Introduction. Advantages of Topical Medications

Transcription

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

2 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

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

4 Introduction Types of products Shampoos Powders Rinses Sprays Lotions Creams Ointments Mousses Spot-ons Wipes

5 Principles of Shampoo Therapy Proper shampoo selection Thorough application Regular application Appropriate contact time Thorough rinsing

6 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

7 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

8 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)

9 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

10 Dry Shampoos Absorbent powders Mild alkali Static electricity may build-up (negative electrical charges = "flyaway hair )

11 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

12 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

13 Detergent Shampoos Salts of lauryl sulfate Additives combat drying Glycerol Lanolin Oils Fatty alcohols

14 Hypoallergenic Shampoos Soap free Moisturizing/cleansing Examples Allergroom DermaLyte HyLyt EFA

15 Moisturizers Humectants Glycerin Propylene glycol Urea Emollients Glycerol esters Lanolin Lanolin derivatives Oils Fatty alcohols

16 Antibacterial Topicals Sulfur Benzoyl peroxide Chlorhexidine Hypochlorous acid Iodophors Hexachlorophene Selenium Triclosan Ethyl lactate Acetic acid Silver

17 Sulfur Keratolytic Keratoplastic Antifungal Antibacterial Antiparasitic Antipruritic Odoriferous Staining

18 Benzoyl Peroxide Antibacterial Antiyeast Keratolytic Follicular flushing Antipruritic Degreasing

19 Chlorhexidine Antibacterial Antifungal Binds to stratum corneum

20 Hypochlorous Acid Weak acid formed when chlorine dissolves in water Oxidizers bleaches, deodorants, disinfectants Dakin s solution kills a broad range of microorganisms (bacteria, yeast, viruses)

21 Iodophors Antibacterial Antifungal Staining Irritating Sensitizing Inactivated by organic debris

22 Hexachlorophene Antibacterial Toxic to cats Sensitizing Systemic absorption seizures Embryotoxic Do not use metal buckets or metal dispensers (damages metal)

23 Selenium Keratolytic Antibacterial Anti-yeast Degreasing/drying Irritating

24 Triclosan Antibacterial

25 Ethyl Lactate Hydrolyzed to ethanol and lactic acid Antibacterial Follicle flushing Colloidal Silver Reported to have antibacterial and antifungal properties

26 Acetic Acid Antibacterial Anti-yeast

27 Antifungal Shampoos Miconazole Sulfur Chlorhexidine Benzoyl peroxide (yeast only) Iodophors Ketoconazole Selenium (yeast only) Acetic acid (yeast only)

28 Miconazole Antifungal Most effective for yeast

29 Clotrimazole Malassezia Microsporum canis

30 Ketoconazole Antifungal Effective for dermatophytes and yeast

31 Antiparasitic Shampoos Sulfur Pyrethrin Pyrethroids Carbamates Lindane

32 Antipruritic Shampoos Moisturizing shampoos Colloidal oatmeal Diphenhydramine HCl Pramoxine HCl Hydrocortisone Sulfur Benzoyl peroxide Menthol Aloe vera

33 Colloidal Oatmeal Moisturizing Binds antigens May have anticyclooxygenase activity (anti-inflammatory)

34 Diphenhydramine HCl Antihistamine

35 Pramoxine HCl Topical anesthetic

36 Hydrocortisone Corticosteroid Anti-inflammatory Short-acting

37 Menthol and Witch Hazel Cooling agents Raise pruritic threshold

38 Aloe Vera Moisturizer May aid wound healing Antibacterial Antifungal

39 Antiseborrheic Shampoos Keratolytic Keratoplastic Degreasing Moisturizing

40 Keratolytic Shampoos Sulfur Salicylic acid Tars Retinoids Benzoyl peroxide Propylene glycol Lactic acid

41 Salicylic Acid Keratoplastic Keratolytic Antipruritic Bacteriostatic Synergistic with sulfur

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

43 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

44 Propylene Glycol Humectant Keratolytic Ceruminolytic Nephrotoxic Irritating

45 Lactic Acid Keratolytic Ceruminolytic

46 Keratoplastic Agents Retinoids Tars Sulfur Salicylic acid

47 Degreasing Shampoos Detergents Benzoyl peroxide Selenium sulfide Ethyl lactate

48 Otic Medications Ceruminolytics TrizEDTA Antibacterial Antifungal Drying agents Anti-inflammatory agents Parasiticides

49 Miscellaneous Products Oligosaccharides Chitosanide Phytosphingosine Zinc gluconate Vitamin B6 Hydrolyzed proteins Topical calcineurin inhibitors Mupirocin Silver sulfadiazine

50 Oligosaccharides Anti-inflammatory May decrease bacterial colonization Allermyl Shampoo L-rhamnose D-mannose D-galactose

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

52 Phytosphingosine A pro-ceramide Repair of epidermal permeability barrier Facilitates normal structure of epidermis Anti-seborrheic activity Anti-inflammatory activity Anti-microbial effects

53 Zinc gluconate Zinc is co-factor in many enzyme systems Facilitates normalization of keratinization May down-regulate sebum production

54 Vitamin B6 Synergistic with zinc in normalizing keratinization Synergistic with zinc in down-regulating sebum production

55 Hydrolyzed proteins Repair split ends by binding to hair keratins Moisturizing

56 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

57 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

58 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

59 Leave-on Formulations Powders Dips Sprays Mousses Lotions Creams Gels Ointments

60 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

61 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)

62 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 (636) (636) fax