DermaZoo

Jessica Melman Bhatia, VMD

Dental Disease
Case Study January 1, 2017

Rango, a 7 year old male castrated Cavalier King Charles, was presented for halitosis. On physical examination, he had a grade 2/4 dental disease, with oligodontia from a prior dental, significant tartar on his maxillary premolars and molars and gingivitis. He also had a grade 2/6 heart murmur which was diagnosed as Mitral Regurgitation by a cardiologist with an echocardiogram. Blood work was performed and he had a mildly elevated Alanine Aminotransferase (ALT). He was started on Denamarin and a dental cleaning was scheduled.

Rango was placed under general anesthesia and a dental cleaning was performed. His remaining incisors needed to be extracted.

He was sent home with a toothbrush and DermaZoo’s TrisDent Gel for the owner to brush his teeth and slow plaque formation. It was also recommended to re-check his liver values 1-2 months post dental and continue the Denamarin until further notice (which was normal when re-checked 3 months post dental).

Jessica Melman Bhatia, VMD

Omega-3 Fatty Acids and Osteoarthritis (OA)
Case Study April 5, 2016      

Sam, a 13 year-old MC Golden Retriever, was presented for chronic intermittent bilateral hind limb lameness 1 year ago. On initial exam, he had pain on manipulation of both coxofemoral joints with no appreciated hind limb lameness, pain or lameness of his front limbs, neck or back. He was overweight with a Body Condition Score of 7/9. Radiographs were declined. Sam was diagnosed with suspect coxofemoral osteoarthritis (OA). Blood work was performed and within normal limits. He was started on the NSAID, Carprofen, and placed on a calorie-restricted diet for weight loss. He was also started on DermaZoo’s EpaZoo Omega-3 Liquid.

Leading DVM’s agree that “considerations for the management of OA in dogs include dietary restriction, weight loss, diets with Omega-3 fatty acid supplementation, controlled activity, and use of amantadine.” (1) Omega-3 fatty acids specifically are “efficacious in decreasing pain and improving mobility in dogs as well as help with weight loss.” (2)

Sam presented 6 months later (6 months ago) and had lost weight, putting him at an ideal body weight of 5/9. The owner reported that he was overall more comfortable but on days that he had increased exercise he was slightly less comfortable. Re-check blood work was within normal limits. NSAIDS and Omega-3 Fatty Acids were continued. Sam was started on twice weekly Adequan injections for 4 weeks followed by monthly injections, and Tramadol was also started on an as needed basis.

Sam recently returned for a re-check (2 months ago). The owner reported that he was much improved. The owner was giving Carprofen, Tramadol and Omega-3 Fatty Acids daily as well monthly Adequan injections. She was also keeping him active and lean. On examination, he had muscle wasting and mild (2/6) lameness of both hind limbs and was noticeably slow to rise after sitting down on examination. Blood work was performed and again within normal limits. We started twice weekly cold laser therapy and are considering amantadine for further pain control if needed.

REFERENCES

1. OA & Surgery: Consideration of NSAIDs. Michael G. Conzemius, DVM, PhD, DACVS. Western States Veterinary Conference, 2016.
2. Keys to OA Management. B. Duncan X. Lascelles, BSc, BVSc, PhD, MRCVS, CertVA, DSAS(ST), DECVS, DACVS & Denis J Marcellin-Little, DEDV, DACVS, DECVS, DACVSMR. Western States Veterinary Conference, 2016.

Jessica Melman Bhatia, VMD

Case Study: Methicillin-Resistant Staphylococcus Pseudintermedius (MRSP) & Gly4Chlor Shampoo
December 2015

Emily, a 13-year female spayed Terrier Mix, presented for a chronic skin infection unresponsive to a 3-week course of Cefpoxidime and Hydroxyzine. She had a history of recurrent skin infection secondary to underlying allergies. The patient was on a hypoallergenic diet and the owner declined a further work-up for possible atopic dermatitis.

According to the owner, the Terrier was pruritic 8/10. On examination, she had epidermal collarettes and pustules on her ventral abdomen, ventral thorax and bilateral inguinal region. Cytology was performed and revealed 3++ cocci and no yeast. A skin scrape was negative. Blood work revealed no significant abnormalities, with only a mild increase in Alkaline Phophatase (ALKP). Finally, a skin culture was performed. The patient was sent home on Doxycycline and with instructions to bathe 2-3 times a week with DermaZoo’s Gly4Chlor Shampoo, pending the skin culture results.

The skin culture results revealed abundant growth of methicillin- resistant Staphylococcus pseudintermedius (MRSP), sensitive to Amikacin, Azithromycin, Chloramphenicol, Clindamycin, Doxycline, Mupirocin and Potentiated Sulfonamide. Doxycycline was prescribed for a total of 6 weeks along with the continuation of 2-3 times weekly Gly4Chlor Shampoo baths. Topical Mupirocin was also dispensed for use on the skin lesions twice daily for 3 weeks.

Staphylococcus pseudintermedius is the most common species of bacteria found on dogs. Usually, this bacteria resides on the skin but does not cause any problems. However, some dogs develop a skin infection (pyoderma) that can usually be cleared with one of the common antibiotics. A small percentage of dogs may develop skin infections caused by methicillin-resistant Staphylococcus pseudintermedius (MRSP), which means that more common antibiotics will not clear the infection. This bacteria is most common in pets with recurrent skin infections due to underlying causes such as allergies or endocrine disease. Staphylococcus pseudintermedius causes infections in pets and only rarely causes infections in people.

At a 4-week re-check, the Terrier no longer had epidermal collarettes or pustules, and the owner was instructed to finish the 6-week course of Doxycycline. A weekly bath with Gly4Chlor and oral Zyrtec as needed is currently been used to keep her comfortable. The patient has been free of infection for several months now.

DermaZoo’s Gly4Chlor Shampoo

DermaZoo’s Gly4Chlor Shampoo is a potent antimicrobial shampoo that contains 1% glycolic acid, 4% chlorhexidine gluconate and ceramides. Gly4Chlor aids in the topical treatment of conditions responsive to a broad spectrum shampoo with the rejuvenating benefits of Glycolic Acid and and antimicrobial benefits of Chlorhexidine. Ceramides aid in restoring moisture to dry and damaged skin. This is a potent antimicrobial shampoo as 4% Chlorhexidine is bactericidal against methicillin-resistant Staphylococcus aureus. (1)

1. Bactericidal activity of antiseptics against methicillin-resistant Staphylococcus aureus in ponies. C E Haley, M Marling-Cason, J W Smith, J P Luby, and P A Mackowiak; J Clin Microbiol. Jun 1985; 21(6): 991-2.

Jessica Melman Bhatia, VMD

Case Study: GlycoBenz and Feline Acne
October 2015

A 10 year-old female spayed domestic short hair cat presented for weight loss and increased appetite. On examination, she had a palpable thyroid nodule, as well as comedones with mild erythema and partial alopecia on her ventral chin.

To further evaluate her chin, a skin scraping was performed and found negative for Demodex. A skin cytology showed cocci and no yeast. Blood work was also performed. The patient was diagnosed with  hyperthyroidism and feline acne.

Methimazole was dispensed to treat her hyperthyroidism. To treat the feline acne she was given a Convenia injection and GlycoBenz Shampoo to apply to the chin once daily for 10 days, and then twice weekly thereafter for maintenance.

Feline acne starts as comedones or blackheads on the chin and lower lip. Poor grooming is believed to play a role by allowing hair follicles to plug with keratin resulting in secondary inflammation and possibleinfection. Other theoretical causes include abnormal keratinization, sebum production or immune-barrier function. Some cats have a single occurrence that does not recur once treated, while others have a continual problem that requires life-long treatment.

At re-check of the patient’s thyroid levels 6 weeks later, her thyroid levels were within normal limits and her feline acne was resolved. The rest of her chemistry and CBC within normal limits as well. The owner elected for continuing radioactive iodine treatment for the hyperthyroidism.

GlycoBenz Shampoo
DermaZoo’s GlycoBenz Shampoo contains 1% Glycolic Acid and 2.5% Benzoyl Peroxide and aids in the topical treatment of seborrhea oleosa (oily/scaly skin), pyoderma, pyotraumatic dermatitis, Demodex, Staphylococcal folliculitis, Malassezia and other conditions where a broad-spectrum shampoo with these active ingredients may be beneficial.

Benzoyl peroxide has antimicrobial, comedolytic/follicular flushing, keratolytic and antiseborrheic actions, and is therefore helpful to use topically in the treatment of feline acne. Benzoyl peroxide shampoos are generally used for oily and scaly skin (seborrhea oleosa), superficial and deep pyodermas, crusty pyodermas (such as seborrheic dermatitis/pyoderma), pyotraumatic dermatitis, furunculosis, and as adjunctive therapy for generalized demodicosis.

Glycolic Acid has antimicrobial properties; it is follicular flushing, and it exfoliates extra/dead skin cells allowing the benzoyl peroxide to get to the skin follicles to work more effectively. For this reason,GlycoBenz Shampoo is more effective than products containing only benzoyl peroxide.

Jessica Melman Bhatia, VMD

What is a Hot Spot?
Pyotraumatic dermatitis or hot spots are moist, erythematous and sometimes bloody when they are fresh, and dry and scabby when they are resolving. They can cover large expanses of skin, can appear as solitary lesions or in multiple locations, but are generally well defined. They are caused by self-mutilation that may be a result of an allergy or an irritation, such as fleas. The basic hot spot treatments are to keep the patient from further irritating the area, promote drying of the moist skin and to alleviate the pruritus. Hot spots below the ear or on the lateral face may be a deeper skin infection and often require more extensive treatment. Deeper skin infection treatment might include oral corticosteroids and/or oral antibiotics in addition to topical antiseptics and anti-inflammatories.

DermaZoo’s Hot Spot Treatment Protocol
Clip the hair from the lesion(s) so that there is an area of unaffected skin surrounding the lesion(s). Then apply GlycoBenz Shampoo to the lesion(s), allowing the medicated shampoo to sit for 10 minutes prior to rinsing. Cleanse the lesion(s) daily with GlycoBenz Shampoo until resolved. Oral corticosteroids and/or topical steroids are often needed as well. Systemic and/or topical antibiotics may also be needed depending on the severity of the lesion(s). An e-collar may be needed as well.

Why use DermaZoo’s GlycoBenz Shampoo?
Benzoyl peroxide has antibacterial and drying effects, and is therefore helpful to use topically in the treatment of pyotraumatic dermatitis. Benzoyl peroxide shampoos are generally used for oily and scaly skin (seborrhea oleosa), superficial and deep pyodermas, crusty pyodermas (such as seborrheic dermatitis/pyoderma), pyotraumatic dermatitis, furunculosis, and as adjunctive therapy for generalized demodicosis. Benzoyl peroxide has antimicrobial, comedolytic/follicular flushing, keratolytic and antiseborrheic actions.

DermaZoo’s GlycoBenz Shampoo contains 1% Glycolic Acid and 2.5% Benzoyl Peroxide and aids in the topical treatment of seborrhea oleosa (oily/scaly skin), pyoderma, pyotraumatic dermatitis, Demodex,  Staphylococcal folliculitis, Malassezia and other conditions where a broad-spectrum shampoo with Benzoyl Peroxide and Glycolic Acid may be  beneficial. See the DermaZoo website for more information.

DermaZoo’s Hot Spot Treatment Testimonial
“Dear DermaZoo, I had great success with your tip for hot spot management on my Golden Retriever. Thank you so much for the advice. I look forward to passing it along as yet another thing DermaZoo products can help our patients with!

Thank you again,
Megan L. Sullivan, University of Florida College of Veterinary Medicine, Class 2017”

Case Study: EpaZoo & Protein Losing Nephropathy
August 2015

A geriatric female spayed Chihuahua presented for lethargy and polyuria/polydypsia for several weeks duration. She had been rescued a few months prior with a history of dental disease. She had a dental cleaning prior to being adopted.

On physical exam, she was obese with cranial organomegaly. The remainder of her exam was within normal limits.

A Chemistry/CBC/Thyroid/Urinalysis and urine culture were performed. Blood work revealed an elevated ALT and ALKP. Urine specific gravity was 1.017 with 3+ protein, and an inactive urine sediment. The urine culture came back negative. An ACTH stimulation was then performed and within normal limits. A repeat urinalysis revealed 2+ protein, and a urine protein:creatinine ratio revealed that she was proteinuric at 2.8.

An abdominal ultrasound was then performed. The abdominal ultrasound findings included hepatomegaly with a hepatic mass and chronic renal changes. A coagulation panel was within normal limits. The patient was sedated for a liver biopsy, which came back as a hepatocellular adenoma. Chest radiographs were also unremarkable.

The patient was diagnosed with renal proteinuria or protein losing nephropathy (PLN), which is a pathologic increase in the quantity of protein present in the urine as a result of glomerular disease. Patients with protein losing nephropathy require a diagnostic workup to try to identify a potential underlying cause for their glomerular disease.

The patient’s blood pressure was taken and within normal limits. A Thromboelastogram (TEG) revealed that she was in a hypercoagulable state, and she was started on Plavix. Leptospirosis titers and a tick panel were also both performed and negative. She was then started on Enalapril, <strong>DermaZoo’s EPAZoo Omega-3 Liquid</strong> fatty acids and a renal diet to treat her PLN.

The treatment plan for this patient is to routinely monitor her blood pressure, renal values and urine:protein creatinine ratio as well as her liver nodule. An ultrasound-guided renal biopsy may be offered if the protein losing nephropathy progresses with treatment.

A geriatric female spayed Chihuahua presented for lethargy and polyuria/polydypsia for several weeks duration. She had been rescued a few months prior with a history of dental disease. She had a dental cleaning prior to being adopted.

On physical exam, she was obese with cranial organomegaly. The remainder of her exam was within normal limits.

A Chemistry/CBC/Thyroid/Urinalysis and urine culture were performed. Blood work revealed an elevated ALT and ALKP. Urine specific gravity was 1.017 with 3+ protein, and an inactive urine sediment. The urine culture came back negative. An ACTH stimulation was then performed and within normal limits. A repeat urinalysis revealed 2+ protein, and a urine protein:creatinine ratio revealed that she was proteinuric at 2.8.

An abdominal ultrasound was then performed. The abdominal ultrasound findings included hepatomegaly with a hepatic mass and chronic renal changes. A coagulation panel was within normal limits. The patient was sedated for a liver biopsy, which came back as a hepatocellular adenoma. Chest radiographs were also unremarkable.

The patient was diagnosed with renal proteinuria or protein losing nephropathy (PLN), which is a pathologic increase in the quantity of protein present in the urine as a result of glomerular disease. Patients with protein losing nephropathy require a diagnostic workup to try to identify a potential underlying cause for their glomerular disease.

The patient’s blood pressure was taken and within normal limits. A Thromboelastogram (TEG) revealed that she was in a hypercoagulable state, and she was started on Plavix. Leptospirosis titers and a tick panel were also both performed and negative. She was then started on Enalapril, DermaZoo’s EpaZoo omega-3 fatty acids and a renal diet to treat her PLN.

The treatment plan for this patient is to routinely monitor her blood pressure, renal values and urine:protein creatinine ratio as well as her liver nodule. An ultrasound-guided renal biopsy may be offered if the protein losing nephropathy progresses with treatment.

EPAZoo Omega-3 Liquid
DermaZoo’s EPAZoo Omega-3 Liquid is a lemon flavored, concentrated, source of 360 mg EPA (Eicosapentaenoic Acid) and 240 mg DHA (Docosahexaenoic Acid) fatty acids plus Vitamin E. EPAZoo contains USP Grade fish oil from wild caught fish.

Omega-3 fatty acids include Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), and Alpha-Linolenic Acid (ALA). Marine oil sources provide EPA & DHA. Marine oil fatty acids have been useful in the treatment of many conditions, such as osteoarthritis, inflammatory skin disorders, cardiovascular disorders, renal disease and cognitive health.

In dogs with experimentally induced chronic kidney disease, omega-3 fatty acids reduced proteinuria and interstitial cellular infiltrates, prevented glomerular hypertension, and decreased the production of proinflammatory eicosanoids compared to safflower oil (containing omega-6 fatty acids). ¹

REFERENCES

1. Effects of dietary polyunsaturated fatty acid supplementation in early renal insufficiency in dogs. Brown SA, Brown CA, Crowell WA, et al. J Lab Clin Med 135:275-286, 2000.

Case Study: Discoid Lupus Erythematous
March 2015

Bruno, an 8 year-old male castrated Shepherd X, presented with mucoid ocular discharge, bilateral erythema, crusting and ulceration of his periocular regions, ulceration and crusting of his lateral nares and crusting and alopecia of his dorsal nasal planum. On physical examination, he also had mild bilateral coxofemoral pain. He had a history of mild crusting of his lateral nares that was left untreated. He was sent home on Cephalexin for 3 weeks and blood work was performed. His blood work came back within normal limits.

After 3 weeks, he was slightly improved, and therefore, he was placed under general anesthesia and multiple punch biopsies were taken from his lesions. The biopsies came back as Discoid Lupus Erythematosus (DLE).

Oral Niacinamide and Doxycycline, as well as topical Betamethasone Cream 0.1% for application once daily to the nasal planum and lateral nares, were all prescribed for 12 weeks. DermaZoo’s oral EPAZoo Omega-3 Fatty Acid with Vitamin E was also prescribed to help reduce the cutaneous inflammation associated with the DLE and to help reduce the inflammation associated with his suspected hind limb arthritis. The owner was also instructed to use sunblock on Bruno’s nasal planum when outdoors in the sun.

Current pictures are displayed. Pictures will be posted after his 12 week re-check occurs.

DLE is an auto-immune skin disease that typically presents as an erosive, ulcerative, and depigmented nasal dermatitis but can also involve other sites, such as the periocular region, pinnal and genital regions. The underlying cause is unknown. DLE appears to be exacerbated by ultraviolet light exposure and is more common in sunnier climates.

Skin biopsy is required to diagnose DLE, and immunomodulatory therapies are used to manage these cases. Some cases respond only to topical or systemic therapy, while some cases require a combination approach. It is recommended to treat until clinical remission then gradually taper to the lowest dose that prevents or minimizes flare-ups.

EPAZoo Omega-3 Liquid
DermaZoo’s EPAZoo Omega-3 Liquid, is a lemon flavored, concentrated source of 360 mg EPA (Eicosapentaenoic Acid) and 240 mg DHA (Docosahexaenoic Acid) fatty acids plus Vitamin E. EPAZoo contains USP Grade fish oil from wild caught fish.

The benefits of Omega-3 supplementation are well documented. Fatty Acids help promote healthy skin and coat, support immunity and aid in decreasing inflammation in the body, such as inflammation in the skin and joints.

Pyoderma and Gly4Chlor Shampoo
November 2014

A middle age female spayed Cocker Spaniel presented for crusty and smelly skin. She was also pruritic according to the owner. On exam, she had generalized crusts along her trunk and was malodorous. A skin scrape was negative and cytology revealed cocci with no yeast or rods. She was diagnosed with pyoderma.

She was placed on the antibiotic Simplicef as well as twice weekly baths with DermaZoo’s Gly4Chlor Shampoo for 3 weeks duration. This shampoo was picked for Glycolic Acid’s keratolytic effects to remove the generalized crusts along with Chlorhexidine’s antimicrobial properties to treat the bacteria topically once the crusty (hyperkeratotic lesions) were exfoliated. She was also placed on the antihistamine Benadryl twice daily for her pruritus.

Gly4Chlor Shampoo aids in the topical treatment of conditions responsive to a broad spectrum shampoo with the rejuvenating benefits of Glycolic Acid and antimicrobial benefits of Chlorhexidine.

Gly4Chlor Shampoo with 1% Glycolic Acid, 4% Chlorhexidine Gluconate and Ceramides is a potent antimicrobial. Chlorhexidine has proven effects against gram-positive and gram-negative organisms. When combined with Glycolic Acid’s keratolytic effects, Chlorhexidine can get past dead skin cells to the target skin site and work. Ceramides in this shampoo also aid in restoring moisture to dry and damaged skin.

At re-check 3 weeks later, she was only mildly pruritic and her pyoderma and crusting was resolved. Blood work was also performed and all within normal limits including her thyroid level. She was placed on DermaZoo’s EpaZoo Omega 3 Liquid and Benadryl twice daily as needed.

Tear Staining Case Study: Tris-Ophtho Wipes
September 2014

A 7 year-old female spayed poodle presented for an annual exam. On examination, she had significant tear staining, moderate dental disease and a grade 3/6 left sided heart murmur.

Based upon the examination, blood work was performed and a referral to a cardiologist was recommended. A dental cleaning was recommend based upon the blood work results and the cardiology consultation. A schirmer tear test and fluroscein stain were also performed and both within normal limits.

DermaZoo’s Tris-Ophtho Wipes were dispensed. The hair around her eyes was clipped by a groomer and then the owner wiped the peri-ocular region of both eyes in a circular motion away from the eyes once daily.

The owner reported significant improvement after using the wipes for several weeks.

Pyotraumatic Dermatitis: GlycoBenz Shampoo
August 2014

A 7 month old male intact Bulldog presented for redness and itching of his neck for one week’s duration. He was already on Cephalexin and Rimadyl from his entropion surgery one week prior and was wearing an e-collar.

On physical examination, he had severe erythema and excoriations with moisture and crusts all along his ventral neck. He was wearing an e-collar to prevent scratching of his eyes post entropion surgery. The e-collar was rubbing against his neck and allowed him to scratch at most of his neck as well.

Pyotraumatic dermatitis or a “hot spot” was diagnosed after cytology was performed and revealed cocci and a skin scrape was negative. His neck was shaved and cleaned with GlycoBenz Shampoo in the hospital.

Pyotraumatic dermatitis or hot spots are moist, erythematous and sometimes bloody when they are fresh, and dry and scabby when they are resolving. They can cover large expanses of skin, can appear as solitary lesions or in multiple locations, but are generally well defined. They are caused by self-mutilation that may be a result of an allergy or an irritation, such as fleas. The basic hot spot treatment are to keep the patient from further irritating the area, promote drying of the moist skin and alleviate the pruritus. Hot spots below the ear or on the lateral face may be a deeper skin infection and often require more extensive treatment. Deeper skin infection treatment might include oral corticosteroids and/or oral antibiotics in addition to topical antiseptics and anti-inflammatories.

Cephalexin was dispensed to the Bulldog for an additional week as he had already been on it for one week’s duration. GlycoBenz Shampoo was dispensed and the owner was instructed to bathe his neck once daily for 10 days. Gentocin spray was also dispensed and the owner was instructed to spray the affected area twice daily, after bathing, for 10 days. He was also placed on oral Benadryl 50 mg twice daily to control the pruritis. A different e-collar was fitted to prevent him from scratching his eyes and most of his neck as well.

DermaZoo’s GlycoBenz was chosen in this case for benzoyl peroxide’s  antibacterial and drying effects. GlycoBenz Shampoo contains 1%  Glycolic Acid and 2.5% Benzoyl Peroxide and aids in the topical  treatment of seborrhea oleosa (oily/scaly skin), pyoderma, Demodex,  Staphylococcal folliculitis, Malassezia and other conditions where a  broad-spectrum shampoo with Benzoyl Peroxide and Glycolic Acid may be  beneficial. See the DermaZoo website for more information.

Benzoyl peroxide shampoos are generally used for oily and scaly skin (seborrhea oleosa), superficial and deep pyodermas, crusty pyodermas (such as seborrheic dermatitis/pyoderma), furunculosis, and as adjunctive therapy for generalized demodicosis. Benzoyl peroxide has antimicrobial, comedolytic/follicular flushing, keratolytic and antiseborrheic actions.

Re-check 10 days later revealed mild erythema and no moisture or crusts. The owner was instructed to stop all medications. The e-collar was removed as the entropion repair had healed and sutures were removed.