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