Pillars Training"

Dermatology

DermatologyDermatology is the study of the skin. We will be discussing skin disease and therapy as it applies to

small animal veterinary practice during this lesson. Skin disease is the most common reason for a pet

to be presented to the animal hospital for examination. The skin is the largest organ of the body and

happens to be on the outside. It is a mirror reflection of internal function and can be seen and

examined easily by the client. Therefore, when hair loss, flakes, bumps, itching or any other change

occurs, the client will bring the pet in for examination.

It is important to understand and appreciate the relationship that clients have with their pets

regarding skin disease. Pets have become members of our family, and because we interact with them

every day by touching and petting them, abnormalities on the skin become self-magnifying concerns.

We need to guard against minimizing or belittling the concerns of our clients. For example: A client

presents their pet for vaccinations and then, almost in passing, mentions the bump on his head. We

should examine the bump, write it in the record, have the doctor examine it and perhaps biopsy it.

Even if this bump looks like a "wart" that you have seen on many other dogs before. The client does

not know what the bump is, and feels it every time she pets him on the head. It would be a great

disservice to the appreciation of the human/companion animal bond if we did not appreciate the

concerns of the client - no matter how minor they may appear.

Skin disease can be frustrating to manage because many skin diseases cannot be cured. This is not to

say that they cannot be managed, just that, when the management stops, the skin disease will reoccur.

As a part of the animal health care team, it is your responsibility to help the client understand the

chronic and ongoing nature of skin disease. And it is your responsibility to help maintain the

continued investment of time and energy that skin problems often require.

The following material will give you the foundation to carry on conversations and communications

with the doctors in the clinic as well as the clients on matters that involve the skin. Your vocabulary

will be expanded to include terms that describe the way the skin has responded to the disease. Thiswill empower you, in turn, to communicate to the client more effectively the recommendations of

the veterinarians in your hospital.

"Diagnose before you treat" should truly be a guiding principle with skin disease. Minor diagnostic

procedures such as magnification glass examination, skin scrapings and fungal cultures are often

overlooked. More invasive tests for skin disease include biopsies. Blood tests and allergy tests can be

done in cases that are more difficult. By understanding the value of these tests, you can helpcommunicate the necessity for them to the client, thereby, helping the pet receive a more accurate

TnniicTwnj ihi Pnttin <! Vtttrinary HtditiM Witt Tou

Copyright 1998, Steven 0. Garner, DVM

Page 1 of 1

$/ Pillars Training"

U't)1(J Dermatology

therapy. You serve as a vital link between the veterinary client and the doctor. Your opinion will be

asked many times in the absence of the doctor, so it is very important that you understand all the

recommendations made by your doctor in order to give accurate advice to the client. History taking

is an important part of diagnosing skin disease, and a brief primer in how to collect all the

information is in order. The first question that you should ask the client is, "Does the pet itch?" If

the answer is,"Yes", then an examination of the skin for lesions is in order. If there are lesions, then

they are described in the record. The client is then asked how the lesions first appeared and how long

they have been present. In addition, it is important to know previous therapies that have been given.

(Most clients will have used or tried something from the grocery store prior to coming to the

veterinarian). If the pet is itching, and the lesions are mostly secondary to biting and scratching, then

we most likely have an allergic or parasitic problem. If the pet is not itching, then we should

consider Demodex mange, ringworm or hormonal diseases. If the pet is young, you would consider

mange or ringworm higher on the list than hormonal disease. An older or adult pet is more likely to

have hormonal dysfunction than a young pet. The most common hormonal problem that is

associated with skin disease is low thyroid hormone - hypothyroidism. After you have asked the

client if any testing has been done, you can proceed to tell them that we like to "diagnose before we

treat". Most pets with skin disease require a skin scraping and this should be explained to the client

as a first step in the diagnosis of the problem.

Once a diagnosis is made, the veterinarian will recommend therapy. Skin disease often requires some

form of topical therapy, either as a primary therapy, or as an adjunctive therapy to oral medications.

It will be your responsibility to understand all the commonly prescribed topical formulations in our

hospital so that you can explain their use to the client. It is very helpful for you to understand how

the skin responds to disease and how this topical therapy counteracts that response to normalize the

skin.

The skin can respond to disease only by making new skin. The skin can respond to disease only by

making new skin - Again - the skin can respond to disease only by making new skin. The previous

three statements were not typos - I want to emphasize this point. The outer cells of the skin

reproduce in an effort to protect the skin from disease. If the skin is abraded - more skin will replace

what is lost in the abrasion. If the skin is inflamed from a fleabite, the skin will thicken where the

flea has bitten. If the animal has chronic irritation, the skin will produce excessive skin in the form of

flakes and scales. If the flakes and scales are mixed with excessive oil, then the pet has seborrhea

oleosa. Regardless, the excessive skin production is treated topically in most cases. This topical

therapy is directed at removal of the excessive accumulation of skin, and is called "keratolytics". The

topical medications that contain coal tar actually reduce the rate of production of the skin. Topical

medications have many functions; some kill bacteria, some moisten dry skin, some provide agents to

stop itching, and some have antihistamines, corticosteroids or oatmeal to reduce inflammation.

Shampoos are for cleansing, and medicated shampoos must stay on the pet long enough for the

TRANSFORMATION

Page 2 of 2

Tftisnnsstj tfec hwtiti of Kituiftiry Ntditins with Tci

Copyright 1998, Steven D. Garner, DVM

tf Pillars Training"

Jj Dermatology

medication to be effective. By studying the following materials, you will gain insight on how to

communicate the doctor's recommendations to the clients.

Structure and Function ofthe Skin

The Skin

The skin is the largest organ of the body and the anatomic and physiologic barrier between animal

and environment. It provides protection from physical, chemical, and microbial injury, and its

sensory components perceive heat, cold, pain, touch, itch and pressure. In addition, the skin is

synergistic with the internal organ systems, and thus reflects pathological processes that are either

primary elsewhere or are shared with other tissues. The skin is a mirror reflecting not only the

internal conditions but also the outside world to which it is exposed.

Anatomy

Physical Characteristics

At each body opening, the skin is continuous with the mucous membrane that lines the internal

surfaces - digestive, respiratory, ocular, and urogenital. The skin is thicker on the top of the body

than the belly and thicker on the feet than on the rest of the leg. The skin is thickest on the forehead,

dorsal neck, dorsal thorax, rump, and base of the tail. It is thinnest on the pinnae, under the arms

and legs, inguinal and around the anus. The hair surface is acidic, with a pH that ranges in dogs and

cats from 5.5 to 7.5.

Hair Follicle/Epidermis

The hair follicle and its associated structures are important to the study of dermatology of our pets.

The follicle extends from the hypodermis, through the dermis, to the epidermis layer. These three

layers are important. The Epidermis^ which contains the Stratum Corneum, is the outer, thin layer

composed of many layers of cells. In general, the epidermis is quite thin although there are many

layers. The five layers are (from outer to inner): horny layer, clear layer, granular layer, spinous layer

and basal layer.

Horny Layer - Thin outer layer of the skin composed completely of -njott? TV, Akeratinized (filled with keratin which is a tough flexible substance like P . ,what calluses are made of), dead cells which are constantly being shed. ' ^

Seborrhea sicca (dry skin) can cause a build up of excess keratin

making the horny layer thicker. As the horny layer becomes thicker, "it cracks and increases the amount of shedding. Thickening of the

horny layer is a normal response of the body to damage or trauma. f . ? \ 8t.i • • • j j 11 i_» i r u i_ i • ■ *l new skm - the hornyThis is evidenced as a callus, or thickening or the horny skin in the J

area of trauma. The function of the horny layer is to provide a barrier

most important function

skin can respond to

layer is the result of this

Ttitjltming til Practice of feuriHiy HicStiiw With Tw

Copyright 1998, Steven D. Garner, DVM

new skin production.

Page 3 of 3

|f Pillars Training™

7 '' '%'/ i

Jf Dermatology

from external influences and preclude outward losses of moisture and other elements. The horny

layer makes up the normal surface in health, as well as the most prominent signs of disease. These

signs are scales, crusts, flakes, dandruff, seborrhea, etc.

Basal Layer - This is the only layer that produces the cells of the epidermis. There are two types of

cells. One produces keratin, the protein substance that gives strength to the horny cells. The other is

the melanocyte that produces melanin pigment (skin color). This layer separates the epidermis from

the dermis.

The Dermis

The dermis accounts for most of the thickness of the skin. The dermis is composed of cells and fibers

that contain the arrector pili muscles, blood vessels, lymph vessels, glands and nerves. The dermis is

responsible for the elastic nature of the skin. The dermis of the scrotum is unique in that it contains

many muscle bundles that allow it to contract in cold conditions. The dermis has fibers that are

responsible for most of the strength.of the skin. The following is a list of some of the structures

contained in the dermis.

• Arrector Pili Muscles - Muscles that are attached to the hair follicle located in the dermis that

allow the hair to "stand up". This reaction will be seen in times of danger or excitement to show

aggression or to appear bigger to an opponent. It may also be used for temperature regulation.

These muscles may help in the expression of sebaceous glands secretions.

• Sebaceous Glands - Glands that open into the hair follicle. Their oily secretion keeps the skin

soft and pliable by forming a surface coating that retains moisture and maintains proper

hydration. The oil film also spreads over the hair shaft giving it a glossy sheen. The secretion is

also antimicrobial. In periods of malnutrition or stress, these glands do not function giving the

coat a dull and dry appearance.

• Sweat Glands - Sweat glands are of two types in dogs and cats. One type is the same as those in

humans and causes the typical sweating. This type is called the eccrine sweat gland. Eccrine

glands are located only on the footpads and nose of dogs and cats. Sweating is seen in agitated or

excited dogs and cats. The other type of sweat gland is called the apocrine sweat gland and is

described below.

• Apocrine Sweat Glands - Apocrine glands are located in close association to most hair follicles all

over the body. These glands open into the hair follicle. There are usually more of them where

the hair is thinner. Sweating from these glands is possible especially in German shepherds and

Labradors and these breeds may show sweating under the arms, in the inguinal areas, or around

the groin.

Specialized Glands

fsnning tki ftwtici cf Vctifimry Htnont With Vcu

Copyright 1998, Steven D. Garner, DVM

Page 4 of 4

•h" Pillars Training"

2j beljnatology

Perianal Glands - These glands surround the anus and may be the source of perianal gland

infections that occur in German shepherds and other breeds. Perianal gland tumors are also

common around the rectum of male dogs. These tumors may respond to surgical removal and

castration.

Anal Sacs - The anal sacs are located caudal to the rectum and produce a foul smelling, thick fluid.

This fluid should be expressed each time a pet defecates. Its primary purpose is for scenting and

marking. There is no other known function of the anal sacs. When the anal sacs do not empty

properly, anal sac impaction can occur. The pet will usually lick the anal area excessively and

scoot the rump on the ground. If this action does not relieve the impaction, anal gland abscess

may occur. Manual expression of the anal glands is a common grooming procedure and is done as

a part of the annual examination of dogs. This procedure is accomplished by the following steps:

raising the tail firmly, then with a gloved hand, grasp anterior to the glands with the thumb and

forefinger. Each gland should be palpable between the respective thumb and forefinger. Squeeze

firmly and apply caudal pressure to empty the glands. If the glands cannot be expressed in this

manner, insert the gloved forefinger into the rectum and grasp the gland between the thumb and

forefinger - squeeze and apply pressure caudal to empty the gland. Repeat on the opposite side.

Chronic impaction or infection is a reason to have the glands surgically removed.

Ear Canal Glands - These glands are responsible for producing earwax and can become a major

problem if they become hypertrophic (enlarged). This most often occurs in cocker spaniels.

Caudal Tail Gland of Dogs - A gland that is on the dorsal surface of the tail and is present in

only five percent of the dogs. The "guard hairs" are found in this area and a very thick amount of

sebaceous secretion is associated with them.

Caudal Tail Gland of Cats - A gland that is present in non-neutered male cats and secrets waxy,

sebaceous secretion that causes matting of the hair in this area. This is called "Stud Tail" in cats.

The caudal tail gland is responsive to testosterone and other hormones. This oval area on the tail

is subject to infection, tumors and seborrhea.

Transfinainj ikt Practice o! Vfltrinry Hidkiiw With Tea

Copyright 1998, Steven D. Garner, DVM

Page 5 of 5

Pillars Training

Epidermis j)

Dermisi

Primary Hairs

Secondary Hairs ■

Stratum Corneum

Sebaceous Glands

Arrector Pili Muscle

Sensory Nerves

Apocrine Sweat Glands

-Dermal Blood Vessels

w

Figure 1. Anatomy of Skin and Hair Follicle

triniftmlnj tkt haclki «l Ifettriiury Hiditim With Ym

Copyright 1998, Steven D. Garner, DVM

Page 6 of 6

V Pillars Training"

;■ Dermatology

Functions of the Skin

1) Enclosing Barrier - The most important function. This function makes it possible for all other

body tissues to live and function.

2) Environmental Protection - The skin provides protection against the entrance of chemical,

physical and microbiological agents into the body.

3) Motion and Shape - The elasticity of the skin allows the body to move and provide much of the

shape of the body.

4) Adnexa Production - The skin produces hair, nails, and certain glands such as sweat glands and

mammary tissue.

5) Temperature Regulation - The hair coat and cutaneous (skin) blood circulation are important in

temperature regulation. Sweat glands function to cool the body also. Heat regulation in the dog is

mostly via the respiratory system by panting. The cat will produce a large amount of saliva that it

will spread over the skin to aid in cooling.

6) Storage - The skin is a reservoir of electrolytes, water, vitamins, fat, carbohydrates, proteins and

other materials.

7) Indicator - The skin is important in reflecting the general health of the pet. Internal disease,

external disease, and the effects of topical substances can be seen on the skin.

8) Immunoregulation - The skin produces defenses against microbes and tumors of the skin.

9) Pigmentation - The skin produces the pigment melanin that causes the skin to turn darker in

response to damage or sunlight. This pigment helps prevent damage from the sun.

10) Antimicrobial Action - The surface of the skin has anti-bacterial and anti-fungal actions.

11) Sensory Perception - Skin is a primary sense organ for touch, heat, pain, itch, cold, and pressure.

12) Secretion - The skin functions to secrete the substances produced in the glands of the skin ,e.g.,

oils, waxes, milk.

13) Excretion - The elimination of waste is a limited function of the skin.

14) Blood Pressure Control - In a limited way, the skin pressure effects blood flow.

15) Vitamin D Production - The skin allows radiation from the sun to convert the inactive form of

vitamin D to the active form. Then transfers active vitamin D to the rest of the body through the

capillary system of the skin.

Human Skin Verses Canine Skin

Many people believe that human

products are good for dogs. This is

false! Many differences in human and

canine skin make human preparations

harmful to a pet's skin. That a

Page 7 of 7

Canine Skin

* Epidermis 3-5 cells thick

* Coat consists of hair bundles

* Apocrine sweat glands

* pH 7.5 average

* Cyclic hair growth

* Epidermal turnover rate about

20 days

Human Skin

* Epidermis 10 -15 cells thick

* Generally solitary hair

* Apocrine and eccrine sweat

glands

"" pH 5.5 average

* Continual hair growth

* Epidermal turnover rate

about 28 days

gtltt FVxtict of Ytttriwy Httfd&t ffith Tct

Copyright 1998, Steven D. Gamer, OVM

,lf Pillars Training

human's skin is thicker than a dog's skin is very important as the human skin is more resistant to

topical products than canine skin.

Dermatology Terms

Primary Lesions

Macule - An area on the skin that is flat and is a different color than the surrounding skin - freckle.

Patch - A patch is a large macule caused by pigmentation changes - birthmark.

Bleeding into the tissue of the skin causes characteristic lesions.

• Petechia - A pinpoint hemorrhage usually found first in gum tissues and may be an early sign of

poor platelet function or low platelet numbers.

• Ecchymosis - A larger form of hemorrhage that has "paintbrush" type discoloration - hickey.

• Extravasation - Frank hemorrhages under the skin as in a severe injury or severe clotting factor

deficiency - rat poisoning.

Papule - A solid, elevated area of the skin, up to one cm. in diameter.

Plaque - A larger papule, but has a flat top.

Pustule - A small elevation of the epidermis, filled with pus.

Nodule - A small, solid elevation of the skin, greater than 1 cm that extends deep into the dermis and

usually has a rounded top.

Tumor/Neoplasm - "Neo" means NEW — "plasm" means GROWTH. A neoplasm is a "new

growth". A tumor is any enlargement of the skin that is caused by a neoplasm.

Vesicle - A sharp elevation of the epidermis, filled with clear fluid. A vesicle is less than 1 cm.

Bulla - A vesicle that is greater than 1 cm. Vesicles and bullas are both rare in dogs.

Tniifsrmiog tki Practin of feuriiwy Hididni With feu

Copyright 1998, Steven D. Garner, DVM

Page 8 of 8

'.if Pillars Training

^ Dermatology

Wheal - A sharply circumscribed, raised lesion consisting of fluid infiltration in the skin (edema) that

appears and disappears within minutes to hours. The wheal is usually white-to-pink, and usually is

caused by allergic reaction - hive.

Dermatology Terms (continued)

Secondary Lesions

Scale - An accumulation of loose fragments of the horny layer of the skin (cornified cells, keratinized

cells). The consistency varies among branny, flaky, powdery, platelike, greasy, dry, loose or

adhering.

Epidermal Collarette - A special type of scale that is in a circular rim of loose keratin flakes. This

structure represents a pustule that is healing.

Crust - Debris formed when dried exudate of serum and scales adhere to the skin. A crust that

contains blood is a scab.

Scar - Area of fibrous tissue that has replaced damaged skin.

Ulcer - A loss of skin all the way down to the dermis resulting in bleeding and scab formation.

Erosion - A defect in the epidermis that does not extend to the dermis and will not bleed. Erosions

cause crusts - scuff.

Comedo - A dilated hair follicle filled with waxy material like a pimple. A comedo is secondary to

seborrhea - blackhead.

Fissure - A crack in the skin that usually occurs in very thick, dry skin such as the nose or footpads

but may occur anywhere. Resembles the muddy bottom of a lake that has dried.

Excoriation - The same as erosion. A good example is a mild hot spot or carpet burn.

Hyperpigmentation - An area of skin that is darker than normal. This color change is a response of

the skin to damage.

g 1st Practict of Yettrifltiy nttfttint With too

Copyright 1998, Steven D. Gamer, DVM

Page 9 of 9

-■5" Pillars Training"

,(

I Dermatology

Hypopigmentation - Hypopigmentation is the result of less pigment in the skin and can be caused

by damage to the pigment producing cells. For example, a dog bowl that is plastic and causes the

brown nose of the dog to turn pink from the action of the plastic on the pigment producing cells.

Hyperkeratosis - Excessive thickening of the horny layers of the skin. This process is a normal

response of the damaged skin and characteristic of many diseases. The epidermal layers increase in

thickness as the number of cells increases due to increased production of cells by the basal cell layer.

Dermatology Terms (continued)

Lesion Distribution

Generalize - Covering most of the body in an equal manner.

Localized - Concentrated on one area of the body. May be localized to the head, to the paws of the

feet, or to the body.

Symmetric - Equal distribution with relation to the right side of the body to the left side.

Asymmetric - Unequal as to right verses left.

Pruritus - The presence or absence of pruritus (itchiness) is one of the most important clinical facts in

the differential diagnosis of dermatosis. Itchy skin is typical of either allergies or parasitic type

infections.

Alopecia - The loss of hair. Alopecia is an important sign in determining the cause of skin disease.

The distribution is important, as is the ability to tell if the hair fell out or was pulled out or chewed

off. Being able to determine if the hair loss is associated with pruritus or some other disease

mechanism is essential to treating the problem correctly.

Hair Colors and Types

Hair Cycle

Hairs do not grow continuously. Each cycle contains a growth period followed by a rest period

followed by death and loss of the hair. The amount of sunlight, time of the year, nutrition, stress,

hormones, and temperature control the cycle. Hail growth occurs until it attains a preset length for

that part of the body, then stops and enters the resting stage, which may last for a long time.

g tfct tacftci of YtwEnafy fttdtcott With Vm

Copyright 1998, Steven D. Garner, DVM

Page 10 of 10

; Pillars Training'

Dermatology

Poor nutrition may cause a poor hair coat that may be dry, brittle, or

thin. Disease or stress may accelerate hair loss and may cause many

hairs to be lost at one time. Synchronization can occur during stress

causing loss of much of the hair coat. Breeders and show people call

this "blowing the coat" and say that pregnancy or illness can cause

it. Sometimes only routine sedation will cause it. Follicular arrest

which is a failure of the skin to re-grow hair shaved for surgery or

biopsy can also occur and may be due to scrubbing with Betadine,

injection or clipping the hair. Normally the hair grows back in three to six months. Hormones such

as thyroid, estrogen and testosterone alter the hair growth. Corticosteroids suppress hair growth.

NOTE: USING CORTISONE

OINTMENTS ON SKIN LESIONS

SUPPRESSES HAIR GROWTH. THE

CLIENT MAY NOT REALIZE THIS AND

MAY CONTINUE TO MEDICATE THE

AREA ONCE THE LESION HAS

RESOLVED. THIS PROLONGED

MEDICATION WILL PREVENT HAIR

FROM REGROWING.

Dog Hair

Normal Coat

The "normal coat" is typified in breeds such as German shepherds, Corgis, and wild dogs such as

wolves, and coyotes. It is composed of primary hairs and secondary hairs. The primary hairs are

called "guard hairs" or "bristles" and the secondary hairs are called "undercoat". There are more

secondary hairs than guard hairs.

Short Coat

The "short coat" can be classified as coarse or fine. Rottweilers and many terriers typify the coarse

coat. This type has a strong growth of coarse or "guard hairs" and fewer undercoat hairs. Boxers,

dachshunds, and miniature pinschers exemplify the fine coat. This coat has the largest number of

hairs per square inch. The secondary hairs are numerous and the primary hairs are reduced in size.

Long Coat

The "long coat" can be classified as fine, long coat and woolly or coarse, long coat. The fine, long

coat is found in the cocker spaniel, Pomeranian and the chow chow. The coarse, long coated breeds

include poodles, Kerry blue and Bedlington terriers. These are primarily made of secondary hairs

that are longer and coarser than usual and do not have a tendency to fall out.

Cat Hair

White is the dominant color in cats and is associated with deafness,

especially if the cat has blue eyes.

Tnnsfenrinj tin Prutitt d Yttuiniiy Hidicin* With too

Copyright 1998, Steven D. Garner, DVM

Page 11 of 11

IS 5*

yf Pillars Training"

"Tipped" is a hair coat that has colored tips overlying a paler color.

"Pointed" is a hair coat in which a darker color is on the ears, nose, and feet, and a lighter color is on

the body. Points are caused by temperature- dependent mechanisms and are common in Siamese,

Himalayan, Balinese, and Birman. The color changes can be induced by shaving, old age, disease,

injection in the skin, or by altering the environmental temperature of the cat.

Care ofthe Skin and Hair Coat

Grooming Procedures in Veterinary Practice

Although it is true that the skin is a reflection of the general health, many vigorous, normal pets have

unkempt hair coats, mainly because of neglect. We, here at Noah's, have highly skilled pet stylists -

groomers - that keep abreast of particular styles and grooming nuances. The following is a

background for understanding pet skin care and for relaying information to the client. The.vast

majority of our clientele is not looking for a "show groom". We generally perform "pet grooms"

In everyday practice we face the need to clip, shave, or otherwise alter a coat for one reason or

another. The cosmetic effects may be drastic and if not carefully explained may provoke intense

client resentment. Hair removal from Old English sheepdogs and Afghan hounds may take as long as

eighteen months to replace. Even necessary clipping can be made less disfiguring if the area is

blended into the normal coat by beveling the edges.

The proper use of groomer's tools to remove mats and snarls

may obviate extensive clipping. Most clients appreciate the

effort to preserve a hair coat. However, when vigorous

efforts are necessary, they must be used. Remember that a

year of neglect cannot be corrected by a two-hour grooming

session - even by a professional groomer.

NOTE: NEVER ADMONISH A CLIENT WHO BRINGS IN

APETW1THANUNKEPTCOAT. THESE CLIENTS

HAVE TAKEN PART OF THEIR BUSY DAY TO TRY TO

HELP THEIR LOVED ONE. THESE PEOPLE NEED TO BE

REWARDED WITH PRAISE, THEN EDUCATED ABOUT

THE PROPER FREQUENCY OF COAT CARE. THEY

SHOULD HAVE THEIR PETS PUT IN OUR REMINDER

SYSTEM FOR "GROOMING" TO HELP THEM

REMEMBER THEIR PET'S NEEDS.

The training" of a pet for

grooming should begin on the

first puppy visit.

Routine Grooming Care

The most important aspect of grooming care is to find a frequency of

care that should keep the pet "looking sharp". Grooming should be as

much a part of every day pet care as is feeding or any other care.

Grooming every day religiously for a few minutes is better than sporadically grooming for a few

hours. The pet should be taught to tolerate grooming by standing still and obeying what is necessary

to groom the puppy. The earlier the puppy can be taught, the better for all parties concerned.

Grooming Tools

TRANSFORMATION

fanfonnliif tfct Prarfci cf Veterinary Hjditini With Ten

Copyright 1998, Steven D. Garner, DVM

Page 12 of 12

Pillars Training1™

i \f ;Dermatology

A non-skid table with a chair in a quiet area frees the groomer of distractions. Comb, brush, nail

clipper, file, towels, cotton, and swab sticks will be needed. Shampoo, ear cleaning solution, flea dips,

and some other specialized grooming tools are also sometimes necessary. With these tools an owner

can perform routine grooming functions, but should consult a professional groomer periodically.

Grooming is a difficult chore and most owners would rather have it done by someone else.

Electric Clippers should be well lubricated and clean to prevent transmission of infection. The

blades should be held lightly and gently on the skin. If the blades become hot or are forced through

the skin, a clipper "burn" may result. The most common cause of clipper burn is dull blades pulling

the live hair out from the follicle.

Blades for a clipper have numbers to designate the size. A number 40 blade will cut close to the skin

if used against the grain and produces a shaven appearance. This blade may cause burn to the skin if

not used carefully. Larger blades such as a 10 blade leave enough hair so the natural color will still

show.

Shears (scissors) are used with a comb to trim long hair and whiskers, around the feet, ears, eyes and

face. Thinning shears are used to thin thick coats.

Mat and Tangle Splitter slices mats so they can be easily removed, leaving some hair as compared to

clipping.

Combs should have rounded teeth to avoid scratching. They should always be inserted deeply to be

effective. Forced combing or pulling at a mat will pull live hairs from a follicle and quickly ruin a

coat.

The Rake is used to hack through a heavy mat in a tangled coat. A rake has a single row of long,

straight teeth. It can inflict serious wounds. It can also pull live hair out.

Brushes may be used in the same way on long coats as the carder. The hair should be brushed with

short strokes with the grain and growth of the hair. Most groomers feel the nylon or synthetic

bristles accumulate static electricity and cause breakage of the coat. Natural pig bristles or wire set in

rubber is best. Fine hair should have a brush with bristles short and closely placed, while longer

coats need longer bristles set further apart.

A Hound Glove is used on short-coated breeds to remove dead hair. Boar hair bristles are in the

palm of the glove. "Zoom Grooms*' are also useful for this.

Stripping combs ("Dressers") - Razor blades encased in serrated teeth are used to pull out dull dead

hair. The hair is put between the thumb and blade and the blade is twisted to pull the hair. Extreme

care needs to be taken with this tool. The purpose is to pull only the dead hair and leave the live.

TRANSFORMATION

Tramfennlnj tki Practice of Vttirinary Ht&tM Wrtti Ten

Copyright 1998, Steven D. Gamer, DVM

Page 13 of 13

Pillars Training1"

('f)Debnatology

This is necessary for certain showing breeds of the terrier group. Machine clipping is faster and

shortens the hair evenly but is less desirable. Snap on combs can help with this effect.

Hand rubbing and toweling rubs out dead hairs, spreads natural oils over the skin and stimulates

circulation in the skin. Use only on short coated breeds.

Special Grooming Needs Prior to Bathing

Preparation

Before bathing, the nails should be clipped. (Only the Chihuahua can

be allowed to have longer nails in the show ring.) With frequent

(weekly) clipping and filing, the quick will recede and the nail can be

maintained properly. The hair between the toes is clipped with

scissors. The anal sacs should be palpated and expressed before or

during bathing. The ears should be plucked and cleaned, if

necessary. We use Epi-Otic® to clean the ears with a cotton ball.

Tangles and mats should be removed before bathing, especially with heavily matted coats.

Always be sure to secure your

dog safely in the tub. ifhe

jumps out, he may be hurt.

All breeds should be bathed prior

to trimming or stripping.

BoneDigital

Pad

ALL MEDIUM AND LONG COATED DOGS SHOULD BE COMBED OUT PRIOR TO BATHING. THEY

SHOULD BE COMBED AGAIN AFTER BATHING WHILE STILL DAMP.

NEVER LEAVE A DOG UNATTENDED

IN A TUB AS HE MAY HANG HIMSELF

ORON A GROOMING TABLE.

Bathing

Following the above-mentioned items, the pet is placed in a

raised tub to bathe. The pet is wet completely with warm

water. Use a liquid flea shampoo or any other as directed by

the veterinarian or groomer. The shampoo is lathered and applied to the back and topline of the pet

to start the lathering. The lather is spread over the legs and underside and applied to the face with a

Page 14 of 14

TriajftnaJnj tit tnt&t el Yeliriury Hidkht Wtlk Ton

Copyright 1898, Steven D. Garner, DVM

Pillars Training1

cloth to prevent it from getting into the eyes. The coat may be brushed to dissolve any dirt or loosen

debris or dead skin. Pay special attention to the ears, rectum area, and pads of the feet. Then if

necessary, the shampoo is repeated. The pet is rinsed thoroughly. Thorough rinsing is essential.

When rinsing, hold your thumb in the ear canal to prevent water from entering and keep a hand over

the eyes to keep any soap from getting into them. Irritation will result if the shampoo is allowed to

stay close to the skin. Rinses are necessary to prevent drying of the coat by the shampoo. A rinse

may be applied to the coat after the shampoo has been removed to coat the fur and prevent drying.

The coat should be squeezed to remove excess water. The coat is then toweled dry before grooming.

Professional grooming salons may towel dry or use a pet dryer to dry the coat before grooming. We

have high velocity blowers to help expedite the drying of the pet.

At Noah's, we utilize the Hydro-Surge bathing system to effectively cleanse the pet.

Dry Baths

To avoid the drying influence of water baths, dry powder products can be used, especially in long

coats. The powder is applied then thoroughly brushed out. With a careful job, the coat is left clean

and lustrous. Dry baths are used only for quick clean up and water baths are the most effective way

to clean the coat. Most groomers do not recommend dry baths.

Grooming Needs of Individual Coat Types

The Long Coat with Undercoat

Typical breeds include Newfoundland's, German shepherds, collies, Old English sheepdogs, Siberian

huskies, Samoyeds, and Welsh corgis.

Equipment includes:

• Rake

• Natural bristle brush

• Slicker® brush

• Regular and fine Resco® combs

• Shedding blade

• Nail clippers (heavy duty)

• Ear cleaner

The dogs should be bathed a least twice yearly, in spring and fall. In many cases, the more frequent

bathing (every three months) may be needed. A rake or shedding blade may be used to remove dead

hair. The coat should be combed and brushed forward over the top and sides, backward over the

flanks. A fine comb is necessary for the hair under the chin and tail and behind the ears.

iDttlu Prtftia of Vrariniiy Htdkini Wild Too

Copyright 1998, Steven D. Garner, DVM

Page 15 of 15

\f Pillars Training™

i (if'/DermatologyI

The Non-Shedding, Curly or Wooly Undercoat

Typical breeds include poodles, Bedlington terriers, and Kerry blue terriers.

Equipment includes:

• Oster* clipper and blades

• Natural bristle brush

• Slicker® brush

• Fine, medium and coarse steel combs

• Scissors

• Nail clippers

• Ear cleaner

The three breeds above must be clipped every four to six weeks for best appearance. Expose the

puppies to grooming at eight weeks of age so they will accept the clippers. Only the scissors should

be used under the tail, as that skin is very easily irritated. Since dead and loose hairs from these coats

are mostly secondary hairs that become enmeshed in the coat, neglect causes "felt" matting. All dead

hairs must be completely combed out before bathing. The ears should be cleaned weekly.

The Silky Coat

Typical breeds include spaniels, Afghan hounds, Maltese and Yorkshire terriers, setters, Lhasa apsos,

and Pekinese.

Equipment includes:

• Slicker® brush

• Medium and fine steel combs

• Natural bristle and pin brushes

• Oster® clipper and blades

• Duplex stripping knife (for show quality grooming)

• Barber scissors (for show quality grooming)

While all long coats require frequent brushing, silky coats in addition require frequent bathing to

prevent mats and skin irritation. It may be necessary to use conditioners such as Humilac® or Alpha

Keri® to keep the hair soft and manageable and to prevent breakage. To brush out these coats, the

hair can be lifted with the hand and combed or brushed down until it is free of snarls to the skin.

Spaniels grow two to three coats a year and need to be stripped or clipped at least every three months.

Some groomers recommend monthly visits for cocker spaniels

The Smooth Coat

Typical breeds include hounds, retrievers, dachshunds, dalmatians, beagles, whippets, Doberman

pinschers, smooth terriers, and boxers.

Tnniftmlnj tht Pntlki of fcttrittrjr HtsStini With Yen

Copyright 1998, Steven D. Garner, DVM

Page 16 of 16

:f Pillars Training1™

■'■I / X, ^

Det-matology

Equipment includes:

• Hound glove or rubber hound brush

• Scissors

• Nail clippers

• Ear cleaners

Dogs should be bathed only as necessary for cleanliness. The scissors are used to trim the tactile hairs

on the face, or shape fringes on the tail, ears or brisket. The coat can be rubbed to shiny sleekness

using the hound glove, the hands, or towels.

The Wiry Coat

Typical breeds include the wire-haired fpx terrier, Welsh terrier, Airedale terrier, Lakeland terrier,

schnauzer, and Sealyham terrier.

Equipment includes:

• Oster® clipper and blades

• Duplex® stripping knife

• Fine and medium steel combs

• Hound glove

• Barber scissors

• Ear cleaner

• Nail trimmers

Trimming the head, ears and tail should start on pups early. As adults, they require machine clipping

every six to eight weeks or hand stripping every twelve weeks. Clippers should never be used on the

bodies of dogs being shown, as this softens the coat by removing the coarse guard hairs.

Unfortunately, this change seems to be permanent, and dogs such as miniature schnauzers may be

ruined for future showing. Hand stripping should only be done when the coat is ready. New hair

should not be stripped except to tidy up a bit.

The Corded Coat

The Komondor and the Puli, two Hungarian breeds.

Only mild shampoo, diluted 10:1 with water before application (so it can be easily rinsed out), a

heavy-duty water spray, and heavy-duty dryer are required.

Dogs should never be clipped or combed. These dogs have a thick double coat that forms naturally

into tassel-like cords described as controlled matting. Always use diluted shampoo. Squeeze it into

the coat- do not brush or rub vigorously. Then thoroughly rinse with large volumes of water,

spraying into the coat to lift and float our the dirt and shampoo. Do not rub dry with towels.

Handle them like a good sweater. Squeeze out by hand and allow to drip-dry.

TwufwrningtSt Pncticc of Vtttriiiiy Hidiciiu With Tm

Copyright 1998, Steven D. Garner, DVM

Page 17 of 17

Pillars Training"

i '!■Dermatology

Special Grooming Problems

Mats

ALL MATS NEED TO BE REMOVED PRIOR TO BATHING TO PREVENT THE TANGLES

FROM BECOMING IMPOSSIBLE TO REMOVE.

Mats can usually be teased apart and combed out if they are small. Very small mats behind the ears

and under the legs can be cut off. Larger mats can be slit with a mat splitter and then teased with one

or two teeth of a comb. Or, a Slicker® brush can be used to brush the mat up, then down, to tease it

apart or loosen it. Some badly neglected, long-coated cats or dogs may have an almost complete

covering of "felt" matting. These mats do not form close to the skin. Occasionally the mats need to

be removed by close shaving under general anesthesia. DO NOT USE SCISSORS!

Mat removal is a separate charge from the grooming charge or the bathing charge.

Tar and Paint

Tar or paint embedded in the coat can be difficult to remove. Small deposits should be allowed to

harden and then cut off. Tar masses can be soaked in vegetable oil with a surfactant and bandaged if

heeded to soften the tar and then the entire mass can be removed with soap and water.

Never use paint removers,

organic solvents, kerosene,

turpentine, or gasoline to

remove tar or paint.

We have in the past used a combination of 50% mineral oil and 50%

acetone to soften the tar, then followed quickly with a detergent

rinse to remove the dissolved solution. This may be repeated as

needed to remove most tar problems.

Odors

Odors on or about the coat usually originate from places such as the mouth, ears, feet, or anal glands.

These should be checked and washed carefully. The coat may have a bacterial infection that may be

causing odors. The bacterial infection may be secondary to seborrhea that may need to be treated

first. Many seborrheas may be secondary to allergies, hypothyroidism, or dietary deficiencies of the

dog. Clorox® solution diluted to two teaspoontuls per gallon water can be used to remove skunk

odor. Oxyfresh® shampoo is a human-grade-cleansing agent that kills bacteria and is sold in the clinic

for pet odors.

Comments on Grooming Cats

There are three types of cat hair in reference to grooming:

1. Short hair, single coat

2. Short hair, double coat

3. Long hair

truuftmlttj Hit ftwtki of ftttrinuy Mtditini With Yoa

Copyright 1998, Steven D. Garner, DVM

Page 18 of 18

'-'? Pillars Training1"

.jljl Deirnajtology

Short hair, single coat

The short hair, single coated cats are typified by the domestic shorthair, the Siamese, Burmese,

Havana brown, Rex, and Korat. These cats can be bathed in shampoo and water, quickly dried to

avoid chilling, and brushed and combed against the coat to remove dead hair. Final brushing is with

the nape of the hair. A fine metal comb and a natural boar bristle brush are all that is needed.

Short hair, double coat

The Abyssinian, Manx, Russian blue, and the American shorthair typify the short hair, double coat.

These cats have two sets of hair - long guard hairs that give the coat the color and shorter, softer

undercoat that provides warmth. These cats are groomed similar to the ones above but caution is

employed to avoid over-grooming. Over-grooming resulting in loss of the guard hairs causes the coat

to have a moth-eaten appearance.

Long hair

The long hair cats are the Persians and Himalayas. These kittens should be groomed beginning at

four weeks of age. Several sizes of combs and bristle brushes are necessary and daily maintenance is

necessary to prevent matting.

Special Feline Grooming Problems

Ears

A cat's ears are less prone to infections than a dog's ears, but they should always be checked and

cleaned if needed. Young cats are especially prone to ear mites.

Stud Tail

The large gland on the top of the tail is a mass of hyperactive sebaceous glands that may cause trouble

if neglected. Breeders call the problem "stud tail" although it occurs in both sexes. A waxy,

unsightly accumulation builds up in the *rea if proper hygiene is neglected. This can be removed

with a powder to soak it up or a fine oil to soften it followed by a shampoo to remove the dissolved

wax.

Disorders ofthe Skin

Seborrhea

Seborrhea is a common canine skin disease that is not contagious. It is similar to but more severe

than human dandruff. There are two major types of seborrhea in the dog. "Seborrhea sicca" is a dry

form of seborrhea in which dry scaling is the major sign. This is seen in Dobermans and Irish setters

and may develop into a dry snowstorm of flakes. "Seborrhea oleosa", or oily seborrhea, occurs with

greasy crusting that is typical of cocker spaniels. Seborrhea may or may not be associated with

inflammation of the skin or dermatitis. An underlying disease such as allergies, hypothyroidism,

Inajftmii); tki Practice of Vtttrinary Kidirini With Too

Copyright 1998, Stsven D. Garner, DVM

Page 19 of 19

Pillars Training

dietary deficiency, or hereditary influences usually causes seborrhea. Technically it is believed that

seborrhea is caused by a defect in the manner the skin matures.

Once the clinical diagnosis is made, we must gain the cooperation and understanding of the disease

from the client. Much time should be spent explaining that seborrhea is a symptom of a disease and

that finding the underlying cause is the only way to cure the disease and cure the problem. Without

this diagnostic effort, the pet is condemned to a lifetime of treatment without cure. Even with this

effort, many causes cannot be found. However, the client may understand better that there is no

cure, and although the pet will always have seborrhea, it may be controlled with the proper

medications and therapies. These therapies are meant to control the signs but are not a cure for the

disease.

Many times with dermatological diseases that are chronic, the client looks for a veterinarian who has

a positive attitude and is enthusiastic about helping with these frustrating problems. If the

veterinarian takes a defensive attitude (because he or she is frustrated with the lack of cure) the client

may seek another more optimistic veterinarian. The ultimate control of many skin diseases is a trial

and error effort that requires cooperation with both the client and the veterinarian.

Seborrhea literally means "flow of sebum" or "flow of suet". The disease includes changes in sebum

production as well as changes in keratinization and inflammation of the skin. Increased epidermal

turnover is the hallmark of seborrhea. Causes include hormonal imbalances, allergies, fleas, mange,

infections, and nutritional and environmental factors.

Hormonal Disorders

Hypothyroidism

Hypothyroidism is the term used to denote low circulating blood thyroid concentration. Thyroid

hormone is the hormone responsible for cellular metabolism. Cellular metabolism is the rate that a

cell performs its functions. The function of skin cells is to provide a protecting and enclosing barrier

for the body. Without adequate levels of thyroid hormone the rate of cellular reproduction is

reduced. The quality and quantity of skin that is produced is changed. The normal cellular defense

mechanisms of the skin are reduced. Hypothyroidism is called "the great imitator". It is a disease

that can mimic any other skin disease and is difficult to diagnose without a blood test for circulating

thyroid hormones. Animals with hypothyroidism may be lethargic and have a "tragic" expression to

their face. Low thyroid hormone can even cause allergies because the skin is not perfect - pollens can

actually penetrate the skin through small defects in it. A rule of thumb is that any animal missing

hair down its tail is suspect for hypothyroidism. Mosi hypothyroid dogs respond well to daily or

Page 20 of 20

Tfuufonnuif tw nmKtw Ytttfiury ntsttni With Tw

Copyright 1998, Steven D. Garner, DVM

•p f

..f Pillars Training"

If'ifM4 DefcnfiatQlogy

twice daily thyroid supplementation of thyroid hormone. Periodic blood tests are used to determine

the dose and frequency of administration. Most pets with chronic skin disease should be tested for

low levels of thyroid hormone in the blood.

Hyperadrenocorticism

Cushing's disease is hyperadrenocorticism. This is the excessive production of cortisol. It can also be

caused by the excessive administration of cortisone to an animal. This is called iatrogenic Cushing's

disease. Cushing's disease is more common in older pets. The typical signs vary from no signs at all

to severe disease. Most common signs include increased drinking of water and excessive urination.

Panting is common. Elevation of the liver enzymes such as alkaline phosphate and low eosinophile

count may also be seen. Cortisol makes an animal feel good so many clients do not report problems

until other more obvious signs occur. These include the signs of pot-bellied appearance and hair loss

over the trunk that does not effect the head and legs. Calcium deposits may also be seen in the skin as

well as other organs. Because cortisone causes reduced healing and immune function, chronic

infections may be seen. The typical animal is an aging poodle that is almost bald on the trunk with a

potbelly. There are two mechanisms for this excessive production of cortisone from the adrenal

gland. One is a tumor of the adrenal gland and the other is a tumor of the pituitary gland. Adrenal

gland tumors account for about fifteen percent of the Cushing's disease cases. Pituitary gland tumors

account for about eighty-five percent of the Cushing's disease cases. The pituitary gland secretes a

hormone called Adrenal Cortico Trophic Hormone (ACTH) every morning. This hormone goes to

the adrenal gland and tells it to make enough cortisol for the day. When the cortisol level is adequate,

the pituitary gland will stop producing ACTH. Pituitary tumors are not typically large enough to

cause overt brain disease. A screening test called the ACTH stimulation test is done to see if excessive

cortisone is in the blood stream. This test is usually performed in the morning by collecting a blood

sample. Then ACTH is given and another blood sample is collected two hours later. Once

diagnosed, medication can be given to reduce the adrenal gland size or to inhibit the release of ACTH

from the pituitary gland. If an adrenal gland tumor is diagnosed, surgery is usually recommended.

Allergies

Allergies are a major cause of skin disease and owner complaints. All skin allergies have the same

basic mechanism. The mechanisms are very complex and intertwined but a simple explanation is

necessary when communicating with clients. The hallmark of allergy is itching. Itching is caused by

the release of histamine into the skin by mast cells.

1) All allergies are the result of exposure to a substance that is foreign to the body. This is called an

"allergen". An allergen may be a pollen of any plant, a drug, the venom of an insect, the fiber of a

carpet, or virtually anything. Animals can become allergic to anything just as people can.

2) The allergen must break into the body in some manner. This can be through breathing the

allergen into the lungs, or by a flea injecting it under the skin, or by washing your hands in it every

day, or by a dog eating the same food for year after year. The allergen eventually gets into the body

Page 21 of 21

Transfonahj thi Pnttki of (tttfimiy Midi'dm With Ttu

Copyright 1998, Steven D. Garner, DVM

V Pillars Training"

J| Dermatology

and is recognized by the surveillance systems of the body to be "foreign". Most allergens are breathed

into the body as pollens in the air. They then get into the blood through the lung tissue.

3) A reaction to the foreign antigen (allergen) develops that results in the development of an IgE

antibody by the lymph node against the offending substance. Normally this antibody would attack

the antigen and destroy it. In an allergic reaction though, the antibody becomes attached to a cell in

the skin. Most defensive antibodies are made of the IgG type and do not cause allergic reactions.

Other antibodies, IgA antibodies, coat the surface of the skin and the mucous membranes to provide

local immunity as the first line of defense against bacterial invasion into the body. For example,

intranasal vaccines stimulate IgA antibodies, whereas, injection vaccines stimulate IgG antibodies.

4) The IgE antibody however, is made for an allergen and becomes attached to a mast cell located in

the skin of the dog. Mast cells can be located anywhere, but they are more prominent in the skin of

the feet, around the eyes, and under the arms and legs of the dog. Therefore, signs related to the dog

scratching his face by rubbing on the carpet or sofa, chewing his feet or licking between his toes, or

scratching under his arms are signs related to pollen allergies.

5) Mast cells are responsible for most of the signs attributable to an allergic reaction. The IgE

antibody acts as a trigger to cause the mast cell to cause an allergic reaction. The IgE antibody will

rest on the mast cell surface causing sensitization of the mast cell to the allergen. The antibody is

actually a receptor for that allergen, and if the allergen comes into contact with the IgE antibody on

the mast cell, the mast cell will de-granulate.

6) De-granulation means the granules in the mast cell will burst out of the mast cell. These granules

contain the major substances that cause an allergic reaction. Histamine, serotonin, SRSA,

bradykinin, MIF, Thromboxane A2, and complement are released into the tissues of the skin.

7) When an allergic reaction in the skin occurs, several functions happen at once. The chemicals

above all have different functions that serve in the itch reaction to follow. Histamine causes the

blood vessels to be leaky, bradykinin stimulates nerves to tell the brain to scratch the area, serotonin

closes outflow blood. Other chemicals attract white blood cells into the area. The net effect of these

chemicals is a red, inflamed (white blood cells), swollen (blood in but no blood out) area that itches

(nerves stimulated). The itching causes scratching which causes more trauma to the area causing

further mast cell de-granulation and more reaction.

8) Containment of the allergen will prevent its spread to the rest of the body and halting blood flow

out of the area accomplishes this. The area is contained to prevent spread of disease and to allow the

white blood cells to accumulate in the area and do their job.

9) Destruction of the allergen is the goal of the body and may be attempted by any of the white blood

cell types. As a result of their action, much unnecessary damage will be done to the area. This is

much like the firemen that tear the house down to put out a fire in the trash can. The macrophages

will come in and clean up the mess afterwards and will pick up the inactivated antigens and carry

them to the lymph node for interrogation. This will result in further refinement of the antibodies

produced in the IgE format that attaches to the nust cells. This will happen during each reaction and

Trut&nnbj Hit Prxcliti«! Vcttrintry Htditini With hi

Copyright 1998, Steven D. Garner, DVM

Page 22 of 22

Pillars Training1

/

atology

will result in subsequent reactions being stronger than previous reactions. Thus, the allergy gets

worse over time.

10) The body is notified of the allergic reaction by the nerves in the area. These nerves happen to be

itch receptors, and they will cause the pet to itch any area in which an allergic reaction is happening.

This scratching will result in more mast cell de-granulation and more damage, more swelling, more

cell death, more macrophages, more antibody formation and worsening of the allergy. This becomes

an "Itch-Scratch Cycle" that is self-perpetuating. The same reaction occurs in humans as "hay fever"

or other allergies. In humans, allergies to pollens cause respiratory signs of sneezing and congestion.

These signs are caused by mast cell de-granulation as well. There are more mast cells in the human's

respiratory tract than in the dog's. In the dog, there are more mast cells in the feet, face and

underarms than in the respiratory tract.. This is why pollens cause a dog to scratch its face and feet

while pollen allergies cause humans to have hay fever. The location of the mast cells determines the

symptoms of the disease.

11) Treatment of allergies can be achieved by only three methods:

A) Remove the source of allergen - fleas, diet, or environment.

B) Suppress the itch with antihistamines or steroids.

C) Hyposensitization to reduce the allergen reaction in the body.

12) Removal of the offending substance would be appropriate if the allergen was food or fleas or

something that is relatively easy to remove. If the allergen is pollen in the air, then the task becomes

more difficult.

13) Suppressing the itch can be done with either antihistamines or corticosteroids. Antihistamines

such as Temaril® or Benadryl® are not effective unless given before the allergy develops. These

work only to suppress histamine, which is only one of the offending chemicals released, by the mast

cell. Antihistamines will sedate the dog and in this way reduce the tendency to scratch. There are

certain newer antihistamines that have been shown to be effective in controlling itch in dogs. There

is a trial and error approach to which one is effective and in general at least for now they are fairly

expensive. Hismanal® is the most used in this category of newer antihistamines for dogs.

14) Corticosteroids do suppress the allergic reaction at all stages before and after the allergy develops.

The mast cells are stabilized and do not de-granulate and the mediators of inflammation and itch are

inhibited. Corticosteroids are very effective but must be used correctly. NOTE: Flea Allergy

Dermatitis is discussed in the Pillars ™ Flea lectures.

Bacterial Infections

Infections of the skin typically are all thought of as bacterial infections, but, virus infections, fungal

infection and parasitic infections are all common

Tnnifiiming Ikt Pntlin of Yftirairjr MtiStintWith Ton

Copyright 1998, Steven D. Gamer, DVM

Page 23 of 23

'■'"-■' Pillars Training""

fl Dermatology"■A

Bacterial infections are classified in two groups, either superficial or deep. Superficial infections affect

only the top layer of the epidermis and possibly the hair follicle. Deep infections have tracts that

extend deep into the dermis.

Bacterial infections are mostly caused by stapbylococcus infections. Stapbylococcus organisms are

located on the body normally. The bacteria are able to cause an infection due to reduced immune

levels during stress. Damage to the skin from allergy induced itching and scratching will cause hair

follicles to become infected. Areas of the skin that are moist, such as a "hot spots", under the front

legs, under the tail, between the toes, or in the ears are predisposed to stapbylococcus infections.

Deep bacterial infections are uncommon but severe when they occur. They can also be present with

Demodex mange infection. Severe trauma to the skin such as in a burn or abscess can also result' in a

deep bacterial infection or furunculosis. Antibiotics and drainage are necessary to treat these

problems. Antibiotics are necessary, yet stapbylococcus has the ability to develop resistance to the

antibiotic. So powerful antibiotics have been developed such as Clavamox®, Tribrissen®,

Cephalexin® (Keflex), and Baytril®. Local therapy for stapbylococcus infections of the skin can

involve soaking the area in diluted Betadine® or Nolvasan® solution, or, topical application of

benzoyl peroxide (Pyoben® or Oxydex gel®) to the affected areas. (Note: These stain carpet and

clothes and may be irritating to the skin of cats). Oxydex® or Pyoben® shampoo can also be used to

help reduce surface infections.

Recurrent Pyoderma is a common syndrome seen in dogs. The term Idiopathic Recurrent Pyoderma is

given to a bacterial skin disease that responds to antibiotics but relapses three to four weeks later.

The disease may not have any underlying reason but the list of possible reasons is long.

Hypothyroidism, immunodeficiency, flea allergy, sarcoptic mange, food allergy and seborrhea are all

possible causes. The hallmark of recurrent, superficial pyoderma is repeated episodes of papular to

pustular eruption, with or without formation of epidermal collarettes, which completely resolve with

antibiotic therapy. Lesions can be generalized or confined to one body region. The loose skin of the

ventral inguinal areas and under the arms is usually involved. Itching is usually severe. Relapses

occur two to four weeks after therapy has stopped. This pyoderma is usually a life-long disease. It is

important that the owners realize that the disease can be managed but rarely cured. Many owners

will switch veterinarians frequently in search of a cure that simply does not exist. The owner should

be made aware that the pet will likely need antibiotics for it's entire lifetime. This can pose a severe

economic burden for the client as well as a time consuming, arduous task of giving medications to the

pet. Euthanasia may be considered by the owner if the veterinarian is not careful to have an

optimistic attitude.

Initial Management of Bacterial Skin Disease

IrisjIsmtmjthtPricticiof Ytitriiury Htdcint With You

Copyright 1998, Steven D. Garner, DVM

Page 24 of 24

^ Pillars Training1"3

/ -iVJ

pi Dermatology

1) Use the correct antibiotic (see below)

2) Use the antibiotic for long enough

3) Avoid corticosteroids

4) Topical adjunctive therapy

Poor antibiotic choices (staphylococcus resistance)

Ampicillin

Amoxicillin®

Hetacillin®

Penicillin

Tetracycline

Good initial antibiotic choices - Poor long-term choices

Chloramphenicol®

Antirobe®

Erythromycin

Lincomycin®

Tribrissen®

Primor®

Good initial antibiotic choices - Good long-term choices

Clavamox® 20mg/kg T.I.D.

Cephalexin 20mg/kg B.I.D.

Oxacillin 20mg/kg T.I.D.

Baytril®

Poor antibiotic choice-(toxic)

Gentamicin®

A common "rule of thumb" for duration of initial antibiotics is to treat for two weeks past clinical

resolution. This may be from four to six weeks of therapy.

Long Term Therapy for Bacterial Skin Disease

1) Topical - Shampoos are easy and inexpensive methods to reduce the bacterial numbers on the

surface of the skin. Oxydex® has been shown to be the most effective in reducing the numbers of

bacteria for the longest time. Once to twice weekly applications are necessary in most cases. This

may be drying to the skin and Humilac ® or hot oil treatments may be helpful. If the pet is too

irritated with this therapy, then Nolvasan® shampoo is recommended on the same schedule.

Localized areas can be treated with Oxydex® or Pyoben gel®.

Fungal Infections

Tnnitennmg th* Prattle* ol totrinary Htdictnt Wilt T«u

Copyright 1998, Steven D. Garner, DVM

Page 25 of 25

If Pillars Training"

I ( W )

Fungal infections are common. There are many types of fungus that infect the skin, but the most

common are the ones that cause "ringworm". Ringworm is not a worm. Ringworm is a fungus that

grows only on the epidermis and only on the dead part of the keratinized, horny layer. The hairs in

this area that are dead will also be infected. Infection of this layer of skin is related to the immune

status of the pet, so young or stressed animals are most likely to have this infection.

The fungal growth of ringworm is in a circular mannei- with hair loss and a crusty area of skin at the

edge of the lesion. A preliminary diagnosis may be made with a Woods light. Only forty percent of

the ringworms respond to a Woods light; therefore, diagnosis is best made by culture of the fungus

on a medium called D.T.M. D.T.M. (Dermatophyte Test Medium) is a test medium (a substance that

ringworm will grow in) that has added to it antibiotics to kill bacteria and other substances. The

medium is kept refrigerated before use. This culture medium will change color (to red) when an

infectious fungus is growing. The sample should be plucked from the edge of the lesion and placed

into the medium. Use clean, dry forceps - no alcohol - do not prep the area. The lid should be left

ajar and the medium kept at room temperature for the culture to grow.

Treatment of ringworm involves shaving the pet, as the hairs are the mode of transmission, and dips,

along with oral medications. Treatment is difficult because the ringworm grows only on dead tissue

and it is difficult to treat dead tissue. Four to six weeks of treatment is sometimes necessary.

Ringworm is contagious, primarily to children and aged adults, but anyone can contract it from, or

give it to, a pet. Other pets are susceptible and contact should be prevented. Cats can be carriers

without showing signs and all cats in a household should be suspect. All cats should have the hair

combed with a toothbrush, then the brush contents applied to the D.T.M. for diagnosis. All positive

animals are treated.

Ringworm may be infectious to hospital personnel. Equipment used to shave an infected animal

should be disinfected with Betadine® or chlorine bleach. The entire area and all hair should be

disinfected immediately. REMEMBER! THE HAIR IS THE TRANSMITTING AGENT!

A relatively new diagnosis has been made as a cause of chronic dermatitis, mostly in West Highland

white terriers. This is a yeast infection (Malassezia pacbydermatis) that is growing on the skin. This

yeast is commonly found in the ears but recently has been discovered as a cause of skin disease. The

signs are typically on the ventral abdomen, feet, face (around mouth), anterior limbs or posterior

thighs. Musty odor and moist dermatitis are the presenting complaints. Oral ketoconazole

(Nizoral®) (lOmg/kg twice daily for 30 days) is the treatment.

ni tkt tactin of YittriMiy titiS tin* Witt You

Copyright 1998, Steven D. Garner, DVM

Page 26 of 26

!■■ Pillars Training"

$ )Ui Dermatology

Corticosteroids

Corticosteroids have been used mostly for hypersensitivity dermatosis (allergic skin reactions) to flea

bite, atopy, food allergy, "hot spots" or immune mediated diseases. The corticosteroid does not cure

the problem but just reduces the clinical signs of the problem. Much like putting a box over a bright

light will not turn out the light but will reduce the effect of the light emitting from it.

Corticosteroids are the most abused drug used by veterinarians. The correct method of

administration involves alternate day therapy at the lowest dose available. Corticosteroids should not

be the only treatment modality and should be used only when other less harmful methods have

failed. The common procedure of giving a long acting injection of a corticosteroid can cause severe

side effects as seen in the chart below. Giving the corticosteroid daily on a continuous basis causes

these same side effects. We should use only the short-acting steroids, such as prednisolone, and only

on an alternate day basis for long term therapy. The side effects of corticosteroid used on a

continuous or long term basis, verses an alternate day therapy, are as follows:

Clinical Sign Treatment Modality

Daily or Long-Acting Injection Alternate Day

Polydipsia (Excessive water drinking) + + + + + /-

Polyuria (Excessive urination) + + + +

Alopecia (Hair loss) + +

Thin Skin +

Liver Damage + +

Distended Abdomen +

Calcinosis Cutis (Calcium deposits in the skin) +

Hyperpigmentation (Excessive dark color to skin) + +

Infection +

Reproductive problems . +

+ indicates a positive occurrence

indicates no occurrence

The action of a corticosteroid on a pet is not entirely predictable and each pet may need to have

adjustments in the dose to prevent undesirable side effects. Pets with heart disease may have special

considerations prior to corticosteroid therapy to prevent the development of complications. Animals

treated with corticosteroids have a tendency to develop bacterial infections of the skin, urinary, and

respiratory systems.

TrtwfonninftbPractittol Vttiniarf Htdxiat VRth Y»Copyright 1998, Steven D. Garner, DVM

Page 17 of 27

Client Communication Note - Corticosteroids may

cause excessive urinating, excessive drinking of water, as

well as panting and nervousness. If the pet is drinking

excessively, limit the water intake to one-ounce drinking

water per pound body weight per twenty-four hours.

Pillars Training"

Dermatology

Parasites

There are many parasitic infections of the skin from exotic worms, to fleas and mange, to the

Cuterebra larva of flies. However, the most important infestation other than fleas is "MANGE".

There are two major types of mange: Demodectic mange and Sarcoptic mange

DEMODECTIC MANGE

Demodex canis

1) Mites are cigar or banana-shaped and live

in the hair follicles.

SARCOPTIC MANGE

Sarcoptes scabiei

1) Mitts are crab-like and live in the epidermis in

crusts on the outer layers of the skin.

2) Hair loss is on the face and feet primarily

but may be on any area of the body.

2) Hair loss may be most severe on the ear margins

and elbows. But the whole body can be affected.

3) The lesions are usually patchy and do

not itch. They may itch if they are

infected.

"3) The entire pet may itch so much that he

cannot take a step without itching.

4) The mite infection is not contagious and

may be hereditary. It is usually seen in

purebred dogs that are highly inbred.

4) The mite infection is very contagious to

dogs and possibly to people.

5) Stress of surgery or infection may cause

it to become apparent.

5) The mite infection may be chronic and a pet

may go undiagnosed for years and may have

received steroids for "allergies" as treatment.

6) A type of white blood cell in the body is

defective in that it can be turned "off" by

the presence of the mite. Because the

white blood cell is off, the mites can

grow.

6) The pet with sarcoptic mange usually is a

mongrel from an animal shelter but also

may be a pure bred.

7) Two forms exist - localized and

generalized. The localized form consists

of a few spots on the body that may

resolve on their own. The generalized

form affects the whole body and may be

fatal.

7) The infection is never fatal and may be

diagnosed by a skin scraping. The skin

scraping should be repeated in 8 to 12

places. Mites can be difficult to find. A

presumptive diagnosis can be made by

folding an ear on itself and rubbing it

together, or by scratching the ear margin

with the thumbnail. If the dog kicks the

Tiuiftninj tfct tattki of Vtttriiury Ktdant With You

Copyright 1998, Steven D. Garner, DVM

Page 28 of 28

Pillars Training

Dermatology

hind leg (Pinna-Pedal reflex) when this is

done the pet is said to have sarcoptes until

proven otherwise.

8) Skin scraping should be done for

Diagnosis. The skin is squeezed hard to

express the mites from the follicle. Then

mineral oil is applied to the skin. A dull

scalpel blade or slide with oil on it is

used to scrape the skin hard enough to

get capillary bleeding. The hair and skin

debris are collected onto a microscope

slide. A coverslip is placed and the slide

is examined.

8) Sarcoptic mange is relatively easy to kill and

dipping with Mitaban®, lime sulfur, or

organo-phosphate dips will be curative.

Injections of ivermectin will also kill the

Mite and is the treatment of choice.

Chronic infections may occur. One

injection of ivermectin has been known to

eliminate infection.

9) Treatment is achieved with doses of

ivermectin. Older treatments include

dipping with Mitaban dip.

9) When dipping the dog, the dip should be

used to clean the cage or kennel to prevent

infestation of the next dog in the cage.

Other equipment and utensils should be

cleaned as well.

10) Home remedies are harmful and

corticosteroids are very harmful and

should not be given.

10) Home remedies are not effective. The

infection on people is self-limiting and will

only last for a few weeks.

11) Repeated dosing may be necessary and

the mite may be impossible to eliminate

due to suppression of the white blood

cells. Life long therapy may be

necessary. Large doses of ivermectin

have recently been shown to be effective.

U) Sarcoptic mange is very common and is

also curable. Therefore, if you suspect

sarcoptic mange to be a possible diagnosis

you should treat it. This will prevent a dog

from being subjected to a life of steroids.

NOTE: Sarcoptic mange is a very common disease of dogs. It is often misdiagnosed as "allergy" andtreated with corticosteroids. Studies have shown that only fifty percent of the dogs that actually havesarcoptic mange will be diagnosed based on doing twelve skin scrapings. A simple and effective test

for sarcoptic mange is to rub the earflap on itself to see if the foot kicks. A positive "pinnal - pedal"reflex is a good indication that sarcoptic mange is the diagnosis. Sarcoptic mange should be treated in

any animal suspected of having it because it is curable whereas allergies are not. By making a

presumptive diagnosis of allergies - you are virtually condemning a dog to a life of steroids.

Tnnsftrrraoj th» Priclit* ol tetrimiy Httitbt With Tew

Copyright 1998, Steven D. Garner, OVM

Page 29 of 29

y' Pillars Training"

i I f )'$ Defm&toiogy

Actions ofDermatological Agents

Benzoyl peroxide (Oxydex®, Pyoben®) containing shampoos have been used for "follicle flushing"

and are keratolytic, antibacterial, antipruritic, and de-greasing.

Coal Tar - keratolytic (peeling), antipruritic (anti-itching), anti-inflammatory, at levels over 2% USP

is antimitotic, keratoplastic, and vasoconstrictive.

Glycerin - moisturizing. -

Lactic acid - reduces keratin formation.

Mineral/Vegetable Oil - occlusive (sealing), moisturizing.

Propylene glycol - antibacterial, moisturizing..

Salicylic acid - mildly antipruritic, bacteriostatic, and keratolytic (peeling).

Selenium - antibacterial, drying.

Sulfur - antibacterial, antifungal, antiparasitic, and drying.

Urea - moisturizing.

Treatments for the Skin

Topical Treatments

Cleaning the skin

The skin surface constantly accumulates debris. The normal skin surface contains products of the

skin, glands, flakes of epidermis, and dirt. Excessive amounts of these, along with serum, blood, and

crusts, are found on the surface of abnormal skin. Most cases of skin disease that need topical

medication require clipping, cleansing, and application of therapeutic agents are logical steps to

effective treatment. Clipping and cleaning the lesion works wonders! Then adding topical

medications. When cleaning, some areas that are acute may be damaged by vigorous washing with

soap and water and may better be treated with wet dressings, or warm oil baths.

Hydrotherapy

Water is a component of many lotions. Plain tap water is one of the most effective agents in the

treatment of skin diseases. It is often neglected - or misused. Water may be used to hydrate the skin

or dehydrate the skin depending on how it is used. Oils soften the skin by blocking evaporation of

water and thus increasing the content of water in the horny layer.

TfinsftnniDg the Pnctiael Vttiriimy Htikiat With ton

Copyright 1998, Steven 0. Garner, DVM

Page 30 of 30

Pillars Training*3

X Dermatology'•£>

Hot Oil Therapy

This is the application of heated cholesterol to the coat after careful cleaning. The hot oil penetrates

cracks and fissures, sealing them and preventing local moisture loss and drying. These areas of

irritation then stay moist, and are therefore less inflamed. The hot oil therapy is a way to greatly

reduce the "itchiness" of a pet while therapeutically sealing the natural moisture in the dog's skin.

The hair coat is also affected causing a very pleasant feel and silkiness to the coat. Most clients and

pets love this approach.

Medications used with water

Astringents, antiseptics or antibiotics are added to water to create other effects. Astringents

precipitate proteins and prevent exudation. The most common astringent used is Aluminum acetate-

or Burrow's solution (HB 101) which is drying, astringent, and antiseptic.

Bath oils are used on humans but have limited use for animals. Products such as Alpha -Keri®, and

Humilac® are available as skin conditioners. Lactic acid and urea have hygroscopic and keratolytic

actions that aid in normalizing the epidermis. Humilac® contains both urea and lactic acid and can

be used as a rinse or a spray. To make a rinse, five capfuls of Humilac® are added to one quart of

water. The mixture is poured over the coat and allowed to dry.

Medicated shampoos contain additional ingredients that supposedly enhance the action of the

shampoo. These substances cannot be expected to work if they are immediately rinsed off.

Proper bathing of a large dog may take a very long time!

Non-medicated or hypoallergenic shampoos are primarily meant for cleansing.

Anti-seborrheic shampoos usually contain salicylic acid, sulfur, and tar. Sulfur is keratolytic,

keratoplastic, antibacterial, antifungal, antiparasitic, antipruritic, and mildly follicular flushing.

Hair care products

Hair is inert and not alive, but many terms have been used to describe its "life", bounce, glossiness,

body, flyaway and manageability.

Shampoos should remove dirt, grime, and sebum and leave the hair soft, shiny, and easy to

comb. To accomplish this they should lather well, rinse freely, leave no residue, cause no eye

damage, and remove soil, not natural oils. Some shampoos still have a soap base but most are

surfactants.

Tnnifenninj *« Pnctici of Vtttrinvy Hiditim Wilh Tan

Copyright 1998, Steven D. Garner, DVM

Page 31 of 31

.;,.)?'" Pillars Training""

,| Dermatology

Soap shampoos work well in soft water but in hard water, they leave a film of calcium salts.

Detergent shampoos are surfactants (usually salts of lauryl sulfate). They do not react in hard

water but are harsh. Other additives are added to combat this such as glycol, lanolin, oils, and

fatty acids are supposed to prevent complete removal of natural oils or tend to replace them.

Baby shampoos are milder and do not harm the eyes but are still harmful to pet's skin and

will not clean heavy oil deposits.

Dry shampoos are not recommended.

Hair conditioners have two main purposes - to reduce static electricity so the hair does not

snarl or become flyaway, and to give body to limp hair or thin hair.

Protein builders or body builders contain oils, which add luster, and protein which coats the

hair and makes it "thicker".

SHAMPOOS

ALLERGROOM® shampoo

This is a moisturizing, hypoallergenic shampoo for dry skin in cats and dogs of any age. It

cleanses without undue stripping of the lipid layer while adding moisture to the stratum

corneum (outer layer of the skin). Allergroom® contains no known sensitizing agents such as

fragrances, soaps or detergents and is pH adjusted to normal canine skin.

EPI-SOOTHE® (AHerderm™)

Natural colloidal oatmeal 2% in shampoo base

An emollient shampoo for soothing and cleansing sensitive skin that is soap free and helps

restore natural skin oils and moisture.

EPI-SOOTHE® cream rinse

This rinse contains natural colloidal oatmeal 20% and.

prevents tangles.

RESICORT® leave-on conditioner

Hydrocortisone 1%

Tnitsfeimin; the Prxtin of Ytttrimry Mtdkim With Tea

Copyright 1998, Steven D. Garner, DVM

Page 32 of 32

Pillars Training"

r[ Vf J, Dermaatology

Topical Formulations

Powders

Powders are pulverized solids that are applied in a thin film. They may be added to water to form

shake lotions, or to ointments to make a paste. Powders are used as drying agents and to cool and

lubricate areas.

Lotions

Lotions are liquid powders - when the liquid evaporates a thin layer of powder is left. Lotions tend

to be more drying than liniments that are oil based. Calamine lotion contains calamine, zinc oxide,

glycerin, and calcium hydroxide. It is soothing and antipruritic and leaves a powder residue.

Emulsions

Emulsions are oily substances dispersed into water. Emulsions are thicker than lotions but thinner

than ointments. Emulsions may be of oil with water or water with oil. A cold cream is mostly oil

with a little water and a vanishing cream is mostly water with a little oil but the effect is the same.

When the water evaporates the oil is left on the skin. Hairy skin does not lend itself to application of

emulsions.

Creams and Ointments

Creams, ointments, salves, and pastes are mentioned in increasing order of viscosity or thickness. All

spread fairly well and maintain contact between the drug and the skin. They may protect the skin

from drying and help to soften the skin. Creams and ointments are mostly oils into which water has

been blended at high speeds. Pastes are the same except large amounts of powders are added. In

general these are not indicated on oozing skin. Creams and ointments tend to lubricate and soothe

skin that has been roughened. They may also serve to transport medicinal agents into the skin. This

type of medication should be applied several times a day in a THIN film. If you can see the oint

ment, it is TOO THICK. Simple oils such as petroleum jelly may soothe and protect inflamed skin.

Gels

Gels are topical formulations composed of propylene glycol, propylene gallate, disodium EDTA and

HC1 to adjust the pH. Gels are good in veterinary medicine. They can be rubbed into the skin to

disappear completely and do not leave the skin with a sticky feeling. Gels are especially useful in

animals because they pass through the hair coat and are not messy. Examples are Pyoben® Oxydex®

and Dermal Wound Gel®.

DMSO

DMSO is a simple, water attracting, solvent. It dissolves in water, oil and alcohol and is an excellent

carrier for drugs and chemicals. Unlike most solvents, penetration is achieved without damage to the

cells of the skin. DMSO acts synergistically with steroids in the cells. DMSO on its own is a

cryoprotectant (preserves tissues against freezing), radioprotectant (preserves tissues against radiation),

Page 33 of 33

Iraitftminj rti foctitt el fettriuiy Httfdst With Tn

Copyright 1998, Steven D. Garner, DVM

Pillars Training1

i§

anti-ischemic, anti-inflammatory and analgesic agent. It is non-toxic and does not cause cancer in lab

animals. In general, anything mixed with it will be carried into the body quickly. It has a fowl odor

and should be handled with gloved hands.

Emollients, Keratolytics, and Dry Skin

Emollients are agents that soften or soothe the skin - keratolytic agents - which promote separation or peeling

of the horny layer of the epidermis. "Dryness of the skin" is recognized when the skin is rough on the

surface, and, when the horny is inflexible and cracks. Any of these can lead to increased scale formation.

Normal skin is not a waterproof covering but is constantly loosing water to the environment. The rate of

water lost is dependent on body temperature, environmental temperature, and the relative humidity. The

flexibility of skin is related to the keratin in the horny layer, and the amount of water in the keratin

determines the softness and flexibility of the epidermis.

HUMILAC® Spray (Dry Skin)

Oil-free dry skin spray and rinse for dogs and cats. Humilac contains three

moisturizers and is used as necessary. We recommend following the baths with a

moisturizer to help prevent the skin from over drying. Add 8 capfuls to a gallon of

water and pour over the pet. Allow product to dry on the pet.

Topical Anti-pruritics (Anti-itch)

Topical anti-itch preparations work in one of four ways:

1) Substituting some other sensation for the itch sensation. Examples are methanol, camphor,

thymol, heat (warm water soaks or baths), *nd cold (ice packs).

2) Protecting the skin from trauma that may simulate release of agents from mast cells or cause

damage to the skin. Protecting from scratching, biting, temperature changes, humidity changes,

pressure, and irritants. This can be done with bandages or any impermeable agents.

3) Anesthetizing the area with lidocaine, benzocaine, tetracaine, benzoyl peroxide, or tars.

4) Using specific biochemical agents such as corticostenids.

Topical Anti-microbial

Antiseptics - topical medications used on live tissue that kill or prevent the growth of microbes.

Disinfectants - agents that prevent infection by destruction of microbes especially on non-living tissue.

Anti-septics

Alcohol - acts by precipitating proteins. Do not use on denuded surfaces. Anti-septics are cooling

astringent, and antibacterial.

Propylene glycol - antibacterial and antifungal. Acts as a vehicle for other medications.

Phenols - are antibacterial and antifungal. Lysol® and Pine Sol® are phenols. All phenols are toxic

to cats. Hexachlorophene is a good cleansing agent used in human medicine.

Nolvasan® (chlorhexidine) - highly effective against many bacteria, fungi, and viruses. It is non-

irritating and safe for cats. A one to ten dilution is safe for irrigating wounds and ears.

Formaldehyde - kills most organisms but is too irritating.

Balsams - mild, counter-irritants and are made of resins aid natural oils.

Acids - acetic and benzoic acids are mildly keratolytic and anti-bacterial.

Page 34 of 34

Tnntfomlajtlit Practici of YtttrinaryHtditintWithlfai

Copyright 1998, Steven D. Garner, DVM

Pillars Training"

/■■ ,u. \%

J, Dermatology

Iodine - Betadine, tincture of iodine, and Lugols iodine are all anti-bacterial, anti-fungal, virucidal,

and sporicidal. All except Betadine are irritating, and even Betadine can be irritating to cats.

Clorox - when diluted with water 1:10, can be used on the skin.

Peroxide- weak germicide.

BenzoyI peroxide- a potent anti-bacterial. Keratolytic, de-greasing, anti-pruritic and follicle flushing.

Sulfur- effective fungicide and is bactericidal.

Corticosteroids

Corticosteroid topical formulations are the most effective for stopping "itch" reactions in dogs and

cats. While the effect is concentrated locally, there is the potential for system absorption. Therefore,

these medications should be used only after less powerful medications have failed to resolve the

problem.

Systemic Formulations

METHYLPREDNISOLONE ACETATE (Depo-Medrol®)

This is a slow release form of a corticosteroid that will last from 3 to 4 weeks.

METICORTEN®

Prednisone injection 10 mg/ml, 40 mg/ml.

This medication is used to quickly reduce inflammation and stop the itch-scratch cycle.

PREDNISONE (derm)

1 to 2 mg/kg ql2h for 1 week; followed by 1.0 mg/kg q24h for 1 week; followed by 0.5 to 1.0

rrig/kg qod for 1 week followed by tapered withdrawal over 2 weeks.

This is a corticosteroid. Typical side effects that you may see include increased appetite,

increased thirst, and increased urination. This is a relatively short-acting medication that is

unlikely to cause severe reactions when used as directed.

jiki Prxtict of Vtttriuiy Ht&a* With In

Copyright 1998, Steven O. Gamer, OVM

Page 35 of 35

Pillars Training1

{ \VDermatology

C/zenf Communications regarding Dermatological Problems

Dietary Recommendations

Hill's Prescription Diet® Canine d/d® (derm)

We recommend feeding Hill's Prescription Diet® Canine d/d® for those pets with dermatologic

disease. This food is composed of a limited number of highly digestible ingredients, which reduces the

incidence of hypersensitivity to the diet.

Hill's Prescription Diet Canine z/d (hydrolyzed)

Z/d is effective for pets who are very highly allergir. to animal proteins. The proteins in z/d are hydrolyzed, or

broken up, to decrease the probability of allergic response by the animal

Diagnostic Recommendations

Routine Blood Screen

We recommend this test as it can determine internal organ function that cannot be determined by

physical examination alone. The skin is an external mirror to the internal functions of the pet and _

many skin problems have their roots in internal organ dysfunction or disease.

Thyroid Function Tests

The thyroid gland is responsible for regulating metabolism. That is the rate that cells multiply and

divide as well as the rate of other bodily functions. The skin has the most rapidly dividing tissue cells

in the body. Skin cells therefore, use thyroid hormone more than other tissues, and deficiencies in

thyroid hormone will be reflected as skin disease. Hypothyroidism (low thyroid hormone) is a

common and correctable cause of skin disease in dogs that can mimic many other skin conditions.

Culture and Sensitivity

A culture and sensitivity test is performed at our reference laboratory. It involves trying to grow the

bacteria in the laboratory so that tests can be done to determine which antibiotic medications will be

most effective in controlling this bacteria. This test will take several days, and the results will help us

prevent reoccurrence of this problem.

Cytology

An aspirate is done by inserting a small needle into a mass and taking a sample of the cells inside the

mass, then placing those cells on a slide that is stained for evaluation under a microscope. Fine needle

aspiration of cells from a mass or tumor can be done to help qualify the type of mass that is present.

The slide preparations from these cells can be examined here in our hospital or sent to the laboratory

for analysis

frusfonniaitlitPnalaal feminity Hiiiti.n With hti

Copyright 1998, Steven D. Garner, DVM

Page 36 of 36

Pillars Training"

| Dermatology

Fungal DTM Test

Many skin diseases can be caused by fungal infections. The most common is ringworm that can be

tested for by this culture technique. The test results will not return for seven to ten days but it will

identify if ringworm is a potential Gause or complication with your pet.

Skin Scraping

The cause of many skin diseases can be determined by taking a sample of the outer surface of the skin

and hair and examining it under the microscope. This is done by scraping the skin with an instrument

or microscope slide after mineral oil has been applied. This procedure will leave a red spot without

hair on your pet but is many times an essential part in the diagnosis of your pet's skin problem.

Skin Biopsy

Difficult skin disease cases require accurate characterization of the type of reaction that the skin is

undergoing. Understanding the relationship of the hair to the skin as well as to infectious or

inflammatory agents is vital in the diagnosis of your pet's skin problem. A full thickness skin biopsy

is collected and sent to a board-certified dermatopathologist for evaluation.

Subcutaneous Fluid Therapy

Administration of fluids under the skin allows us to correct the dehydration that comes from fever

and inappetence associated with this condition.

Tumor Biopsy

All masses are abnormal. There is no method to determine if the cells in the mass are aggressive in

their growth without microscopic examination. Therefore, we recommend this test on all lumps,

bumps and masses so that we can determine if additional surrounding tissues need to be removed,

lymph nodes need to be biopsied, or radiographs need to be taken.

Allergy Testing

Atopic dermatitis indicates an itchy disease of the skin that is primarily caused by an adverse reaction

to plant pollens, grasses, dust or other allergens. These substances when inside the body stimulate the

release of histamine and other itch causing substances from mast cells in the skin. This reaction can be

blocked by antibodies created by vaccination against the substances that your pet is allergic to. In

order to create such a vaccine, we need to test your pet's blood for the presence of allergic reaction to

these substances. The test will pinpoint which pollens or other allergens are the offenders. A vaccine

will then be made against those substances specifically for your pet. This vaccination will have to be

given on a schedule that will prevent this excessive itch reaction from occurring.

Trinifarmtnj ttu Fntila of Vtttrinirf Hiditint With Tin

Copyright 1996, Steven D. Gamer, DVM

Page 37 of 37