Hello, everyone, it's Anthony Chadwick from the Webinar Vett welcoming you to yet another of our evening webinars, which we're very pleased to welcome Peter Forsythe, who's going to be talking about working up the Itchy Dog. A very uncommon thing that we see in practise itchy dogs. We don't see many of them at all, do we, Peter?
No. One or two maybe. So I'm sure this is going to be a really interesting webinar.
I mean, it's one of my areas of interest, as some people might know, not doing dermatology now at the moment. I always kind of admired and looked up to Peter because he is a great, great dermatologist, lecturing. On dermatology at the weekend at the study group, the veterinary dermatology study group.
Not too late to go if you haven't. It's in Manchester at the airport, always good to listen to. But of course, you know, we wouldn't be able to do this without the kind sponsorship of Zooettis, who have just, of course, brought out this new product cita Point that we're going to be talking about more next week with another very famous dermatologist, Andrew Hillier.
So, we, we'll leave that to one side for the moment, but thank you very much, Zettis, for making tonight possible. I'm really looking forward to the webinar, Peter. If there are any issues, I will come on.
Otherwise, I'm just gonna sit back and enjoy and hopefully at the end, we've got some time for questions, but over to you, Peter. OK, thanks, Anthony. Good evening, everyone.
Thank you very much for joining this webinar. And thank you to Zoatas. I'll add my thanks to Zoatas for, for sponsoring this.
As Anthony says, they've, and I'm sure everybody will be aware that they've just brought out, a new product, Cite to Point or LoyvetMab, a very innovative. And exciting treatment, a monoclonal antibody that's directed against interleukin 31. And that's licenced for the treatment or management of atopic dermatitis in in dogs.
And Andy Hillier will be covering that webinar next week, and I urge you to listen to Andy. He's an excellent speaker. So I'm really the kind of warm-up act for Andy, really.
And the point about this is that it's important when we're using these kind of products to Use them, appropriately and, and that is, for the treatment of atopic dermatitis. So what I'm covering, going to cover tonight is just the basic clinical workup of the itchy dog, with a view to improving our diagnostic, hip rate for, for atopic dermatitis. So When we're talking about itchy dogs, of course, what we're really talking about is, is pruritus, .
Which is, in, in sort of human terminology, it's an unpleasant sensation that provokes the desire to scratch, although of course with our patients that can mean a whole load of other activities. It can mean licking, biting, chewing, rubbing, shaking, over grooming in the case of cats, and so on. So, And I think it's very important that we define pruritus, to our clients, and we have an understanding when we're talking to clients of exactly what it is we're talking about, because ask them, does your dog, is your dog itchy?
They may just think about scratching, and does the dog scratch, and not about all these other activities, and they may easily think that the dog that Spends its time nibbling its paws, it's just keeping his nails short, and actually they may not appreciate that that usually indicates pedal pruritis. And, and pruritus is, is a, a really difficult. Thing to quantify, because, it's notoriously difficult to study.
and when we're, when, studies are being undertaken to assess the efficacy of drugs and controlling pruritus, actually measuring, getting an objective measurement of pruritus is, is difficult. And, and there are some good, pruritus scales which are used now, visual analogue scales that clients can be asked to fill in, and we use those in the practise, and they're, they're quite useful. But it, it, it, you know, everybody, all clients tend to have a different perception of how itchy their dog is, and, and one client's threshold level for, you know, what they would consider to be pruritus of a, of a significant pruritus could be quite different to somebody else's.
So, it, it is difficult to compare, cases, and we just have to go on what the individual client, is telling us. There, of course, things like activity monitors are now starting to be used to try and get a more objective measurement of pruritus, but, it's in the very early days yet, and it's difficult to differentiate pruritus from other forms of activity sometimes. So, difficult subject to, to measure.
What I want to do is I want to briefly review the causes of pruritus. I'm not going to go into all of them in detail, and then I want to cover the workup of the itchy dog, the pruritic dog, in a, in a clinical situation. So let's just review the causes of pruritus, and, and these are the, the first three columns are the common ones.
So, When we're thinking about pruritic skin diseases, we always, first of all, consider parasites, and infections before, diagnosing or considering allergies or any of the unusual other causes of pruritus. So there's a list of parasitic diseases here that, most of which we'll be familiar with, infections, and the two main infections that we're talking about here are Staphylococcal, pyoderma and malacasia infections, and then, the allergies, which would include fleaal dermatitis, atopic dermatitis, and as we'll discover, food, adverse food reactions are really part of the atopic dermato considered part of the atopic dermatitis spectrum. So I'm going to talk about some of these I'm going to highlight just 3 of the parasitic diseases, or 3 or 4 maybe, these two infections and, the, the important allergies.
I'm not going to talk about allergic contact dermatitis and I'm not going to talk about any of these, diseases in column 4. So, first thing I want to just briefly review is kyleolosis. And Kyleiolosis is a parasitic disease caused by kyletiella mites, and there are 3 species, well, there are more than 3 actually, but there are 3 species of kyletiella mites that you might encounter in In practise, There's one that affects cats, well, at least there's one whose natural host is the cat, one that's whose natural host is the dog, and one whose natural host is the rabbit.
But they are not host specific. And to be honest with you, it really doesn't matter whether it's a rabbit mite that you're dealing with, or a cat one or a dog one. We treat them all the same way, and, in reality, you're probably not going to be able to tell the difference unless you're an expert entomologist and have a very good quality microscope.
But they all look like this, and we can tell them that one of the distinctive features of these hooked mouth parts that they have. These are superficially living mites. They have a roughly 3 week, or slightly greater than 3 week life cycle.
Some, some techs will say up to up to 5 weeks. One of the important things is that they can survive in the environment for periods of time, so they can survive in the owner's furniture or in the carpets and, and act as a source of reinfestation. And that makes it more difficult to treat this this disease.
And they result prominently and mainly predominantly in dorsal scaling and pruritus in the host, although, as we'll see, they're not always that scaly, and they are also an important zoonosis, and people get bitten primarily on their forearms and, and their calves as can be seen here. So the distribution of chileosis, a distribution of pruritus and lesions, as you can see, is predominantly dorsal. It can be more generalised, and this would be the typical pattern up here on the right, where you have, this white scale in the hair coat.
Some people call it walking dandruff, where you can actually see the mites moving around on a dark surface. But actually, as you can see, On this bottom right picture, this is a dog with chiletulosis, a border terrier, a very prutic dog, but there's no scale here at all. So the lack of scale does not rule out this disease.
For me, one of the sort of best ways of, of, of, things that makes me suspicious that the doctor might have caletulosis is if you tickle them over the dorsal trunk and you get this scratch reflex. And, and that is, you know, it's a strong indicator for kleosis. It could be a flea allergic dog or it, it, there is another mite infestation but we'll see in a minute that can do that too, but that's a strong indicator that Caletiella might be involved.
Canine scabies is caused by the burrowing mite, sarcopy scabii. It's a highly contagious mite and foxes are an important, urban foxes are an important source of the mite, and the, the, the, the parasite can be transferred. Indirectly through fox faeces or places where foxes have rubbed against a tree and the dog comes in contact with scale or or a fox spore.
And it causes, it's, it's a burrowing mites, it's a deeper, it, it lives deeper in the skin than chileosis, and it, it, it causes an extremely prutic papular skin disease. And it is also zoonosis and these little Papules you can see on this man's torso here are caused by bites from sarcopy scabii mites from a dog. In fact, it was from this dog here, this German shepherd, and you can see how pruritic a disease this is.
And, and scabies is one of those dogs with the diseases and the dog comes into the consulting room and cannot stop scratching, then scabies goes straight to the top of your list of differentials. It's worth saying in dogs that have had chronic disease, where they've had the disease for many months or longer, then they can actually go into a sort of phase of being quite lethargic and very depressed, and there, you know, with general malaise, and they can become less potic then. But typically, the distribution of the lesions is the pinna, as you can see here, there's crusting and scaling over the pinna.
The elbows and the hocks and the ventral chest are the classic lesion distributions. But if disease lasts for long enough, then it can become generalised, and you can see in this. These pictures on the right.
This is a dog de Bordeaux, that had been diagnosed with atopic dermatitis. This was some time ago and treated with glucocorticoids and then cyclosporin, but pruritus and skin lesions persisted. And when you looked at this dog's skin, you can see that there's a distinct papular eruption over the medial thigh.
And that's not something you usually see with atopic dermatitis, and it gives a clue, as, as to the cause of the disease. A brief word about demidiosis. Actually, 3 forms of demodex mite can be found in the dog.
The most common one is Demodex canus, which is the sort of medium size of mite, and this we were taught that demidiosis was not a pruritic skin disease, but actually it can be an extremely pruritic disease in, in probably something around about 25% of cases. And this was a staffageable terrier with dematocosis, and the lesions are fairly distinctive, I'm sorry, the lesions are fairly distinctive and, This dog was extremely, extremely poetic. This is, this picture at the bottom left is the short form, is the second form of the parasite that we see, and it's nearly always seen in association with Demodex Canis, and some genetic studies have identified this as genetically identical to Demodex canus.
But you will sometimes see this mite in association with Demodex canus. Some people call it unofficially it's called Demodex corneae, but you treat it in exactly the same way. The one that's worth being aware of though.
That you may not yet be aware of, it's, it's much less common, but it definitely is out there, we see it periodically, is Demodex inja. And this is a demodex mite that's probably 1.5 times the size of a demodex canni mite.
I've put some, this photograph of a demodex canis mites here down in the corner just to show you the different appearance. You can see how long the tail is in this parasite and how long the legs are. And this causes Two or 3 different syndromes, but the most common one is a greasy pruritic skin disease affecting the dorsal trunk, of, predominantly terrier breeds.
So the border terrier, the wirehead fox terrier, the Westie, we've seen it, and Scottish terriers as well, and they are extremely itchy, extremely pertic over the dorsal trunk, and as I say, the hair coat has this characteristic greasy appearance. OK, those are the parasitic diseases I wanted to highlight. I also want to highlight, these important infections that we see as a major component of pruritus in, in many dogs, and a very common reason that treatment for pruritus, in atopic dermatitis, that would be with drugs like glucocorticoids or cyclosporin or, Olacitinib or narruloyvetab, Where those treatments don't seem to be working, and if you, if you see a case like that, then suspect an infection.
And the two infections that we are concerned with are Staphylococcal pyoderma and malacesia, yeast dermatitis. And just remember that these are resident organisms. They are present on, carried, in the nasal, in the area, and around the anus and redistributed to the skin surface where they can cause, skin, infections and pruritus.
These are, because they're res. Organisms, they are, they are secondary problems. There is always, or should always be an identifiable underlying reason why the dog has developed the infection in the first place, and most commonly, that would be, underlying atopic disease.
So here's some typical cases of clinical pictures of malashesia dermatitis. It likes skin fold areas, so, the ears, the lip folds, the flexual aspects of joints, up in the groyne area, you can see this lesion, at the base of the scrotum here. There are certain breeds that are very prone to malaysia dermatitis, bassets being one, cocker spaniels being another, and this is an atopic cocker spaniel with severe secondary yeast infection, and they're pruritic and they're scaly, and they're erythematous, and they are greasy.
Here's some more typical photographs. This is on the left, the skin fold areas with this adherent scale and erythema and grease. This lesion over the ventral neck of a cocker spaniel is a very typical lesion for malaysia dermatitis.
We quite often, it likes to affect the interdigital areas and you get this characteristic. A slightly shiny, greasy appearance, the hair loss and the erythema, that's just very typical for malacisia dermatitis on the pores. And the other thing you see is malacasia parachia, an infection in the claw folds that results in this brown staining of the proximal nails.
And here's a basset with more, less well-defined lesions perhaps, but this more sort of diffuse erythema and the slight lichnification, in the groyne area. Pyoderma is the is the other infection caused by infection usually with Staphylococcus pseudontermedius. It has many presentations, it's way beyond the scope of this lecture to cover all of those, but .
It, it is something to be aware of, and there's a couple of things I just want to highlight here. So, on the right at the top here, we have. A German shepherd with a typical superficial pioderma with papules and pustules and some scaling.
Sometimes the lesions can be very subtle, and this is a a golden retriever. And atopic out golden retriever with a secondary folliculitis, this dog's probably just become pruritic, and you look through the hair coat and you see these little bits of scale, and you look closely underlying and you can see an epidermal cholet, which is the end stage of a pustule. And we can have larger spreading lesions, and these are called target lesions, where you have an erythematous active margin, and then, central healing, if you like, and post-inflammatory pigmentation, giving you this target appearance.
And on the right here, this is a very pruritic Dalmatian who's chewing at his flanks, and it would be very easy to say, oh, this, this pruritus is just, this hair loss rather, is just due to. The pruritus, the act of chewing. But in fact, when you look closely, you see a lot of the alopecia is stemming from these little focal patches of alopecia, and, and that indicates a folliculitis, and most of the time that kind of folliculitis would be due to a staphylococcal infection.
Temidiosis is another important differential, of course. And the other type of infection I really want to highlight as well, because this is very common, or quite common in, in atopic dogs, is bacterial overgrowth. Now, these dogs don't develop papules and pustules and typical lesions of superficial pyoderma.
They have a very non-specific type of inflammation, a kind of chronic appearing, inflamed skin, where they can be erythema, they can be pigmentation and lightnification, as you can see here, and it would be very easy to assume that this is just due to licking. This is an atopic dog. It's pru.
It's licking those areas and producing those lesions. But actually, when you do the cytology on this, you find this is very heavily colonised with, with, with cocci on the skin surface, and, and this is known as bacterial overgrowth and something to watch out for. And then lastly, the, the 2 or 3 allergic diseases I want to highlight, firstly, canine atopic dermatitis.
Typically presents in young dogs, and the classic distribution would be the muzzle, the periocular area, the pinna and the external ear canal, axilla groyne, perineum and the paws, as you can see here. And most typically in the early stage, the pruritus is nonlesional. Occasionally you might see little micropapular eruptions, but very commonly there's not much to see, just a pruritic dog.
And later on, as the dog scratches and perhaps develops secondary infections, then you start to get other lesions appearing. So on the left, very early atopic dermatitis, in a young, guide dog actually. Are periocular erythri in a mild diffuse erythema around the muzzle, really not much else to see.
More advanced lesions here where you've got more diffuse erythema and alopecia of the ventral trunk. More marked erythema here and the skin's becoming lichenified. It's very common to see limb and pedal involvement.
This is hair loss and excoriation due to self trauma, and the same with this. Of course, an important differential here would be dematocosis with this pore here, but this is actually hair removed by licking. And of course, otitis externa is very common in atopic dermatitis.
Something like 80% of atopic dogs will develop otitis at one stage or another. And secondary infections, yeast or bacterial infections. It's now accepted that some .
Oh, I have a problem. For some reason. Anthony, are you there?
Hello. Yeah, Peter, is it just not going forward for you? No, it's not, unfortunately.
And I, I can just, can I just come out of this and just try and just yeah, just escape and just come back in and see what happens and then I can always take over if you want me to and show slides because I've got your. Your PowerPoint if it's not working, just, yeah, just just reload it and just see what happens. So we'll carry on where we left off.
I was about to talk about food-induced atopic dermatitis, and, and it's now generally accepted that some adverse reactions to foods are manifest as atopic dermatitis. We don't any longer talk about atopic dermatitis and food allergies being separate conditions. I think most people are kind of familiar with that concept now.
So this is a disease that causes a pruritic skin disease that's indistinguishable from A to B. It might, it may be a wider range range. So, you know, maybe in very young dogs or older dogs, you know, you might increase your index of suspicion for a food-related problem.
And it is said that some food reactions, some dogs with adverse food reactions or food-induced atopic dermatitis have a poorer response to glucocorticoids or cyclosporin. And, occasionally, these, adverse food reactions can be manifest as as other skin diseases. So recurrent pyederma, for example, or a dog that might have a dorsal pruritus that could resemble a flea allergy.
So that's just something to watch out for. So food-induced ectopic dermatitis. OK, Anthony.
Next slide please. Anthony? Yeah, I've got it onto the flea allergy one now, flea allergy dermatitis.
Sorry, you, thank you. So yeah, flea allergy dermatitis. I think I'm not going to say much about this, but I think everybody is familiar with this.
typically this results in a, a pruritic skin disease affecting the lumbar, the lumbosacral area, but it can also affect around the neck and over the groyne, and, I'm not going to say any more about that at this stage. Next slide. Oh yeah, OK, so, and that's just a reminder that, hotspots and, and, fleas can also be a zoonosis.
So, I want to move on to talking about the approach to the pruritic dog in the clinic, and it, it, you know, It may be that the there's a very obvious immediate diagnosis, you know, you see fleas on the animal, when it's presented to you, or it's a typical, typical dog with a scabies, but with scabies, but. If the diagnosis isn't immediately obvious, then these cases require a more systematic workup, and that involves taking a history, thorough examinations, drawing up a list of differential diagnoses, and then working your way through that list with diagnostic tests and hopefully reaching a definitive diagnosis. So we're going to examine that in a bit more detail.
So In referral practise for us, history is really key, and, and not, it's not just for us, it's for, for anyone investigating pruritus or any skin disease come to that. History is really key to making the diagnosis. And just keep flicking them on, Antony, if you wouldn't mind.
So, I'll always start by talking, I take my histories in exactly the same way every time, varied a little depending on the presentation of the dog, but thank you, that's fine. But, . This history is very detailed, very thorough, as you can see, and probably takes me 15 minutes of the 1 hour consultation to go through with the client.
And by the end of that, 15 minutes or so, you know, usually you have a pretty good idea of the diagnosis, but clearly in first opinion practise, and I was in first opinion practise for For 15 years, I know what the limitations are, with a 10 minute or a 15 minute consultation, you clearly don't have time to go through all this, helpful as it is. So, next slide please. So I would suggest that, in a 10 minute consult, you know, that some key questions to ask with a pruritic dog would be, one, what age did it start with its signs at, with the pruritis at?
Because if it's a young dog. You know, you may well be thinking parasitic or allergic disease. If it's a dog that's 9, 10 or 11 years of age, then, you know, atopic dermatitis would be it would be extremely rare for that to to that disease to start in a dog at that age.
It's helped, helpful to know the distribution of the pruritus and the type of skin lesions. So, you know, which areas are affected? Is it dorsal?
Is it pedal? Is it ventral face? And I will specifically ask the client, does he rub his face?
Does he scratch his ears or shake his head? Does he chew his paws? Does he scratch his stummy?
Does he rub his bottom on the ground, and so on. So you get a good picture of the distribution of the pruritus, and that's very helpful from a diagnostic point of view. And if the dog has skin lesions, it's helpful to know whether the pruritus started before or after the onset of the lesion.
So if this was a pyederma and the dog developed a rash and then became pruritic, that's different to a dog that's pruritic, and without any lesions, and the, you know, the most likely thing there would be an allergic disease, and then develops a rash, which is probably a secondary ionoderma. And it's worth asking about contagion or zoonosis. Now these are not, you should never rule out ectopparasitic or fungal infections, for example, in the absence of contagion or zoonosis, but if it's present, it's a very helpful diagnostic clue.
OK? So that would be my 10 minute consult brief history. And then it's important to, to examine the dog, and, full physical examination is what we try and do whenever possible, and then examine the whole of the, the, the dog's skin and try and establish the general pattern of disease, as we've been discussing.
And also, are there lesions present and if so, what kind of lesions are they? So the lesion morphology. So, next one.
So I'll start by examining the dog's head and, and then keep flicking through underneath if you wouldn't mind. And then work my way down the legs and look at the paws and the nail folds and the interdigital skin, then turn the dog around and examine the dorsal trunk, and then turn the dog over and, roll the dog over and have a look at the groyne area and the axilla, and then finally the hind limbs and, the, the, the pores and the planar aspect of the pores between the digits. Very important to look at that.
OK, next slide. And we see common patterns of canine pruritis, so we'll see. The distribution with, with the the sort of typical atopic distribution where you have the face and the eyes and the ears and the, and the ventrum and sometimes the limbs, or we'll see sometimes dogs with dorsal pruritus, or we might see dogs with pedal pruritus, and so the dorsal lesions would indicate, could indicate kyletiella or fleas or a pyoderma over that area or deinex ini, those kind of diseases.
And pedal lesions often, represent, demidiosis or possibly harvest mites, pyoderma or malacasia, or an allergic disease. So, having examined, taken the history and examined the dog, we use all the information we have and draw up a differential diagnosis list. And it's helpful to, to write that down and work your way through the list.
And it's not gonna all probably all happen in one visit, but over a period of time. So initially, always firstly consider, could there be a parasitic disease. Could there be, is there evidence of infection?
Before you, we jump into the diagnosis of an allergic disease or some other much more obscure condition. OK. And then it's a case of working through your list of differentials, and the first thing is to, is that we'll usually do some basic tests for parasitic diseases and flea chroming.
And the wet cotton wool test, which we're all familiar with. It is helpful, if fleas are present, you may be lucky and, and find evidence. I like doing coat brushings where you brush the dog's coat onto a piece of paper.
You then fold the paper and tap it so the material falls down into the crease. You then examine that. Don't throw it away though.
Remove the hair and pick it up on a piece of tape, drag the tape across the surface of the paper, and then examine that under the low power light microscope. And you may see little fragments of flea dirt, these little ruby appearing. structures, and you might be, that might be the only evidence of fleas or things like kyletiello or lice.
So I find this coat brushing technique, a very useful one. OK. Don't worry about playing the movies here.
There's a movie of the skin scraping, but, there are, it might not go, I think, Antony, but don't worry. So there are indications for skin scrapings. So any disease where there's alopecia or papules or pustules or scale or commiones, then it's worth doing skin scrapes, clip the area.
Apply a small amount of liquid paraffin, squeeze the skin between your thumb and forefinger and scrape until you get capillary oozing, and then mount that on a slide under a cover slip, . And examine it under the light microscope. And as you can see from the diagram, it's important to examine the whole of the area under the cover slip.
And just examination under the x 4 objective is enough, and you see it, if you see something you want to look at in more detail then go up to the times 10. And then if any of these diseases, sarcoptic mange or chileosis or flea allergy dermatitis, are on your differential diagnosis list but not found on examination, then a therapeutic trial is indicated. And it's important to use an effective treatment.
And nowadays we're lucky because we have the isoxazolines, which are. Pretty broad spectrum, in effective treatments for many ectoparasitic conditions, and, and, they're, they're useful drugs, and I'm not going to say, we all have our favourites, but we use, we used to use and still do a lot of Cellemectin to rule out, ex-parasitic disease, but, imidochloride and moxidectin are also appropriate. It's important to consider whether it's necessary to treat in contact.
So if you suspect Kyletiella or you suspect fleas, and yes, it is. And, it would also be important, especially in those diseases, to treat the environment as well with, with an adult aide and, and in the case of fleas, and insect growth regulator. So, It's really, one of the, kind of hopefully the take home things tonight will be the, the diagnosis of infections.
It's really important to identify, infections when they are present. And we can diagnose the, the, yeast infections and bacterial infections on clinical signs, but also on cytology, and I apologise, these videos are probably not going to run, but, if you see a pustule as in the top right-hand corner there, don't waste it. You can gently open that pustule with a, with a fine needle and take an impression smear.
But if you haven't got pustules, don't worry, any crusty exuberive lesion is worth taking an impression smear from and staining and examining under the light microscope. Use oil immersion, to examine those, slides. And if we're looking for if, if we have a scaly or a greasy lesion, typically with, you see with malaysia dermatitis, then that's where the tape strip, technique is useful.
So let's have a look at some typical cytologies, and on the left here we can see this is a superficial pyoderma with this dog with the papules and pustules, and typically this is what you would see where you'll see neutrophils, you see some red blood cells, the orangey colour, non-nucleated cells, and in the centre there you can see a neutrophil that's phagocytosed, a whole lot of cockcoid bacteria, almost certainly staphylococci. On the right, and this shows up very well on my screen. I hope it does on yours too, is the dog with a bacterial overgrowth.
This is what you see with bacterial overgrowth. These large things that Anthony's highlighting here with the pointer. These are two keratocytes, right?
The, the, the sort of large flat thing, and on the surface of the keratocyte are all these little blue, cooid bacteria you have. You haven't got phagocytosis, you've just got a mass of bacteria. Adherent onto the surface of the keratinic site, and that's bacterial overgrowth.
And if we're treating these infections, you know, if you see evidence of bacterial infection. So. But there are very good shampoos, sprays, mousses, wipes available now, a whole range of things.
The important thing is, isn't frequently enough, and, and probably, you know, twice a week is not going to be enough to treat this sort of thing, you know, I usually will have the owner treat with this sort of lesion on a daily basis. It might not be, might be shampooed 2 or 3 times a week and then maybe a mousse or a wipe on the days that the dog's not shampooed. And, if we have to use systemic antibiotics, well, fair enough, but select antibiotics, wisely avoid the repeated use, try and identify the underlying cause.
I like the Swedish guidelines, which have been out for some years now, where they recommend initial topical therapy for 2 weeks, and if there hasn't been a response after that time, then consider the use of systemic antibiotics. Thanks. And then malacasia infections, I think everybody's familiar with what malacasia looks like, the yeast bodies look like, so I'm not going to labour that.
And I think people are also familiar with the treatment, so there are good shampoos, chlorhexidine, myconazole shampoos. Used 2 or 3 times weekly are known to be effective, and there are a range of wipes, creams, mousses, foams, and so on available now. And if necessary, systemic treatment, using, itraconazole or ketoconazole, can be used if necessary.
So, This, what, where we've come so far can be summarised in this diagram. So we, we, we have a pruritic dog. We take the history, we examine the dog, and we draw up a list of differentials, and we rule out parasitic diseases with our scrapes and our plucks and our trial therapy, and then we, we identify and treat infections, by doing cytology and, and perhaps culture, but certainly, therapeutic trials to rule out to treat the infection.
And if having done all that, the dog is still showing signs of prurituss and the history and the clinical signs are consistent with the diagnosis of atopic dermatitis, then we have a clinical diagnosis. And at that point, we would probably go ahead and do elimination diet trials and allergy testing, but the clinical diagnosis is made by those first three steps, the, the sort of orange one, the grey one, and the blue one, and the yellow step is, is really just finessing the diagnosis. So A clinical diagnosis of atopic dermatitis may be made in a case with compatible history.
So this is a young dog, probably, and clinical signs and where other diseases have been ruled out, just as we've been saying. And If you click on Anthony, that would be good. And, and history really is the key to diagnosis, as we've already said.
You know, the atopic dermatitis starts in young dogs. It's a disease that, that, that starts between in dogs between 6 months and 3 years of age, or the vast majority of cases, and typically this will be nonlesional pruritus, and very typically they are very steroid responsive. That's not necessarily a diagnostic test, but it's a historical clue, as it were.
And we've already said that some adverse reactions to foods are manifest as atopic dermatitis, and I would argue that an elimination diet trial is indicated in all cases of non-seasonal prurituss. So with the dog's pruritic all year round, it's worth ruling out food allergy. Food allergy is, is not a common condition, but it is an easy problem to control, and it's a pity to treat a dog for its life with drug therapy when a diet would be enough to control the symptoms.
It, it's very commonplace for people to use serology to try and diagnose food allergy, but there are now several studies that show that really in any individual dog, it's, this is not a useful diagnostic test. I'll just highlight the The, the one from veterinary dermatology there which was published in 2014, where they compared groups of dogs, several groups of dogs, dogs with atopic dermatitis, dogs with proven food allergy, dogs with other skin diseases, healthy dogs, and dogs with Other diseases that weren't involved in the skin, and the test cannot differentiate between those different groups of dogs. So We shouldn't really, there really is no substitute to using a, doing a proper elimination diet trial.
And, the sake of time, I'm going to go through this pretty quickly, but there are different diets that we can use. You can either use a novel protein diet, which is a protein the dog's not previously been exposed to, or you can use a hydrolyzed diet. And the recommendation now is if you're using a hydrolyzed diet, you want to use a diet.
Derived from a novel parent protein source. So if the dog has already been fed chicken, it's probably better not to feed a diet that is hydrolyzed chicken. So, try and feed a diet that can, as I say, that the hydroly food that derives from a novel parent protein.
We try and do diet trials for 6 to 8 weeks. We give owners written instructions so they know exactly what they can and can't do. We find that more effective than verbal instructions.
And it's important to control, maybe important to control pruritus during the diet trials, so we'll often give, You know, short courses of steroids or a supply of steroids, and the owner can give steroids for maybe 3 or 4 days, or you could use that placitinib if you want, but something just to give the dogs and the owner some relief without masking. Any effect, any improvement from the diet. And, if the dog does get better, then it's important to rechallenge with the original food and make sure that pruritis recurs, because the, the improvement may be due to other factors such as season.
Food trials can produce dramatic results, and in the top is a dog that was, diagnosed on the basis of serology actually for, with atopic dermatitis and treated with allergen immunotherapy for a year, and that's how the dog looked on the left. when I saw him, and then we put him on a diet trial and 3 months later, his hair had regrown and pruritus had resolved, and there's another case below, a sort of similar case with before and after the diet trial and you could see the improvement. So why do we do allergy testing?
Well, we do allergy testing not to diagnose the disease, but to identify allergens, principally. For the purposes of allergens specific immunotherapy, for desensitisation. To a certain extent it's also useful for allergen and avoidance, but the main reason is for immunotherapy.
These are not tests for atopic dermatitis. And I think there's still to a degree, an overreliance on these tests to diagnose this disease. if you could move on a slide, Antony, for those of you who are in any, need any convincing, really, there are lots of studies that show allergy testing, serological testing, or intradermal testing can be positive in many completely normal healthy dogs, and I've just picked out three studies here.
And, and it's just to, to really show and prove that, you know, you cannot use these tests to diagnose atopic dermatitis. The diagnosis is a clinical one, and this is really just to identify allergens for immunotherapy. So I've kind of been doing this for a long, oh sorry, Antony, could you go back?
Thank you. I've been doing this for a long time and I've read lots and hundreds and hundreds and thousands of case histories, case history printouts over the years, and you can see where problems arise, you know, and I think the pitfalls of diagnosis and prurituss are, it takes time. You often have to.
Go through this process over several visits and, you know, in large multi vet practises where different people are seeing the dog, that can prove difficult. So, You need to have a plan written down and ideally try and stick to it and it's best, I think if you can see your own case through from start to finish. It's important to manage to be a clinical scientist.
If a dog is very pruritic and you're doing a diet trial which might not make any difference to it, to maximise owner compliance, it's important to give them some way of managing the pruritus, as we've talked about. And identify, microbial involvement. So, you know, our cocker spaniel friend here with the Malaysia dermatitis won't respond to a diet trial if he still has this yeast infection.
So identify infections and treat them before moving on to the next step. And there is certainly still an over-reliance on serological testing, both for food allergies and also for, for environmental allergies for the diagnosis. Remember that these tests do not diagnose the disease.
It's a clinical diagnosis. And the last slide I have is just to show you this paper here, which I think is an excellent paper. It was published 3 years ago, 2 years ago now, and it reviews really beautifully the, the guidelines for the diagnosis, and allergen identification in canine atopic dermatitis.
It's free to download. You just Google guidelines, K9 atopic dermatitis, and you would find this, and it's a really nice review of what I've just been talking about this evening. So I'm sorry, I think we've probably gone over time with the shenanigans with my computer, so apologies for that, but I don't know if we have time for questions or not.
Yes, Peter, no problem. There is always time for questions and no, I think timing was, was just fine there, sorry that we had that little hiccup, everyone, but it to do with Anthony, that was entirely at my end. People, people used to have .
Have bulbs blowing on projectors and things didn't they, which wouldn't and and maybe sometimes you didn't have a bulb in your in your packet so . Anyway, we're all OK, we've sorted and, happy to take some questions. Perhaps while people are just thinking about questions, if perhaps just to, to show that you can get in there, do you want to either in the chat box or in the question and answer box, just say where you're listening in from, because it's always nice to know where people are, are listening in from.
So if you want to pop those in. From what part of the country or from other countries, pop them in and that will be, that will be great. And I think Joo has just put the link in for that article, so you can, you can all go into the chat box and see that.
So we've got Portugal, Cambridge, Edinburgh, Manchester, Teesside, Glasgow, Limerick, Suffolk, South Wales, Inverness, Germany, Wiltshire, South Africa, Denmark. Macclesfield, the Lake District, so lots of, lots of different places that people are listening in from. Where else have we got?
We got anywhere else exotic from France, which is great. Where else, let me just see. We have France, yeah, we've got Dorset, Manchester, all good.
Raquel is saying great talk, by the way, thank you very much and very clear. And then Maltraith, which I think is up your neck of the woods, isn't it? Is that right?
Or am I thinking of somewhere else? I, I think is it Wales? Is Maltraith Wales?
I'm, I'm, I'm recognising I've been there, but I'm not sure. So James, tell us where that is and County Antrim, Northern Ireland, Otto from, Otto from Austria. So we all know, well, at least Peter and I know who Otto is Otto is, so nice to hear you on the line, Otto.
OK, so we've got a couple of questions. If you suspect a dog is allergic to chicken, ah well, we've answered that question actually. Would you still use royal cannon and allergenic as a possible diet, as this is based on poultry feathers, that would be OK, would it?
Yeah, yeah, that's a good question actually, and I, I, that thought crossed my mind as I, the one exception with the hydrolyzed diets is probably an an allergenic in theory anyway, you know, . Because of the degree of hydrolysis of the food, it's smashed into such small pieces, isn't it, that we, we kind of think it can't be allergic, isn't it? I'd probably be comfortable with doing that, yes, yeah.
Raquel is saying, do you have any criteria to choose between glucocorticoids, Apaquel, or the new injection from Zoettis when it comes to stop pruritus. But I think it already is here, isn't it? We, you, you're already using that, yeah, that definitely is in.
Raquel, if you're not in the UK then obviously it, it may not have come yet, but, certainly it's available in the UK. It is. So my criteria, I suppose that's probably something that Andy might well cover next week and it's a bit off topic for this talk, but I'm happy to, to give you my quick thoughts on it and that is that, .
For me, it, you know, it's a, it's a multifaceted decision really. I, I, it, it's, based on a discussion, well, first of all, the dog itself, the, a discussion with the. Owner, and a full discussion of the pros and cons of each of the treatments.
And I don't usually decide. It's usually the owner that decides what they want to do, and most people, having been given the facts, will, will make a decision. So for some clients, cost is a factor, for others.
You know, a, a long proven track record where the, you know, it's been a drug that's been used for 15 or 20 years and been shown to be safe might be the most important thing. For another client, it might be that they really like the idea of a monthly injection. For other people it may be speed of onset or, you know, so every client has their own.
Preferences, and I think given time for discussion, they, most people are able to make an informed decision. So I don't have a favourite treatment. I'm just as happy to treat a dog with glucocorticoids, provided that dog.
Is well controlled and is not developing unacceptable side effects, as I am to treat them with cytopoint or cytosporin. So, it really, it, it's absolutely on a case by case basis. And I wouldn't say that in our practise, we use more.
Particularly of one type of treatment or another. Clearly, I, I, I think Apaquil has probably stolen the show over the last couple of years, and it is undoubtedly a very useful drug, but I'm sure that Cytopoint will also prove to be a very useful addition to the, the armoury. And I think the thing is, you know, I, I used to do lectures on, you know, steroids are very useful, but of course, some people don't use them correctly and abuse them, and then it's not a great medicine, so it's all about.
Using them at the right time and don't use them before you've made a diagnosis as well. A lot of the time. And these treatments, you know, as I, I, I hope I've kind of tried to make clear, you know, these treatments won't work very well in, in the face of this associated with infection.
You know, and, and, and you'll find, you know, you'll find that one often in a particular case, you'll often find that one drug works really well and another one not so well, and you sometimes you, you might have something and then have to switch to something else because the, because the effect is, is, you know, it's not effective enough. And also using drugs in combination, so, you know, shampooing will often help in combination with other things, won't it? So .
I, I'm worrying about my, mental, capacities now because of course Malraith is in Anglesey where I lived for a year. That's which is, which I knew I knew it, but I just couldn't quite place, so just in case people were wondering about that. And Rick has asked and Rick Queen Avond, another one of our dermatologists, so great to see so many dermatologists on the line.
Are isoxazolines effective to rule out Kaylatiella? Well, the truth is, I don't think we know, but, I, because actually I don't think there's any licenced treatment for kyleosis, and we can only go and publish evidence, and I don't think to my knowledge, and I might be wrong, but to my knowledge, I don't think anybody yet has published anything on isoxazolins and Kyletiella if I'm wrong, but I suspect that they probably will work OK. I mean, they are effective against.
You know, sarcoptic mange are effective against Demodex. I think OK for Kyla Tella. Do you see a lot of Kayla Tella up in, in your place up in Scotland?
I don't think it's as common probably as it used to be, is it because of the good quality flea product. Absolutely. We, we hardly see it at all now.
I I might see one case a year and actually typically I won't necessarily find mites on that dog. It'll be a dog that just has dorsal pruritis and I can't find mites, but responds to exparasitic treatment. So, .
Yeah, no, it's really an uncommon disease now. I, I don't know whether people in general practise see it more frequently. I suspect they might do, but we almost never see it now.
Yeah, if, if anybody is seeing it and tell us how, how often you're seeing it, perhaps again in the chat or in the question box. I, I think it, it used to be a really horrid disease to treat, didn't it? I remember people used to use saline for six weeks, and it was still there because of course they weren't treating the environment.
And then fipronil came about. I, I did a paper in JSA in the late 90s just on fipronil spray, and I think the fact that it was lasting for so long. You got a month out of it meant that you were killing those mites that otherwise were harboured in the house and could jump back on and be OK because New Van Top only lasted for a couple of days or whatever.
So I think the new products have kind of pushed it out a bit, haven't they? Yeah, no, definitely, yeah. And Right, OK.
Can you recommend any papers or articles from Hannah this question, which are helpful when choosing topical treatments for bacterial infections, such as foam, shampoos and wipes? Or do you want to just make a quick comment on that? .
I'm just I think that there are. There is a review in veterinary dermatology from, in fact, I have a feeling Andy Hillier was an author on that, but I might be wrong, on, it was a review of topical, therapy for the treatment of superficial pyederma, and it was published. I don't know, it's possible.
I can't, I, off the top of my head, I, I'd have to go online and Google it, but you'll, you or look it up in veterinary dermatology and probably from circa 2012, I think, and that was a pretty good review of the published evidence. Was it a Ross Bond paper? Sorry, Ross, if it wasn't one.
But, anyway, yes, there, there are those papers, but what I can tell you, I'm happy to tell you what we use, and I, we, we use a lot of. Chlorhexidine and myconazole. You know, that product, and then lots of, most of the wipes and sprays and mousses and shampoos have chlorhexidine or chlorhexidine and climbazole, and they seem to be in our hands, we've been very happy with, using those treatments to treat superficial pyoderma, but you, as I said in my talk, you do need to do them frequently enough.
So, you know, I, I kind of try and encourage clients from more severely affected cases to, to use them. Use something daily, but there, there, you know, there are papers that have shown that 3 times, 2 or 3 times weekly cohexidine shampoos are treating superficial pioderma, and then there are, you know, the bleach products, and we do use, . Bleach, and we do use diluted household bleach, to, to, as a rinse to treat superficial pyoderma as well.
I'm a bit reluctant to just to sort of give the concentration, but, in case I get that. Wrong or somebody writes it down wrong, but, it's cheap and, and certainly can be effective. So, you know, there are a number of things and then of course there's things like medical honey, which, we don't particularly much, silver sulphur diazine cream, .
So yeah, there's a number of different things, but the chlorhexidine, chlorhexidine, chlorhexidine, climbazole, chlooxidine myconazole are all effective treatments. Well, I think especially once we do see MRSP, you know, they are the treatments that we're using because of course it's, it's more and more difficult to use antibiotics. I think we do have a slightly more Responsible use compared with maybe some of the countries where, you know, many different antibiotics are used, triple treatment and all this kind of thing.
And you know, we are using a lot more shampoos in those MRSP cases, which thankfully, we don't see quite as often as perhaps some of the countries do. Surprisingly common actually and Anthony, we, you know, there's hardly a week goes by that we don't see we're an MRSA now, and they nearly are all they're in our clinic you're seeing more MRSA. Yeah, they're, they're dogs that have been treated, they're often atopic dogs that have just had repeated treatments with antibiotics, you know.
Yeah, I know, it's interesting, and, you know, I think what we're, it's all about this 10 day course that that with some steroids, where the dog looks a lot better, you know, the client doesn't bring the dog back and then a month, 6 weeks, it's happening again. I mean, it's a, it's a huge area, we could spend a long time talking about antibiotic resistance. I mean, we've certainly done webinars on it, if, if people are particularly interested, but if you're not particularly interested, you should be, because of course, Well, this is only going to be a problem that I think will increase and it's so important, you know, you're hearing Peter talking about reduction in.
Antibiotic usage because we've, we need to be as sensible as possible in, in using the antibiotics, don't we, Peter? We do. And, and really, I think you'd be surprised for anybody who kind of feels the compulsion to reach for systemic antibiotics with superficialiodermas, you'd be surprised how effective is, you know, I, I, it's, I don't even think now about reaching for an antibiotic.
We, you know, we, we use a shampoo or a wipe and I. And I also think most clients, or a lot of clients now, and you get all kinds of clients and even in referral practise, but, you know, most clients are aware of, heard about the problem of antibiotic resistance and are keen to avoid that happening and they're and they're happy, most of them, the vast majority. You're happy to put in the work using topical treatment, which is much easier now with the mousses and the sprays and the wipes compared to having to shamp, you know, to do a couple of times a week shampoo and use something else on the most of them have to do that, undertake that.
And You know, are you finding that once, let's say you do that for, you know, 4 to 6 weeks, are you then carrying that on unless you, you know, you've, you obviously are looking for the underlying cause, but is, is that something that you will then stop using? Because of course, there is some evidence of chlorhexidine resistance as well, isn't there? Yeah, there's much, much less.
Yeah, yeah, yeah. Yeah, so typically what we would do, you know, if, if the dog presents with a superficial pyoderma, we'll treat it, I'll get the dog back in 2 or 3 weeks. Usually for superficial infections, they're usually resolved within that time, or lastly resolved.
And then, you know, we'll be, we'll be working the dog up and trying to identify which developed the infection and managing the underlying cause, commonly atopic dermatitis, of course. But once the infection is under control, then typically we might have a dog, the owner, carry on doing a weekly bathing programme, you know, or using a shampoo once a week and a wipe or a mousse once a week. And sometimes these can be in folds and things.
Are you also, you know, given the fact that you're presumably not using as much antibiotics, you're presumably not doing as much culture and sensitivity then? We, we do a fair bit of culture and sensitivity, because we like to know what it is we're dealing with. OK.
So if we kind of suspect, you know, if a dog comes in, it's had, you know, recurrent pyerma, we'll, we'll culture those ones, even though we don't necessarily treat them with systemic antibiotics because we like to know if it's a, it's an MRSP infection because there are implications for that, you know, and, . And certainly we'll do cultures if we're, you know, wherever we can, we'll do cultures for, if we're using systemic therapy. Yeah, sure.
Yeah, I think it, it's. I mean, I, I'm not gonna say we do that every time, Anthony, a lie, but you know, if the dog, if it's the first presentation, the dog's not had recurrent oderma and the, you know, you see cockoid bacteria. On cytology, yes, then we might still use empirical, you know, tier one antibiotics in that circumstance, you know.
But, but treating it adequately at the beginning is the big thing, isn't it? Because if you have treated or treat it with a lower dose than you should do, that's when you start ending up with problems, isn't it? We still see that, you know, on the.
Optimal, you know, some data sheet doses of Dogs 25 kilogrammes, but it's going to be expensive, so we do it as a 20 kilogramme dog. Well, as a 10 kg. Yeah, yeah, OK.
And James is coming back from, from Anglesey saying, where should we put the blue plaque? Sorry, but haven't got the budget for the statue just yet. Because I lived in Anglesey for a year, so I, I thought it was a very funny joke.
But just, you can do something like, what, what is it, you've got all these, fundraising sites now, just, just get your finger out, James. Anyway, moving on to more important things. Anne said, when left with a presumptive elimination diagnosis of atopic dermatitis.
Would you always aim to select intradermal testing over serology for immunotherapy? I have some clients that are keen to go for it, but I often bypass. Serology so as not to waste money and refer for IDT.
OK, so It's a common question. It, it's still. The intradermal testing is still considered the gold standard for identification of putative allergens, you know, and that's because atopic dermatitis, the target organ in atopic dermatitis is the skin, and that's what you, what you're testing when you do your skin test is you're testing for the presence of IgE antibody in the skin.
But if you're in a clinical situation and you don't have access to intradermal testing and referrals not an option for intradermal testing, but you want to do something, there's absolutely nothing wrong with doing serology, but you should look at the results of the serology and make sure they correlate with the dog's history. So if the dog has non-seasonal prurituss, And the serological test shows up a few reactions to grass pollens, that probably doesn't make, that doesn't correlate very well. And I wouldn't be confident using those results to formulate an immunotherapy treatment.
But if it does correlate well with the dog's history, then, you know, and you, you're confident with your diagnosis and you've ruled out everything else, then. For sure, you know, use that to formulate an immunotherapy set and, and be confident in what you're doing. No, that's great.
We have, I'm just finding this, I've gone past this, . Couple of people saying they've rarely seen, Kayla Tella, and mainly in rabbits rather than in, rather than in dogs. Jess has said been graduated 8 years, never seen Kayla Tella in the dog.
Sandra was saying, only seen it in rabbits. Shona, mostly in rabbits, odd puppy from a farm breeder. Where I suppose they're outside and it's, it's much more likely.
. Charlotte is saying, how long do you do a therapeutic trial for parasites for? OK, that's a, that's a good question. So if you suspect yosis, then I, I, you know, I'll try and do.
For 6 weeks, and probably in reality, that's how long we should be doing trials for fleas as well, ruling, ruling out flea allergy, you know, it can take time to eliminate a heavy flea burden or a heavy flea infestation. In fact, there's an argument for doing it even longer than that. If it's, if it's sarcotic mange, probably a month is, is enough, you know, to get an idea of the dog pruritus might not have resolved, but it should have been significantly improved during that.
So, you know, 4 to 6 weeks for parasitic disease would be a a reasonable. And, and I suppose with fleas, if you think it's part of the conundrum of the itch, you know, they, they are the allergic dermatitis flea by hypersensitivity, you, you may argue to. Keep that going, you know, fairly consistently, especially if you're living down south and it's a, it's a bit warmer than Bonny Scotland.
Yeah, yeah, actually fleas, we've seen more fleas this this autumn than for for a few years, but it's a pretty uncommon thing for us to see. Yes. Jenny is saying great talk to build confidence with cases.
They can be quite daunting having just graduated this summer. So I hope you've, I'm glad you've enjoyed that, Jenny, and, and keep up the faith, it's a. It's a fantastic, discipline, I think, isn't it, Peter?
We're also friendly dermatologists. Yeah, absolutely. We're not like those surgeons, are we, Peter?
We're not, no. Hopefully, no, I shouldn't, I've got some good friends of sewer surgeons, so I better not say anything. They won't be on, they won't be on.
Don't worry about it. No, I, the thing I was gonna say about dermatology is it's a very. Logical subject, you know, and it's a, it's a, you know, it's, it's all about process and if you skip that kind of process, you won't go far wrong and it doesn't really matter what kind of disease it is you're, you're dealing with, it's the same kind of basic process.
And none of it's terribly, you know, well, at a certain level it can be very complex, but on a clinical level, none of it's terribly complicated, you know, it's just, but it is just being methodical and logical. Yeah, Thomas is saying great session, mighty talk, and Thomas is from one of my favourite places in Ireland, from Killarney. Have you been to Killarney, Peter?
No, I've never been to Killarney. To, Southern Ireland yeah, Kerry or Where was I? Limerick and Kerry is a fantastic place, the Ring of Kerry, great, and of course the Tralee is all around there and, and Fungi, the, the dolphin when I last went, was still there, so well worth considering for the summer holidays and glad you're, you enjoyed the talk, Thomas, .
We've got, I, listen guys, this, the good thing about webinars is you can slink out of the lecture theatre and none of us will know, but most people are staying, but me and Peter could be here till midnight because we love dermatology. I think he'll get bored of me before I get bored of him anyway, so we'll, we'll carry on for a little bit if you're OK with that, Peter, yeah. Yeah, so feel free to leave.
I mean, before perhaps people do all leave, I think we should say thank you very much to Zoettas for making it possible. It's, You know, it's, it's a very interesting new product that they've got that we're going to be talking about next week, but obviously they're very significant company in the dermatology world with, Well, I think they do steroids as well. They've obviously got strongholds, so there's lots of products there that have, have made a big contribution.
I remember being one of the guys who was testing out, Stronghold for, for scabies. And of course scabies is just one of those diseases, Peter, that you don't want to To miss, it's always an embarrassing consult if they've come in having spent hundreds and hundreds of pounds on skin testing and on, you know, atopic type vaccines when you scrape and find a scabies mite, isn't it? I know we must always rule that out, I think.
We don't see many of them, don't see many of those. It's all good. It's all good.
It's just embarrassing. When you see the, the occasional one. Konstantinos got a really interesting question listening in from Greece, has said, do you think that skin barrier products are helpful?
I wonder if that's the Konstantinos, I think it is. Do I think they're helpful? That's.
A good question, . For those of you kind of maybe kind of less familiar with that whole concept, you know, part of the pathogenesis of atopic dermatitis is thought to be an impairment of skin barrier function, which means that irritants and allergens, and probably microbial, peptides and so on, all. All manner of things that can irritate and inflame the skin, penetrate the skin more easily than they should, and water leaks away from the skin surface as well, and dries the skin out, which, will, exacerbate or could feasibly exacerbate pruritus.
And there are different reasons and, you know, genetic mutations that can be responsible for. Impairments of skin barrier function. So there is a move, and, and anybody who's been an eczema sufferer will know that, you know, part of the treatment in people is slapping on masses and ollients to improve your skin barrier function.
And of course, because our patients are so hairy, then we tend, you know, it's probably been the side of things that has been neglected. And I, I think there are certain breeds where, dry skin is quite evident. I mean, thinking of the Labrador retriever, the atopic Labrador has a dry dorsal scaling, and, you know, certainly in that circumstances, I, I might well use a one of the kind of ceramide and, lipid products that, will, that you, they can be spot on treatments that you or, that will, you know, the idea of being to improve skin barrier function.
So, but they're only ever going to be, at least for the type of cases that we see, they're only ever going to be an adjunctive. And I think the thing is that We have to consider cost and it's very easy to add in all manner of treatments and not be sure whether they're doing very much or not. And, and I'm never particularly comfortable with that.
And one of the problems with these products for improving skin barrier function is we really don't yet have any good controlled studies that have shown efficacy, but they are certainly something to think about, and we do some, I do sometimes use them. It was interesting. I was at ESPD a couple of years ago, and I think they had the human doctor who was saying, you know, definitely they've made the, the link with the skin barry in humans, but there's no absolute.
Definite evidence, to look at that, although I know I did see some good work done by Fairback which was showing a normalisation of the skin barrier after applying, you know, one of their products. So it's . It was a, yeah, I mean it's an interesting area, isn't it?
Yeah, it is. There was a study a good few years ago actually which looked at applying, I can't remember which product it was now to Atopic Westies. The results were.
Pretty spectacular, too. Ariel, talking about emollients and adding things in and things. I work at the PDSA and have quite a few clients using Sudocrem on their pets.
It is harmful. We've, we've had lots of clients use Sudocrem over the years, and it used to be one of the things that we recommended if we were trying to get a dog off steroids for long enough to do intradermal testing before we had cyclosporin and not placeinib, then we would often, we often had clients supplying Sudocrem to excoriated areas, and I've never ever seen a problem with it. Great.
And, and many clients remarked that it definitely seemed to help soothe the, the inflamed areas. Christiane is saying there is the suspicion that oloitinib can induce pioderma. What is your experience?
And then as a secondary, which you can answer separately, are flavoured tablets allowed during elimination diets? So, I'll answer the second one first. no, we try and avoid flavoured tablets during elimination diets, if at all possible.
And. Yeah, the, the. Oh, I'm just trying to, there was .
Recite a point, there were, you know, there was a suspicion of increased incidence of pyoderma, but actually when you looked at the figures, it was very, very small, you know, and I think the same goes for Apaquil, and I have to say clinical experience with Apaquil, I don't think we see particularly increased incidences of pyoderma in dogs treated with Aquil. We have seen. 2 or 3 cases of dermadiosis, that I haven't seen, I think clinical impression is that we don't see an increased incidence of, of pyoderma.
I think it's with that, but I, I mean, I think it's, it's a case of it. Sometimes people Don't recognise the ioedema and therefore don't treat it, do they? And that could also be a problem, I would guess.
Yeah, no, I think that's probably true. but no, I mean, I, I would. I think, I think that, that, that's very true actually, Anthony, yeah.
I remember seeing a dog that was on cyclosporin and, you know, it had an extremely deep pyderma. I mean, I don't know quite because I obviously only saw it on the day I saw it, but, you know, it was clear that this was a dog who needed antibiotics rather than cyclosporin, and it wasn't helping its condition, but exactly if that had contributed how much it was. Difficult to know because of course you only see it on the day that you, you see it, don't you?
Yeah, I mean, I, I don't with Apaquil I, I, I don't worry about dogs developing pyodermas when I use Apaquil, and if I had an ectopic dog that that. Had a history of recurrent pyederma that wouldn't put me off using well if Aperol was an appropriate therapy for that dog. Great.
I'm, I'm thinking that we're running out of questions. Martina, this is the problem now where we can't all retire to the bar and have a pint together because we're on a webinar, but a virtual pint is OK if anybody wants to have a virtual pint, or they may have a pint with them now, you know, while they're listening, or a glass of wine, but, we probably can't join in that. But Martina is saying, thank you so much for this webinar greetings from Poland.
Angela Webb, thanks for lots of reminders. So, thank you. We always like you to remember to come, but of course, we are recording it.
So, people, if you, if you think it will be useful for others, do tell them about it. They can go on the website and they'll get a link to, to send them to the right place. Darryl's saying, thank you for the great chat, and Anna is saying, thanks for the webinar greetings from Swansea.
So there we go. We'll finish with, we'll finish with that. Again, Peter, thank you so much.
I always love listening to you. You're such a great speaker. I think you've seen from, from all the comments that you can't hear the tumultuous applause, but, there's been plenty of people saying positive things.
And of course, wouldn't be possible without, the help of, of Zooetters. So, thank you so much to Zuettas as well. And of course, next week, we've got Andy Hilliers's going to be talking all about, This very exciting new monoclonal antibody that they've brought out, you may not have it in your country, but I think it is around in the UK.
Pete's been using it. It'll be fascinating just to see what Andy's take on it is as well. And he is a great speaker.
Really, first. Yeah, no, Andy's very good, isn't he? So, thank you so much, everyone, and for those of you holding.
On for questions and hopefully I'll see you next Tuesday. Will you be coming on, Peter, to have a little listen to what, I might, yeah, so we, we may pull you in and get you into the questions well, but don't, don't, don't worry if you can't make it. But thank you very much, everyone, and looking forward to seeing you all next week.
Bye bye. Thanks, Anthony. Thanks, Peter.
