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 microorganisms (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 anticyclooxygenase 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 campbellmotsingerk@missouri.edu klcampbe@illinois.edu