Good afternoon and thank you for joining me in this lecture about no dermatitis. It is a pleasure to talk about this disease that is very common in small animal practise in our days. This presentation will allow you to diagnose and understand this challenging disease.
With the diagnosis, you will be able to decide for the appropriate treatment and understand the rationale behind the treatment choices available nowadays. So let's start. First we are we are going to talk about the dog and then second, we'll talk about the cat.
Now let's understand a bit about the dog. Microbiota on the skin, the microbiota. Before, we thought that the most common spec species was melas pachyderm, because in the past we are using cultures to identify the Mela.
Now, in nowadays we have molecular technology and molecular technology allows us to, identify the species in a much more variable way. And now we know that the most common species in the dog skin is Mela melas Toria. So that's the higher number, followed by melas, pa Ma and then in and a smaller in a lower number will have noia gluba.
And it's, I this is the the skin of a completely healthy dog. Now what happens in a dog that is allergic even if the dog doesn't have, the patient doesn't have any lesions. We know that an allergic, patient will will have what is called a dy biosis because it has an ongoing, inflammation.
Even if it's only microscopically it has an ongoing inflammation which allow, allow to change the numbers of a mola the species of mola. So we will have in the this this biosis which in fact is characterised by a higher number of molas pachyderms compared to a lower number of melas Globus MC a restrictor. Now, this means that, multi thepay dermatis will be, will be the most abundant species in the non allergic skin.
So we have what we call a di a This bio at this bio with loss of diversity, and this biosis along with the defects of the skin barrier that are, common and are present on the skin of an at topic dog. Plus, the chronic inflammation will predispose these patients to the molas. dermatitis.
In fact, this is the oldest will worsening. Will make the defect of the skin bar get worse and also will make increase the inflammation of the skin. So everything taken together, we will have a melas derma clinically derma physio dermatitis with inflammation of the skin.
More inflammation or meshes overgrowth. Not much inflammation. And we can also have anaesthesia Arthritis.
OK, so now we understand more about the, how does this relation happens now? We also know from the past that, the most, that they are breeds that are predisposed to mostly the dermatitis and that includes West Highland White area, the English setter shu But the American cocker spaniel Boxer Dutch Dutch house be between, amongst other breeds. So the breeds will depend many times on The area of the world is located the practise because we know that the breeds vary between countries.
Now we are so if we need this biosis to, have, mo, moly pyti proliferation. That means that we have a concurrent disease. So we have an underlying disease for this problem.
OK, that's it. Most of the time, we are looking to, to allergic patients. We are looking to patients that have at topic dermatitis or allergies to the, environmental, allergen and or allergies to the food.
So, a food allergy. Oh, so allergic patients are number one the number one, cause behind the mela dermatitis or the skin. Already, there is also a possibility that the patient that is not allergic but will have defects on cornification or endocrinopathies or potentially any disease can cause, proliferation of the meia due to the fact that it, interferes with the, with the skin microbiota.
Now, in the past, we, we used, to say that, folds can be by themselves, a predisposing factor for the development of melas overgrowth. Locally. Now, there is a more recent, publication, in dermatological problems of brachia dog.
And they have found that messia. In fact, when the melas is on the phone, it tends to be secondary to the fact that the patient has at topic dermatitis or food allergies or less likely sis or deny for a so, in fact, what we can take from here is that we if we have a brachy poly patient, That is, Having recurrent nohesi overgrowth on the fold. We should look, check if the if this patient has an underlying disease for and may be common, we will find again an allergic problem.
OK, so how are we going to recognise the, clinical, signs of mederma? Tis now one common or one Common, sign is without any question is pedal Piso So will say he leaks and he licks his feet. And this pedal PPOP can affect the front limbs, the hind limbs, all of them at the same time.
And this little breed of RS normally is associated with erythema between the digits as we can see here in the first picture and also sometimes the presence of a brownish, cyberia, between the digits. The hair might become stained with a brownish colour. In fact, some, the erythema can become quite se it can become quite severe.
And the patient, will lick and lick the feet. And that's very when when you look at the patient that have these clinical signs, it's important that you do a skin pathology, which is the way to do the diagnosis, as you will. as we are going to see in a few minutes.
OK, going on with the clinical signs? We, another clinical sign that can cause also lots of feet leaking is melas paraic. And in this case, Melas is on the ned and will stain, the clo with a reddish brown staining.
Again, the patient will leak most of the time. In my experience, the NAYIA is associated with the Intell digital melas for growth. But I have seen cases where we only have melas paran.
So make sure if you, when you examine the, the feet of your patient, make sure that you look at the nails and look at the nail bed going on to another area of the, to another area of the body. The VM. The VM can be the vent.
Fromm. The Acela can be, localised areas affected by melas dermatitis. And as you can see here, this patient is, affect unilateral.
This has been already going for a few weeks. We can see not only the urethra, but also the hyperpigmentation, and he has been leaking specifically just that. Part of the vru donor was able to notice that and again, the skin psychology will help us.
No. Another area where we can find where we can find the anaesthesia. Proliferation is the in the anus.
Anal area or perianal area for anal will be a common complaint. The owner will say that he licks, he, his anal area or rubs against, against the floor. So, when you, have patients that are somehow they are leaking?
Also check for malasa apart from your your other differential in, in this area of the body and many times the mother city will come with again with Eisa. No time goes by and sometimes go go by with melas dermatitis the skin will develop hyperpigmentation skin will become dark and along with the upper pigmentation, we will have like an application like an application. Due to the fact that the stratum cord will be thicker, the tal part will be thicker and along with the time more and more a CAC odour will come from the skin will come from the skin, and normally and again the donor will notice that.
So we can see here in this in this picture that this patient has been with me dermatitis according to the history for more than one year. And we can see these chronic changes, with, the like unification hyperpigmentation. Still some here, some erythema on the border, But we can see very prominent.
These prominent chronic changes. Well, speaking about chronic changes, this one is the ver we have the application of the skin. It's a generalised.
. A generalised distribution for this dog has been like this. This patient has been like this already for for a very long and all the skin.
. Changes will increase in the skin. Mark.
We will see in these very chronic cases. So normally, this patient, they are, very critical. You know, speaking about diagnosis, I already talked to you about, cytology.
Cytology. Skin cytology is by far by far the number one, the one diagnostic technique that you should use that we use to diagnose melas on the skin. Skin pathology is very easy to do in general practise as long as, you have Normally we use, this quick sting, and a microscope for the most common methodology for in, psychology is to use a type strip, and it has to be a clear and good quality type strip that will make your life easier.
And electric strip is very easy because you apply the type between the digit very easy to do. You will apply on the fold, or you can use it in any area of the body. Now, once you have your the material in the centre of your type strip, you can you, put the top of the type street on the microscopic slide and then put it on the, on the stain so this will be free to be stained.
And you, in this case, if you're using a thread strip, you don't use the FT. You don't use the you don't need to use the first one. Or you don't.
You need to use the second one. Just use the last one. The last one during normally the, the producer of the this week will take something like 15, seconds to stain it.
So just use the U, wa the blue one and then wash it and put the tape on the microscopic side. Now, if you're not using a test strip, you can do an impression smear using the, flying directly the microscopic slide on the skin. And in this case, then you use the full this quick thing because you need the fixative to fix the material on your slide.
So and again following the instruct the instructions of, of the manufacturer of the, of your product now. So you have your sample already and you're going to, look at the mm yes, your psychology using, the immersion oil objectives and the emission oil objective, allows you to have a semi quantitative, a semi quantitative, a evaluation of your material. So use that to be quantitative because it has been shown that, the reproducibility, between the different observers when they different people look up at the same psychology is not 100% self.
The best way to do it is to do, a scale of zero for which is zero says no, bacteria is inflammatory cells. So because you can use this not only for yeast, but also for bacteria and inflammatory cells. So this classification, in our case, we are looking at B mees.
So if you looking for me, it will be no presence of yeast. One was occasional yeast that, that are present. But the SP still needs to be scanned carefully for detection.
Two plus about low numbers, but detectable rapidly without difficulties. A three plus you have used in the larger numbers and you can get easy detects. And a four plus is amazing, basic amount of yeast.
So, in real life, you have might have just occasionally That's a one plus. And again don't book only to one. Field.
You're going to look at several, at several fields. At least 10. You're going to have have a two, plus here with all numbers of melas, three plus larger numbers.
And then that's a four plus with massive numbers of yeast. Now. So that means that you if you follow this, this scale, which is published, you will get used to have a scale a scale.
And that's important not only for the diagnosis, but also for assessing the efficacy. The ey of your treatment now. So for the diagnosis will do you look only to the you look only to the psychology.
No. You need to be aware that five that the number of Nouria will organisms depends on the breed On the anatom anatom anomic outside, there are areas like inter agility where there is more moesia naturally than a healthy dog. So for a dog with me.
So look at the anatom anatomical side. Look at the bleed. Some methods also make a difference and host iun status.
So when I'm going to make your diagnosis is that you base your decision based on the history compatible clinical science and psychology. So you have most on your psychology and also, by evaluating and interpreting your psychology at the light test history and clinical sign, you will be able to decide which is the best treatment. And now, in our days, it is, the approach we'll do, an approach that treat what you see and decide the best treatment for your patient, not only by looking at the psychology, but by looking at the clinical case No many times with meals.
Yeah, we will have, also start to the intermediate and that to remediate as we know, lives a part of of the of the microbiota of the healthy dog skin can also, have biotic on the allergic dog. But, more recently has been, suggested in in the that's in human medicine. Then the few hawkers can have potentially, it is like, so who is, an enterprise.
So a commercial relationship with meia. So this means that these two mark organisms can potentially help them help help themselves, help the, among two different ways, But it can help them to, to overgrow. So if we have higher numbers of melas in real life, this means that if we have higher numbers of meia potentially, we'll also have an antibiotics with higher numbers of ST Intermediate.
And the other thing is that the media with higher numbers of TIMS, potentially you can have at the same time Melanesia overgrown, and this happened again in a topic. I've seen this, in a topic station where we have both micro organisms in high numbers, both microorganisms populating the skin and con and making it worse. The skin barrier and contributing, to the worsening of the inflammation and of the pruritis.
Look at this. Look at this. Do skin.
It is this dog. The skin is very spoiled. And he has been, the problem has, already, already some time.
No maleia. We also have it. It's possible also, to have maleia maleia IGECCTPT and maleia IGECCTPT is characterised by the presence of production of IgE against maleia.
And this, And clinically this ITE against noshes. Yeah, might cause by itself, because it's an allergic reaction. Skin inflammation and psoriasis, even with low number of melas.
I think this is happening, in, in normally in the topic dogs. And, also, it has been published that at topic dogs, when they have melas sensitivity. Normally, this these patients, in this patient is a topic patient.
This mela sensitivity is associated with health. The mite sensitivity now, does the noshes P in that MITI increases the prevalence of how the mite hypersensitivity due to interference in with skin barrier. That's the question, because nohesi definite, contributes for worsening of the skin barrier.
So again, we are looking here at a topic dog. Now, how do you check for the presence of ITE? It is possible to check for the presence of IG by intradermal skin test, but that's not very common.
Using in general practise the easy way will be to do virology testing against IG. Depending on the lab, you can get different different methodology. So put and variable results.
But if you know that there is IgE against polycystic derma molas pyti potentially it is potentially it is possible to use immunotherapy and we only have against this micro organism. So we are not treating the melas dermatitis here. Be aware of that.
We are here. We are here approaching the presence of melas IgE with immunotherapy. And this, there is a study or with, a study with immunotherapy W which they it was observed that, a bit more than a half of the patients about 65 56% of the cases is a small study only with 16 cases, they showed reduction of the antifungal and anti-inflammatory or anti-inflammatory medication and pruritis score when, immunotherapy against another CT were used.
No adverse effects were reported in this study. No. OK, so let's go back to our topic to our, patients with melas dys with melas dermatitis.
The one that we done. We have the compatible clinical sign. We have compatible history.
We have a positive skin cytology with lower or higher numbers of melas. So we need to do something about that. And so So we are going to start the treatment, and the very first thing we are going to think is about tropical treatment.
In fact, tropical treatment can be, the only treatment that is used in many cases. We need to see OK if it is generalised localised, severe mild case, but, the priority. It's always for the topical treatment.
So I'm going to, to start by talking about basic. We know that basing is effective against molasses, and it has been shown that basing with shampoo, with chlorine at 2% and miconazole at 2% it is effective if used if it is used twice a week during three weeks. The there is also evidence of efficacy for a chloroxine shampoo.
Or if it used twice a week now, bearing in mind that the CHLOROXINE is effective against, mela at this at this concentration, a smaller study and more, recent study. We have, tested a silver based shampoo. This is only an open study with 14 dogs.
Now, there is another study, of, a study with emollient bathing and this I emollient bathing a heavy aim not only to control the moly numbers, but also to improve the skin barrier by applying cleansing oils before the, the shampoo, which was the Imo shampoo. And then after bathing with the shampoo, the patient would receive a moisturiser. And in this study, they compared the two bathing method method.
So this method with the oils and followed by shampoo and then moisturising and they compared the, the two, the two, methodologies. Compare this with, 2% chlorine and miconazole shampoo. And they, and the investigators reported a difference in the lesion.
Scheme a decreased in the lesion scheme. with the emulate bathing after four weeks So, there was a statistical difference between the two groups and the emollient bathing had less skin vision? No, we can bathe and again depends on the area of the body.
Or we can wash it. Just, localised. For example, between the digits.
If it's not a city between the digits, you don't need to wash. No need for the, patient to have a full bath, but another way to, to clean, treat anaesthesia. Topically is by using pets WiFi and fluoxetine.
And it has been shown that you use daily pets so clean daily with, this pet with work that has Ayro and Forex in at 3%. They, are effective in reducing the number of noia as we can see in the picture. The number of noia in seven days and that number maintains very low.
If they sort so then effective. This is an individual study not, so individual study with cleaning wipes, policing wipes with chloroxine zinc gluconate, climbs sole and trees, ETA and again effects that showed in Vito efficacy against Mela dermatitis. Mela Pyatt Story is not in vitro and a sta kill intermediate.
And we have here another product to use topically, which is, a concentrate. And this Concentrate. This, concentrate is applied, on the skin.
It's a concentrate with zinc. And it has been shown in a split body protocol. Which one?
14 was treated with this product and it has been shown that in two weeks factory effectively reduces the east count. If the, the treatment with this didn't concentrate is done, is done, daily? No.
We also have another, product. It's a Nobel, tropical spray. And again, this will depend on the country.
A Nobel tropical spray with botanical, oil that again in the sleep body protocol showed efficacy. So one again is an in vitro. in vivo study.
Sorry. In vivo clinic, it's a clinical study, and this product has composed of sodium vate alcohol and botanical oil that are E effective against meia. again.
And it's applied and has been applied inter digitally. Now, his, there is now a trend to look at, as we can see. Avoid the antifungal or you and use potentially nonconventional.
Alternative. Like honey. I ha I've done myself a work lab.
Work with a honey honey based shell or manua honey POY oil lacto extra soft blends Lizin and pharmas Ole. So there is lots of investigations are going on. No, As I said, the priority.
It's always, to our topical treatment. And, it is possible if it, if the owner can do it. And if the patient tolerates well, the topical treatment, Well, it is possible that we don't need, systemic treatment.
But in some cases, we will need systemic treatment. And for the systemic treatment we can use, itraconazole econazole is effective against malas. The, normally, we can be used, given once a day, or it can be used as a P therapy with two days of treatment.
Two days, five days without treatment. without treatment. Econazole, as you know, is, safer, than, econazole again, the era or the Keto Conal availability will depend on the country where you are.
But you, if both of the regimes has been shown to be ef, to be, efficacy to have efficacy against the meia. Now, if we are going to choose ketoconazole. But occasionally the ketoconazole.
Has. You know, it can be producing vomit or diarrhoea. Potentially ketoconazole, can induce liver injury.
So, make sure that you monitor liver enzymes, before the treatment. And then during the treatment, it has also been reported one case of erogenic hypo adrenal cortices that results after stopping the treatment and one case report of temporary male infertility. No, There is another azole molecule, that we can use and that molecule is fluconazole.
And, a very recent study has shown that, fluconazole compared fluconazole with Hero conazole. And there was a comparison with three groups. One group received glucon fluconazole at the dose of five milligrammes per kilo and a second group.
You, received the dose of 10 milligrammes per kilo. And a stem group received the dose of five milligrammes per kilo of itraconazole. And these are the time, the the mean, east count.
During the treatment, and as we can see two weeks later, that's day 14. And Day 28 there was a substantial re, reduction on the, on the mi, mis count. In all groups.
There was substantial reduction clinically, statistically sign, Significant from day zero to after two weeks or after four weeks. So, in fact, and also this study, it's, a study that you can access online. And it's a study that shows that fluconazole is effective in both dosage and both dosage, can be effective.
Also, head effective, he hero conazole. Finally another antifungal drug turbine thaine it, it belongs to another group. Pair of antifungals, as we know and turbinen has been reported to C can be used once a day or in P therapy.
Also, check for, liver enzymes. But it thin. We need, pro.
We need clinical studies, in order to evaluate properly the effi, the efficacy and the potential side effects of this drug now, regardless the treatment that you are using If it's topically or topically ansys Don't forget. Don't be aware that if you systemically, it's important also to use. Still use your topical treatment.
You need to monitor. You need to monitor the treatment. Normally, the best way will be to see the patient in two weeks, and then in later on in four weeks.
And what you want to see is a clinical remission of Le Associated with decrease in the numbers of, Melas in your psychology. The numbers should, decrease substantially. Might be you might be hard.
You might still be seeing an occasional melas Stasia, because again, you know, that is, It's part of the microbiota, so but a lot. But you always have to interpret again your, cytology by and looking at the clinical signs at the lightest of the clinical signs. But look at all of your patients.
I do wonder if the patient is still operating and monitor with psychology. Now, sometimes the things are not He, are not easy. And, it might happen that, melas is producing biofilm and the biofilm is a pro is a protection against and and against antifungal and environmental aggression.
So the NIA will be, protected from the, from the antifungal again the topical treatment is here very important to clean the skin if there is biofilm. Another problem that has been reported in the literature. Although it's, antifungal resistance.
Although most of the wild moesia is remain susceptible to a author. So we have in fact, occasional reports of chic failures of mala melas Amati with as well as And therefore now it is prudent, to see to use more topical and be aware that potentially potentially frequent and lengthy treatment might, induce resistance to question. But it's, Now we are, it's important to do a prudent use of this antifungal.
OK, so now we are going to go to the last part of this presentation and the last part is about kids. Now, kids also have microbiota and the most prevalent prevalent yeast are melas restricted and Mela Globo that they also have Melanesia, other species of Melanesia, including fluffy por Nana Ayer Matis There Syd Allis, Jonni AUSA and Yamato Yamato Ensis. So there's a quite a diversity here and very interestingly, it has been published that, depending on the cat breed, as you can see, the number of mola and we are talking about all species of mola.
The number of molasses varies between in different breeds and the demon or is the one if you look here to the P? Column, the 700 is the ones that tend to have higher number of yeast in, in the microbiota. So we are looking here at healthy, cats.
And we are also, looking here to, the study also demonstrated that the number of yeasts the defence varies between different areas of the body. So this way there is variation between the, the the mouth nostril high number of mouths, the grind beer, canal and the dorsal. Now, again, conc multi dermatitis.
This biosis is much less common in the cat compared to the dog, although again in honour, in order to happen this this biosis or there is there are concurrent diseases. So there's something wrong with that skin, and most of the time they are allergic. Many times they are allergic patients.
The, cell skin folds are also published in the LA To has been a predispose predisposing factor as well as cases of idiopathic facial dermatitis in the, Persian and Malayan feline pancreatic perineoplasty alopecia. And in cases of thymoma associated Expo dermatitis. So be aware.
Be careful if there is an older cat with most dermatitis that never had any kid problem. potentially can be a neo an, neoplasia at the underlying cause now it is. In fact, was a young cat a a young cat about one year old.
And this cat was pic very freaky in the, around the, eyes. As you can see in the muscle itself, All the muscle has a brownish, material typically of anaesthesia. Skin, has erythema was inflamed?
Cat was, in discomfort. His well is again very anal area. And the cat was being kept already for monthly in the collar.
It's very easy even here on the eye to do a skin again. Skin cytology with a tape and see, check if there are moles. They do, in fact, a lot.
This was a young cat FL F, FA V. Positive. No.
Treated these patients, cats. We are most of the Times again. We are using the same topical treatment because we know that topical treatments Most of them are approved to be used, in the cat.
Well, again, depending on the country and always look at your, your laws and legislation, but it's, in the case Also has been according to the guidelines, it its the itraconazole has been advocated. Have the drug that, the drug of choice again, it's effective. It's safe.
Given once a day or it can be used used in the psychic regime with seven days on on treatment, seven days without treatment. And so this patient received the treatment. And it's for two months later, the no more Paris.
No more colour, the skin looking doing much, much better. Happy cat. And, I had the opportunity to also to see, stop the treatment, Of course.
And then just that the the client just keep the skin clean. Come here. And the dog.
The cat. Sorry. Came four months later.
And a happy and normal cat. Having a happy life and happened that, I have seen I've seen this patient one year later and the patient was still doing perfect. Now, sometimes what happens is that we can treat moles, molas dermatitis, dog or cat.
But we treat it, 100% but it comes back, I need to come back. Oh, we have what we call the rla. And we know we have a relapse.
We really need to look at the underlying cause. It means that we haven't diagnosed or we haven't. Monitor treated the underlying cost.
And so we have to control the disease. And most of the time now we have here many times we have here have been no allergic patients, and so therefore, that it might be necessary. If the Melas is relaxing and relaxing, it will need that.
We need to do something about that melas, about the atop dermatitis, or we need to We need to make a diagnosis. We need to put, and we might need to, put in the, treatment a long term treatment, for example, if it's for topic dermatitis, OK, if it is a dog with food allergy or dog or cat with food allergy again. We need to make a diagnosis.
And, make sure that we are feeding the patient with the right diet. In the long term, and by avoiding by treating these, underlying causes, we will normally avoid the me the relapse of the melas dermatitis and the same thing will apply to melas. Poti.
If we you want to use, . You want to prevent the relapse? Go on, Go for topical, treatment again.
Topical treatment can be used habitat for treatment or for the long term, prevention. Like, for example, the topic dog can be back once a week, to avoid meia and dermatitis. I do that, Commonly, along with the proper, control of the at topic dermatitis.
So finally, I just want to say that messia, dermatitis is the disease that, it's a disease that is common. It's a challenge, but you can do the difference for the patient and for the owner. In nowadays, we have good treatments, effective treatment, Di, and, you can make your diagnosis in your practise.
So it's something that I it is. You can help your patients by pre thinking with this disease with efficacy. Thank you very much for assisting this Webinar.
I'm located in Lisbon. And once again, thank you for assisting.