Topical Therapy · • Benzoyl peroxide • Chlorhexidine • Hypochlorous acid • Iodophors • Hexachlorophene • Selenium ... antifungal properties. Acetic Acid • Antibacterial
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TOPICAL THERAPYKaren L. Campbell, DVM, MS, DACVIM,
DACVDProfessor 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 absorptionseizures• 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 ShampooL-rhamnoseD-mannoseD-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 oticsolution
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, MSDiplomate, American College of Veterinary Internal MedicineDiplomate, American College of Veterinary Dermatology
University of Missouri Veterinary Health Center—Wentzville1092 Wentzville ParkwayWentzville, MO 63385
(636) 332-5041(636) 327-6400 fax
campbellmotsingerk@missouri.edu
klcampbe@Illinois.edu
mailto:campbellmotsingerk@missouri.edu
Topical TherapyIntroductionIntroductionIntroductionPrinciples of Shampoo TherapyCharacteristics of the Ideal Shampoo Factors in Shampoo Selection�Preparation of Animal for BathDifferences in Human, Dog and Cat SkinDry ShampoosRinse-Free ShampoosSoap ShampoosDetergent Shampoos“Hypoallergenic Shampoos”MoisturizersAntibacterial TopicalsSulfurBenzoyl PeroxideChlorhexidineHypochlorous AcidIodophorsHexachloropheneSeleniumTriclosanEthyl LactateAcetic AcidAntifungal ShampoosMiconazoleClotrimazoleKetoconazoleAntiparasitic ShampoosAntipruritic ShampoosColloidal OatmealDiphenhydramine HClPramoxine HClHydrocortisoneMenthol and Witch HazelAloe VeraAntiseborrheic ShampoosKeratolytic ShampoosSalicylic AcidTarsRetinoidsPropylene GlycolLactic AcidKeratoplastic AgentsDegreasing ShampoosOtic MedicationsMiscellaneous ProductsOligosaccharidesChitosanidePhytosphingosineZinc gluconateVitamin B6Hydrolyzed proteinsTopical calcineurin inhibitors�MupirocinSilver SulfadiazineLeave-on FormulationsSummarySlide Number 61Slide Number 62
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