Itchy & Twitchy Pets Part 2: What’s New in Dermatology Medications?

To bring some humor to part two of this blog discussion of skin products, I thought I would start with my December 1965 Christmas photo pfeaturing my “fake hair pony tail”. I look at it now and think it looks like one of those before pictures of extreme makeovers. What was I thinking? 

I mention this because pets hide a lot of things internally. However, when there is itching and the hair looks bad, there is no doubt things are awry. So I will "fly in" to some of the new medications. (Yes, that is me with a Piper Cherokee airplane  I flew during veterinary school in the late 1970’s.)

Is there a once a day oral antibiotic for superficial skin infections?

Yes!Cefpodoxine (Simplicef) is a 3rd generation cephalosporin administered orally once a day. The concern with this drug longterm is that overuse of antibiotics sometimes leads to things such as Methicillin-resistant Staphylococcal pseudointermedius. This  antibiotic should be saved for more advance infections, not the first line treatment. 

As mentioned last week, when possible, skin infections should be first treated with topical antiseptics. This lowers the risk associated with long term,repetitive use of antibiotics and possible drug resistance. There are other oral  antibiotic medications, such as potentiated sulfa drugs and higher doses of oral clindamycin that should be tried initially if once once a day treatments are suggested.

My pet is difficult to give oral medications to and often becomes nauseated after administration. Is there an antibiotic injection that lasts 7 to 14 days?

The injectable cefovecin (Convenia) is also a 3rd generation cephalosporin that has broad spectrum activity compared to traditional cephalexin for skin infections. Concerns with use of this product include that once the effective blood level is gone; there is a sub-therapeutic level that may persist in the tissue for up to 2 months. The potential is multi-level drug resistance with future use. Therefore, use should be limited to pets who are difficult to medicate orally, exhibiting nausea , or when first or second level tier antibiotics were tried and found ineffective. 

What's new in topical ear medications? 

Most medications are dispensed in drops, and that can be difficult to accurately administer due to inadequate volume or improper administration/application. EasOtic (Virbac) is approved for treatment of ear infections with a once-a-day treatment for five days using a pre-measured 1ml pump system. It goes deep into the ear canal. In my experience, this is easier for owners; however, many pets may need two to four weeks (or more) of topical medication. This is due to the chronicity of the infection that is secondary to the primary issue of flea, food, or environmental allergies. 

My dog is on oral prednisone to cut scratching. It leads to increased thirst and urination. Are there any alternatives to suppress the itch reflex?

Oclacitinib (Apoquel, Zoetis) is a JAX (Janus kinase) inhibitor and was recently approved to treat severe, chronic itching attributed to allergies when other treatments have failed.  It was introduced in the spring of 2014, and has none of the common side effects attributed to steroids such as prednisone. Unfortunately, it was wildly successful in its first two weeks on the market, so much so that the entire year’s drug supply was used up!  Dosing is twice-a-day for 14 days in dogs. After 14 days dosing is once-a-day. Note: This medication can mask mange, flea, bacterial, and yeast infections. It is best used as a temporary medication to alleviate incessant scratching until the primary disease is identified, such as adverse food reaction or environmental allergies.  

I conclude to pay tribute to Misty Beasley, a fabulous therapy dog that recently passed away. She was loved and will be deeply missed by all of us at Creature Comforts.

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners, Canine and Feline

Creature Comforts Animal Hospital

Cary, NC 27518

Itchy Twitchy Dogs and Cats, Part One, Shampoos

While recently attending a veterinary conference in Orlando, Florida, I began wondering what topics would be of interest to the blog followers. How about skin diseases and treatments? 

Being in a southern climate, itching is a chronic problem due to a variety of inciting causes:  fleas, insect bite hypersensitivity, and environmental allergens.  The most common complaint I hear from clients is incessant scratching to the point of a neurosis for pets and their owners.

What is itching?
Itching (pruritus) is a neurological sensation that provokes an intense desire to rub or scratch. Then the sensation travels through nerves to the spinal cord to the brain.  

Tell me about Benadryl (diphenhydramine, an anti-histamine) and why it often does not seem to help my dog?
The Classic Benadryl model (anti-histamine type 1) is at best very controversial as to its effectiveness in dogs. New evidence indicates many other allergy chemical mediators (neuropeptides, peptides, cytokines, and leukotrienes for example) beg for newer and different medications. Stay tuned!

What can on owner do to help in the itchy pet assessment and evaluation? 

Bring to your pet's exam a photo of your pet looking normal as well as their history including:  scratch site(s), food trials, a photo or collection of prior medications, and dynamics of the household (new baby, owner traveling, frequency of flea control of all pets exposed, and seasonality). Itching is rarely induced by a solo cause. Interestingly, allergies are not responsible in up to 25 percent of cats. There is a new app called “ITCHOLOGY’ that can help track patterns of seasonal itching. 

Why can't we just do a food trial with Pet store food e(x. venison or fish and potato) for itchy pets?

A large percentage of pet store foods have cross contamination with proteins not listed in the ingredients. Even marketed “grain free diets” can induce allergies.

Tell me about shampoo categories and why bathing pets is important?

Bathing a pet is like cleaning off a Swiffer duster: less foreign matter on the fur this it decreases the itch sensation. Topical (on the skin) therapy can cut the frequency of oral antibiotics, thus lowering risk of drug resistant bacteria in the home. There are several types of bathing products for itchy pets. (Creature Comforts regularly carries these products for your convenience.)

Class 1- moisturizing, soap free shampoos  

Example: Aloe and Oatmeal shampoo. Used to remove chemicals, irritants, and allergens. 

Itchy pets have lost a barrier outer skin function which allows moisture loss, drying skin, and an entry point for allergens into deeper layers causing itching.  

Class 2- antibacterial shampoos  

Examples: Douxo Chlorhexidine, Malaket, Seba-hex, and Pyoben shampoo.  Used to control surface bacteria & combined with other agents to control yeast. 

Recent discoveries indicate many skin bacteria produce a protective biofilm (think the sticky plaque on your teeth) hindering the efficacy of oral antibiotics, while topical therapy, such as an antibacterial shampoo, can penetrate even with just one minute of contact time.  

Class 3- anti-yeast shampoos   

Example:  Malaket shampooo. Often used in combination with antibacterial agents to control surface malassezia.

Class 4- anti-seborrheic shampoos  

Examples: Seba-Hex and DermaBenSs (Dechra). Controls irritating scaling that harbors infectious agents.

Group 5- flea shampoos. Example: NO LONGER RECOMMENDED. Contain pyrethrins. 

There is zero residual flea control left after rinsing this shampoo. Solo use is discouraged, as most flea infested pets would need one of the above therapeutic products along with systemic flea control available from your vet (avoid over-the-counter systemic flea control as it is problematic in production quality and effectiveness).  Veterinary prescription products such as Ectokyl have become obsolete and no longer recommended.

Next week I will discuss new medications for itchy pets.

In the introduction photo, note the heart on the front of the chest of my dog, Taco Belle. The Maine Coon cat is named Tabby. 

 Betsy Sigmon DVM

Creature Comforts Animal Hospital

Cary, NC