PHARMACY REPORT

Application of Semi-solid Medicine in Dermatitis Case for Cats and Dogs

LIEW JOEY
B04158021

DEPARTMENT OF VETERINARY CLINIC REPRODUCTION AND PATHOLOGY

VETERINARY MEDICINE FACULTY
IPB UNIVERSITY
2019
 INTRODUCTION

Although the word dermatitis is used to describe many types of skin rashes, there are two
common forms: atopic dermatitis and contact dermatitis. Atopic dermatitis is inherited and usually
occurs first when children are infants. Contact dermatitis occurs when the skin comes in contact
with something that causes an allergic reaction (allergic contact dermatitis) or injures the skin
(irritant contact dermatitis.
Inflammation of the skin can be produced by numerous agents, including external irritants,
burns, allergens, trauma, and infection (bacterial, viral, parasitic, or fungal). It can be associated
with concurrent internal or systemic disease; hereditary factors also may be involved. Allergies
form an important group of etiologic factors, especially in small animals.
The skin’s response to insult is generically called dermatitis and manifests as any
combination of pruritus, scaling, erythema, thickening or lichenification of the skin,
hyperpigmentation, oily seborrhea, odor, and hair loss. The usual progression of a skin disease
involves an underlying trigger (disease syndrome) that causes primary lesions such as papules,
pustules, and vesicles. Pruritus is a common clinical sign in many diseases, and in conditions that
are not inherently pruritic, it is often present because of secondary infections or as a result of
production of inflammatory mediators. As the inflammatory changes progress, crusting and scaling
develop. If the process involves the deeper dermis, exudation, pain, and sloughing of the skin may
occur. Secondary bacterial and yeast infections commonly develop as a result of skin inflammation.
As dermatitis becomes chronic, acute signs of inflammation (eg, erythema) subside and primary
lesions become obscured by signs of chronic inflammation (thickening of the skin,
hyperpigmentation, scaling, seborrhea). Often, the skin becomes drier; if pruritus is not a
component of the underlying trigger, it will often develop at this stage. Resolution of dermatitis
requires identification of the underlying cause and treatment of secondary infections or other
complications.
Contact dermatitis occurs when the skin comes in contact with a substance that causes a
delayed allergic reaction (allergic contact dermatitis) or when there is an injury to the skin's surface
(irritant contact dermatitis). Skin can become allergic to a substance after many exposures or after
just one exposure. Irritants such as feces or urine, and chemicals such as acids, alkali, detergents,
irritant plants, medications and home furnishings can all cause the condition. In cats and dogs
lesions usually occur on thinly-haired areas such as the skin of the ventral abdomen, feet, chest,
eyelids and axillae. These substances can wear down the oily, protective layer on the skin's surface
and lead to irritant contact dermatitis.
Atopic dermatitis is a heritable disorder in which animals are hypersensitive to common
environmental allergens. It is one of the most common skin diseases of dogs and cats worldwide.
The most common allergens involved in atopic dermatitis are those of house dust mites
(Dermatophagoides farinae) and grain mites. Human and animal danders, house dust, grass and
tree pollen and molds also frequently incite reactions. Susceptible animals produce allergen-
specific IgE to these normally-innocuous allergens, which then binds to receptors on cutaneous
mast cells. Atopic animals may have defects in the epidermis, leading to impaired barrier function,
and it is thought that further allergen exposure occurs via percutaneous absorption. This further
exposure gives mast cell degranluation, releasing histamine, cytokines, chemokines, leukotrienes,
prostaglandins and other chemical mediators. This is a type 1 (immediate) hypersensitivity
reaction1, and leads to vasodilation, inflammatory cell infiltration and pruritus. It appears that the
cytokines involved are abnormally biased towards a Th2 response. IL-4 in particular is produced;
this cytokine is responsible for B-cell production of IgE. Bacterial superantigens and autoantigens
released due to keratinocyte damage play a role in perpetuating inflammation.
Semi-solid products have been manufactured for many years for distribution as
pharmaceutical drug products, cosmetics and health supplements. The semi-solid drug category is
comprised of creams, gels, ointments, suppositories, and other special topical dosage forms. Semi-
solid drug formulations share many common attributes which include consistency, dosage
uniformity, preservatives, the route of administration and their formulation basis.
Most routes of administration for semi-solid dosage (SSD) form products are predominantly
topical or by method of insertion of the drug product into an orifice of the body. Some of the
advantages presented by SSD form products are the ability to apply the drug product directly on
the affected area and the administration of this dosage form to be readily administered to patients
of any age. However, SSD forms also present the challenge of delivering the drug’s active
ingredient across the patient’s skin or other physical membrane to reach the target system.
The SSD form products are formed through intricate formulations having complex
structural elements. Often, they are composed of two phases—oil and water—one of which is a
continuous (external) phase, and the other of which is a dispersed (internal) phase. The active
ingredient is often dissolved in one phase. In the event the drug is not fully soluble in a single
phase, it is dispersed in both phases, thus creating a three-phase system.
Many of the physical properties of the dosage form depend upon various factors such as,
size of the dispersed particles; Interfacial tension between the phases; Partition coefficient of the
active ingredient between the phases; and Product rheology or the flow characteristics of these
substances.
These factors combined determine the release characteristics of the drug, as well as other
characteristics, such as viscosity. A semisolid product achieves uniformity of its active ingredient
during its mixing process. Because of the consistency and viscosity of these products, once the
active pharmaceutical ingredient (API) is distributed in the manufacturing batch, the API is less
prone to segregation than solid dosage formulations.
Drug products topically administered via the skin fall into two general categories, one
category for local action as creams, gels, and ointments and the second category being
suppositories.
 LITERATURE REVIEW

ETIOLOGY OF DERMATITIS
Dermatitis can be caused by the things in environment, such as field grass, feces and urine.
Patients in this category are physically and nutritionally normal, but show symptoms of pruritus,
hair loss and skin irritation. Dermatologic food reactions are non-seasonal reactions which occur
following ingestion of one or more allergy causing substances in an animal’s food. The physical
reaction is frequently excessive itchiness, with resultant excessive scratching at the skin. Example
of food that can cause dermatologic food reaction are beef, chicken, eggs, corn, wheat, soy, and
milk.
Flea allergy dermatitis is an allergic reaction to a flea bite that manifests in a pet’s skin.
Both dogs and cats can develop FAD. Affected pets can have an extreme allergic reaction to certain
proteins in the flea’s saliva, which the flea injects into the pet’s skin during biting and feeding.
Some pets are so allergic that even a single bite can cause a severe reaction. FAD can make pets
feel miserable. If left untreated, the associated severe itching and inflammation can lead to
excessive scratching and chewing that will serve to damage the skin. Secondary bacterial or fungal
infections are common as a result of skin trauma and localized inflammation caused by the allergic
response and will invariably lead to more scratching and chewing while potentially compounding
the allergic reaction.
Sarcoptic mange is one of the most uncomfortable skin diseases that dog and cat can
contract. It is highly contagious, sarcoptic mange is caused by a mite called Sarcoptes scabeie var.
canis and is transmissible to humans. These mites burrow into a host animal's skin, causing scaling,
yellowish crust, hair matting and loss, and severe itching. Some animals never develop the classic
skin lesions, but will itch constantly year round. Often, animals with this condition will be
misdiagnosed as having allergies. Diagnosis can be very difficult because the mites frequently are
not found on skin scrapings. Thus, treatment frequently is based on the suspicion of scabies, rather
than a definitive diagnosis.
The demodex mite is a normal inhabitant of your dog’s skin. In low numbers, these mites
cause no symptoms and may serve an important role as part of your dog’s normal skin microfauna.
Three species of mites have been identified to cause mange in dogs. The species of mite most
commonly associated with demodicosis is the Demodex canis, which inhabits the skin and hair
follicles and may transfer from mother to newborn during nursing. This means that nearly all dogs
carry these mites, and very few suffer symptoms. However, when dogs have a compromised
immune system, the mites can start to multiply unchecked, which leads to demodectic mange and
itchy skin. Unlike Sarcopoptic mites, Demodectic mites can be seen in skin scrapings seen under
a microscope.
Bacterial and fungal organisms are skin pathogens. Fungal organisms are called
dermatophytes. One type called Microsporum canis, causes circular and non-pruritic ulcers, hair
loss, often called ringworm. Bacterial dermatitis rarely occurs spontaneously. Normal skin has
various types of bacteria that exist at any time. Parasitic skin damage will cause bacterial invasion
and trigger a defense mechanism.

TYPES OF SEMI SOLID DRUGS

Creams are semisolid emulsion products which are viscous with an opaque appearance.
The consistency and rheological character of the formulation will depend on whether the cream is
water in oil (W/O) or oil in water (O/W). Properly designed O/W creams are an elegant drug
delivery system, pleasing in both appearance and feel post-application. Each type of cream is good
for most topical purposes and is considered particularly well suited for application to open wounds.
Gels are semisolid systems in which a liquid phase is entrapped within a polymeric matrix.
This matrix can have a high degree of physical or chemical cross-linking. Gels are aqueous
colloidal suspensions in a hydrated form of the insoluble API(s). Many gel products are turbid, as
the polymer is present in colloidal aggregates that disperse light. Gels are used for medication,
lubrication and other miscellaneous applications.
Ointments are semisolid preparations intended for external application to the skin or
mucous membranes. Ointments can be classified into four types depending on the carrier of the
drug or base used for its formulation: Hydrocarbon or oleaginous bases. Main components are
petrolatum, white petrolatum, yellow or white ointment, or mineral oil. These bases are emollient,
occlusive, and endure on the applied surface for a long time. The hydrophobic nature promotes
water retention within the applied surface.
The next one is absorbent or anhydrous base. This class of bases may be divided into two
groups: the first consists of bases that permit the incorporation of aqueous solutions (small amounts)
with the formation of a water-in-oil emulsion (e.g. Petrolatum and Lanolin) and the second group
consists of water-in-oil emulsions that permit the incorporation of oil soluble active
pharmaceutical ingredients. Absorption bases also are useful as emollients.
Another type of ointment is emulsion or water miscible base. Emulsion bases may be
water/oil (W/O) or oil/water (O/W). W/O emulsions are emollient, occlusive, may feel greasy,
and hard to wash off. O/W emulsions are not occlusive, do not feel greasy, and clean well with
water.
The last one is water soluble base. Majority are polyethylene glycol-based. Not occlusive,
not grease.
Suppositories are a solid body drug delivery system of various weights and shapes, adapted
for introduction into orifices of the human body. The external membrane of the suppository will
typically melt, soften, or dissolve at body temperature which allows the active ingredient to then
be absorbed by the surrounding tissue. Suppository bases usually employed are cocoa butter,
glycerinated gelatin, hydrogenated vegetable oils, mixtures of polyethylene glycols of various
molecular weights, and fatty acid esters of polyethylene glycol. The suppository base employed
has a marked influence on the release of the active ingredient incorporated in it.y, and water-
washable. A gel would be a type of water-soluble base.

DISCUSSION

CLINICAL SIGNS
Symptoms of contact dermatitis in dogs appear on the skin and can cause a good deal of
itchiness or discomfort. It may take up to 48 hours after contact with an allergen or irritant for
these symptoms to appear. Swelling, bumps, rashes, or other skin conditions will be visible and
generally appear on body parts that come into contact with the ground when a dog is walking,
sitting, or lying down. These areas include the chin, neck, groin, anal region, chest, abdomen, tail,
genital region, and between toes, though other body parts may be affected depending on where
skin made contact with the irritant or allergen. Symptoms may appear more often at certain times
of the year in cases of seasonal allergic contact dermatitis. Example of the symptoms are:
 Patches of soreness
 Inflammation
 Itchiness
 Blisters
 Alopecia (hair loss)
 Lesions or ulcers
 Redness or changes in skin color
 Scaly, dry, or thickened skin
 Discharge from the affected area
 Wounds from scratching, chewing, or licking
 Runny eyes or nose
Sarcoptic mange can either be localized or affect specific areas of your dog’s body.
Sarcoptic mange is intensely itchy and will make the animal scratch and chew its skin. It will also
develop red papules that resemble small pimples. Male scabies mites stay on the surface of the
skin, but female scabies mites create short zig-zag or S-shaped burrows down into the skin, often
accompanied by small bug-bite pimples. The symptoms from sarcops are thought to be the result
of an allergy to the mite itself. If left untreated, chronic skin conditions including lesions, darkening
of the skin, patchy hair loss, and thickening and wrinkling of the skin can develop. Mange
symptoms will appear up to four weeks after mites infest the animal skin. A mite that causes mange
in animal stays on the skin approximately 10 to 17 days.
 When demodex first appears, it may just look like a small spot of hair loss, possibly from
rubbing the area. However, if you notice any crusting on the skin or the hair loss spreads contact
your veterinarian for an appointment. Symptoms of demodex to look for include:
 Hair loss in patches
 Rubbing their face or head
 Redness or inflammation of the skin
 Excessive oil on the skin
 Crusting on the skin
 Paws that are swelling (pododermatitis)
 blackheads on the skin.

Source: http://www.theskinvet.co.nz/demodex-mites-and-dogs/

Symptoms of ringworm in animals often include some combination of the following:

 Hair loss (alopecia), which may be patchy or circular
 Broken hairs and poor hair coat
 Reddened or ulcerated skin
 Dandruff (scales)
 Darkened skin
 Crusting of the skin
 Itchiness (pruritus) may or may not be present
Less frequently, animals develop a raised nodular lesion that may ooze called a kerion. The
nails and claw folds (the skin bordering the nail) may also be infected by ringworm fungus, which
results in brittle or misshapen nails. Occasionally, dogs are classified as asymptomatic or silent
carriers. In other words, they harbor the disease-causing fungus but present no visible signs of the
condition. These dogs can still pass the disease on to humans and other animals.
 Ringworm in dog.
Source: http://dogsarena.com/using-essential-oils-to-combat-ringworm-in-dogs/

DIAGNOSTIC
Skin cases benefit from a detailed history, a physical examination to determine the health
status of the patient and a dermatological examination. From this, a differential diagnosis list can
be formulated, which, once ranked in order of most likely to least likely, can suggest the diagnostic
tests necessary to confirm a diagnosis. Ranking is important since it enables tests to be targeted,
avoiding the unnecessary expense of tests that may not be relevant to the case in question.
1. Skin scraping
It is slightly more time consuming than the previous tests but is essential in cases suspected
of parasitic involvement if less invasive tests are negative. It is used primarily to identify surface
and burrowing mites causing demodicosis or scabies or, in some cases, other mites such as
Cheyletiella. For demodicosis, deep scraping is required. Clip to remove hair if necessary.
Squeeze the skin in the area to be scraped and apply liquid paraffin to the skin. This has the effect
of lubricating and penetrating the skin and facilitating collection of material. Use a blunt blade
scrape in the direction of hair growth. The first few scrapes can be superficial and then
subsequently deep (enough to cause capillary ooze). Material should be transferred to a slide,
mixed with liquid paraffin, a cover slip applied and examination performed under low power. For
scabies, multiple scrapings, both superficial and deep, in non-excoriated areas are required. This
is because many cases are associated with hypersensitivity to Sarcoptes scabiei and few mites may
be present. Scanning of the slide under low power and not high facilitates the identification of a
limited number of mites. Liquid paraffin does not kill the mite and subtle movement may help to
locate its position.
2. Tape strips
Tape stripping is an extremely useful and versatile diagnostic test. It is quick, inexpensive
and often yields valuable diagnostic information. It is a technique employed by veterinary
dermatologists in the majority of cases, as it can be used to diagnose superficial pyoderma bacterial
overgrowth, some autoimmune diseases and parasites. Tape stripping is the most common
technique for diagnosing Malassezia dermatitis or overgrowth. Several 10cm pieces of tape are
pressed onto the surface of the skin. One sample is examined under low power for parasites such
as Demodex, Sarcoptes, Cheyletiella and lice. For the identification of bacteria or Malassezia, tape
is partially attached to the slide and stained with Diff-Quik and then completely attached for
examination under high power with oil immersion.
3. Slide impressions and swab smears
Slide impressions of the surface of a lesion should be used for any purulent or exudative
lesion. This technique is valuable for differentiating between bacterial infection and sterile lesions
such as those seen in pemphigus foliaceus.
Suitable areas for microscopic examination are located under low power and identification
of bacteria and Malassezia (Figure 9) is facilitated under high power with oil immersion. The glass
slide is pressed against the moist lesion, fixed and stained with Diff-Quik. Alternatively, for
purulent material, including pricked pustules, a swab is used to collect material, which is then
gently rolled over the surface of the slide.
4. Wood’s lamp examination
Wood’s lamp examination is a very useful inexpensive screening test for dermatophytosis
caused by Microsporum canis only (other dermatophytes of veterinary significance do not
fluoresce). It is important that the Wood’s lamp is of a suitable standard from a recognised
veterinary supplier. It should produce ultraviolet light at a wavelength of 253.7 nanometres. Good
quality Wood’s lamps have two bars and an inbuilt magnifying lens.
Examination must take place in a very dark room. Warm the lamp for five minutes. Scan the
animal for a few minutes as sometimes fluorescence is delayed. Position the lamp over hairs
collected by brushing, as many dermatophytosis hairs are damaged and therefore easily removed
by brushing.
Only infected hairs fluoresce (not surrounding skin or scale) and the apple green colour is
very important as it distinguishes true fluorescence from false. Positive fluorescing hairs can be
plucked, examined microscopically and cultured for confirmation. It is also useful to demonstrate
positive fluorescence to all clinical staff, vets and nurses, as the fluorescence is striking and
educational.
5. Coat brushing
This very simple test, perhaps underutilised in practice, is a useful screen for ectoparasites,
eggs, flea farces and follicular abnormalities. The animal should be brushed over a black
consulting table or over brown paper. The hairs and epithelial debris should be collected and the
hair separated from scale. The hairs are placed in a petri dish enabling them to be examined with
the Wood’s lamp and mounted in liquid paraffin with a cover slip for microscopic examination.
The scale is also mounted in liquid paraffin and a cover slip applied. Lice, nits, Cheyletiella and
fragmented flea faeces, perhaps missed macroscopically in cases of fleabite hypersensitivity, may
be found.
TREAMENT AND PREVENTION
Drugs that may be used in or on the skin fall into several categories—antibiotics, antifungal
drugs, antiparasitic drugs, nonsteroidal anti-inflammatory drugs, drugs that modulate the immune
system, hormones, psychotropic agents, and vitamin and mineral supplements. Several factors may
contribute to the signs associated with skin disorders. Each factor should be identified and
addressed if treatment is to succeed. Successful treatment of skin diseases may require longterm
or lifelong treatment and is frequently a matter of successful control rather than cure.
Ketoconazole cream is used to treat tinea corporis (ringworm; fungal skin infection that
causes a red scaly rash on different parts of the body), tinea cruris (jock itch; fungal infection of
the skin in the groin or buttocks), tinea pedis (athlete's foot; fungal infection of the skin on the feet
and between the toes), tinea versicolor (fungal infection of the skin that causes brown or light
colored spots on the chest, back, arms, legs, or neck), and yeast infections of the skin.
Benzoyl peroxide is an anti-bacterial preparation that also eliminates oiliness. It is
beneficial to humans as well as dogs for certain skin conditions. Benzoyl peroxide is a treatment
for dogs with skin conditions such as pyotraumatic dermatitis (hot spots), seborrhea, canine acne
and demodectic mange.
Some brands of salicylic acid are used on the skin to treat common skin and foot (plantar)
warts, while other brands are used to remove corns and calluses. This product contains 2 main
ingredients. Salicylic acid is a keratolytic. It belongs to the same class of drugs as aspirin
(salicylates). It works by breaking down the thick top layer of skin and increasing the amount of
moisture in the skin. It causes the wart, corn, or callus to gradually peel off. Flexible collodion
works by forming a protective coating over the treated area. It helps to keep the area clean and also
keeps the salicylic acid and moisture in contact with the skin.
Clotrimazole is a cream form antifungal medicine that is used to treat skin infections such
as athlete's foot, jock itch, ringworm, and other fungal skin infections (candidiasis). This
medication is also used to treat a skin condition known as pityriasis (tinea versicolor), a fungal
infection that causes a lightening or darkening of the skin of the neck, chest, arms, or legs.
Clotrimazole is an azole antifungal that works by preventing the growth of fungus.
Terbinafine gel is used to treat a variety of fungal skin infections such as ringworm,
athlete's foot, and jock itch. It also helps to relieve the itching, burning, cracking, and scaling from
these infections. Terbinafine is an antifungal that works by preventing the growth of fungus.
 REFERENCE

Parenteral Drug Association, Technical Report No.60-2 Process Validation: A Lifecycle Approach
Annex 1: Oral Solid Dosage/Semisolid Dosage Forms, 2017.
Tanesh, S., et al., Skin Cream as Topical Drug Delivery System: A Review, Journal of
Pharmaceutical and Biological Sciences, Volume 4, Issue 5, pages 149-154, September 2016.
The Pharmaceutics and Compounding Laboratory, Ointments: Preparation and Evaluation of Drug
Release, UNC Eshelman School of Pharmacy
Hillier A (2002) Allergy testin and treatment for canine atopic dermatitis. Vet Med 97: 210–24
Favrot C, Steffan J, Seewald W, Picco F (2010) A prospective study on the clinical features of
chronic canine atopic dermatitis and its diagnosis. Vet Dermatol 21: 23–31
Halliwell R (2006) Revised nomenclature for veterinary allergy. Vet Immunol Immunopathol 114:
207–8
Olivry T, Deboer DJ, Favrot C et al (2010) Treatment of canine atopic dermatitis: 2010 clinical
practice guidelines from the International Task Force on Canine Atopic Dermatitis.Vet Dermatol
21: 233–48