As you undoubtedly know and have experienced in your daily work, ICF has believed in the importance of topical products for over 30 years, presenting a wide range of shampoo formulations and solutions to be used for the specific needs of dogs and cats with skin barrier alterations.
Today, shampoo therapy is increasingly talked about as a more than valid alternative to antibiotic therapy, thanks also to articles such as the one published in the Veterinary Dermatology Journal (Effectiveness of a combined (4% chlorhexidinedigluconate shampoo and solution) protocol in MRSand non-MRS canine superficial pyoderma: arandomized, blinded, antibiotic-controlled study, Borio S., Colombo S., La Rosa G., De Lucia M., Damborg P., Guardabassi L., Vet Dermatol 2015; 26: 339-e72). This article shows that in the course of superficial pyoderma, topical treatment with shampoo and solution with 4% chlorhexidine (Clorexyderm Shampoo 4% and Clorexyderm Solution 4% ICF) is equally effective to systemic treatment with Amoxicillin+Clavulanic Acid.
This is precisely why we asked two colleagues, Chiara Noli, ECVD graduate (European College of Veterinary Dermatology), current president of the scientific committee of the ESVD (European Society of Veterinary Dermatology), author of numerous articles in national and international journals and scientific texts and Irina Matricoti, Resident ECVD, to prepare a specific text dedicated to this topic, full of information, bibliography and insights that we are sure will meet your interest.
Enjoy your reading!
SHAMPOO THERAPY
Therina Matricoti, DVM, ResECVD and Chiara Noli, DVM, DipECVD
Introduction
Shampoo-based therapies have become extremely important in veterinary medicine over the last ten years. Shampoos are used not only for cosmetic purposes, but also as therapeutic tools in many dermatological conditions, such as bacterial or fungal infections, allergies, keratinisation abnormalities or other desquamation problems. They are available on the market today in a variety of formulations, and the choice of treatment will depend on the pathological condition, the desired effect and the goal of therapy.
As a general rule, shampoos should remain in contact with the skin for at least 10 minutes before being removed. The contact time allows the active ingredient to perform its action and the water to rehydrate the stratum corneum. Most shampoos usually state on the label the minimum contact time required for that specific product.
The frequency of treatment depends on the type of shampoo used and the type of pathology the clinician is treating. In the case of skin infections, twice-weekly application is the best compromise between owner compliance and shampoo efficacy. More frequent application or a combination of daily disinfectant solutions is advisable if topical therapy is used as the sole treatment of superficial pyoderma. In the case of kerato-seborrhoeic disorders, the frequency of application is variable and should be modified depending on the results and severity of the pathology.
Surfactants (washing, foaming and conditioning agents) and other agents such as softeners, preservatives and 'degreasing' agents are present in shampoo formulations. Surfactants are molecules with a lipid tail and a hydrophilic head. In water, they can form micellar structures that trap slag and lipid residues, facilitating their elimination. Veterinary shampoos are formulated with different surfactant combinations in order to combine good cleansing properties and topical tolerance. Indeed, dog and cat skin is more sensitive than human skin to topical treatments because it has a stratum corneum thinner, a more alkaline skin pH and greater follicle density, which may facilitate the penetration of active agents through the skin.
Depending on their function, shampoos are classified as: antibacterial, antifungal, antipruritic/anti-inflammatory, emollient/detergent, anti-parasitic and anti-seborrhoeic. Some agents, however, have multiple effects. For example, benzoyl peroxide is both antibacterial and anti-seborrhoeic, chlorhexidine is active against bacteria and yeasts; emollient and cleansing shampoos have a weak anti-itching action and are mostly used in the case of allergic conditions. Only the agents most frequently used in veterinary dermatology are listed below.
Antibacterial shampoos
Antibacterial shampoo is mostly used in cases of cutaneous pyoderma. It can be used as a support or even in a therapy for superficial folliculitis, acute moist dermatitis, pyoderma of the skin folds or impetigo. In the case of deep pyoderma, it is recommended to be used together with an antibiotic treatment selected on the basis of the sensitivity test. In recent decades, researchers have paid great attention to the antibacterial function of certain agents due to the dramatic increase in methicillin-resistant staphylococcal infections. Fortunately, today antibacterial shampoos represent an effective alternative therapeutic approach in cases of superficial pyoderma, especially in cases where systemic antibiotics are ineffective or potentially toxic. Antibacterial shampoo contains antiseptics such as benzoyl peroxide, phytosphingosine, ethyl lactate, glycoproteins, antimicrobial peptides and chlorhexidine. The latter is one of the most frequently used agents in clinical practice, both because of its efficacy and the general lack of side effects associated with its use.
The chlorhexidine has bactericidal activity against Gram-positives and Gram-negatives. Chlorhexidine destroys bacterial cell membranes by inducing bacterial shedding. It is commonly used in veterinary dermatology in concentrations between 2 and 4%. From a study in vitro It appears that a higher concentration (3-4%) has faster bactericidal activity than higher dilutions (Lloyd 1999). In clinical trials, however, both formulations are reported to be equally effective against Staphylococcus pseudointermedius, the main cause of pyoderma in dogs (Murayama 2010, Loeffler 2011). In practice, chlorhexidine-based shampoos are commonly used in all cases of pyoderma. In addition, a 4% chlorhexidine shampoo has been shown to be effective as sole therapy in cases of superficial methicillin-resistant staphylococcal pyoderma (MRSP) when used twice a week in combination with a daily application of a 4% chlorhexidine solution (Borio 2015). This highlights the importance of topical therapy to reduce the use of systemic antibiotics, offers an alternative therapy in case of MRSP and supports the current recommendations to use antiseptics as sole therapy in case of superficial skin infections.
Antimicrobial peptides (AMP) natural ones are a large group of proteins secreted by the skin of vertebrates, with a protective action against microorganisms. They have the role of recognising and attacking viruses, bacteria and fungi. In the case of bacteria, the peptides adhere to the surface and form pores in the cell membrane, leading to lysis of the microorganism. They also play an important role in immunity, as they promote the selection and accumulation of various immune cells in the skin. In addition to their bactericidal activity, AMPs inhibit the emergence of resistance. Indeed, in order to become resistant to AMP, bacteria must change their basic structure and these mutations would lead to their death. Recently, a new shampoo containing synthetic antimicrobial peptides was launched on the market. The product showed rapid and complete antimicrobial activity against a panel of bacterial and fungal strains involved in canine skin infections. It is certainly a very promising product in clinical practice, capable of contributing to the reduction of systemic antibiotic use (Ghibaudo 2016).
Benzoyl peroxide is an antibacterial agent that also has antiseborrhoeic properties due to its keratinolytic and keratinoplastic effect. It is metabolised by the skin in the form of benzoic acid and oxygen. Benzoic acid inhibits epidermal proliferation and sebum production (keratolytic effect), while oxygen radicals cause oxidation of bacteria (Lloyd 1984; Young 2012). It is commonly used in the 2.5% concentration, although it may be irritating, especially in higher concentrations. It should not be used on cats. Benzoyl peroxide also has strong degreasing activity through inhibition of sebaceous gland activity, especially at concentrations above 5%. Excessive dryness of the skin may occur and a moisturising balm may be required after each bath. Dogs with dark hair tend to "discolour", especially black dogs may acquire a red/brown colour. For these reasons, its main use is in cases of seborrhoeic diseases, particularly in cases where the skin is oily or if the animal has follicular plugs (cylinders), follicular cast (follicular keratinisation defect), or comedones.
Ethyl lactate is metabolised into ethanol and lactic acid by bacterial lipase in hair follicles and sebaceous glands. Ethanol solubilises lipids and lactic acid reduces the pH of the skin, resulting in a bactericidal effect. It appears effective, however, only at higher concentrations (above 10%) (Young 2012) and there is still some controversy regarding its recommendation in clinical practice (Muller 2012)
Anti-seborrhoeic shampoos
Anti-seborrhoeic shampoos are used to manage different seborrhoeic disorders and keratinisation alterations. They generally contain multiple agents with a keratoplastic and/or keratolytic effect. Keratolytic agents remove excessive desquamation by reducing the cohesion between corneocytes and softening the stratum corneum. Keratoplastic agents act on the basal cells of the epidermis, 'normalising' skin turnover and the keratinisation process. The most commonly used agents are sulphide, salicylic acid, benzoyl peroxide, selenium sulphide and propylene glycol.
Salicylic acid and sulphur shampoos are used effectively in many seborrheic disorders, such as dry seborrhea, sebaceous adenitis, ichthyosis, dermatosis of the auricular margin and superficial pyoderma with dry exfoliation. Salicylic acid and sulphur both have keratoplastic and keratolytic, as well as anti-itch and bacteriostatic activity. The keratolytic action of the former is due to the lowering of the skin's pH, which results in the hydration of keratin and the growth of the stratum corneum. In the case of sulphur, the keratoplastic action is mediated by the cytostatic mechanism, while the keratolytic and antiseptic actions are due to the formation of hydrogen sulphide and pentatonic acid. Salicylic and sulphuric acid are usually present in equal proportions, generally 2% (Muller 2012; Ghibaudo). Sulphur/salicylic acid shampoo is the only antiseborrhoeic product that can be tolerated by cats and can be used effectively on feline patients with oily seborrhoea, feline acne or stallion tail.
The selenium sulphide is a keratoplastic, keratolytic and degreasing agent. The keratoplastic action is mediated by reducing skin cell turnover, while the keratolytic action is mediated by disrupting the formation of hydrogen bonds within keratin filaments. Good results have been reported in primary idiopathic seborrhoea in Cocker Spaniels. Veterinary shampoo with selenium sulphide is not registered in all countries. A selenium sulphide formulation with 2% chlorhexidine and 2% miconazole is registered in some countries and is indicated for the treatment of oily seborrhoea complicated by Malassezia or bacterial infection. When treating dry seborrhoea or after treatment of oily seborrhoea with degreasing agents, the use of balm containing emollient or hygroscopic agents is indicated.
Propylene glycol is a hygroscopic (wetting) agent with a high molecular weight that is incorporated into the stratum corneum and attracts water. It has antiseptic, lipid-solvent and keratolytic properties and contributes to the penetration of other medicines into the skin. It is used for its hygroscopic effect at a concentration of 20%. Higher concentrations (up to 75%) are used when strong keratolytic properties are required, e.g. in cases of sebaceous adenitis.
Antifungal shampoos
These products are recommended as sole therapy in cases of localised or mild Malassezia dermatitis. In cases of dermatophytosis their use should always be considered as a support to systemic therapies (Moriello 2004).
Miconazole on the cytochrome P450 of fungal elements and inhibits the synthesis of ergosterol, triglycerides, phospholipids, chitin and oxidative and peroxidative enzymes. All these changes disrupt numerous yeast membrane functions, leading to the accumulation of hydrogen peroxide that kills fungal cells. Miconazole is available at a concentration of 2% combined with chlorhexidine 2% and is recommended in cases of Malassezia dermatitis, to be applied twice a week for at least 3 weeks (Bond 1995; Mason 1995). Similarly, chlorhexidine alone at 3% or even lower concentrations appears to be largely effective against Malassezia (Jasmin 2003; Pasquetti 2010). Other azole-based solutions are also recommended as an adjunct to systemic therapies in cases of dermatophytosis and in these same cases should not be used as the sole therapy. Lime Sulfur, enilconazole and miconazole have antifungal activity in the treatment of dermatophytosis and are generally used twice a week until culture negative (Moriello 2004).
Anti-itch and emollient shampoo
The preferred shampoos for patients with allergies and itching are those containing humectants/emollients such as colloidal oats, glycerine, fatty acids, sodium lactate, epilobium, coconut or other vegetable oils. These products are formulated to moisturise the skin surface, increase skin water content by reducing trans-epidermal water loss (TEWL), restore the lipid barrier and remove allergens from the skin (Löflath 2007).
Colloidal oats is used in various shampoos for its anti-inflammatory and anti-itching effects. It strengthens the skin barrier function through its antioxidant action.
Epilobium ha attività anti-irritante, anti-infiammatoria e antiossidante. Uno dei componenti bioattivi presenti nell’Epilobio è l’enoteina B, un polifenolo che può modulare direttamente le risposte cellulari. Vari componenti della specie Epilobio sono stati utilizzati in medicina umana per trattare una varietà di malattie, come eczema o rosacea. In dermatologia veterinaria è un componente di uno shampoo che, in un trial clinico, ha dimostrato di essere efficace nella riduzione di eczema e prurito in cani con allergia (Ghibaudo).
Pest control shampoo
Antiparasitic shampoos are rarely used and, unlike topical and systemic parasiticidal agents, have no residual activity and are therefore inadequate for long-term control of fleas and ticks.
Conclusion
In conclusion, shampoo therapy in veterinary medicine has multiple applications, especially in reducing the systemic use of antibiotic, antifungal or even anti-itch medicines. The use of antibacterial shampoos must be considered the first approach to superficial pyoderma in order to rationalise the use of antibiotics and avoid the emergence of multi-resistant bacteria. Anti-seborrhoeic shampoos represent the most popular therapy in cases of keratinisation alterations or flaky dermatoses. Finally, shampoo must always be considered as part of a multimodal approach to the allergic patient in order to relieve itching and restore the damaged skin barrier. The treatment protocol must be designed individually for each patient, depending on the active agents, the animal's response and the owner's compliance.
References
Bond R, Rose JF, Ellis JW et al. Comparison of two shampoos for treatment of Malassezia pachydermatis-associated seborrhoeic dermatitis in basset hounds. J Small Anim Pract 1995; 36: 99-104.
Borio S, Colombo S, La Rosa G et al. (. Effectiveness of a combined (4% chlorhexidine digluconate shampoo and solution) protocol in MRS and non-MRS canine superficial pyoderma: a randomised, blinded, antibiotic-controlled study. Vet Dermatol 2015; 26: 339-e72.
Ghibaudo G, Santospirito D, Sala A et al.In vitro activity of a commercial otological solution containing a novel antimicrobial peptide on 30 clinical isolates of Pseudomonas aeruginosa from canine otitis. Abstract P69 in the Abstracts from the 8th World Congress of Veterinary Dermatology, Brussels 2016.
Ghibaudo G. Efficacy and tolerability of Ermidrà® shampoo against itchy and erythematous dermatitis in dogs. ICF Bulletin
Ghibaudo G. Efficacy and tolerability of Zincoseb® shampoo against canine keratoseborrhoeic disorders (clinical study of 20 cases). Proceedings of the 25th Annual Congress of the European College and the European Society of Veterinary Dermatology, Brussels, 2012.
Jasmin P, Schroeder H, Briggs M, Last R, Sanquer A. Assessment of the efficacy of a 3% chlorhexidine shampoo in the control of elevated cutaneous Malassezia populations and associated clinical signs (Malassezia dermatitis) in dogs. Proceedings of the 19th Annual Congress of the ESVD ECVD, Tenerife, 2003: 170
Lloyd DH, Lamport AI. Activity of chlorhexidine shampoo in vitro against Staphylococcus intermedius, Pseudomonas aerginosa and Malassezia pachydermatis. Vet Rec 1999; 144: 536-7
Lloyd H, Reyss-Brion A. Le Peroxyde de benzoyle: efficacite cli- nique et bacteriologique dans le traitement des pyodermites chroniques. Prat Med Chir Anim Comp 1984; 19: 445-449
Loeffler A, Cobb MA, Bond R. Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. Vet Rec 2011; 169: 249.
Löflath, A, Voigts-Rhetz V, Jaeger K. et al. The efficacy of a commercial shampoo and whirlpooling in the treatment of canine pruritus-a double-blinded, randomised, placebo-controlled study. Vet Dermatol 2007; 18: 427-431.
Mason KV, Atwell RB. Clinical efficacy trials on a chlorhexidine/ miconazole shampoo for the treatment of seborrhoeic dermatitis associated with an overgrowth of Malassezia pachydermatitis and coccoid bacteria. Proceedings of the 12th Annual Congress of the European College and the European Society of Veterinary Dermatology, Barcelona, 1995: 222.
Moriello K A. Treatment of dermatophytosis in dogs and cats: review of published studies. Vet Dermatol 2004 15: 99-107.
Mueller RS, Bergvall K, Bensignor E et al.. A review of topical therapy for skin infections with bacteria and yeast. Vet Dermatol 2012; 23: 330.
Murayama N, Nagata M, Terada Y et al. . Efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma. Veterinary dermatology 2010; 21: 586-592.
Pasquetti M, Gallo MG, Ghibaudo G et al. Use in-vitro activity of two products containing chlorhexidine against malassezia pachydermatis. Atti 10° Congresso Nazionale FIMUA Milano 2010.
Young R, Buckley L, McEwan N et al. Comparative in vitro efficacy of antimicrobial shampoos: a pilot study. Vet Dermatol 2012; 23: 36-e8.
Shampoo therapy
As you undoubtedly know and have experienced in your daily work, ICF has believed in the importance of topical products for over 30 years, presenting a wide range of shampoo formulations and solutions to be used for the specific needs of dogs and cats with skin barrier alterations.
Today, shampoo therapy is increasingly talked about as a more than valid alternative to antibiotic therapy, thanks also to articles such as the one published in the Veterinary Dermatology Journal (Effectiveness of a combined (4% chlorhexidinedigluconate shampoo and solution) protocol in MRSand non-MRS canine superficial pyoderma: arandomized, blinded, antibiotic-controlled study, Borio S., Colombo S., La Rosa G., De Lucia M., Damborg P., Guardabassi L., Vet Dermatol 2015; 26: 339-e72). This article shows that in the course of superficial pyoderma, topical treatment with shampoo and solution with 4% chlorhexidine (Clorexyderm Shampoo 4% and Clorexyderm Solution 4% ICF) is equally effective to systemic treatment with Amoxicillin+Clavulanic Acid.
This is precisely why we asked two colleagues, Chiara Noli, ECVD graduate (European College of Veterinary Dermatology), current president of the scientific committee of the ESVD (European Society of Veterinary Dermatology), author of numerous articles in national and international journals and scientific texts and Irina Matricoti, Resident ECVD, to prepare a specific text dedicated to this topic, full of information, bibliography and insights that we are sure will meet your interest.
Enjoy your reading!
SHAMPOO THERAPY
Therina Matricoti, DVM, ResECVD and Chiara Noli, DVM, DipECVD
Introduction
Shampoo-based therapies have become extremely important in veterinary medicine over the last ten years. Shampoos are used not only for cosmetic purposes, but also as therapeutic tools in many dermatological conditions, such as bacterial or fungal infections, allergies, keratinisation abnormalities or other desquamation problems. They are available on the market today in a variety of formulations, and the choice of treatment will depend on the pathological condition, the desired effect and the goal of therapy.
As a general rule, shampoos should remain in contact with the skin for at least 10 minutes before being removed. The contact time allows the active ingredient to perform its action and the water to rehydrate the stratum corneum. Most shampoos usually state on the label the minimum contact time required for that specific product.
The frequency of treatment depends on the type of shampoo used and the type of pathology the clinician is treating. In the case of skin infections, twice-weekly application is the best compromise between owner compliance and shampoo efficacy. More frequent application or a combination of daily disinfectant solutions is advisable if topical therapy is used as the sole treatment of superficial pyoderma. In the case of kerato-seborrhoeic disorders, the frequency of application is variable and should be modified depending on the results and severity of the pathology.
Surfactants (washing, foaming and conditioning agents) and other agents such as softeners, preservatives and 'degreasing' agents are present in shampoo formulations. Surfactants are molecules with a lipid tail and a hydrophilic head. In water, they can form micellar structures that trap slag and lipid residues, facilitating their elimination. Veterinary shampoos are formulated with different surfactant combinations in order to combine good cleansing properties and topical tolerance. Indeed, dog and cat skin is more sensitive than human skin to topical treatments because it has a stratum corneum thinner, a more alkaline skin pH and greater follicle density, which may facilitate the penetration of active agents through the skin.
Depending on their function, shampoos are classified as: antibacterial, antifungal, antipruritic/anti-inflammatory, emollient/detergent, anti-parasitic and anti-seborrhoeic. Some agents, however, have multiple effects. For example, benzoyl peroxide is both antibacterial and anti-seborrhoeic, chlorhexidine is active against bacteria and yeasts; emollient and cleansing shampoos have a weak anti-itching action and are mostly used in the case of allergic conditions. Only the agents most frequently used in veterinary dermatology are listed below.
Antibacterial shampoos
Antibacterial shampoo is mostly used in cases of cutaneous pyoderma. It can be used as a support or even in a therapy for superficial folliculitis, acute moist dermatitis, pyoderma of the skin folds or impetigo. In the case of deep pyoderma, it is recommended to be used together with an antibiotic treatment selected on the basis of the sensitivity test. In recent decades, researchers have paid great attention to the antibacterial function of certain agents due to the dramatic increase in methicillin-resistant staphylococcal infections. Fortunately, today antibacterial shampoos represent an effective alternative therapeutic approach in cases of superficial pyoderma, especially in cases where systemic antibiotics are ineffective or potentially toxic. Antibacterial shampoo contains antiseptics such as benzoyl peroxide, phytosphingosine, ethyl lactate, glycoproteins, antimicrobial peptides and chlorhexidine. The latter is one of the most frequently used agents in clinical practice, both because of its efficacy and the general lack of side effects associated with its use.
The chlorhexidine has bactericidal activity against Gram-positives and Gram-negatives. Chlorhexidine destroys bacterial cell membranes by inducing bacterial shedding. It is commonly used in veterinary dermatology in concentrations between 2 and 4%. From a study in vitro It appears that a higher concentration (3-4%) has faster bactericidal activity than higher dilutions (Lloyd 1999). In clinical trials, however, both formulations are reported to be equally effective against Staphylococcus pseudointermedius, the main cause of pyoderma in dogs (Murayama 2010, Loeffler 2011). In practice, chlorhexidine-based shampoos are commonly used in all cases of pyoderma. In addition, a 4% chlorhexidine shampoo has been shown to be effective as sole therapy in cases of superficial methicillin-resistant staphylococcal pyoderma (MRSP) when used twice a week in combination with a daily application of a 4% chlorhexidine solution (Borio 2015). This highlights the importance of topical therapy to reduce the use of systemic antibiotics, offers an alternative therapy in case of MRSP and supports the current recommendations to use antiseptics as sole therapy in case of superficial skin infections.
Antimicrobial peptides (AMP) natural ones are a large group of proteins secreted by the skin of vertebrates, with a protective action against microorganisms. They have the role of recognising and attacking viruses, bacteria and fungi. In the case of bacteria, the peptides adhere to the surface and form pores in the cell membrane, leading to lysis of the microorganism. They also play an important role in immunity, as they promote the selection and accumulation of various immune cells in the skin. In addition to their bactericidal activity, AMPs inhibit the emergence of resistance. Indeed, in order to become resistant to AMP, bacteria must change their basic structure and these mutations would lead to their death. Recently, a new shampoo containing synthetic antimicrobial peptides was launched on the market. The product showed rapid and complete antimicrobial activity against a panel of bacterial and fungal strains involved in canine skin infections. It is certainly a very promising product in clinical practice, capable of contributing to the reduction of systemic antibiotic use (Ghibaudo 2016).
Benzoyl peroxide is an antibacterial agent that also has antiseborrhoeic properties due to its keratinolytic and keratinoplastic effect. It is metabolised by the skin in the form of benzoic acid and oxygen. Benzoic acid inhibits epidermal proliferation and sebum production (keratolytic effect), while oxygen radicals cause oxidation of bacteria (Lloyd 1984; Young 2012). It is commonly used in the 2.5% concentration, although it may be irritating, especially in higher concentrations. It should not be used on cats. Benzoyl peroxide also has strong degreasing activity through inhibition of sebaceous gland activity, especially at concentrations above 5%. Excessive dryness of the skin may occur and a moisturising balm may be required after each bath. Dogs with dark hair tend to "discolour", especially black dogs may acquire a red/brown colour. For these reasons, its main use is in cases of seborrhoeic diseases, particularly in cases where the skin is oily or if the animal has follicular plugs (cylinders), follicular cast (follicular keratinisation defect), or comedones.
Ethyl lactate is metabolised into ethanol and lactic acid by bacterial lipase in hair follicles and sebaceous glands. Ethanol solubilises lipids and lactic acid reduces the pH of the skin, resulting in a bactericidal effect. It appears effective, however, only at higher concentrations (above 10%) (Young 2012) and there is still some controversy regarding its recommendation in clinical practice (Muller 2012)
Anti-seborrhoeic shampoos
Anti-seborrhoeic shampoos are used to manage different seborrhoeic disorders and keratinisation alterations. They generally contain multiple agents with a keratoplastic and/or keratolytic effect. Keratolytic agents remove excessive desquamation by reducing the cohesion between corneocytes and softening the stratum corneum. Keratoplastic agents act on the basal cells of the epidermis, 'normalising' skin turnover and the keratinisation process. The most commonly used agents are sulphide, salicylic acid, benzoyl peroxide, selenium sulphide and propylene glycol.
Salicylic acid and sulphur shampoos are used effectively in many seborrheic disorders, such as dry seborrhea, sebaceous adenitis, ichthyosis, dermatosis of the auricular margin and superficial pyoderma with dry exfoliation. Salicylic acid and sulphur both have keratoplastic and keratolytic, as well as anti-itch and bacteriostatic activity. The keratolytic action of the former is due to the lowering of the skin's pH, which results in the hydration of keratin and the growth of the stratum corneum. In the case of sulphur, the keratoplastic action is mediated by the cytostatic mechanism, while the keratolytic and antiseptic actions are due to the formation of hydrogen sulphide and pentatonic acid. Salicylic and sulphuric acid are usually present in equal proportions, generally 2% (Muller 2012; Ghibaudo). Sulphur/salicylic acid shampoo is the only antiseborrhoeic product that can be tolerated by cats and can be used effectively on feline patients with oily seborrhoea, feline acne or stallion tail.
The selenium sulphide is a keratoplastic, keratolytic and degreasing agent. The keratoplastic action is mediated by reducing skin cell turnover, while the keratolytic action is mediated by disrupting the formation of hydrogen bonds within keratin filaments. Good results have been reported in primary idiopathic seborrhoea in Cocker Spaniels. Veterinary shampoo with selenium sulphide is not registered in all countries. A selenium sulphide formulation with 2% chlorhexidine and 2% miconazole is registered in some countries and is indicated for the treatment of oily seborrhoea complicated by Malassezia or bacterial infection. When treating dry seborrhoea or after treatment of oily seborrhoea with degreasing agents, the use of balm containing emollient or hygroscopic agents is indicated.
Propylene glycol is a hygroscopic (wetting) agent with a high molecular weight that is incorporated into the stratum corneum and attracts water. It has antiseptic, lipid-solvent and keratolytic properties and contributes to the penetration of other medicines into the skin. It is used for its hygroscopic effect at a concentration of 20%. Higher concentrations (up to 75%) are used when strong keratolytic properties are required, e.g. in cases of sebaceous adenitis.
Antifungal shampoos
These products are recommended as sole therapy in cases of localised or mild Malassezia dermatitis. In cases of dermatophytosis their use should always be considered as a support to systemic therapies (Moriello 2004).
Miconazole on the cytochrome P450 of fungal elements and inhibits the synthesis of ergosterol, triglycerides, phospholipids, chitin and oxidative and peroxidative enzymes. All these changes disrupt numerous yeast membrane functions, leading to the accumulation of hydrogen peroxide that kills fungal cells. Miconazole is available at a concentration of 2% combined with chlorhexidine 2% and is recommended in cases of Malassezia dermatitis, to be applied twice a week for at least 3 weeks (Bond 1995; Mason 1995). Similarly, chlorhexidine alone at 3% or even lower concentrations appears to be largely effective against Malassezia (Jasmin 2003; Pasquetti 2010). Other azole-based solutions are also recommended as an adjunct to systemic therapies in cases of dermatophytosis and in these same cases should not be used as the sole therapy. Lime Sulfur, enilconazole and miconazole have antifungal activity in the treatment of dermatophytosis and are generally used twice a week until culture negative (Moriello 2004).
Anti-itch and emollient shampoo
The preferred shampoos for patients with allergies and itching are those containing humectants/emollients such as colloidal oats, glycerine, fatty acids, sodium lactate, epilobium, coconut or other vegetable oils. These products are formulated to moisturise the skin surface, increase skin water content by reducing trans-epidermal water loss (TEWL), restore the lipid barrier and remove allergens from the skin (Löflath 2007).
Colloidal oats is used in various shampoos for its anti-inflammatory and anti-itching effects. It strengthens the skin barrier function through its antioxidant action.
Epilobium ha attività anti-irritante, anti-infiammatoria e antiossidante. Uno dei componenti bioattivi presenti nell’Epilobio è l’enoteina B, un polifenolo che può modulare direttamente le risposte cellulari. Vari componenti della specie Epilobio sono stati utilizzati in medicina umana per trattare una varietà di malattie, come eczema o rosacea. In dermatologia veterinaria è un componente di uno shampoo che, in un trial clinico, ha dimostrato di essere efficace nella riduzione di eczema e prurito in cani con allergia (Ghibaudo).
Pest control shampoo
Antiparasitic shampoos are rarely used and, unlike topical and systemic parasiticidal agents, have no residual activity and are therefore inadequate for long-term control of fleas and ticks.
Conclusion
In conclusion, shampoo therapy in veterinary medicine has multiple applications, especially in reducing the systemic use of antibiotic, antifungal or even anti-itch medicines. The use of antibacterial shampoos must be considered the first approach to superficial pyoderma in order to rationalise the use of antibiotics and avoid the emergence of multi-resistant bacteria. Anti-seborrhoeic shampoos represent the most popular therapy in cases of keratinisation alterations or flaky dermatoses. Finally, shampoo must always be considered as part of a multimodal approach to the allergic patient in order to relieve itching and restore the damaged skin barrier. The treatment protocol must be designed individually for each patient, depending on the active agents, the animal's response and the owner's compliance.
References
Bond R, Rose JF, Ellis JW et al. Comparison of two shampoos for treatment of Malassezia pachydermatis-associated seborrhoeic dermatitis in basset hounds. J Small Anim Pract 1995; 36: 99-104.
Borio S, Colombo S, La Rosa G et al. (. Effectiveness of a combined (4% chlorhexidine digluconate shampoo and solution) protocol in MRS and non-MRS canine superficial pyoderma: a randomised, blinded, antibiotic-controlled study. Vet Dermatol 2015; 26: 339-e72.
Ghibaudo G, Santospirito D, Sala A et al.In vitro activity of a commercial otological solution containing a novel antimicrobial peptide on 30 clinical isolates of Pseudomonas aeruginosa from canine otitis. Abstract P69 in the Abstracts from the 8th World Congress of Veterinary Dermatology, Brussels 2016.
Ghibaudo G. Efficacy and tolerability of Ermidrà® shampoo against itchy and erythematous dermatitis in dogs. ICF Bulletin
Ghibaudo G. Efficacy and tolerability of Zincoseb® shampoo against canine keratoseborrhoeic disorders (clinical study of 20 cases). Proceedings of the 25th Annual Congress of the European College and the European Society of Veterinary Dermatology, Brussels, 2012.
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