Why the intense focus on topical therapy for dog skin care? Why now?

Karen Helton Rhodes, DVM, DACVD

Terri Bonenberger, DVM, DACVD

Your dog’s dermatologists 

Why the intense focus on topical therapy for dog skin care?  Why now?

 

Until recently, veterinarians promoted systemic therapy as a first option for many common disorders.  Pills, injections, and/or oral solutions were given to patients to treat common problems such as ear infections, allergy, and skin infections.  The trend has dramatically changed.  Dog skin care, as well as newer human protocols, now focuses on topical therapy without the use of systemic medications.  This is why!

Two primary reasons for the change in mindset.

 

Reason #1:   The emergence of resistant strains of bacteria:  MRSA (methicillin resistant staphylococcus aureus) and other multi-drug resistant staph organisms  such as MRSP (methicillin resistant staphylococcus pseudintermedius) and MRSS.  

staphylococcus bacteria

 

For way too many years, veterinarians and physicians over-used antibiotics.  You have an ear infection…..get antibiotics. You have a cold……get antibiotics.  You have a rash…..get antibiotics.  This trend needs to stop!  The bacteria have become smarter and more efficient due to repeated exposure to antibiotics.  They have “learned” how to resist our antibiotics.  Thus the emergence of resistant strains of bacteria.  This resistance is not limited to Staphylococcus bacteria.  We are also seeing resistance with other organisms such as E.coli and Pseudomonas.  We now have a serious problem:  what therapy do we choose to combat these organisms?  Topical therapy may have the answer!  

Topical Therapies can help prevent multi-drug resistance!

Reason #2:    The discovery that canine allergy is associated with epidermal barrier defectsTopical therapy can improve some of these defects and may lead to clinical improvement.  

stratum corneum barrier is the outer layer of the epidermis

stratum corneum barrier is the outer layer of the epidermis

Layers of the skin

 

 

 

The Stratum corneum is the outer layer of the epidermis of the skin.  It is the primary barrier between the body and the environment.  Minor changes in the structure can have devastating clinical effects.  Keep in mi

nd that the skin controls hydration. We can see as much as 0.5 liters of water loss from normal skin in man in only one day!  If the stratum corneum barrier is damaged or altered in any manner, the water loss can be much more pronounced!  Also, a healthy epidermis is a primary defense against  allergens, pollutants, and irritants.  The skin helps control commensal bacterial organisms so that the normal flora does not cause disease.  It also absorbs UV irradiation.  A defect in the barrier can alter any one or several of these functions.

 

Two main diseases/disorders with alterations in the epidermal lipid barrier:

Atopic dermatitis (allergy): The epidermal defect may be due to a hereditary defect or actually due to inflammation caused by the allergy?? Allergy patients have

decreased and abnormal ceramide content in SC.  Research is ongoing.  Ceramides are a key ingredient in some of the topical therapies for this very reason. (ex. CSS Recovery shampoo)                                   

Keratinization disorders: Keratinization disorders (scaling diseases) are due to alterations in the maturation of the skin.  The skin actually regenerates itself every 21 -28 days thus you get a new skin every 3-4 weeks.  Now, in normal skin the old cells fall off into the environment as the new cells are “formed” causing a perfect balance.  In keratiization disorders, the new cells develop too rapidly and the old cells do not fall off……causing the skin to be very scaly!

 

* in a perfect world--à correct the disorder….otherwise, try to replace or repair the defect….. thus the addition of ingredients such as ceramides

excess scaling

 

Key point:  Steroids further inhibit the barrier…try to avoid if at all possible

 

 Topicals therapies can improve a damaged skin barrier!

 

If we look at an overall benefit of topical therapy then we can easily realize that there is actually no reason not to rely on this mode of treatment and prevention.  Yes, it may be somewhat inconvenient to bathe your dog but the benefits far outweigh that inconvenience! 

Advantages of Topical therapy

1.  antibacterial without having to use antibiotics (treatment)

2.  hydrate the skin (moisture repair)

3.  replenish the defective epidermal barrier

4.  mechanically remove bacteria from the skin surface (control)

5.  mechanically remove allergens from the skin surface

6anti-itching

7.  anti-odor

8.  remove environmental toxins

9.  help control inflammation

 

 

Topical ingredients to look for in your chosen products that can address the above listed advantages:

1.  Na Hypochlorite:  antibacterial with no evidence of resistance!

                                          *the actual ingredient chosen by physicians to

                                           treat MRSA

                                           *effective for both bacteria & yeast 

2.  Benzoyl peroxide: antibacterial, degreasing, lowers skin pH

                                           *can be excessively drying & irritating (often used

                                             in “over the counter” acne treatments

                                           *may damage the epidermal barrier so not best

                                             for use in allergy patients

3.  Chlorhexidine: a common antibacterial ingredient

                                     *there has been documented variability in efficacy

                                      between different brands

4.  Mupirocin:  an effective antibacterial ointment (not available in

                               other forms); often used to treat MRSA

5.  Nisin:  naturally derived antimicrobial found in cow’s milk

                    *works by lowering the skin pH

                    *primarily used for Staph infections

6.  Miconazole: primarily an antifungal but has some antibacterial

                               properties

7.  Phytosphingosines (pro-ceramide) or Ceramides  

                                   *Comprise 40-50% of epidermal lipids

                                   *Barrier maintenance

                                   *Anti-inflammatory: anti-IL activity, decrease PGE2…. 

8.  Fatty Acids & Vitamin E:  used to replenish the hyro-lipidic film and    

                                    hydrate the skin

9.  Salicylic Acid:  keratolytic- helps with desquamation (decrease

                                    scaling)

                                    *decreases skin pH àincreases water absorption

                                    *antibacterial

 

Veterinary Dermatology has endorsed this new way of thinking:  “incorporating skin biology into an understanding of the pathogenic mechanisms contributing to skin disease and designing a physiological restorative treatment” (Professor Patrick Bourdeau)

 

Canine Skin Solutions has taken these values and formulated a topical therapy line to specifically address certain diseases in dogs.  Na hypochlorite, ceramides, fatty acids, vitamin E, and salicylic acid have been incorporated into our products.  New topicals are in formulation.  Our goal at CSS is to bring novel products to pet parents.  Not to simply re-invent products already on the market!