Topical Therapy · • Benzoyl peroxide • Chlorhexidine • Hypochlorous acid • Iodophors •...
Transcript of Topical Therapy · • Benzoyl peroxide • Chlorhexidine • Hypochlorous acid • Iodophors •...
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TOPICAL THERAPYKaren L. Campbell, DVM, MS, DACVIM,
DACVDProfessor Emerita, University of Illinois
Clinical Professor of Dermatology, University of Missouri
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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
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Introduction
• Indications• Cleansing• Antibacterial• Antifungal• Antiparasitic• Antipruritic• Antiseborrheic
• Keratolytic• Keratoplastic• Degreasing
• Otic Agents
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Introduction
• Types of products • Shampoos• Powders• Rinses• Sprays• Lotions• Creams• Ointments• Mousses• Spot-ons• Wipes
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Principles of Shampoo Therapy
• Proper shampoo selection• Thorough application• Regular application• Appropriate contact time• Thorough rinsing
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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
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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
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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)
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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
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Dry Shampoos
• Absorbent powders• Mild alkali• Static electricity may
build-up (negative electrical charges = "flyaway hair”)
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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
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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
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Detergent Shampoos
• Salts of lauryl sulfate• Additives combat drying
• Glycerol• Lanolin• Oils• Fatty alcohols
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“Hypoallergenic Shampoos”
• Soap free• Moisturizing/cleansing• Examples
• Allergroom• DermaLyte• HyLyt EFA
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Moisturizers
• Humectants• Glycerin• Propylene glycol• Urea
• Emollients• Glycerol esters• Lanolin• Lanolin derivatives• Oils• Fatty alcohols
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Antibacterial Topicals
• Sulfur• Benzoyl peroxide• Chlorhexidine• Hypochlorous acid• Iodophors• Hexachlorophene• Selenium• Triclosan• Ethyl lactate• Acetic acid• Silver
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Sulfur
• Keratolytic• Keratoplastic• Antifungal• Antibacterial• Antiparasitic• Antipruritic• Odoriferous• Staining
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Benzoyl Peroxide
• Antibacterial• Antiyeast• Keratolytic• Follicular flushing• Antipruritic• Degreasing
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Chlorhexidine
• Antibacterial• Antifungal• Binds to stratum
corneum
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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)
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Iodophors
• Antibacterial• Antifungal• Staining• Irritating• Sensitizing• Inactivated by organic debris
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Hexachlorophene
• Antibacterial• Toxic to cats• Sensitizing• Systemic absorptionseizures• Embryotoxic• Do not use metal buckets or metal dispensers
(damages metal)
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Selenium
• Keratolytic• Antibacterial • Anti-yeast • Degreasing/drying• Irritating
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Triclosan
• Antibacterial
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Ethyl Lactate• Hydrolyzed to ethanol and lactic acid• Antibacterial• Follicle flushing
Colloidal Silver• Reported to have antibacterial and
antifungal properties
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Acetic Acid
• Antibacterial• Anti-yeast
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Antifungal Shampoos
• Miconazole• Sulfur• Chlorhexidine• Benzoyl peroxide (yeast only)• Iodophors• Ketoconazole • Selenium (yeast only)• Acetic acid (yeast only)
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Miconazole
• Antifungal• Most effective for yeast
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Clotrimazole
• Malassezia• Microsporum canis
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Ketoconazole
• Antifungal• Effective for dermatophytes and yeast
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Antiparasitic Shampoos
• Sulfur• Pyrethrin• Pyrethroids• Carbamates• Lindane
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Antipruritic Shampoos
• Moisturizing shampoos• Colloidal oatmeal• Diphenhydramine HCl• Pramoxine HCl• Hydrocortisone• Sulfur• Benzoyl peroxide• Menthol• Aloe vera
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Colloidal Oatmeal
• Moisturizing• Binds antigens• May have anti-
cyclooxygenase activity (anti-inflammatory)
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Diphenhydramine HCl
• Antihistamine
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Pramoxine HCl
• Topical anesthetic
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Hydrocortisone
• Corticosteroid• Anti-inflammatory• Short-acting
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Menthol and Witch Hazel
• Cooling agents• Raise pruritic threshold
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Aloe Vera
• Moisturizer• May aid wound
healing• Antibacterial• Antifungal
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Antiseborrheic Shampoos
• Keratolytic• Keratoplastic• Degreasing• Moisturizing
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Keratolytic Shampoos
• Sulfur• Salicylic acid• Tars• Retinoids• Benzoyl peroxide• Propylene glycol• Lactic acid
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Salicylic Acid
• Keratoplastic• Keratolytic• Antipruritic• Bacteriostatic• Synergistic with sulfur
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Tars
• Toxic to cats!• Keratolytic• Keratoplastic (antimitotic)• Antipruritic• Antimitotic• Degreasing• Anti-inflammatory• Some may be carcinogenic
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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
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Propylene Glycol
• Humectant• Keratolytic• Ceruminolytic• Nephrotoxic• Irritating
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Lactic Acid
• Keratolytic• Ceruminolytic
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Keratoplastic Agents
• Retinoids• Tars• Sulfur• Salicylic acid
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Degreasing Shampoos
• Detergents• Benzoyl peroxide• Selenium sulfide• Ethyl lactate
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Otic Medications
• Ceruminolytics• TrizEDTA• Antibacterial• Antifungal• Drying agents• Anti-inflammatory agents• Parasiticides
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Miscellaneous Products
• Oligosaccharides• Chitosanide• Phytosphingosine• Zinc gluconate• Vitamin B6• Hydrolyzed proteins• Topical calcineurin inhibitors• Mupirocin• Silver sulfadiazine
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Oligosaccharides
• Anti-inflammatory• May decrease
bacterial colonization
Allermyl ShampooL-rhamnoseD-mannoseD-galactose
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Chitosanide
• Biopolymer produced from chitosan in crustacean shells
• Forms a protective film• Acts as a skin moisturizing agent
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Phytosphingosine
• A pro-ceramide• Repair of epidermal permeability barrier• Facilitates normal structure of epidermis• Anti-seborrheic activity• Anti-inflammatory activity• Anti-microbial effects
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Zinc gluconate
• Zinc is co-factor in many enzyme systems
• Facilitates normalization of keratinization
• May down-regulate sebum production
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Vitamin B6
• Synergistic with zinc in normalizing keratinization• Synergistic with zinc in down-regulating sebum
production
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Hydrolyzed proteins
• “Repair split ends” by binding to hair keratins
• Moisturizing
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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
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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
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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
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Leave-on Formulations
• Powders• Dips• Sprays• Mousses• Lotions• Creams• Gels• Ointments
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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
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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)
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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
mailto:[email protected]
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