Hi everyone, thanks for joining our recorded webinar, and joining in. The webinar topic is on the interface between dermatology and behavioural medicine. And I'm extremely pleased and excited to introduce to you Doctor Sarah Heath, who I'm sure doesn't really need an introduction, but Sarah, for those of you who don't know, is a European veterinary specialist in behavioural medicine, and recently was awarded a Fellow of the Royal College of Veterinary Surgeons in recognition of her work developing behavioural medicine as a specific veterinary discipline.

She's based and owns and works for behavioural referrals veterinary practise in Chester, and this practise deals exclusively with behavioural medicine cases. They're all seen on a referral basis from general practise, and the approach is from a veterinary medicine perspective, which we're about to learn. It's not as clear cut as just behaviour and medicine that they're all intertwined, so very relevant to the, to the webinar today.

So thank you so much for joining us, Sarah, and, I'm gonna hand over to you for the, for the webinar. Thanks very much. Andy, for that introduction, and welcome, everybody.

So we're going to be talking about the interface between dermatology and behavioural medicine. And if we think about the link here, and we look at human medicine, we know that the importance of considering emotional factors in that human field of dermatology is really well recognised. They talk about, behavioural dermatology or emotional dermatology.

They talk about cases in those terms. And as we can see in this illustration, as an illustration of, of psoriasis, And there are other conditions I'm sure you're familiar with, such as eczema, etc. But it's estimated that emotional factors are actually a significant consideration in the management of about a third of human dermatological cases.

But the concept of veterinary behavioural dermatology is still relatively new. And that's really what we're talking about, this two-way relationship. The relationship between your emotional state and your physical health is well documented.

And you may be familiar with. That in a feline context, for example, in the influence of emotion on FIC. But when we think about dermatological cases, this interplay warrants consideration that emotional influences may occur in the onset and the progression of primary dermatological disorders, but also that there's a potential for dermatological change to then influence emotional state.

So, as I say, it's a two-way relationship. And when we talk about a behavioural medicine perspective, what do we mean? Well, behavioural medicine recognises that there is a so-called health triad.

Three equally important aspects of healthcare. Physical health, emotional health, and cognitive health. And whilst in the veterinary profession, traditionally, we've concentrate.

On physical health, we now realise that the emotional and cognitive components of health cannot be ignored when dealing with physical health conditions. So, if we're presented with a dermatological case, a behavioural medicine approach is going to involve consideration of that case from all three of these perspectives. So, from a physical health perspective, of course, we're going to collaborate with the dermatologist.

We're going to look at it from our GP dermatology perspective, and then, if necessary, refer that case to somebody with more specialised qualifications in dermatology if the case warrants that. So, I'm not gonna talk today about physical health component of dermatological cases, but more about the other two aspects of the health triad. So firstly, if we think of the emotional health aspect, we can think in terms of the sync analogy, which some of you may already be familiar with.

And in this analogy, we consider emotion in terms of its valence. Now valence is represented here by the different. Taps and the red or the hot tap is representing the so-called protective emotions, and I'm gonna come back to those in a second and their influence in these cases.

And then the engaging emotions on the other side, the blue tap. And the emotional valence of engaging emotion is also going to be relevant when we consider how we handle some of these cases. And then emotional arousal is the amount of emotion.

So we, analogy of that in the sink analogy is the amount of water in the sink, and arousal also needs to be considered. And then I talked about cognitive health, and we are gonna just touch on cognitive health in this presentation, considering the potential for learned components of health to be involved in not only in the way in which dermatological cases are presented, but also, particularly in the way we might manage them or approach the treatment of them. So how can emotional health influence the onset and the progression of dermatological disease?

Well, we know that emotional motivations lead to behavioural responses. So we've got the approach or engaging, behavioural responses coming from the so-called positive emotions, and then we've got a range of different ways of protecting oneself if you have protective emotional motivation. When we're talking about the onset and the progression of dermatological disease, we're thinking about the physiological responses.

So emotions not only have an output in what the animal does, but also have an influence on them physiologically, and that can be relevant in this interplay with dermatology. And then we're also going to think about this concept of emotional arousal, because of the fact that that leads to so-called drainage and displacement behaviours, which also can be relevant in dermatology. So let's start with the physiological responses.

So, Emotional motivations have this potential for physiological impact. And if we have prolonged negative or protective emotional bias, that has the potential to influence physical health. What we mean by that is if an animal is in a prolonged state of one of the protective emotions, fear, anxiety, frustration, etc.

And if If you're in that prolonged state and you have these physiological changes, then some of the things that happen, we can think of in dermatology. So, an impact on physical health in terms of mucosal integrity. So, the integrity of the skin being influenced by that chronic state of physiological stress, as it, it's termed.

It also can have an effect on immune functions. Of course, that Can be important in terms of the potential for there to be either immunocompromise in terms of abnormal immune responses, or in situations of secondary infections, for example. So, if we have prolonged protective emotional bias altering immune function, that may manifest itself physically in a dermatological presentation.

Also, we have the influence of that protective emotional bias on pain perception. So when we're thinking about things like neurological, conditions, like with neuropathic pain involved, so if we think about the picture on the, bottom right-hand corner here is a cap with, feline or a facial pain syndrome. And if you can see my cursor.

And then above that, of course, the classic illustration of syringomyeliachiari malformation, the cavalier, King Charles Spaniel. So we can see that the physiological impact of emotions may influence dermatological health. And then emotional arousal needs to be considered, because in addition to that valence, when we think about arousal, when the arousal becomes high, so that means we've got a lot of emotion in this metaphorical sink, then two things happen.

One is that there's an increase in so-called drainage. Behaviour. And the other is that the level of emotion may reach the point where it's nearly at the coping threshold.

And at that point, you get the induction of so-called displacement behaviours likened in this model to the overflow flow hole at the top of the sink. So drainage and displacement behaviours are important because some of them, some of the common ways in which animals drain emotionally and show displacement behaviours have the potential to have dermatological consequences. So, for example, grooming can be an important drainage behaviour, in cats, for example, and we know.

That the, effects of either intense or excessive grooming can have an effect on skin health. And then we also have things like self-licking and scratching as displacement behaviours. So we have animals in a high state of arousal.

They're more likely to scratch and self-lick, and that may be important in the onset of dermatological change. As well as that, we need to think about the fact that behavioural medicine can be involved not only in onset and progression through the effects we just talked about, but also, there's a potential to consider behavioural medicine during the diagnosis and treatment of cases. And I'm just gonna take an example in the interest of time, for this presentation.

And one specific example is found in the diagnosis and treatment of dogs with sore ears. So, sore ears is a common, condition, a common presentation in general practise, common dermatological consideration. And when we think about how we're going to diagnose and treat, we're obviously going to want to examine the ear during the diagnostic part, and often wanting to apply, treatment, topical treatment into the ear during the treatment phase.

And consideration of emotional and learned behavioural factors can really help both the dog and the caregiver and the veterinary professional. So we can look at the considerations from different angles. First of all, the angle of the caregiver and the veterinary professional.

What are our concerns in terms of giving this medication or making the examination in order to get the information to make a diagnosis, we may be thinking about the possibility of injury, if we've got an animal who's reacting with protective. Emotion and becoming repelling in their behaviour. We may also be thinking about concern over the emotional health of the dog, even if they're not showing repulsion.

I'm going to talk a little bit in a minute about the different responses. Even if it's not repulsion, there's the potential for there to be compromised emotion for the patient. And that's gonna be a concern, of course, for the caregiver, but also for the veterinary professional.

And for the animal, they have concerns, because we may have an inability to adequately examine the ear itself and not be able to reach an accurate diagnosis. And we also may be limited in our ability to provide successful treatment and administer medication if we have emotional and cognitive health compromise around the process of actually looking in the ear and touching it. And therefore, of course, there may be a negative emotional impact for the animal in the here and now, during the attempt to treat, but also an ongoing, emotional impact because of cognitive health and the ability to make negative associations with being handled, with the context of the veterinary practise, sometimes even with the presence or approach of the caregiver, which can then lead on to all sorts of implications in terms of their relationship.

And obviously from our point of view as veterinary professionals as well, we have the consideration for the potential to build up negative associations for both the caregiver and the dog about coming to the veterinary practise location. And if these concerns can't be successfully, addressed, then the treatment of that animal's health condition might be compromised. So, maybe the first question to ask when we're presented with one of these cases is, is it urgent to examine or treat in this moment today?

Do we need to do it now? And obviously, that is going to be determined by the clinical presentation. If it's possible to delay the actual examination, For the caregiver to go home with some systemic or topical anti-inflammatory, for example, which won't make the subsequent examination easier, then that may be something that we want to consider.

Now obviously there will be health considerations that may not make that possible. So if the examination is definitely necessary, we have to do it now. Is there a possibility to incorporate some form of analgesia or some form of chemical restraint to enable us to do this initial examination so that we're not building up that negative association for the future?

We might, for example, think about the inclusion of a benzodiazepine in order to block short-term memory formation and try and reduce the potential for negative associations to be building up in the future. If we are gonna think about using chemical restraint, then sooner rather than later is usually an important rationale, because if we start to struggle and restrain this animal, it's got a very sore ear. Then we've got a couple of things that are going to happen.

One is we're gonna increase emotional arousal, which we've already said can make things worse in terms of the impact of emotion on the physical health, but also, it's gonna make it more difficult to physically gain control. But also, we're going to trigger these protective emotions, particularly fear and frustration. And those emotional factors might also limit the effectiveness of the chemical restraint.

So the dog may have already learned some negative associations with handling, and that leads to a progression for us with the ongoing treatment, remembering that some of these are, are, are long duration clinical problems or also potentially recurrent problems. That goes back to the other link, that if they're living in some kind of compromised emotional state, that that may actually be influencing them in terms of, recurrence. So, recurrent presentations can happen because of emotional factors.

And obviously, the more we develop these negative emotion or associations, the worse things get, the next time. So another consideration is whether a systemic approach might be the answer. It might be a sensible choice, particularly if the if the ears are really painful and handling is problematic.

So it might be a good initial approach, a short course of systemic pain relief prior to actually starting. With the topical interventions might also be a useful consideration to reduce the risk of painful associations. And then we might think about applying topical analgesia prior to the treatment, if there's a really appreciable resistance to being handled.

But long-term systemic therapy is not necessarily without problems from an emotional point of view, particularly if we've got problems of palatability, leading to problems of administration. We might be able to use products that, that mask the taste of the medication, and that can be beneficial. So we might be able to administer it in things like, Pil Assist and Vivitreats and things like that, that enable us to get some level of masking of the taste.

But remember, if we're going on to long-term administration, we may all Also get protective expectation with that. So, it's not quite so simple that, systemic's always better than, than topical. But sometimes thinking about a combination of starting with systemic in order to get at least a lower level of pain and inflammation before we start to directly handle maybe something to consider.

So therapy selection is determined by your diagnosis primarily, of course. But it's also important to take into consideration the potential that the therapy could actually influence the emotion and the cognition. And therefore influence the the ongoing success of the administration.

So it's not just an a decision based on the diagnosis, it's also or the physical diagnosis, but also on that emotional and cognitive component. So, topical application, of course, though, is necessary in many cases, to achieve effective treatment. And it may be that we want to think about ongoing management of ear health using things like cleaning products as well.

So we may want to be concentrating on how we're going to make this better so that we can in the future administer the correct preventatives and also, therapeutic treatments. Well, one thing is a problem with, particularly with dogs, that the head is a very sensitive area of the body, even in the absence of pain. And so, when we approach the head, particularly in dogs, when we approach from above, it intrinsically increases anxiety.

One of the reasons for this is because the approach is through a physical blind spot, so they're not aware of the hand approaching. They're more likely to be, anxious about that approach. And resistance to handling may be coming from that anxiety, inherently, which is then increased when pain is a feature of the present condition, or when this animal has got some understanding from previous interactions that pain can be part of this process.

So, knowing the previous history of the patient is definitely an advantage. If we know the individual, we can plan better for how we're going to approach them. So, treatment protocol selection can be one step to reducing the negative effects.

But in addition to that, we may also want to think about improving the success of the treatment by creating more of a positive perception of the veterinary practise, not only for the, dog, but also for the caregiver. So, so it's not just about the here and now, it's also about these long-term effects. So we want to consider emotional motivations.

So that's the valence that we talked about earlier. Species-specific behaviour. So, the fact it's a dog or a cat, and therefore, the choice of its responses to those emotions is something to consider.

And then I want to just finish off with looking at learning theory and the cognition. So in terms of emotional considerations, one of them is the underlying emotional state of this individual. So, not to do with its present physical presentation, but this individual, is it inherently protective in its emotional state?

Does it have a so-called protective cognitive bias? Is it that it is more like To anticipate a potential problem. So it has a, an underlying anxiety predisposition.

And that may have nothing to do with this dermatological condition. It may be something that's already there for other reasons, or it may be that it's enhanced by the fact that we have some pain component to this ongoing condition. And the other consideration is the potential for the administration itself to induce protective emotions.

So is the animal coming into this situation because it already has this bias, or are we creating that by the way in which we're trying to interact? And so, to understand the emotional part of it, we need to remember that there are these different emotional systems, the ones highlighted here, fear, anxiety, pain and frustration. The protective emotions, which are probably most relevant when we're considering this into play between dermatology and behavioural medicine.

I've put desire seeking highlighted there, because we're going to consider that as well. It, because one of the ways we try to manage these conditions and this, administration of treatment is by influencing the positive or engaging emotion of desire seeking. So let's start with the fear, anxiety, and pain.

They're protective, they're triggered by a perception of danger or threat. And then any novel interaction can be associated with anxiety. If that interaction has happened before and had a negative outcome, so that's the animal who's got a recurrent problem with its ear health, then it's more likely that that fear response is going to be triggered.

And the consideration, particularly in these cases is pain or discomfort because that is associated with not only the condition but also potentially, as we've said, with the treatment. So, it's important to consider the influence of the limited field, visual field of the dogs that we're dealing with. So this leads to some individual consideration based on whether we're dealing with a brachycephalic or a more daocephalic, breed, because the species-specific interpretation of head approach is going to be different if we're coming, to the brachycephalic dog, we've got a really limited.

Limited, field of vision in comparison to those more daleocephalic types. And therefore, we need to be really careful that we're not going to be coming through a blind spot. We're not gonna be taking them by surprise.

And we also need to remember that if we come head on in any approach, that that is likely to be seen as being more confrontational. So, it's a compromise between the two. And we can use an influence of order.

Interaction as well, to make sure they're aware that we're coming in, that we're going to approach them. So, not just, you know, be so busy talking to the caregiver that we just start handling the animal without actually having, introduced ourselves or explained we're about to interact or given some preliminary, contact before we suddenly putting something straight into the ear and making contact with the sensitive part of the body. We also might think about things of course here in terms of things like the temperature of the, of what we're using, have we made sure it's at room temperature, we're not putting something freezing cold onto a painful part of the skin as well.

And the negative effects of administration can be minimised quite a lot by just looking at the way we approach. So these sideways on approaches with some preliminary verbal interaction first. So, fear, anxiety certainly is, is thought of as the primary emotion we need to be concerned about.

But frustration is the one I think we sometimes forget. And when topical medication has to be administered, there's a lot of potential for there to be frustration. First of all, we need to physically hold on to the animal, and that can result in them having a sensation that they've lost control.

This can be particularly important for feline patients where, because of their natural social behaviour, they are control freaks. And if you take away that sensation of control, that can lead them to be frustrated. Also, if they're attempting to show you that they are in a situation of pain and fear, anxiety, and that is unsuccessful, we're not responding appropriately, then that leads to a failure to respond to those emotions, and again, failure of emotional success leads to frustration.

And so, looking at the potential responses, we can think that some of these animals are going to want to use avoidance as their response. And obviously, we're gonna want to avoid that avoidance. We're gonna want to restrict it by restraint.

And as we limit the potential to get away, we're likely to increase frustration. We also need to remember that they may select inhibition. Inhibition is where the animal just is trying to gather information.

Now, temporarily, this may make it a lot easier for us to administer this, this treatment, because they're still, but that might lead us to a false impression that they're fine, that they're not bothered by what we're doing, and can then lead to us being more persistent, taking longer over the job, for example, and therefore, tipping them into frustration. The other thing they may do is use appeasement, appeasement like leaning in, as illustrated by, the dog at the bottom here. So, we've got the dog that's trying to avoid and get away, dog that's showing appease, inhibition, and just, taking in visual information here, and this dog that's showing appeasement.

And appeasement can be mistaken as being friendly or affectionate. Oh, he's fine doing this because he's engaging with me. And if we fail to understand these other behavioural responses, unfortunately, repulsion might be selected, not because it was the primary.

behavioural response of the individual, the thing the animal wanted to use, but because of the fact that it was not successful in using any other of its ways of defending itself. So, appeasement, inhibition, avoidance were not possible. That increases the risk.

A repulsion response. But it also increases the risk of repulsion being more intense, and that's where frustration comes in. That frustration increases the, increases the speed, increases the intensity of behaviours, but it also makes the behaviour more likely to be confrontational.

So when we're considering emotional health, when we're interacting with these animals, it's important to listen to what the dog has to say. And to look not only for the behavioural response to protective emotion of repulsion, but also look for inhibition and appeasement as well, and potential to trying to avoid. And to recognise when that is happening, so that we don't persist in handling leading to levels of frustration.

And what are we looking for? We're looking for body language signals, of course. So we're looking for body posture, facial features, tail movement, and we're also looking for the, the context in which those behaviours are being shown.

What do we do when we see those? Well, I guess that then leads to our consideration we talked about at the beginning as to whether we might modify the treatment approach we've selected, decide that, actually, what we'll do is send them home with some systemic treatment and have them back to do this examination, or use chemical restraint if we feel that we need to get that examination done now. So, cognition was the other thing I wanted to talk about, and to talk about the fact that learning is important.

Obviously, we've talked about how it can be detrimental, but also we can use learning to reduce resistance to handling. And particularly if we take a prophylactic approach during early development, when puppies are experientially naive, so they haven't had any previous situations of handling around their, their ears or other parts of their skin where we're doing other dermatological cases. And it's important to form positive emotional associations with handling and restraint, particularly handling and restraint, which is associated with clinical examination.

And then to look out for any signs of protective emotion and stop interaction at the point of those, so that we can then wait till they're fully relaxed again, start again, and make sure that the handling, particularly the example we're giving now around the head to prepare them for ear medications and for ear cleaning, that we start that in this process of habituation. Remember, habituation is where you'll just be Becoming comfortable with that interaction. So that's the first part of the learning.

And then we will want to develop and go forward from that habituation into actually developing, hopefully, positive emotional associations. So, they actually like having their head handled or their ears interacted with. And the use of food is something I'm sure most people have thought about or heard about.

And the use of food as a reinforcement at this age can be really important. This is pure cognition of using the food to reinforce, for example, a sit posture whilst we're handling, so they learn to be still while we're handling them. But we can also use food as well to use it as an emotional cue.

So, I mentioned before, in the list of emotions, this desire seeking, and we can trigger that desire-seeking system with food. And it's important that when we're talking about prevention, talking about prophylaxis in puppies, that we explain to clients that inducing that positive emotional state before handling. So not just touching the ear and then giving a treat.

But giving the treat first to enhance a positive emotional bias before we start to handle, can increase the possibility of forming positive associations and decrease the potential for there to be sensitization. So, in both of these videos, we're dealing not, not with a problem situation, but with an animal that's learning. Pardon me, about being handled, one of them at home using a grooming table to introduce the idea of being handled around all of the body, but also particularly around the head for a breed like this bearded collie, they need to be able to, deal with, scissors and things near to their face.

And then with the puppy, we're doing it in a veterinary context. First of all, just with the context of the, of the hospital, and then starting to introduce handling. Now, obviously, in patients who are already showing clinical signs, particularly where they've had pain, it's much harder to introduce handling for medication just using a more of a, of a associative learning situation, because we're going to potentially poison the cue, the food, if we introduce it when they're already in a negative emotional bias.

So, we need to think about other ways in which we can use desire seeking to influence perceptions. So, what I'm gonna finish with is how we might use food to change the emotional bias of these patients. So food is a is a cue for this positive emotional system of desire seeking.

Also, social company may also be enough of a trigger for this desire-seeking system in some individuals. And provided desire-seeking motivation is higher than the protective emotion associated with the handling, then we're likely to get some level of cooperation. But if the individual has a higher fear anxiety motivation than desire-seeking, then cooperation, unfortunately, is unlikely.

So what we're saying is that behavioural output is influenced by the predominant emotion. Doesn't mean that other emotions are not present. So food is a social facilitator, it has high motivation to eat in a social context as a species, so that means food can be much more useful for our canine than our feline patients where food is not a social facilitator.

So we think about dogs. Food is useful, and also because we use it in the context of training often, where we're using it more in a cognitive sense to reinforce behaviours. But it means that dogs are often commonly anticipatory of food in a positive context.

So these two positive aspects mean that we can use food more easily with our canine patients. Either we're going to use it to emotionally cue them, so to increase that animal's positive, engaging emotion, or we might use it as well as a reinforcer to Increase the likelihood of a desirable response. So, if we can use it first of all, to get them to be in a positive emotional bias, then when they are using engaging, behaviours with us, when they are approaching us, we can then use the food to reinforce that approach as well.

So I wanted to just finish by showing some videos of a dog being introduced to ear cleaning, and this is a, a dog where it may have had ear problems in the past. And we start the introduction very. Very slowly, because this is what we're doing.

We're doing this associative learning. So here, we're just using the food to create positive associations with an approach behaviour. So, here, the approach is to the piece of cotton wool.

As she approaches it, she gets the food rewards. So, we're using it to get a positive response. Here, we're reinforcing an acceptance of being handled.

At the moment, we're not touching the ear. So we're introducing that in the second part. So, we, first of all, we were adjust the cotton wool and touching lower down on the body.

Now, we're starting to touch the area that we're actually going to need to treat. And what we're starting to see here as well, is that the negative emotion has not gone away. And I think that's really important.

The fear anxiety is still there. You can see she is apprehensive. She goes into an inhibition state here when she notices that you're about to touch the ear.

But what we're trying to do is create a. Positive association with the things that are going to need to come near to that ear, and we're breaking it down into stages. So we don't do it all in one go, because otherwise, we have the potential.

This dog already has some negative bias, then we're going to potentially poison the food if we're not careful. So we're looking for a behavioural response, yes, but we're also looking for an emotional response as well. OK, and then We're going to finally move up to actually As you see, there's a little bit of a setback there.

And what we did was we then used food, so now we're actually applying the treatment. The negative emotion has not stopped. She's still apprehensive, she's still anxious about having that in, but she can tolerate it and she can cooperate.

She's not being held. It's a single handler, and it's being able to be achieved because the predominant emotion at that point is the desire seeking, even though the fear of anxiety is still present. OK.

So, in conclusion, what I've tried to do in a, a short time period is to look at this, influence, this bilateral influence between emotional and physical health in this particular context of dermatology. We know that the two things are inextricably linked, and even when we have a dermatological diagnosis, Then we still need to consider the potential for an emotional component. And that emotional component may be part of the onset or the progression of the actual condition, because of what we talked about at the beginning, because of the emotional impact on physical health.

But it may also mean that, investigation of the progression, the recurrence, needs to be looked at from a behavioural perspective. So we know we've got a dermatological condition, we've diagnosed it. We're treating it, but we're getting resurgence of it.

Have we looked at whether there's any other influence on this dog's emotional health outside of the dermatology? Does it have some protective emotional bias, independent of the dermatological condition that needs to be addressed? And then also, behavioural medicine is important when we're considering therapeutic approaches.

And although we've talked about the ear specifically today, that is just a, an illustrative example. And there are many other ways in which considering emotional and cognitive health when we're thinking about therapy is going to be important. Thank you.

My name is Emily, and I'm a best advisor at Steve Animal Health. So in this short presentation, I'll give you an overview of the DUXOS3 range, how the vitrium was selected for DUXOS3, and I'll also show you the final data in some of the clinical studies that Tim touched on in his presentation. I'll start by giving you a brief run-through of how Dukwey and its main ingredient came about.

The development of DOS3 started with some quite extensive market research where vets and pet owners were asked what was important to them when using a dermatopical. So it's found that pet owners wanted products that are well tolerated by their pets as well as themselves, because they are the ones to apply the products, and they also wanted products that don't contain any controversial ingredients. What was also important to them was that the product obviously had proven performance on the skin barrier, and this was also the key factor for vets.

And these results then provided the criteria for the search of the active ingredient for desoy. So with the market research done and the criteria identified, they could then then get on with the selection process for the active ingredients. And this started off as literature searches where more than 250 ingredients were identified.

These ingredients were then narrowed down to more than more than 50, which went through an in-depth research and development analysis. This identified two high performing ingredients which were subsequently tested on human and canine skin models. And following these in vitro tests, ofitrium came out on top with beneficial effects on the three skin barriers of the mechanical, microbiological, and immunological skin barriers.

And oytrium is a natural extract from the Japanese monograss plant or Oopagon japonicus. We'll now move on to some of the field trials that have been carried out for DUXO S3, and I'll start with DUXO S3 PIO. So DuxoS3 pyo contains eytrium and 3% chlorhexxale diluconate and this trial, the objective was to assess if weekly shampooing with mousse applications in between was a key factor when managing bacterial or yeast overgrowth cases, or if one initial shampoo at the start, followed by mousse applications for 3 weeks was sufficient.

So the dogs were recruited to this study, they were client owned dogs, that had a bacterial and or yeast overgrowth that was diagnosed by a dermatologist. The overgrowth was diagnosed by cytological examination and the severity and extent of the lesions were also given a score to to make up the bacterial overgrowth score. The dogs were then allocated to one or two protocols, so they were either given one shampoo at the start, which was followed up by mousse applications every 2 to 3 days for 3 weeks, or they were given weekly shampoos followed by 2 mousse applications, 2 to 3 days apart for 3 weeks in between the shampoos.

And the dogs were assessed by a dermatologist on day 0, day 7, and day 21. Moving on to the results then, so as you can see from the graph, there was no statistically significant difference between the two protocols. So this shows that one shampoo followed by mousse applications is as effective as shampooing once a week and having mousses done in between the shampoos.

And as we all probably know, dogs and especially cats don't always like to be bathed. So the fact that the owner only has to give. The pet bath that one time at the beginning, and then just use a leave on moose, could really improve compliance as it makes it a lot easier and more convenient for the owner.

The pet also gets a really nice massage during the application of the moose, which makes it quite nice and enjoyable for them as well. And obviously, chlorhexidine, which is in the ducts of S3 pio range, we do know that that can be quite drying. We probably all know that from scrubbing up to several surgeries a day, we get quite, quite dry and crackly, itchy hands.

So the added a fitrium to the range actually helps to counteract that drying effect, which makes the skin quite nice and hydrated. There's also a nice added hypoallergenic cocoa vanilla scent, which masks the smell of the chlorhexidine, because chlorhexidine can have quite a medicated smell that owners don't usually like. So the addition of this scent actually could also help with compliance, as the pets will smell nice and fresh, throughout the day instead of smelling like lhexsteam.

Here is an example of one of the cases that was part of this trial. And this is an 8 year old French bulldog that has suffered from itchy skin and optitis from the age of 8 months old, so quite a long time. He had been diagnosed with allergies, but kept having frequently relapses of bacterial overgrowth, which is quite frustrating for the owner, really.

So as you can see in the image on the left, the dog had a large epidermal coloret on his abdomen. The pink line there is from, is the remnants from a previous unsuccessful treatment attempt, but this dog was started on DixoS3 yo, where they used one shampoo at the start of the protocol, and then followed by mousse applications every 2 to 3 days for 3 weeks. And after 21 days, you can see that the lesions have have healed and cytology was was negative for any bacteria at that point as well.

In this next study, we're looking at the use of dexoS3 py pads for localised lesions, bacterial and or yeast overgrowth in dogs. So the dogs included in this study were diagnosed with focal bacterial and or yeast overgrowth lesions. And that was done by cytological examination by a dermatologist.

So and they also scored the severity and extent of the lesions. And the owner's perception of of how itchy the lesions actually were at the time. The pads, pile pads were used once daily for 14 days, and the dog's cytological and itch scores were evaluated by a dermatologist and the owner on day 0, day 7, and day 14.

Moving on to the results then, so as you can see in the graph, the mean bacterial and yeast counts significantly decreased after just 7 days of daily applications of the pads, and 89% of the dogs in the study had cytologically recovered after just 14 days of of applying the pads to the affected areas. And this showed that the Dixo estu yopads were effective at disinfecting the skin and restoring the skin's microflora. When looking at the itch scores, there was a mean decrease of just over 71% at day 14 when compared to day 0, which shows the soothing effects the pads have on the skin alongside its antibacterial and anti.

Properties. So this is important as the itching is what the owners see and by seeing an improvement in the scratching and licking, they will they will probably be more likely to continue using the product till the end of the protocol. And 94% of owners were also very pleased with how effective the protocol was.

If you would like to read further about this study, this has recently been published in Frontiers in Veterinary Medicine, and it's available as open access, and you have the reference at the in the bottom right corner there. So this is a little Yorkie that was part of this trial and she presented to the vet with a very itchy and crusty lesion on the bridge of her nose, and the cytology revealed a yeast overgrowth and she was started on DOS3 pile pads. And after 7 days of using the pads, the owner reported that the itch had completely resolved, and after 14 days of daily pad use, the yeast overgrowth had completely cleared up and the use of the pads was stopped.

The dog was then seen again 2 weeks later, but for another concern that the owner had at the time, and you can see from the image on the on the far right there that the skin has fully healed without any recurrence of the problem. Next, we'll have a look at the European field trial for DuxoS3 calm. The objective for this study was to evaluate the performance of DixoS3 calm shampoo and mousse in dogs with sensitive skin that presented with a skin flare-up.

So, for dogs to be included in the study, they had to be up to date with their ectoparasite control and have no other skin conditions, such as a pyroderma. The dermatologists assessed the dog's CADI scores on day 0, day 7, and day 21, and the owners assessed their dog's score at the same time points. The protocol that was used in this study included one shampoo at the beginning, followed by mousse applications every 2 to 3 days for 3 weeks.

So looking at the results, at inclusion, the mean CAD score was 18, and by day seven, the score had decreased to 7.9 and has continued to decrease to 6.4 by day 21.

A score below 10 is considered to be normal. So this showed a mean decrease of the CADI score of 58.3% at day 21 compared to day 0, and almost 70.4% of the dogs had a decrease of 50% or more in theirAISE scores at day 21, and close to 80% of the dogs had a score of less than 10% at day 21.

When they're looking at the itch scores, there was a mean decrease of close to 31% between day 0 and day 21, and the reduction in the scores at day 7 and day 21 were statistically significant when compared to day zero. So this shows that DixoS3 calm, when you're using one shampoo, followed by mousse applications every 2 to 3 days for 3 weeks, has soothing effects on the skin and significantly reduces itching. To show you an example from this study then, here we have a one year old staffy type dog with red, irritated and very itchy skin and excoriations in his axilla.

He was suspected to be a topic, but he was on no immunomodulatory medication at the time. So he was started on Ducks Were calm, shampoo and mousse, where they gave. One initial shampoo, followed by mousse applications every 2 to 3 days or 3 weeks.

And after 21 days, you can see that the redness and excoriations have gone, and the dog was much more comfortable and it wasn't scratching anymore. Lastly, I'll give you an overview of the Duxo S3 family and the 4 ranges that it comes in. These are the four ranges of Duxo S3 that we have.

So you have your calm, yo, Seb, and care. So Duxo S3 Calm is for dogs and cats with itchy, irritated and sensitive skin, and calm has a higher concentration of vitrium in it compared to the other ranges, and that's to provide that extra soothing effects. And this is available as a shampoo and a mousse.

DixoS3 pyo contains oytrium and 3% chlorhexidine digluconate for those cases where you need an antibacterial or antifungal action. The added fitrium to this range helps to counteract the drying effects of the clorhexidine, and it also supports the skin barrier, and this is available as a shampoo mousse or pads. So for your oily or dandruff your patients, you have the Dexo SVE range and the se contains aytrium and seals.

Seances is a natural extract from the pomegranate peel, which helps to normalise the kerainization process, and you have this available as shampoo and a mousse. And lastly, there's a Dexa Sweet Care range, which is, which is your general shampoo that can be used on any dog or cat, if you like, as well as puppies. And this, this also contains a vitrium to support and protect the skin barrier and you have that available as a shampoo.

Thank you for listening. If you have any questions or would like any further information, you can always email me on the email address on this slide. On the webinar page, you should also have access to a dynamic PDF called Journey So Far, where you can access all of our brochures, recommended protocols, case studies, abstracts of studies, and more.

So please head there for for more information as well. Thanks again. Thanks again.

In this test, they looked at the fitrium's effect on the mechanical skin barrier. So a dye called Lucifer yellow was added to the skin sample, and a cocktail of pro-inflammatory cytokines were added to the sample, seen here as the stress control in the image on the left. So as you can see in the image of the stress control, the dye has penetrated into the skin, indicating damage to the mechanical skin barrier.

Efitrium was then added to the stress control and as you can see in the image on the right, the dye is now contained to the surface of the skin. And this shows that vitrium helps strengthen and restore the damaged mechanical skin barrier, making it less permeable. So lastly they looked at the effect of vitrium has on the immunological skin barrier.

And the skin samples were exposed to different cytokines and pro-inflammatory markers in this test. And in the example here, you can see that the level of TSLP increased after the skin sample was stressed. And with the addition of vitrium, the levels returned back to normal.

And this shows that aytrium has soothing effects on the skin and similar effects were seen for 8 and IL 13 as well. We'll now move on to some of the field trials that have been carried out for DuxA S3 and I'll start with DuxO S3 PIO. So Dixo S3O contains eytrium and 3% chlorhexxale diluconate.

And this trial, the objective was to assess if weekly shampooing with mousse applications in between was a key factor when managing bacterial or yeast overgrowth cases, or if one initial shampoo at the start, followed by mousse applications for 3 weeks was sufficient. So the dogs were recruited to this study. They were clients on dogs that had a bacterial and or yeast overgrowth that was diagnosed by a dermatologist.

The overgrowth was diagnosed by cytological examination and the severity and extent of the lesions were also given a score to make up the bacterial overgrowth score. The dogs were then allocated to one of two protocols, so they were either given one shampoo at the start, which was followed up by mousse applications every 2 to 3 days for 3 weeks, or they were given weekly shampoos followed by 2 mousse applications, 2 to 3 days apart for 3 weeks in between the shampoos. And the dogs were assessed by a dermatologist on day 0, day 7, and day 21.

Moving on to the results then, so as you can see from the graph, there was no statistically significant difference between the two protocols. So this shows that one shampoo followed by mousse applications is as effective as shampooing once a week and having mousses done in between the shampoos. And as we all probably know, dogs and especially cats don't always like to be bathed.

So the fact that the owner only has to give. The pets bath that one time at the beginning, and then just use a leave on moose could really improve compliance as it makes it a lot easier and more convenient for the owner. The pets also get some really nice massage during the application of the moose, which makes it quite nice and enjoyable for them as well.

And obviously chlorhexidine, which is in the of S3 pio range, we do know that that can be quite drying. We probably all know that from scrubbing up to several surgeries a day, we get quite, quite dry and crackly, itchy hands. So the added a fitrium to the range actually helps to counteract that drying effect, which makes the skin quite nice and hydrated.

And there's also a nice added hypoallergenic cocoa vanilla scent, which masks the smell of the chlorhexidine, because chlorhexidine can have quite a medicated smell that owners don't usually like. So the addition of this scent actually could also help with compliance as the pets will smell nice and fresh throughout the day instead of smelling like chlorhexteine. Here is an example of one of the cases I was part of this trial.

And this is an 8 year old French bulldog that has suffered from itchy skin and optitis from the age of 8 months old, so quite a long time. He had been diagnosed with allergies, but kept having frequently relapses of bacterial overgrowth, which was quite frustrating for the owner, really. So as you can see in the image on the left, the dog had a large epidermal coloret on his abdomen.

The pink line there is from, is the remnants from a previous unsuccessful treatment attempt. But this dog was started on DixS3 yo, where they use one shampoo at the start of the protocol, and then followed by mousse applications every 2 to 3 days for 3 weeks. And after 21 days, you can see that the lesions have healed and cytology was was negative for any bacteria at that point as well.

In this next study, we're looking at the use of DS3 pile pads for localised lesions, bacterial and or yeast overgrowth in dogs. So the dogs included in this study were diagnosed with focal bacterial and or yeast overgrowth lesions. And that was done by cytological examination by a dermatologist.

So and they also scored the severity and extent of the lesions. And the owner's perception of of how itchy the lesions actually were at the time. The pads, pads were used once daily for 14 days, and the dog's cytological and itch scores were evaluated by a dermatologist and the owner on day 0, day 7, and day 14.

Moving on to the results then. So as you can see in the graph, the main bacterial and yeast counts significantly decreased after just 7 days of daily applications of the pads and 89% of the dogs in the study had cytologically recovered after just 14 days of of applying the pads to the affected areas. And this showed that the Dixo esto yo pads were effective at disinfecting the skin and restoring the skin's microflora.

When looking at the itch scores, there was a mean decrease of just over 71% at day 14 when compared to day 0, which shows the soothing effects the pads have on the skin alongside its antibacterial and anti. Properties. So this is important as the itching is what the owners see and by seeing an improvement in the scratching and licking, they will they will probably be more likely to continue using the product till the end of the protocol.

And 94% of owners were also very pleased with how effective the protocol was. If you would like to read further about this study, this has recently been published in Frontiers in Veterinary Medicine, and it's available as open access, and you have the reference at the in the bottom right corner there. So this is a little Yorkie that was part of this trial and she presented to the vet with a very itchy and crusty lesion on the bridge of her nose, and the cytology revealed a yeast overgrowth and she was started on DS3 pile pads.

And after 7 days of using the pads, the owner reported that the itch had completely resolved, and after 14 days of daily pad use, the yeast overgrowth had completely cleared up and the use of the pads was stopped. The dog was then seen again two weeks later, but for another concern that the owner had at the time, and you can see from the image on the on the far right there that the skin has fully healed without any recurrence of the problem. The objective for this study was to evaluate the performance of DuxoS3 calm shampoo and mousse in dogs with sensitive skin that presented with a skin flare-up.

So for dogs to be included in the study, they had to be up to date with their parasite control and have no other skin conditions, such as a yoderma. The dermatologists assessed the dog's CADC scores on day 0, day 7, and day 21, and the owners assessed their dog's score at the same time points. The protocol that was used in this study included one shampoo at the beginning, followed by mousse applications every 2 to 3 days for 3 weeks.

So looking at the results, at inclusion, the mean CAD score was 18, and by day seven, the score had decreased to 7.9, and has continued to decrease to 6.4 by day 21.

A score below 10 is considered to be normal. So this showed a mean decrease of the CADSI score of 58.3% at day 21 compared to day 0, and almost 70.4% of the dogs had a decrease of 50% or more in the CAISE scores at day 21 and close to 80% of the dogs had a score of less than 10% at day 21.

When they're looking at the itch scores, there was a mean decrease of close to 31% between day 0 and day 21, and the reduction in the scores at day 7 and day 21 were statistically significant when compared to day 0. So this shows that DixoS3 calm when you're using one shampoo, followed by mousse applications every 2 to 3 days for 3 weeks, has soothing effects on the skin and significantly reduces itching. To show you an example from this study then, here we have a one year old Staffy type dog with red, irritated and very itchy skin.

And excoriations in his a silly. He was suspected to be a topic, but he was on no immunomodulatory medication at the time. So he was started on Dus West calm shampoo and mousse, where they gave one initial shampoo, followed by mousse applications every 2 to 3 days or 3 weeks.

And after 21 days, you can see that the redness and excoriations have gone. And the dog was much more comfortable and he wasn't scratching anymore. These are the four ranges of Dxo S3 that we have.

So you have a calm, yo, Seb, and care. So Duxo S3 Calm is for dogs and cats with itchy, irritated and sensitive skin, and calm has a higher concentration of vitrium in it compared to the other ranges, and that's to provide that extra soothing effect. And this is available as a shampoo and a mousse.

DixoS3 yo contains eytrium and 3% chlorhexidine diluconate for those cases where you need an antibacterial or antifungal action. The added fitrium to this range helps to counteract the drying effects of the chlorhexidine, and it also supports the skin barrier, and this is available as a shampoo mousse or pads. So for your oily or dandruff your patients, you have the Dexa SVE range and the se contains aytrium and seals.

Seances is a natural extract from the pomegranate peel, which helps to normalise the keratinization process, and you have this available as shampoo and a mousse. And lastly, there's a Dx S3 care range, which is, which is your general shampoo that can be used on any dog or cat, if you like, as well as puppies. And this, this also contains a vitrium to support and protect the skin barrier and you have that available as a shampoo.

Thank you for listening. If you have any questions or would like any further information, you can always email me on the email address on this slide. On the webinar page, you should also have access to a dynamic PDF called Journey So Far, where you can access all of our brochures, recommended protocols, case studies, abstracts of studies, and more.

So please head there for for more information as well. Thanks again.