Good afternoon everyone. My name is Charlotte, and welcome to today's webinar, Pravat Dermatology 101. This webinar will cover common and not so common, skin diseases of rabbits, their presentation, differential diagnoses and treatment.

We are very grateful that this webinar is free to attend with big thanks to the Rabbit Welfare Association for their kind sponsorship. Today's webinar is presented by the lovely Richard A. Saunders.

Richard graduated from the University of Liverpool in 1994, also obtaining an intercalculated degree in zoology. He worked in general small animal practise for 2 years before joining the RSPCA at Norfolk Wildlife Hospital, working with British wildlife. After that, he worked in increasingly exotic animal practise, obtaining his certificate in zoological medicine in 2001, and his diploma in zoological medicine in 2010.

He obtained his ECZM diploma and specialist status in 2018. He joined Bristol Zoological Gardens as a resident in 2008 and staffed in 2011. He works part-time for Bristol Zoo and teaches at the University of Bristol.

He is the RWAF veterinary advisor as well. He's also the author of several chapters on rabbits and other small animal mammal species. So please use Richard's fountain of Knowledge by using a Q&A box if you have any questions or queries, which we will discuss at the end of today's session if we have time.

I would now like to hand over to Richard to start today's presentation. Thank you, Richard. Thanks very much and welcome to everybody who's here live and hopefully people who will see this recorded.

I'm going to go through, as as was said, some common and not so common dermatological problems. I'm going to try and keep it topical. I'm going to try and keep it relevant to what we're seeing at the moment as the weather warms up, and I've decided in view of it being lunchtime, I'd cut out most of the maggot pictures.

But apart from that we're going to show some fairly gory pictures. So just it may not be best to eat your lunch while you're watching this, so. And I've broken these down into broadly speaking, infectious and noninfectious skin diseases, dermatological diseases of rabbits, and I've put a miscellaneous category in there just to cover a few kind of mishaps that the rabbits can succumb to, but I thought we'd start with the infectious diseases and starting with the bacterial ones, really rabbits don't tend to get the same kind of superficial or deep yermas that That dogs do.

This one is pretty much an unusual case. This is a pretty exceptional case in that we did culture MRSA, methicillin resistant Staph aureus from this rabbit, and it may well be that there was an underlying cause that that was responsible here, but we didn't manage to pin that down to a specific specific reason. But this kind of generalised skin bacterial skin disease is relatively common in rabbits.

Rabbit skin appears to be relatively resistant to infection. We don't get those very kind of reactive inflammatory and bacterially infected skins that we do in particularly dogs. On the other hand, rabbits get into all sorts of situations where the skin is compromised and we do see some, you know, rather nasty bacterial secondary skin disease, and that predominantly tends to happen at one end or the other, starting with the the kind of genital and perineal area.

One of the biggest problems we see is urine scold, and this is very much a multifactorial disease. It's, it's not, It it isn't primarily a skin disease. We've we've cultured all sorts of things from these, these cases, including Pseudomonas and some real nasties, but they aren't predominantly, sorry, they aren't primarily skin diseases.

There's always an underlying cause for these and there's always a reason why, why they're occurring. So we do need to cast the net quite wide and yes, certainly it's helpful in some cases to take a swab to do culture and sensitivity and decide what topical or systemic action we need to take, antimicrobial action we need to take, but very much focusing on dealing with the underlying cause. Sometimes these are musculoskeletal.

These are rabbits that are sitting in a pool of urine, and especially if they've got quite thick fur, it acts as a sponge. It just kind of holds the urine close to the body, close to the skin, and irritates it and causes damage. Sometimes it's due to the fact that the rabbit is so obese that they can't turn around and clean themselves up.

They can't hop around. They can't move, even after they've lost weight. Sometimes they have skin folds around there which trap urine and cause problems.

We've seen spinal disease causing this sort of thing. Spondylosis defilmans is really common in rabbits and whilst sometimes it doesn't really seem to be clinically significant, certainly while it's forming, I think it can cause quite severe pain. If the rabbit suddenly kicks and struggles and snaps one of these kinds of osteophytes, that can be acutely painful.

And even in the best case scenario where it's non-painful, the spine, the lumbar spine is very commonly fused along two or three of the vertebrae, meaning that it's really difficult for these rabbits to keep themselves clean. And then obviously we have eunicula, which is a primarily a renal disease, but we mainly see it for its CNS signs, its effects on head tilt, but also its effects causing hind liposis, and I think a lot of these rabbits simply don't know that they're urinating. They have true urinary incontinence and as a result they end up with some very, very sore skin.

If we're lucky, we pick it up at this stage. Owners pick it up at this stage, but owners are very reluctant and with some good reason to turn the rabbits over to have a look underneath, and it's it's a bind. It really is.

It's difficult to know what advice to give an owner with a rabbit who is very shy, who would require catching up every day to turn them upside down. And my best advice really is to feed them a small amount of tasty food items, high value food items, first thing in the morning. And just run a hand over the rump underneath the back end, which is likely to be a lot less stressful for the rabbit than physically picking them up and just feel for wetness.

Use all your senses, use your sense of smell as well that can often be the first sign of. Problems and preventative healthcare is always really, really important. So seeing these rabbits in the clinic once or twice a year for vaccination, possibly more frequently than that for dental health checks and always examining the rabbit, from top to toe.

Many of these cases, we only really pick up, when they come in for something completely different, oh sorry, when they come in for the, the final step in the cycle, which is very often, fly strike, unfortunately. This, this rabbit did have a very, very clear reason why it had this terrible year in scold, and this rabbit sadly called Jigsaw by the rescue that adopted him because he was missing a piece, was a rabbit who was attacked by one of their litter mates whilst whilst they were waiting for rehoming and Rabbits tend to do this thing where they they tend to sort of attack the genital region, and I always used to think it was male rabbits fighting with other male rabbits. One male rabbit would basically assert dominance by attacking the genital area, and certainly that does occur, but increasingly I've sort of been aware that sometimes it's because a male rabbit is attempting to And the charming term that's often used is head humping is attempting to mate with the head of a female rabbit.

She takes one look at him, turns her head sideways, and bites straight through either the scrotum or the penis. If you're lucky, it's the scrotum. And they've half castrated the rabbit, and you just need to tidy them up and finish it off.

In this particular case, they'd lacerated all the way through the urethra, and he was spraying urine in all directions, all down the underside of his thighs and legs, and he was obviously a very, very high risk for fly strike and so on. But in the meantime we have this denuded area of skin where urine has just soaked into the skin and caused problems. This was luckily without any real significant bacterial infection because the referring vets were doing an excellent job of managing that, but we had to see him for reconstructive surgery to try and put him back together and stop him urinating all down the inside of his thighs.

Interestingly, there's a situation. Called Hyperspadia, which we see in rabbits quite commonly, mini lops and dwarf flops, and whilst they haven't developed the the closure of the prep, sorry, the closure of the penis on the ventral floor, and they do tend to spray urine, they tend to spray urine away from the body and we've certainly had these so well developed, so abnormal that they've been mistaken for female rabbits because the the slit-like opening of the penis has looked more like a vulva. In one case, one rabbit won best in show as a female and then best in show as a male when his testicles dropped, and I think that's a pretty unique situation to win the same, to win both prizes in the same competition.

This unfortunately is the end result of all sorts of primary skin diseases in this case and underlying problems. We've got not diarrhoea, which is very often what they're presented with, but urine scald, seekotroph accumulation, and the causes of that are really, really very similar to urine scold in that they tend to be musculoskeletal, they tend to be echiicula related, but they also tend to be diet related. With a rabbit who's being fed too, if you like, rich a diet, a diet that's got too much in the way of readily available carbohydrates, it changes the composition of the yer droves, changes the volatile fatty acid makeup of those, making those quite unpleasant tasting and also creating a huge rush of those going through the gut because they've got lots of substrate to work with.

In addition, those rabbits are very often obese, so they find it difficult to turn around and clean themselves up. If they're given a hutch which is too short to not high enough, they're not able to sit up properly and bend over properly and keep themselves clean, and the height of hutches is often underestimated. Rabbits do like to sit up.

It's good for their musculoskeletal health. It's good for them to be able to adopt those positions. The other issue with rabbits all the time is dental disease, and it's equally possible that this rabbit has incisors which are maoccluded, overgrown, and simply can't groom itself as a result of those overgrown incisors or has mouth pain at the back of the mouth with cheek teeth stabbing into the tongue, having lacerated the sides of the tongue due to spurs in the mouth.

And as you can see, this rabbit hasn't just got some of those problems. It has got a true primary skin disease. I'm dragging this back to actual skin disease, and this looks like the classic appearance of walking dandruff, the calatiella parasitivorrex or organism, the mite infestation that we see in rabbits, relatively large and associated with flakes of dandruffy, flaky skin to the point where you can see the little flakes move as they're carried around by the mites.

And if you want to encourage good client compliance in terms of medicating the rabbit, just show them these mites under the microscope or even under something like an otoscope or a scope hand lens type thing. Once they've seen these these little guys crawling around, they'll start scratching themselves, and they'll they'll definitely be coming back for the ivermectin or whatever we're going to treat them with. I will talk about treatment a little bit more for this disorder when we get on to parasites.

This is a slightly different presentation of this situation. This is a female rabbit where there are quite pronounced perineal folds around the area, and we've got some secondary infection. We've got quite a marked inflammation.

We might well have not so much a urinary tract problem as a genital tract problem in that rabbits with early uterine adenocarcinoma or some of the processes, some of the intervening kind of stages before you get to an actual neoplastic disorder, they go through a kind of cystic endometrial hyperplasia phase a little bit like the progression to pyometra. We see an increase in quite protein rich exudate coming from the vulva, and that can cause irritation around there as well as again obviously being really, really attractive to flies and causing potential problems and we can in radical cases perform a kind of a tummy tuck type procedure, a skin flap removal so we can remove these skin folds and make it easier for these rabbits to keep themselves clean. But always look for an underlying cause.

It's very common that these rabbits will have spinal disease and echinua and so on, and obviously recommend neutering in this particular case if this is an entire rabbit. Going to the other end again, this isn't really a primary skin infection. This is very much a secondary bacterial infection, and both darius cystitis and epiphera can cause this.

It's arguable whether this is actually drear cystitis. I would define epiphera a simple overflow of tears onto the face into this kind of ventracranial area just below and in front of the medial canthus of the eye. We've got tears coming out of the eye, filling up the, sorry, coming out of the the tear gland, filling up the conjunct tival sac and just spilling onto the face because the nasal lacrimal duct is blocked.

That's in 99 cases out of 100 due to overgrown or inflamed areas or misshapen bone around the nasal lacrimal duct as a result of dental disease. And in very few cases we've got a foreign body. Rabbits for an animal that kind of spends a lot of time associated with hay and straw and suchlike and grasses and so on fairly rarely get grass seeds and suchlike in the eyes and the ears, but I have occasionally fetched little bits of grassy material or straw or actual grass seeds out of the nasal amo duct.

More often than not though. We've got dentally associated swelling of the bone and the soft tissues around here. We've got closure of the nasal mal duct, and tears spill out onto the outside of the face.

Even ordinary tears tend to dry out and leave a kind of mucoprotinaceous residue which sticks to the fur and causes great irritation. But if we've got associated dacryocystitis and we've actually got infection. Present in the duct, then we've obviously got a lot of bacteria to add to that which is going to make life even worse.

But it's it's interesting that tears which are so benign and so good for the surface of the eye are actually incredibly irritant to the skin after a while. In these cases, obviously, again, we need to treat the underlying condition, which is easier said than done. Dental disease is a massive undertaking to diagnose and treat.

I'd start with intraoral examination. I take radiographs or ideally if you've got access to it, CT of the head and plan what you're going to do with the teeth to try and restore normal functional occlusion as best you can. And remember it's very much management.

We're going to be repeating those processes, those procedures every perhaps 2 to 6 months for the rest of that rabbit's life or until its teeth stop growing. To deal with this situation, initially clipping and cleaning or teasing away the fur and cleaning is helpful. We might consider bacterial culture and sensitivity on the basis that all sorts of bacteria from fairly standard skin bacteria to the more wild and wonderful bacteria can set up can set up home there.

Topical treatments probably most appropriate to these situations as with the the problems at the other end, and I like things like silver sulfadiazine cream or it may just be that we use a simple barrier material such as Vaseline or something just to help the tears kind of slide off that material and away from the skin. In some cases we'll find that this, if you quiz the owner deeply enough, is as a result of their companion rabbits dying or becoming ill themselves and not doing the grooming that rabbits usually do to one another around the head area. And in some cases, the best advice you can possibly give this owner is get another rabbit.

I don't mean get another rabbit instead of this, but find a new companion for this rabbit, bond this rabbit to another rabbit so they can look after each other and keep themselves clean. And once that kind of residue is removed on a regular basis by by a friendly social companionship and grooming, the skin very often heals completely. As a salvage procedure, what we have done in some cases is instead of allowing the tears to flow onto the side of the face, to open the lacrimal sac itself, marsupialize it, and have the tears coming away from the eye and allowing an easier area to clean, and very often that's useful where we've got eyes which have become really, really sore as a result of particularly dacyro cystitis and the presence of lots of puss sitting on the surface of the eye.

So that can be helpful just to kind of open the, the duct up and bring it away from the eye, and make it easier to clean. Going back to dental disease, other places that we might end up becoming moist and, areas that can be, affected and infected are under the chin, around the dewlap, . And that's especially an issue if the rabbit is obese or the rabbit is an entire female who has a well-developed dewlap.

In this particular case, we've got a rabbit who's drooling as a result of, dental spurs of lingual spurs on the, the mandibular cheek teeth stabbing into the tongue every time the rabbit takes a bite to eat or drink. And remember that, Operating a water drinker requires the rabbit to flick its tongue backwards and forwards and press the little ball valve in quite frequently, quite, quite rapidly, and that can be a very difficult action for that rabbit to take if it's got dental disease. Rabbits in this case hyper salivate.

Rabbits don't produce normally much saliva at all, but they do when they're in pain and they're unable to swallow, and you've got this constant pain to the tongue and the soft tissues of the mouth. They drool saliva that collects again around the the dewlap area. And causes a nice environment for bacteria to grow.

And sometimes you'll see this described as blue fur disease because we do get this pseudomonas with a classic blue tinge to it, but more often than not, I find it's just matted and infected fur and skin. If we move on to away from the kind of standard true bacteria, we certainly see treponema as a definite primary pathogen, and it's an interesting disorder in that in rabbits it's venerially transmitted, so it's transmitted typically from a male stud rabbit to female rabbits during mating. And then all the babies born to that female rabbit are infected as they exit the birth canal and they're cleaned up and weaned and suchlike.

So those animals are very often subclinically infected throughout their life and at times of stress that flares up. And the classic, classic presentation is this kind of crusting, blistering lesion around the nose, around the nasal philtrum, around the lips, all those mucocutaneous junctions. It doesn't tend to affect the ears so much, but it does also affect the genital area.

It is really, really important to remember this kind of subclinical nature of things because too often people just treat the the individual rabbits and not be in contact rabbits and of course it just spreads back again and again and again. In some cases I've seen breeders who have had rabbits with skin presentations like this use, I think it's abanin or one of the penicillin-based eye drops or even dry cow tubes to treat these lesions topically, which causes them to settle down, but it doesn't stop that animal being infected and obviously then goes on to infect other animals and doesn't ever really get on top of it. Affected bucks, affected entire males are said to even after infection have star-shaped stars on the scrotum.

So this is supposed to be a way to identify it. And certainly once the scabs are lifted off, you can see those kind of classic scars left on scrotal skin and so on. With something like this, obviously we've got concerns about using a penicillin, and penicillin is often suggested as the best treatment, and you know reponema is exquisitely sensitive to penicillin and all the penicillin-like organism, all the penicillin like drugs, so beta lactams generally.

So it doesn't necessarily mean that you have to reach for duplicillin or G or P penicillin. Any of the long acting amoxicillin type preparations work equally well. The difficult, well, sorry, the difference is in the one area of slight confusion is that there are some very well established protocols for treating this, and typically they involve injecting the rabbit every 7 days for 3 doses and because treponema is so susceptible to penicillin, that works very, very well.

Using that kind of fairly infrequent treatment, it's very unlikely that you're going to see gut side effects. Gut side effects as a result of penicillin or beta lactam treatment in general tend to mean that the die-off of a lot of the in inverted commas, good bacteria. And as a result we have then a wide open space for the clostridial organisms which have been killed off by the penicillin but have formed a resistant spir related form to recruits, to reestablish themselves, and so typically about 2 weeks after you you finish treatment, those clostridal organisms cause potentially fatal antibiotic associated enterocolitis, and the rabbit develops hideous diarrhoea and dies.

We can avoid that in two ways. One is by not giving penicillins directly into the gut, so by giving them by injection and giving them fairly intermittently, as with treponema, that, that kind of treatment pattern, again mitigates the risk. On the other hand, Certainly people have extrapolated occasionally and thought that that routine, that regime will treat abscesses and other true bacterial or bacterial diseases that are due to penicillin susceptible bacteria.

And whilst penicillin is an excellent drug for treating many bacteria that cause abscesses, partly because it's bactericidal, partly because there's very little resistance to it, because it's so widely, sorry, it's so rarely used in rabbits. And partly because it's very effective against the mix of bacteria that we tend to find in periodontal abscesses, even though all of those are the case. It, it can be associated with GI problems if it's given on a daily basis and certainly if it's given orally.

So to mitigate that risk, we obviously try and give it systemically. We teach owners to give it by injection, typically every day or every other day in the case of long acting preparations. The only danger there really is that in some rabbits who've been given injections on a frequent basis, on a daily or every other day basis for sometimes weeks or months as a measure as a method to stop these bacteria proliferating and stop these abscesses growing, you can end up with some really thick gra granulomatously lumpy tissue around the scapula where they're being injected, and it's not impossible that people inject.

And when they take the needle out, the penicillin based solution pretty much comes back out of the hole as a result of that scar tissue formation. You then have the rabbit turning around and licking itself or a companion rabbit licking itself and potentially getting that penicillin-based drug into the gut and causing problems. So it is worth moving sites, switching treatments if that sort of problem is occurring.

Moving from bacteria to viral diseases, again, I'm sorry to say it's probably topical, we're starting to see myxomatosis cases in the in the spring, in the summer, particularly I think in the peak in the in the late summer and early autumn, especially every few years, we tend to see this kind of cyclical 3 or 4 year cycle in terms of mortality, particularly in wild rabbits, and it does tend to be more common. In warm wet summers where we've had a really good kind of growth of mosquitoes and other biting arthropod insects which spread disease. I don't need to dwell on this.

This is pretty much pathonemonic, you know, you all know unfortunately what myxomatosis looks like in rabbits, but it is a primary skin disease, although death in the final stages is usually by respiratory damage, by damage to the respiratory epithelium. We tend to see infection around the head, particularly around the eyes. Secondary bacterial infection causing this discharge from the eyes where the myxedema, where the swollen edematous eyelids have pretty much closed the eyes over the over the globe.

We'll see infection around the nose, around the mouth, and thickening of the of the skin on the ears. We see a slightly different presentation and my sort of simplistic view of this is that because we tend to see this in resistant rabbits who've either encountered myxomatosis in the past and survived it or obviously more commonly been vaccinated, essentially what's happening is that these animals are bitten by an insect vector, either a rabbit flea or a mosquito, and quite literally the virus doesn't get much further than this area of skin. And we see typically a sort of 5 to 10 pence piece sized area of necrotic dark solid tissue form a kind of plug, and as it retracts as it kind of necrotizes and retracts away from the skin.

Around it we tend to end up with this, this almost perfectly circular, sometimes quite deep, sometimes almost or entirely down to bone, hole in the skin. It takes quite a long time for these things to fall off, about 3 weeks after you first notice them, they fall off, and depending on whether the skin underneath has healed. Or whether it hasn't, you tend to see either a nice healing granuloma granulating lesion or you tend to see, you know, a full thickness skin wound.

So this is the classic presentation after things have healed, it's healed beautifully. The fur will grow back, I'm sure, and it will be absolutely fine. Other places that can occur typically again around the head, so eyelids around the nose, around the ears.

And unless you've got a full thickness lesion through the eyelid, which is going to cause problems to the eyes, in most cases we won't close them, we'll just let them granulate. A hole through the ear could be potentially a problem if the rabbit's charging around the undergrowth in the garden and getting hooked up, but something like this we closed because I mean the wound itself was beautifully clean when the plug of tissue fell away, but obviously it did need to be closed. Remember that myxomatosis does affect the genital area, so you've got this kind of edematous scrotal skin in the male, and if you gently put pressure on this, you can feel the kind of pitting edoema present in the scrotal skin, which should be extremely fine.

You can see in this rabbit we've got pinkness around the nose and around the eyes, but no true kind of blistering lesion, so this is probably quite early myxomatosis. And this is not myxomatosis. This is a testicular tumour.

I just put it in there for completeness, but rabbits can get the whole gamut of testicular tumours, the same types as dogs, cats, people, etc. But one area that does get affected by myxomatosis, which is just worth knowing from a practical point of view, is that the skin on the ears becomes quite thickly edematous. And on this perfectly normal rabbit we can see that the marginal vein is very accessible, very easy to access for whatever reason, but in the myxedematous rabbits this can be really tricky and so I would really strongly advise not trying to use this vein if that's the case, if you're performing euthanasia on these rabbits because it doesn't tend to be a straightforward proposition.

And things tend to be a lot more drawn out, so I would ideally either pre-place a catheter if you can and bring the rabbit back to the owner, or I would access a different veins such as the lateral sinus for this purpose. Something that can look quite similar. Is ringworm and again it tends to affect the areas around the eyes, the nose, the base of the ear.

It doesn't really tend to affect the genital area, although it can do because like reponema, like syphilis, you've got the rabbit cleaning itself up, eating yo tropes, and this constant touching of the face and the genital perineal area, so the spread of infection is really common. We tend to see this mainly in rabbits that haven't been cared for very well, so particularly rescued rabbits, rabbits who've been mixed in multi kind of situations where rabbits of different health status are mixed, so it can potentially occur following. Rabbits being brought to a pet shop, but generally speaking, it tends to be guinea pigs that we tend to see ringworm in in the pet shop scenario, mainly.

This is obviously again zoonotic. And so we need to be very, very careful that if people have got their little baby rabbits, the little fluffy rabbits with ringworm, and they're handling them and they're touching them all the time, that we're not spreading disease to people, especially, potentially, although I would argue they're not the best owners for sorry, they're not the best people to be looking after rabbits, particularly children. Again, the lesions tend to be kind of around the head end, but again they can occur around the genital area, and it is very zoonotic.

This is something which can be spread to people and can affect the skin of the hands, and they can be transferred to the face by scratching and running your hands through the hair and so on. So it is something that can be cosmetically quite unpleasant and requires fairly urgent treatment. If we're going to identify this in rabbits, standard processes, the standard sort of things that you do in a cat or a dog, toothbrush, skin brushing, skin scrapes submitted for dermatophyte culture and so on.

In terms of treatment, I quite like the itraconsole liquid because it's easily titrated. It's relatively tasty. It's available under the cascade.

We can use it off licence because we've got a product that's designed for cats and we can legitimately use that in rabbits under the cascade. Sometimes I generally don't have a treatment break every few days or every 5 to 10 days as you would in a cat because rabbits' livers are a lot more resistant to itraconazole than cats' livers. But if you notice inhabitants developing, the rabbit going off its food, the rabbit looking in any way ill, I would just institute a few days' treatment break just to allow their livers to recover.

It works. Very effectively in these patients, and you might want to use adjunctive topical treatment, but because a lot of these lesions around the face, they're just going to be licked off and I don't find it terribly effective. We don't need to go to the, the extremes of shaving rabbits, clipping rabbits, removing, the, the affected fur and so on.

I don't find that is, is necessary. Moving on to parasites, I didn't used to see ticks until I came down to the southwest. I would still say they're a relatively uncommon issue in, in rabbits.

Fleas are interesting in that we've got two main species of flea that we're worried about. One is the cat flea, well, cat or dog flea, but perhaps mainly the cat flea. We have cat fleas jumping from cats to rabbits, biting them, and if the cat is flea allergic, then if you're treating the cats and you're treating the environment and you're not treating the rabbit, then you're missing a potential host, a potential reservoir of fleas to just jump back on the cat.

So ironically, in the case of cat fleas that are on cats for jumping onto rabbits, you're probably best off making sure that you treat the rabbit for the benefit of the cat. And of course making sure that if you're treating the rabbit, you're not using a frontline fipronil based products such as Frontline, which can be acutely toxic to rabbits. On the other hand, You may find that you're treating the cat for the benefit of the rabbit if we have a cat who's going out and hunting and potentially coming back with actual baby rabbits from a nest or coming back with rabbit fleas after having hunted rabbits, bringing those fleas back into the house and potentially allowing those fleas to attack rabbits and spreading myxomatosis to them.

So in those cases you're treating the cat for the benefit of the rabbit and again likewise it's vitally important that we don't use a permethrin-based product such as you might use a rabbits on the cat. In both cases, you could use imidocloprid or some other kind of anti-active parasite treatment. And that obviously is down to the choice of what's available in your practise, but the key thing is not to use a fipronil-based product on rabbits.

It seems very safe across the board on most other species of exotic. I've doused chinchillas in frontline to treat. Parasites preventatively before exporting them, and there have been no downsides apart from the fact that they look so bedraggled and so sad and you don't want to put them in an open flame to warm them up afterwards, but generally speaking it seems very safe in exotics but not funnily enough in rabbits.

The main one that we're concerned about perhaps is Kaylitiella, and there are a couple of other mite species which I'll I'll touch on in a moment. Again, walking dandruff. We're concerned about this because it's irritating to the rabbit.

It's potentially zoonotic if the rabbit is being held by the owner and the mites are crawling onto them. But my main kind of concern about this is that it's a big red flag for this rabbit having mobility problems. There is always, always, always a reason for Cayletella in the rabbit beyond the actual caliella itself.

It's semi-commensal in totally healthy rabbits. So we need to look at this rabbit, think about what its teeth are like, think about what its musculoskeletal ability to turn around and groom itself is like, and so on. This is the rabbit that if you treat Cello, yes, it'll go away, but this rabbit will come back 6 weeks later with Flystrike for the same reasons, the same underlying reasons.

So treat this rabbit, treat the incontact rabbits, but do look beyond that. This is your warning sign that that rabbit has got problems which could lead to more serious life threatening problems later. An interesting one of the little salt and pepper mites, the Listrophilus or Lapiacus gibbbus species, these tend to show up white against black fur and black against white fur, hence the name, and these are a little bit trickier to treat.

They don't usually cause problems. They usually sit on the fur itself, but they can, they can in vast quantities sometimes be a cause of a source of irritation that causes rabbits to become pruritic. And because they don't really spend a lot of time on the skin.

They can be quite tricky to treat with systemic ivermectin or other kind of products like that. We've already said that Frontline that fipronil-based products and sprays are not a particularly good idea in rabbits, and so this is one situation where I might reach for generic kind of permethrin-based powders and the sort of sprays that you can buy for use on puppies and kittens from pet shops and suchlike. If I'm pressed to put something together to treat them with in the practise, I'd probably make a solution of ivermectin in water and recommend that that's shaken up and sprayed onto the rabbits, so it actually gets onto the coat and it actually kills these these mites that don't contact the skin that much.

And just a couple of weird situations I've seen. I've seen people repurposing. Chicken coops for rabbits or keeping rabbits and chickens together in the same coope.

I'm not worried about coccidia. They're two different species. It's Imeria in rabbits, and I can't remember what it is in chickens, but I have seen red mite on rabbits, and that crawls back into the woodwork at during the daytime.

They can suck quite appreciable quantities of blood as the colour suggests out of the rabbit overnight. However, I think the nastiest one of the bunch is seroptes. Seroptesunicula is very closely related to Seroptesovus, the sheep's cab mite, and it produces some very, very nasty lesions within the ear.

I say within the ear, but I've seen cases where these mites have crawled out of the ear and they've caused lesions around the base of the ear, under the chin, around the dewlap, and I saw one case of scrotal ear mite where again because the rabbit was eating yotrophs they'd spread from the head end to the perineal end. The treatment is remarkably simple. And they do very, very well.

You don't need to pull the wax out. It's very satisfying, but you bring quite a bit of the inside of the rabbit's ear with it. You absolutely don't need to touch the ear.

Systemic avermectins Salemectin is probably my treatment of choice because one treatment is usually sufficient, but you can use ivermectin by spot on or injection and so on. And these rabbits is clear up dramatically quickly once the mites are dead and the exudate just dries up and falls out and the rabbit grooms the rest of it off. So these, these will be good as new within a couple of weeks or so after one treatment.

Non infectious diseases we've got fewer of these, so we've only got a little bit of time left, so I'll cover these. Neoplasia, skin neoplasia can affect any species rabbits, cats, dogs, etc. The treatment is very similar to that that it would be in dogs and cats.

We're looking at identifying the lesion, potentially staging it. We're concerned about the spread. A fine needle aspirate if you are able to and want to do that or excisional biopsy and removal if you prefer to do that.

I wouldn't say that there's anything remarkable or dramatic to say about skin neoplasia and rabbits. I would, I would generally say it's less common than dogs and cats, but that may just be because we don't get presented the, the same kind of case load. And because people are stroking their cats and patting their dogs, these things are often picked up earlier, in fact, at all in those pets, whereas they very often aren't in a predominantly outside rabbit.

It still remains though that most lumps on rabbits are abscesses rather than neoplasia, but sometimes they are tumours. This is a neoplastic lesion, but it's not. A strictly speaking, I guess a skin lesion.

It's a mucocutaneous lesion. This is an erectile papillae. And sometimes they they form and as the rabbit strains it.

Sort of pops out like a little like a little sort of raspberry. They can be removed quite easily by sharp dissection, by electrosurgery, by cryosurgery. You'd think this would be an absolute magnet for fly strike, but I've never seen fly strike associated with these kinds of lesions.

And we see both true sebaceous adenitis, but also a kind of perineoplastic syndrome causing this exfoliative dermatitis where skin develops a kind of silvery sheen to it and sheets of skin are produced, exfoliated and removed. And whilst this can be due to a number of reasons, one reason that we typically see and we identify this, this does look like Kelitiella. One reason that we identified this on a skin scrape, sorry, skin biopsy, and then we popped this rabbit through the little doughnut of truth, and I know this is an X-ray, not a CT, but we saw a mediastinal mass which was exerting a perineoplastic influence on the skin of the rabbit.

Just by the by this is nothing to do with skin at all, but we spent perhaps several 100 or a couple of 1000 pounds diagnosing this, but there's a lovely test that you can perform on rabbits who have mediastinal masses, which is to gently raise the hindquarters of the rabbit and so to exacerbate the effect on backflow of blood venous return from the areas behind the eyes, and this was the rabbit in question. One of the rabbits in question who developed these enlarged sinuses behind the eyes as a result of that thoracic mass affecting return to the heart. So slightly quicker and easier test for thymoma than CT and much more dramatic.

I was I have been kind of very sceptical about these rabbits which are presented with A diagnosis of hay fever, if you like, of being actually allergic to substrate or allergic to inhaled allergens, but we certainly see a few of them. This one isn't, but a lot of them are white coloured rabbits, and I think there is an atopic kind of situation going on in these, these patients because it tends to be the feet because it very often tends to be the front feet. They're very tasty things to chew.

They're very appealing things for the rabbit to nibble on, and sometimes these rabbits have developed really nasty secondary lesions, secondary damage to the skin as a result with secondary infection, and so on. And this is probably one of the few cases along with allergic respiratory tract disease where I would consider very, very cautious use of steroids after we've excluded all the other possibilities. And this the rabbit has carefully barbered the skin and barbered the fur and done relatively little damage to the skin, but I've seen some where they've actually chewed down onto the toenails and and really kind of broken the skin and ended up with quite severe lesions.

There's a few rabbits out there, I think, who seem to be particularly particular magnets for insect bites, and I've seen a few lesions on the pinny and again, topical insecticide treatments, topical deterrent treatments such as the permethrin-based products and so on, do a pretty good job of keeping those away. If they're hatch bound rabbits, then we can look at putting things in the, either on the hutch to deter insects or we can look at covering the hatches. The problem with that.

As it is for myxomatosis control, is that if you cover hutches in the summer months, particularly the temperatures in there can get really, really high. So obviously rabbits should not just be in a hutch, they should be allowed access, ideally free access to a run all the time, giving them lots of fresh air and lots of shade where appropriate, but. Just to say that you could end up doing more harm to the rabbit's respiratory tract by excluding fresh air and insects than you can you can good.

This was a strange little rabbit who ended up, a very sweet little rabbit, who ended up with a sort of screw tail type lesion, and this followed some treatment for a urogenital tract disorder, and we were a little bit of a loss to work out the precise kind of correlation between the two, but I think there was some neurogenic issues to do with the tail, and that became a source of irritation we had to just amputate the tip, which was a slightly unusual case. It's more commonly the feet that rabbits tend to self-traumatize. And the other place where they tend to be irritated by and self-traumatized is identification rings.

These are placed by the British Rabbit Council members, the Pedigree Rabbit Association, and they used to be stainless steel. They used to be impervious to damage and they used to be fairly inert and not cause a problem to rabbits unless the rabbit's leg became swollen and they cut the blood supply off. But some of the new ones that they've used, you can see are kind of pitted and grooved.

And if the rabbit plays with it, if the rabbit chews on it, perhaps either through boredom or just perhaps irritation at being present, it can cause little tiny nicks and cuts in the surface of the ring which can then traumatise the skin. This on the other hand, is after we've removed a stainless steel ring, and you can see that it's cut into the skin following perhaps swelling of the leg for some completely separate reason or using a ring that was too small and the rabbit's grown into it and it's cut in and again that was identified in time to remove the ring and perform some closure of the skin. The other situation I've seen with vascular damage is a rabbit that was presented, having had an ear cannula placed in, and this rabbit had had the ear taped down onto the, instead of using a nice kind of squidgy sausage of rolled up gauze, they'd used a, a more kind of solid, thing, a, I think it was a, a cardboard inner from a, a conforming bandage tube.

Roll they placed that inside the ear, taped the ear down onto that, and obviously constricted the blood supply to the ear, and we saw this kind of wet gangrenous appearance. So just a word of caution to be careful there. And I think with about 10 minutes to go I'll stop, and if there are any questions, I'm very happy to answer them.

Thank you very much. Thank you, Richard. We do have quite a few session questions submitted today.

I'm happy to, yeah, any unanswered questions we will forward them to the Rabbit Welfare Association to assist as well, and then we can email them out, but we'll see what we can get through. Let's have a look here. So, da da da.

I've got a question. We have, how do you treat socoptic mange and rabbits that is having multiple episodes of relapse symptoms. We faced a number of cases here in the tropics.

I was going to say that isn't a UK question. I've heard of cases of sarcoptic mange, particularly in places like Singapore and other other countries where I think it's it's far more prevalent either through Just the prevalence of the mite itself or the the humidity and the temperature and so on supporting it. I mean, I'm relatively unfamiliar with that because we don't tend to see sarcoptic mange that much in the UK.

But I think you're looking that is different to Kayley Tella and that it is a primary pathogen, and I would probably just follow the standard dog protocols as much as you possibly can that you would follow for treating dogs in similar situations. So I'm afraid I'm, we don't tend to see that in the UK, so I can't offer a terribly good answer. Avermectins would probably be my treatment of choice.

Amitraz, I think, has probably gone off the market now, but some of the newer medications that are used for dogs with, sarcoptes would probably be my, go to. Thank you. And another one we have is what is your preferred test to confirm, tripptosomiasis?

Sorry, can you say that again? I didn't. What is your preferred test to confirm?

Oh no, so I always say it wrong. I think, I think, I think that's trepanema. I've got to say, if that, if the question was syphilis, rabbit syphilis, treponema, I've got to say I diagnosed my treatments basically if the rabbit looks like it's got treponema.

If you give it penicillin and it gets better, it is treponema. If it doesn't get any better, it's probably ringworm, and if it gets worse, it's myxomatosis. So yes, diagnosis by treatment I'm afraid in that case you can do skin scrapes, you can do dark field microscopy, silver staining, you can do serology, but I generally find that treating and seeing what happens is the best option.

Ah, thank you. And one on that sort of note as well is just saying, how can you, Differentiate basically between the early stages of treponemia and mixo. I again, I guess it would be.

Again, it's it's time, basically. They can look very similar in the early stages because when you've got that kind of swollen, slightly edematous myxomatosis lesion and you've got the first beginnings of a treponema lesion, they can be very, very difficult to tell apart and I think it is just a question of seeing how they they. Over the next 2 to 3 days and as I say, I would treat fortrepomin if it's starting.

They get better remarkably quickly with a single injection of penicillin and then if they do that, keep up the treatments and if they don't, I'm afraid you'll know fairly fairly soon whether it's mixedomtosis. You'll find out quicker by watching them than you will waiting for results to come back. Thank you.

And I'm guessing that's similar again with the question we've got differentiating normal fur shedding to skin diseases as well. Well, I mean, normal fur shedding follows a really clear pattern. You'll see a line of fur that that kind of appears above the nose and kind of moves back along the, the head, and then it sweeps down the body along the back and Kind of extends down the body towards the ground surface, so it follows a very, very clear line and the fur that hasn't been shed comes out easily.

The fur that has been shared, what remains is perfectly intact and doesn't come out. So if you're seeing that very, very clear demarcation between old fur and new fur, it doesn't tend to come out in random handfuls all over. It tends to follow quite a clear line.

If it's all over the place, it's typically skin disease, and Kayly Tella, for example, is any acetate test, acetate strip, cellotape strip, chunk of fur that you put under the microscope will be hooching with it. You can practically see it with the naked eye, so it's, it's not a difficult diagnosis. Thank you.

Another one is, how safe is ivermectin injection compared to Cellemectin or moxidectin spot on. Can you comment on the efficacy of them also? Well, my experience is that injectable ivermectin.

And spot on ellemectin are both very effective. I'm less impressed by the efficacy of spot on ivermectin, and I'm afraid I've got no data on oxidectin because I've never needed to use anything other than ivermectin or Salamectin, so they would be my go to products typically under the cascade again. You're licenced to use, you're allowed to use the next product on the on the cascade on the the flow chart if you like, if there isn't a licenced product designed for it.

And whilst there are products licenced under the small animal exemption scheme, they don't trump the cascade and you can legitimately use Cellemectin spot on or ivermectin injection. Thank you. Another one, saying a great webinar, Richard.

Any advice, please, as in rescue, we sometimes come across rabbits, which overgrowing partners causing nasty skin irritation, particularly in spring. Is there anything you would recommend we could dab on the skin to deter the over grooming to give the skin time to heal? That's really interesting because I've always thought of grooming and I've watched my own rabbits do it, and although you sometimes feel that one of them is being slightly put on by the other, I've never seen it develop to the point where it damages the skin.

You can certainly see barbering in mice and rats and guinea pigs. Guinea pigs often do it to rabbits. They literally sit on the rabbit and chew the fur on top of their head, but rabbits, I think if they're grooming and actually over grooming, there is a behavioural issue.

There is a stress related issue either between the pair of them or due to the situation surrounding the rescue situation because of the homes they've come from and the background they've come from. So I think it's a behavioural problem rather than the skin problem. Certainly you can try putting things on skin.

Obviously rabbits have got different taste buds to us and And certainly I've put bitter spray and suchlike on animals and they've loved it and they've lapped it, you know, licked it off wounds and such like. I would, I'd be kind of, I think, investigating the behavioural situation surrounding those, those, those rabbits rather than putting stuff on the skin. Thank you.

I'm just going through there's quite a lot here. I have to get back as you like. Yeah, let's have a look.

I did see one, is it better to treat as once a week for 3 weeks treatment, or is it 5 consecutive day treatments? Sorry, what treating what there? .

B E N T S. All right, OK, I think one of the old names for treponema syphilis is vent disease because it affects that kind of area which is colloquially known as the vent, and I think once a week for 3 weeks. I think otherwise what you're likely to do is is damp it down, create a carrier state where it's just going to flare up in the future.

So yeah, once a week for 3 weeks. Perfect. Is there any antibiotics that you find that you use most often?

Well, if I'm going to be honest, bare is, I find I very rarely use in rabbits. I tend to use poteniated sulfonamides as my go to first line because they're relatively tasty. They're exceptionally safe in rabbits, and they're very effective against a lot of the skin bacteria that we see.

If they aren't working, then I probably do reach for a cultural and sensitivity result and use an antibiotic. Depending on what that grows, tetracyclines, you can use tetracyclines to treat treponema, for example. They, they, they are effective against that.

It's just quite a long course of oral antibiotics that you've got to get into the rabbit. But yeah, TMPS is probably my go to. In in rabbits Perfect.

I have a few rabbits, non, er, non-pruits, but lots of dandruff, dry, flaky skin on dorsum only, sometimes just on ear pin. It was DTM negative for ringworm and non-responsive to Callemectin to rule out parasites. Do you rub Let's just get dry skin and what would the treatment be for these?

Do we need skin biopsies, try topical omega 3 treatment with minimal response? OK, it's an interesting one. I mean, I, I would say I would say if you test trial treated with cele.

I consider that a pretty good guarantee that you haven't got litella certainly you might want to take a deeper scrape and look for demodex, which is relatively uncommon in rabbits, but still could be the case, especially if you've got a bunch of rabbits in the same environment that have got issues, and for that you may need a more intensive course of antiectopparasitic treatment. I agree. I haven't found the kind of essential fatty acid supplementation to be terribly useful in rabbits.

Yes, they can get dry skin. It's not so common, commonly seen as in animals such as chinchillas, but, you know, it can occur. Yeah, if it's a group thing, you're, I think you're looking at either a common Environmental pathogen or a common environmental factor.

So I'd certainly be looking at the diet. I'd be looking at the substrate. I'd be looking at whether there's anything irritating present in the atmosphere.

I'd be looking at the storage of the diet, the vitamin E levels and suchlike, and but yeah, ultimately you may need to go for a skin biopsy from a representative rabbit or two if you've you've got a real problem, yeah. And probably this will be have to be our last one, unfortunately. Do you l or skin abscesses or do you try with antibiotics first?

So I kind of left abscesses out of this because I think they're primarily a dental problem, and we could do a whole Yeah, and I'm sure somebody at some point in this series is doing a webinar on dental abscesses. I would say that skin abscesses actually sort of confined within the skin are pretty uncommon, and they'll only really be if there's been a little sliver of a. Shavings or spike a bit of straw or a bite or something like that and they're well confined to the skin and my general advice would be to excise them to chop the whole thing out and be done with it because anything else is probably going to just keep coming back.

If it's a dental abscess and it's burst out onto the skin or under the skin. Then, as I say, there's a whole we could spend over an hour talking about the options for that, but the treatment is going to revolve around treating the underlying dental problem. But skin abscesses, if you can chop the whole thing out, chop the whole thing out.

If you can't, then opening them up as long as they don't go deeper and treating them with systemic antibiotics is and topical antibiotics is reasonable. Lovely, thank you so much. So yeah, unfortunately, everyone, we're going to have to end it here.

But thank you again, Richard, for today's. That's right. And like I said, we have got quite a few questions, so we will get back to everyone by email and we also will receive a certificate attending today's session.

I'd like to also again thank the Association for their sponsorship, you know, to make today's webinar possible. You're welcome. Thank you.

I hope everyone enjoyed today's session and I hope you have a lovely rest of your day. Thank you very much. Thank you.