (CCGs) provide the veterinary by the members of the panel. A draft is prepared by the panel, community with current information on the pathophysiology, followed by a presentation of the guidelines at major national diagnosis and treatment of commonly encountered dermatologi- and/or international veterinary meetings. Access to the guide- cal conditions. The World Association for Veterinary Dermatology lines will be available on the WAVD web site. Solicitation for (WAVD) oversees selection of relevant topics, identification of input from WAVD member organizations and affiliate and provi- panel members possessing the expertise to draft the Clinical sional member groups will result in the incorporation of this feed- Consensus Guidelines, and any other aspects required to assure back into the guidelines. The final CCG manuscript will be the integrity of the process. The statements are derived from evi- submitted to the Veterinary Dermatology journal, where it is dence-based medicine whenever possible, however when such reviewed and edited before publication. The authors are solely evidence does not exist then expert opinions would be utilized responsible for the content of the statements. Accepted 22 December 2016 Sources of Funding: This study was self-funded. Conflicts of Interest: Karen Moriello has received honoraria, consulting fees, and/or has collaborated with: 3M Company, Pfizer Limited, Alpharma Co, Novartis Animal Health, Elanco Animal Health, Fort Dodge Laboratories, Delmont Laboratories, Dechra Animal Health, Bayer Animal Health, IDEXX Laboratories, Ogena Solutions, Kinetic Vet, Stanley Steemer and Zoetis Animal Health. Kimberly Coyner has received honoraria, consulting fees, and/or has collaborated with: Dechra Animal Health and Pfizer/ Zoetis Animal Health. Sue Paterson has received an honorarium, consulting fees and /or collaboration with Novartis Animal Health, Elanco Animal Health, Dechra Animal Health, Bayer Animal Health, Nationwide Laboratories, Ceva Animal Health, ICF, Zoetis Animal Health, Royal Canin and Merial Animal Health. Bernard Mignon has received an honorarium, consulting fees, and/or has collaborated with American Cyanamid-Fort Dodge Animal Health, Auriga International, Bayer Animal Health, Dow Corning Europe SA, Eurogentec, Hoescht S.K.W., Janssen Animal Health, MNLpharma Ltd, Oystershell nv, Pfizer, Prodivet sa, Regivet bv, Schering-Plough Animal Health, Vernique Biotech Ltd and Virbac. 266 © 2017 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the ESVD and ACVD, 28, 266–e68. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. WAVD cannot be held responsible for errors or any consequences arising from the use of information contained in this article. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own countries. Clinical consensus guidelines dermatophytosis Table of contents Summary of the Clinical Consensus Guidelines 268 1 Introduction 269 2 Disease overview 269 2.1 Pathogens of importance, new classifications 269 2.2 Prevalence and risk factors 270 2.3 Conclusions 272 2.4 Pathogenesis of infection/immune response 272 2.5 Clinical signs 272 3 Diagnostic testing 273 3.1 Wood’s lamp and fluorescence 273 3.2 Dermoscopy 275 3.3 Direct examination of hair and/or scale 275 3.4 Fungal culture 276 3.5 Polymerase chain reaction 277 3.6 Biopsy 279 3.7 Conclusions 279 4 Topical antifungal treatments 280 4.1 Whole body treatments (See summary in Supporting Information Table S2) 280 4.2 Conclusions 284 5 Systemic treatment 284 5.1 Itraconazole (See Supporting Information Table S3 for summary) 284 5.2 Ketoconazole (See Supporting Information Table S4 for summary) 286 5.3 Fluconazole 287 5.4 Terbinafine (See Supporting Information Table S5 for summary) 287 5.5 Griseofulvin (See Supporting Information Table S6 for summary) 288 5.6 Lufenuron (See Supporting Information Table S7 for summary) 289 5.7 Fungal vaccines (see Supporting Information Table S8 for summary) 290 5.8 Conclusions 291 6 Environmental disinfection 291 6.1 Fungal spores in the environment 292 6.2 Veterinary clinics 292 6.3 Viability and infectivity of environmental spores 292 6.4 Antifungal disinfectants 293 6.5 Strategies to minimize shedding and spread of infective material 294 6.6 Conclusions 294 7 Zoonotic considerations 295 7.1 Conclusions 295 References 296 Supporting Information 303 © 2017 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the ESVD and ACVD, 28, 266–e68. 267 Moriello et al. Summary of the Clinical Consensus Guidelines Diagnosis and treatment of dermatophytosis in dogs and cats 1 Prevalence and risk factors a Determination of the true prevalence and breed predispositions for dermatophytosis is difficult because this is not a spontaneously occurring disease, it is not reportable and it is not a fatal disease. Infection varies in severity and resolves without treatment in many dogs and cats. All of these factors bias breed and prevalence predilec- tion data. b Subcutaneous dermatophytic infections have been reported most commonly in Persian cats, and Yorkshire terrier dogs. c The activities of working and hunting dogs may increase their risk of exposure to dermatophyte spores and hence superficial and, less commonly nodular lesions. d Seropositive FIV and/or FeLV status in cats alone does not increase the risk of dermatophytosis. 2 Diagnostic testing a No one test was identified as a “gold standard”. b Dermatophytosis is diagnosed by utilizing a number of complementary diagnostic tests, including Woods lamp and direct examination to document active hair infection, dermatophyte culture by toothbrush technique to diagnose fungal species involved and monitor response to therapy, and biopsy with special fungal stains for nodular or atypical infections. c Dermoscopy may be a useful clinical tool with or without concurrent use of a Wood’s lamp to identify hairs for culture and/or direct examination. d PCR detection of dermatophyte DNA can be helpful, however a positive PCR does not necessarily indicate active infection, as dead fungal organisms from a successfully treated infection will still be detected on PCR, as will non-infected fomite carriers. e Contrary to what is believed, Wood’s lamp examination is likely to be positive in most cases of M. canis dermatophytosis. Fluorescing hairs are most likely to be found in untreated infections; fluorescence may be diffi- cult to find in treated cats. False positive and false negative results are most commonly