In vitro efficacy of a topical antimicrobial mousse and shampoo at proximal and distal hair locations against Staphylococcus pseudintermedius and Staphylococcus schleiferi.

BACKGROUND: Topical therapy is essential in assisting with the resolution of pyoderma. OBJECTIVES: (i) Evaluate the in vitro efficacy and residual activity of two different hair segments treated with shampoo and mousse against meticillin-sensitive and meticillin-resistant staphylococci; (ii) compare proximal and distal hair portions treated with the products and (iii) describe a new disc diffusion method for assessing residual efficacy. ANIMALS: Eleven privately owned, medium-haired dogs. MATERIALS AND METHODS: In this randomised, blinded and negatively controlled study, dogs were treated once with a 3% chlorhexidine digluconate-0.5% ophytrium shampoo on the lateral thorax, and the corresponding mousse on the opposite side. Hairs were plucked before treatment, two hours post-treatment, and day (D)2, D4, D7, D10 and D14. Hairs were weighed (0.01 g) and cut (1.0 cm) from the proximal portion, moistened with saline and placed on a sterile diffusion disc to absorb the solution. Proximal and distal hair bundles and diffusion discs were placed onto agar inoculated with an isolate of meticillin-sensitive or meticillin-resistant Staphylococcus pseudintermedius or Staphylococcus schleiferi. Inhibition zones were measured following incubation. RESULTS: Distal hairs had larger (p < 0.001) inhibition zones compared to proximal hairs. Mousse had significant differences (p < 0.05) between time points and locations for both the hair bundles and discs, while shampoo only had a significant difference (p < 0.001) between time points for the hairs. CONCLUSIONS AND CLINICAL RELEVANCE: Mousse was effective, and shampoo was only minimally effective in inhibiting bacterial growth in vitro, with the greatest effect occurring at the two hours time point. The distal hair shafts had greater inhibition.

An open-label clinical trial to evaluate the efficacy of an elemental diet for the diagnosis of adverse food reactions in dogs.

BACKGROUND: The diagnosis of cutaneous adverse food reactions (CAFR) in dogs is dependent on a diet trial and provocative challenge. HYPOTHESIS/OBJECTIVES: To evaluate the efficacy of an elemental diet for the diagnosis of CAFR in dogs. ANIMALS: Sixty-two client-owned nonseasonally pruritic dogs. MATERIALS AND METHODS: A prospective, uncontrolled, observational elimination diet trial study. Dogs were fed a commercially available elemental canine diet (Pro Plan Veterinary Diets EL Elemental Canine Formula, Nestlé Purina PetCare Company) for up to eight weeks. Pruritus was assessed using a validated Visual Analog Scale (PVAS), lesions with the Canine Atopic Dermatitis and Severity Index, 4th iteration (CADESI-04) and gastrointestinal (GI) signs with a client questionnaire. All dogs were challenged with their previous diet for up to 14 days. Treats were added from Day (D)7 to D14. RESULTS: Forty-five dogs completed the study. Eighteen (40%) of these were diagnosed with CAFR and 27 (60%) were diet-nonresponsive (NR). Dogs with CAFR flared on provocative challenges within 14 days. The smallest volume of previous diet that induced a CAFR flare was one teaspoon in two dogs (11.1%). The mean number of days leading to a provocation of clinical signs was 4.88 days. Gastrointestinal signs improved in both groups. Eight of the dogs with CAFR (44.4%) were subsequently maintained on the elemental diet alone. CONCLUSION AND CLINICAL RELEVANCE: Pro Plan Veterinary Diets EL Elemental Canine Formula is efficacious for the diagnosis of canine CAFR. One teaspoon of the offending diet may induce clinical signs in some dogs with CAFR.

Effect of ear cleaning on treatment outcome for canine otitis externa.

BACKGROUND: Ear cleaning is often recommended for management of canine otitis externa (OE). Few in vivo studies evaluate how ear cleaning affects treatment outcome. HYPOTHESIS/OBJECTIVES: To determine the effect of ear cleaning on canine OE by comparing treatment outcome in cleaned versus noncleaned ears. ANIMALS: Twenty-three client-owned dogs with ceruminous or purulent OE. MATERIALS AND METHODS: Forty ears were randomised to one of two groups: 20 ears were wiped with dry or saline-moistened gauze (grp1), and 20 external ear canals received manual cleaning (grp2) with a commercial product. One millilitre of a commercial otic suspension containing hydrocortisone aceponate, miconazole nitrate and gentamicin sulfate was applied to affected ears every 24 h for five days. Cytological scores, modified otitis index score (OTIS3), pruritus Visual Analog Scale (PVAS), modified PVAS and client questionnaire were compared on Day (D)0 and D7. RESULTS: There were no statistical differences between cytological scores, modified OTIS3, PVAS, modified PVAS or client assessments between groups at D7. Both groups had significant reduction in all treatment parameters from D0 to D7 with the exception of cytological rod scores that were only significantly decreased in cleaned ears. There was a significant difference in OTIS3 before and after cleaning on D0. CONCLUSIONS AND CLINICAL RELEVANCE: Both groups achieved successful outcome regardless of cleaning. Ear cleaning may be more important when rod-shaped bacteria are present.

Comparison of three canine nose guards for reduction of ultraviolet (UVA and UVB) solar radiation.

BACKGROUND: Protection from solar ultraviolet (UV) radiation is paramount for some dermatological conditions, yet there are no studies assessing UV nose guards for dogs. OBJECTIVES: Compare the ability of three nasal guards to block solar UV radiation (UVR) from the canine nose, using two commercial products and one created by the authors. ANIMALS: Four fabric model dogs were used in this prospective controlled trial. MATERIALS AND METHODS: Each model had a UV dosimeter applied to the dorsal nose and anterior nasal planum. Three models had nose protectors applied: (1) a mesh hood (OutFox Field Guard, OutFox For Dogs); (2) a fabric nose shield (Nose Protector, Dog Nose Protectors); or (3) a basket muzzle with ultraviolet protection factor (UPF) 50+ fabric developed by the authors. The control had no protective device applied. All the models were placed in direct sunlight and measurements taken over nine 2 h time periods. Total cumulative UVR was analysed for each location and type of guard or control. RESULTS: All guards provided statistically significant UV protection compared to control at all time points (p < 0.001). The basket muzzle with UPF 50+ guard was consistent in protecting the dorsal and anterior nose, blocking 94.2% and 94.3% UVR, respectively. The fabric nose protector blocked 99.2% UVR from the dorsal and 82.9% anterior. The mesh hood blocked 72.5% of UVR dorsal and 71.4% anterior. CONCLUSIONS AND CLINICAL RELEVANCE: Two guards were superior in blocking UVR; however, the choice of UV guard in a clinical setting depends on an individual's disease location and tolerance of the device.

The use of oclacitinib compared to azathioprine in the management of canine pemphigus foliaceus: A retrospective analysis.

BACKGROUND: Oclacitinib (Apoquel; Zoetis) has been reported to be beneficial for treating immune-mediated disorders. HYPOTHESIS/OBJECTIVES: This retrospective study evaluates in which group of dogs [oclacitinib (OC) or azathioprine (AZ)] remission of pemphigus foliaceus (PF) was more effectively achieved with matched induction dosing of glucocorticoids; it further evaluates which group had a higher glucocorticoid-sparing effect. ANIMALS: Review of 30 medical records of dogs diagnosed with PF presented to a private practice dermatological service. MATERIALS AND METHODS: Retrospective analysis of dogs diagnosed with PF and treated with OC or AZ in combination with glucocorticoids. RESULTS: There was no significant difference in the ability to induce remission between AZ and OC groups. In the AZ group, 13 of 15 dogs went into some type of remission (partial or complete), compared with 11 of 15 in the OC group. There was no significant difference between the two groups for the glucocorticoid-sparing effect. The AZ group had an average reduction of 77.9% from the induction glucocorticoid dose, and OC group had an average reduction of 64.4%. One of 15 patients in the AZ group and three of 15 patients in the OC group had a 100% reduction of the glucocorticoid dose. CONCLUSIONS AND CLINICAL RELEVANCE: These results indicate that OC can be considered as a treatment option for canine PF.

Evaluation of the use of paired modified Wright's and periodic acid Schiff stains to identify microbial aggregates on cytological smears of dogs with microbial otitis externa and suspected biofilm.

BACKGROUND: Micro-organisms associated with canine otitis externa (OE) may cause biofilm-associated infections (BAI). A key component of biofilm is microbial aggregate and extracellular polymeric substance (EPS). Periodic acid Schiff (PAS) can stain polysaccharide EPS in human otitis media with effusion, but this has not been tested in canine OE. There is no cytological definition for microbial aggregate, and definitive methods for identifying BAI in a clinical setting in canine OE have not been defined. OBJECTIVES: To establish whether PAS stain can identify polysaccharide matrix on cytological smears; and to determine the reproducibility of identification of microbial aggregates within a discrete area of stained matrix, using paired modified Wright's and PAS-stained smears. ANIMALS: Forty privately-owned dogs presenting to a dermatological referral practice. METHODS AND MATERIALS: In this prospective, cross-sectional study, three investigators independently and blindly classified 40 paired modified Wright's-PAS slide sets into groups: aggregate-associated infection (AAI) and non-AAI (n = 27); and control (n = 13). Agreement between investigators for presence of AAI was measured using Fleiss' kappa statistic (FK). Agreement between investigators and dermatologists for presence of AAI upon cytological evaluation, and suspected BAI based on clinical examination, was measured using Cohen's kappa statistic. RESULTS: The matrix was confirmed to stain PAS-positive. Interinvestigator agreement for AAI was very good using PAS (0.82 FK) and fair using modified-Wright's (MW) (0.33 FK). Reproducible cytological features associated with AAI were the presence of: three or more distinct aggregates (0.76 FK); discrete areas of PAS-positive matrix (0.70 FK); and the presence of high-density material (0.70 FK) using PAS stain. CONCLUSION: PAS can stain the extracellular matrix on otic smears, and a novel protocol for reproducible identification of cytological features such as microbial aggregates has been established.

Development of multiple cutaneous and follicular neoplasms associated with canine papillomavirus type 3 in a dog.

A 12-year-old spayed English pointer dog developed multiple skin lesions including pigmented viral plaques, basal cell carcinomas, squamous cell carcinomas and trichoblastomas. Canine papillomavirus type 3 was detected in multiple lesions suggesting common aetiology.

Un Pointer anglais de 12 ans a développé de multiples lésions cutanées dont des plaques virales pigmentées, des carcinomes baso-cellulaires, des carcinomes épidermoïdes et des trichoblastomes. Un papillomavirus canin de type 3 a été détecté dans plusieurs lésions, suggérant une étiologie commune.

Uma cadela pointer inglês castrada de 12 anos de idade desenvolveu múltiplas lesões de pele, incluindo placas virais pigmentadas, carcinomas de células basais, carcinomas de células escamosas e tricoblastomas. O vírus do papiloma canino tipo 3 foi detectado em múltiplas lesões, sugerindo etiologia comum.

Un perro de raza Pointer Inglés esterilizado de 12 años desarrolló múltiples lesiones cutáneas, incluidas placas virales pigmentadas, carcinomas de células basales, carcinomas de células escamosas y tricoblastomas. Se detectó virus del papiloma canino tipo 3 en múltiples lesiones, lo que sugiere una etiología común.

Development of a core outcome set for therapeutic clinical trials enrolling dogs with atopic dermatitis (COSCAD'18).

BACKGROUND: For decades, the efficacy of interventions in clinical trials enrolling dogs with atopic dermatitis (AD) relied on heterogeneous evaluations of skin lesions and pruritus using unvalidated tools. Although some instruments for clinical signs were validated later, there was little impact on standardizing outcome measures resulting in difficulties in comparing treatment efficacy between trials and impeding meta-analyses. RESULTS: Participants in the Outcome Measures subcommittee of the International Committee of Allergic Diseases of Animals (ICADA) collaborated for two years to develop a core outcome set (COS) for canine AD, the COSCAD. This project involved several steps, constantly-re-assessed during online exchanges, to define the scope of this COS, to identify the relevant stakeholders, the domains to be evaluated, the instruments available for measuring agreed-upon domains and how to express outcome measures. This COSCAD'18 was designed principally for therapeutic-but not preventive or proactive-clinical trials enrolling dogs with chronic, nonseasonal (perennial), moderate-to-severe AD. Selected domains were skin lesions, pruritus manifestations and perception of treatment efficacy. Instruments to evaluate these domains were the CADESI4 or CADLI, the 10-point pruritus visual analog scale (PVAS10) and the Owner Global Assessment of Treatment Efficacy (OGATE), respectively. The COSCAD'18 has three outcome measures: the percentages of dogs with veterinarian-assessed skin lesions or owner-rated pruritus manifestation scores in the range of normal dogs or those with mild AD; the third is a good-to-excellent global assessment by the pet owners of their perception of treatment efficacy. Importantly, this COSCAD'18 is not meant to represent the sole-or primary-outcome measures evaluated in a trial; authors are always free to add any others, which they deem will best assess the efficacy of tested interventions. Benchmarks to define a threshold for treatment success were not set, as what constitutes a clinically-relevant therapeutic efficacy is expected to vary greatly depending interventions. CONCLUSIONS: This COSCAD'18 should help veterinarians and owners compare the benefits of treatments in future trials. This COS should also facilitate the combination of trial results in future systematic reviews, thereby producing more reliable summary estimates of treatment effects and enhancing evidence-based veterinary dermatology.

Trichographic features of hair from normal black Dobermann pinscher dogs.

BACKGROUND: Dobermann dogs are predisposed to colour dilution alopecia and follicular dysplasia. Limited information is available regarding the trichographic features of normal canine hair shafts, including those from Dobermanns, with no studies of inter-observer agreement for canine trichographic features. OBJECTIVES: To characterize the trichographic features of normal black Dobermann hair shafts evaluating the following variables; gross appearance, primary versus secondary hairs, colour change, tip structure, curling, twisting, bending, cuticle changes (breaks, compression, loss or abnormal overlapping), fractures and variations in hair diameter. ANIMALS: Twenty client-owned, normal, black Dobermanns of different ages and genders. METHODS AND MATERIALS: A systemized trichographic evaluation of hair samples from five body locations, which were evaluated independently by two observers, and inter-observer agreement evaluation. Kappa statistics, positive and negative agreement were determined. RESULTS: Agreement between investigators ranged from 87% to 99% for each examined variable. Kappa statistics showed excellent (0.81-1.00) to substantial agreement (0.61-0.80) for all variables with the exception of moderate agreement (0.41-0.60) for cuticle compressions and variations in hair diameter. A novel finding of a "round hair tip" was made, which was more commonly found on the dorsal head. Colour change to the proximal hair shaft was more common on the thighs and flanks. CONCLUSIONS AND CLINICAL IMPORTANCE: Trichographic features of 500 hairs collected from 20 normal black Dobermann dogs are described. A previously unreported finding of round hair tips was seen. We describe a systematic approach for evaluating hair shafts that can be applied in future studies for both normal and abnormal Dobermanns, and potentially other dog breeds.

Comparison of two ear cytological collection techniques in dogs with otitis externa.

BACKGROUND: Canine otitis externa is a common disease. Cytological evaluation of otic exudate is a useful diagnostic test to direct and monitor treatment for otitis externa. One method of collecting ear cytological specimens utilizes a cotton-tipped swab inserted into the vertical ear canal. A proposed alternative method is to aspirate exudate from the deep horizontal canal using a rubber tube. HYPOTHESIS/OBJECTIVES: To compare cytological findings between two different collection techniques by evaluating the numbers of bacteria, Malassezia yeast and inflammatory cells. ANIMALS: Thirty client-owned dogs with otitis externa. METHODS AND MATERIALS: A prospective, randomized, blinded comparison study. Ear canals from each dog were sampled using cotton swab and rubber tube. Ear cytological preparations were evaluated independently by two investigators for polymorphonuclear leucocytes (PMN), monocytes/lymphocytes, macrophages, yeast, intracellular (IC) cocci, extracellular (EC) cocci, IC bacilli and EC bacilli. RESULTS: A paired Student's t-test was used to compare the two techniques. The inter-investigator reliability for PMN, EC bacilli and yeast was good, and for EC cocci was moderate. There were significantly higher numbers of PMNs obtained by the tube method (P = 0.0024) than by the cotton swab method. There were no statistically significant differences between cotton swab and rubber tube methods for monocytes/lymphocytes (P = 0.7780), macrophages (P = 0.1751), EC cocci (P = 0.1262), EC bacilli (P = 0.1162), yeast (P = 0.5371), IC cocci (P = 0.6606) or IC bacilli (P = 0.6761). The technique was well tolerated. CONCLUSION: An alternative ear cytological collection technique was identified which enables sampling of the deep horizontal canal.

A cross-sectional study of show English bulldogs in the United States: evaluating paw lesions, cytological findings, pruritic behaviours and gastrointestinal signs.

BACKGROUND: English bulldogs (EBDs) are considered to commonly show signs of pododermatitis and gastrointestinal (GI) disease. HYPOTHESIS/OBJECTIVES: To describe a population of presumed healthy EBDs: (i) evaluate dogs according to published criteria for health, (ii) describe paw lesions, if present, (iii) report pruritic behaviours and GI signs and compare to normal values, (iv) report pedal cytological findings, and (v) determine correlation between lesions, cytological results and pruritic behaviours. ANIMALS: Thirty four EBDs participating in a dog show. METHODS AND MATERIALS: Dogs were examined, and pedal cytological samples were collected. Pruritic behaviours, GI signs and medical history were assessed. Owners completed questionnaires regarding history and assessed pruritus. RESULTS: No dog met criteria for being healthy. All dogs had an abnormal dermatological examination, 22 of 34 had a history of recent drug administration and 16 of 34 had a history of dermatological disease. Every dog had at least one erythematous paw. Compared to values for a healthy dog population, facial rubbing was the only increased pruritic behaviour, and GI signs differed in belching, flatulence and regurgitation. Mean cytological evaluation values were within normal ranges except for inflammation. Lesions did not correlate with cytological findings or pruritic behaviours, with the exception of white coloured exudation with inflammation and cocci. CONCLUSIONS AND CLINICAL IMPORTANCE: This study supports that show EBDs have frequent pedal lesions and history of dermatological disease, with over half receiving medication, as well as increased frequency of belching, flatulence and facial rubbing. Pedal cytological findings were not predictive of lesions, with the exception of white coloured exudation.

Determination of threshold concentrations of plant pollens in intradermal testing using fluorescein in clinically healthy nonallergic cats.

BACKGROUND: Currently the same allergen concentrations for canine intradermal testing (IDT) are recommended for feline IDT. Feline skin reactions are subtle and more difficult to read than canine reactions. This difference may be due to suboptimal allergen concentrations used for IDT in cats. HYPOTHESIS/OBJECTIVES: To determine the irritant threshold concentration (ITC) of 16 pollen allergens using serial dilutions of allergen and intravenous fluorescein. The hypothesis tested was that feline IDT currently is performed at suboptimal allergen concentrations for pollens. ANIMALS: Twenty privately owned healthy clinically nonallergic cats. METHODS: IDT was performed in duplicate using 16 pollen allergens (weeds, grasses and trees) at a dilution of 8000 PNU/mL. Two blinded investigators graded the test reactions independently using subjective and objective criteria. Intravenous fluorescein was then administered and the test reactions were re-evaluated. IDT was repeated for any allergen that was positive, using serial dilutions of allergen at a concentration of 6000 and 4000 PNU/mL. RESULTS: The ITC for 2 of 16 of the allergens was determined. The ITC of Cynodon dactylon (Bermuda grass) and Schinus spp. (Peppercorn) was determined to be between 6000 and 8000 PNU/mL. The ITC of all other allergens tested in this study was >8000 PNU/mL. CONCLUSIONS AND CLINICAL IMPORTANCE: This study confirms that suboptimal allergen concentrations currently are used for feline IDT as the ITC is >8000 PNU/mL for 14 of 16 of the grass, weed and tree pollens evaluated. The ITC of Cynodon dactylon and Schinus spp. was determined to be between 6000 and 8000 PNU/mL.

Comparison of the intradermal irritant threshold concentrations of nine allergens from two different manufacturers in clinically nonallergic dogs in the USA.

BACKGROUND: The intradermal irritant threshold concentration for many allergens is unknown. OBJECTIVE: To determine the intradermal irritant threshold concentration (ITC) of nine allergens from two different manufacturers. ANIMALS: Twenty privately owned clinically nonallergic dogs. METHODS: Alternaria, cat dander, Dermatophagoides farinae, Chenopodium album (lamb's quarter), Xanthium strumarium (cocklebur), Prosopis glandulosa (mesquite), Morus alba (white mulberry), Cynodon dactylon (Bermuda grass) and Phleum pretense (Timothy grass) from two manufacturers (ALK; Round Rock, TX, USA and Greer® Laboratories; Lenoir, NC, USA) were injected intradermally at two dilutions and at 15 and 30 min evaluated subjectively (1-4) and objectively (horizontal wheal diameter) by two blinded investigators. A subjective score of 3 or 4 by either investigator at either timed reading was considered positive. If both concentrations resulted in positive reactions, two additional dilutions were performed. The ITC was defined as the lowest tested concentration that elicited a positive reaction in ≥10% of animals. RESULTS: The ITCs were Alternaria >2,000 PNU/mL; cat dander 750 PNU/mL (ALK) and 2,000 PNU/mL (Greer® ); D. farinae <1:10,000 w/v; C. album <6,000 PNU/mL; X. strumarium <6,000 PNU/mL; P. glandulosa <500 PNU/mL; M. alba <6,000 PNU/mL; C. dactylon <10,000 PNU/mL (ALK) and <6,000 PNU/mL (Greer® ); and P. pretense <6,000 PNU/mL. CONCLUSIONS AND CLINICAL SIGNIFICANCE: There were significant differences in subjective scoring and objective measurement between manufacturers for Alternaria, cat dander and P. pretense. Results revealed significant positive correlation between subjective scoring and objective measurement for each time, investigator and manufacturer separately.

Residual antibacterial activity of canine hair treated with topical antimicrobial sprays against Staphylococcus pseudintermedius in vitro.

BACKGROUND: Topical antimicrobial therapy is increasingly important in the treatment of canine pyoderma as the incidence of multidrug resistance has risen. However, little information is reported on the persistence of activity of topical antimicrobial products. OBJECTIVE: To determine the residual antibacterial activity of canine hairs treated with antimicrobial sprays. ANIMALS: Twelve privately owned dogs with no history of dermatological disease. METHODS: Dogs were treated once with four different spray products [(A) 1% chlorhexidine digluconate, (B) 2% miconazole nitrate, 2% chlorhexidine gluconate, tromethamine USP/disodium EDTA (TrizEDTA), (C) 3% chlorhexidine gluconate, phytosphingosine salicyloyl and (D) 4% chlorhexidine gluconate, TrizEDTA] in separate 5 × 5 cm sections on the trunk. Hairs were collected via shaving before, one hour after and 2, 4, 7 and 10 days after treatment. Hairs were incubated on agar plates streaked with Staphylococcus pseudintermedius for 24 h and the bacterial growth inhibition zone around the hairs was measured. RESULTS: There were significant overall treatment and day (P < 0.0001) differences in inhibition zones. The largest zones of inhibition were from hairs treated with spray B, followed by sprays D, C and A, respectively. All sprays demonstrated residual antimicrobial activity for the ten days evaluated. CONCLUSIONS AND CLINICAL SIGNIFICANCE: Results suggest that the efficacy of an antimicrobial spray is dependent on both the concentration and combination of active ingredients. Several ingredient profiles appear to effectively inhibit S. pseudintermedius growth for at least 10 days, which may be beneficial in the treatment of canine pyoderma.

Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification.

BACKGROUND: Canine atopic dermatitis (AD) is a common, genetically predisposed, inflammatory and pruritic skin disease. The variation in clinical presentations, due to genetic factors, extent of the lesions, stage of the disease, secondary infections, as well as resemblance to other non-atopic related skin diseases, can complicate a diagnosis of canine AD. A sub-group of the International Committee for Allergic Diseases in Animals (ICADA) was tasked with the development of a set of practical guidelines that can be used to assist practitioners and researchers in the diagnosis of canine AD. Online citation databases and abstracts from international meetings were searched for publications related to the topic, and combined with expert opinion where necessary. The final set of guidelines was approved by the entire ICADA committee. RESULTS: A total of 81 publications relevant for this review were identified. The guidelines generated focus on three aspects of the diagnostic approach: 1. Ruling out of other skin conditions with clinical signs resembling, or overlapping with canine AD. 2. Detailed interpretation of the historical and clinical features of patients affected by canine AD. 3. Allergy testing by intradermal versus allergen-specific IgE serum testing. CONCLUSIONS: The diagnosis of canine AD is based on meeting clinical criteria and ruling out other possible causes with similar clinical signs. Flea combing, skin scraping and cytology should be performed, where necessary, as part of a thorough work-up. Elimination diet trials are required for patients with perennial pruritus and/or concurrent gastrointestinal signs. Once a clinical diagnosis of canine AD is made, allergy testing can be performed to identify potential causative allergens for allergen-specific immunotherapy.

Owner assessment of pruritus and gastrointestinal signs in apparently healthy dogs with no history of cutaneous or noncutaneous disease.

BACKGROUND: Determining the cause of pruritus relies on establishing the pattern of abnormal pruritus. The presence of gastrointestinal (GI) disease has also been helpful in determining the cause of pruritus. No study has systematically evaluated typical GI signs and pruritic behaviours in apparently healthy dogs. HYPOTHESIS/OBJECTIVES: To evaluate owners' perceptions of pruritus and GI signs in apparently healthy dogs, and determine if age, breed, activity, diet or supplements affected these signs. ANIMALS: Three hundred and fourteen apparently healthy dogs ≥ 12 months old with an unremarkable physical examination and no history of pruritus, otitis, skin/hair disease, metabolic or GI disease were enrolled. METHODS: Thirty one veterinarians enrolled dogs after establishing their pruritus visual analog scale (PVAS) score and faecal consistency score (FCS); owners completed a comprehensive online survey regarding GI signs, possible pruritic behaviours, ear cleaning and sneezing. RESULTS: A PVAS score of ≤ 1.9 was recorded in 87.6% of dogs and the FCS was 2-3 in 94.9% of dogs. PVAS was positively correlated with paw licking/chewing, facial/muzzle rubbing, head shaking and sneezing. Scooting was positively correlated with sneezing. Over 96% of dogs had 1-3 bowel movements (BM) per day. Age was positively correlated with facial/muzzle rubbing, sneezing, coprophagia and borborygmi. The number of walks/day was positively correlated with paw licking/chewing, head shaking, sneezing, number of BM/day, coprophagia, belching, flatulence and borborygmi. CONCLUSION AND CLINICAL IMPORTANCE: A standard method of asking relevant questions was developed and the frequency of GI signs and many behaviours that may indicate pruritus in apparently healthy dogs was established.

Clinical efficacy of low-level laser therapy on localized canine atopic dermatitis severity score and localized pruritic visual analog score in pedal pruritus due to canine atopic dermatitis.

BACKGROUND: Canine atopic dermatitis is a genetically predisposed inflammatory skin disease often requiring multimodal treatment. There is a need to find further low-risk adjunctive therapies. HYPOTHESIS/OBJECTIVES: To evaluate the localized effect of low-level laser therapy (LLLT) on the paws of dogs with atopic dermatitis using a localized canine atopic dermatitis severity score (LCADSS) and owner localized pruritic visual analog score (LPVAS) in comparison to treatment with a placebo. ANIMALS: Thirty client-owned dogs with symmetrical pedal pruritus due to canine atopic dermatitis. METHODS: Dogs were randomly assigned into two groups. In each group, one paw was treated with LLLT and one paw treated with a placebo laser (comparing either both fore- or hindpaws). Treatments were administered at 4 J/cm(2) (area from carpus/tarsus to distal aspect of digit 3) three times per week for the first 2 weeks and two times per week for the second 2 weeks. Scores were assessed for each paw at weeks 0, 2, 4 and 5. RESULTS: There were no significant differences in LCADSS or LPVAS between LLLT and placebo treatments between weeks 0 and 5 (P = 0.0856 and 0.5017, respectively). However, LCADSS and LPVAS significantly decreased from week 0 at weeks 2, 4 and 5 in both LLLT and placebo groups (P < 0.0001 for all). CONCLUSIONS AND CLINICAL IMPORTANCE: Low-level laser therapy is not an effective localized treatment for pedal pruritus in canine atopic dermatitis.

Validation of the Canine Atopic Dermatitis Extent and Severity Index (CADESI)-4, a simplified severity scale for assessing skin lesions of atopic dermatitis in dogs.

BACKGROUND: Severity scales are used to grade skin lesions in clinical trials for treatment of dogs with atopic dermatitis (AD). At this time, only two scales have been validated, namely the Canine Atopic Dermatitis Extent and Severity Index (CADESI)-3 and the Canine Atopic Dermatitis Lesion Index (CADLI). However, the high number of assessed sites makes the CADESI-3 impractical. HYPOTHESIS/OBJECTIVES: The aim of this study was to develop and validate a fourth version of the CADESI that is simpler and quicker to administer. METHODS: Body sites, lesions and severity grades were revised by members of the International Committee on Allergic Diseases of Animals (ICADA). The newly designed CADESI-4 was tested for its validity (i.e. content, construct and criterion), reliability (i.e. inter- and intra-observer reliability and internal consistency), responsiveness (i.e. sensitivity to change) and time to administer. Disease severity benchmarks were chosen using receiver operating characteristic methodology. RESULTS: The CADESI-4 was simplified in comparison to its previous version to comprise 20 body sites typically affected in atopic dogs. Three lesions (erythema, lichenification and alopecia/excoriation) were scored from 0 to 3 at each site. The CADESI-4 had satisfactory validity, reliability and sensitivity to change. On average, the time to administer a CADESI-4 was one-third that of a CADESI-3. Proposed benchmarks for mild, moderate and severe AD skin lesions are 10, 35 and 60, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: The CADESI-4 is simpler to use and quicker to administer than its previous version. The ICADA recommends the CADESI-4 instead of the CADESI-3 to score skin lesions of AD in dogs enrolled in clinical trials.

Reproducibility of a quantitative cutaneous cytological technique.

BACKGROUND: Cutaneous cytology is a valuable tool for diagnosis of canine superficial pyoderma. Current published reproducible techniques are semiquantitative. HYPOTHESIS/OBJECTIVES: The aim of this study was to evaluate the reproducibility of a quantitative method for skin surface cytology in dogs with superficial pyoderma. ANIMALS: Impression smears were collected from five normal dogs and 20 dogs with clinical and cytological evidence of superficial pyoderma. METHODS: Four investigators evaluated 10 oil immersion fields (OIF) on 25 slides, selecting fields with inflammatory cells, nuclear streaming and or keratinocytes under ×10 magnification. Investigators repeated blinded evaluations of all slides at least twice. For each OIF, polymorphonuclear leukocytes (PMNs), intracellular (IC) cocci, extracellular (EC) cocci, IC rods, EC rods and yeast were quantified. Nuclear streaming was scored as present or absent. For each parameter, within-reader and between-reader agreements were expressed by the intraclass correlation (ICC) value (≤0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good and 0.81-1.00 excellent) or kappa statistic (κ). RESULTS: Reproducible parameters included: PMNs (ICC = 0.58), nuclear streaming (ICC = 0.68), EC cocci (ICC = 0.64) and IC cocci (ICC = 0.32). When qualified as present or absent, within-reader κ for IC cocci was 0.71. The method demonstrated 93% sensitivity in identifying dogs with superficial pyoderma and 51% specificity in identifying normal dogs according to established criteria. However, if criteria for normal dogs were limited to the absence of PMNs and IC bacteria, sensitivity of 64% and specificity of 98% were demonstrated. CONCLUSIONS AND CLINICAL IMPORTANCE: For several parameters, including PMNs, nuclear streaming, EC cocci and IC cocci, a reproducible, quantitative cytological technique was identified.

Evaluation of azithromycin in systemic and toothpaste forms for the treatment of ciclosporin-associated gingival overgrowth in dogs.

BACKGROUND: Gingival overgrowth is an adverse effect of ciclosporin therapy. Azithromycin (AZI) in capsule and toothpaste form is an effective treatment for ciclosporin-associated gingival overgrowth (CsAGO) in humans. HYPOTHESIS/OBJECTIVES: To evaluate AZI in a systemic and a toothpaste form for the treatment of CsAGO in dogs. The secondary objective was to determine which treatment is more effective. ANIMALS: Thirty-six client-owned dogs with CsAGO. METHODS: Dogs were randomly assigned to the following four groups: AZI capsule; AZI toothpaste; placebo capsule; and placebo toothpaste. Treatments were for 4 weeks, and measurements of gingival sulcus depth, tooth length and subjective global scores were taken at weeks 0, 2, 4 and 8. The AZI dose was 10 mg/kg daily, and brushing (8.5% AZI) was once daily. RESULTS: There was a significant decrease in gingival sulcus depth for the AZI capsule group at week 8 and for the AZI toothpaste group at weeks 2, 4 and 8. The mean decrease in gingival sulcus depth was significantly greater in active versus placebo groups (P = 0.0356). The tooth length and subjective global scores were not significantly different for any groups. Gastrointestinal adverse events occurred in all groups, but more frequently in the AZI capsule group. CONCLUSIONS AND CLINICAL IMPORTANCE: Azithromycin improved CsAGO in only one measured parameter, gingival sulcus depth. Only one dog in the AZI capsule group had complete resolution of CsAGO. Further studies are warranted. Azithromycin capsules were associated with the most gastrointestinal adverse effects.