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LEAH FCP > Skin pharmacology > Flashcards

Skin pharmacology Flashcards

(52 cards)

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1
Q

What are the different types of skin barrier treatments?

A

Emollients
- Soften, lubricate & soothe skin
- Occlusive: seal in water content of stratum corneum –> decreased trans-epidermal water loss
- e.g. lanolin, coconut oil, Vaseline

Moisturisers
- Increase water content of stratum corneum
- e.g. colloidal oatmeal, urea, glycerine, aloe vera

Agents to improve skin barrier function
- e.g. Essential fatty acids & oils

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2
Q

What is the purpose of antiseborrhoeic agents?

A

Control scale

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3
Q

What are the actions of antiseborrhoeic agents?

A

Keratolytic → ↓ cohesion between stratum corneum cells

Keratoplastic → Normalises epidermal turnover & keratinisation

May include degreasing action

Examples: salicylic acid, sulphur

Product choice depends on coat type (greasy vs dry)

Use mildest effective agent to avoid excessive drying

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4
Q

Why is it important to identify the underlying primary problem in otitis externa?

A

Ear infections are often secondary to allergies or other conditions

Treating underlying cause is necessary for long-term resolution

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5
Q

How does dysbiosis contribute to otitis externa?

A

Microbial imbalances precede infection

Early intervention with topical corticosteroids ± antimicrobial cleaners can prevent full infection, reducing need for antibiotics

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6
Q

Why is cytology essential in treating otitis externa?

A

Helps confirm infectious agent

Guides appropriate treatment selection, preventing unnecessary antibiotic use

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7
Q

What components are commonly found in ear drops/creams?

A

Antibiotic + antifungal + corticosteroid (polypharmacy)

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8
Q

What factors influence ear treatment selection?

A

Organism type → Based on cytology/culture

Level of inflammation → Use lowest potency glucocorticoid needed

Potential ototoxicity → Avoid certain drugs if tympanic membrane is ruptured

Nature of exudate → Some antibiotics (e.g. polymyxin B) are inactivated by pus

Frequency of application

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9
Q

What are some key components of ear cleaners?

A

Cerumenolytics → Dissolve/soften wax (e.g. squalene, mineral oils)

Antimicrobials → Kill/control microbes (e.g. chlorhexidine, acetic acid)

Surfactants → Emulsify debris (e.g. sodium decusate)

Astringents → Dry ear canal (e.g. boric acid, alcohols)

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10
Q

When should ear cleaning be done?

A

To remove exudate & improve medication efficacy

To manage microbial dysbiosis

For maintenance cleaning (max 1-2x weekly to prevent irritation)

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11
Q

What are the advantages of topical therapy in dermatology?

A

Higher drug concentration at site of infection

Minimises concerns about side effects associated with systemic drugs (e.g. antibiotics, glucocorticoids)

Targeted action on different areas of skin

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12
Q

What are the challenges of topical therapy?

A

Labour-intensive → Requires compliance

Formulation considerations → Sprays, wipes, foams may be easier than shampoos

Application difficulty → Hair, location (e.g. eyes, head) may hinder use

Risk of ingestion → Some drugs may be toxic if licked off

Some animals won’t tolerate

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13
Q

What are key principles when using antimicrobials for skin infections?

A

Confirm bacterial involvement – always do cytology where possible

Avoid unnecessary antibiotic use – not suitable for Malassezia dermatitis, pruritus, or ectoparasites

Use topical treatments when possible

Choose narrow-spectrum antibiotics & lowest EMA Category drug

Address underlying cause for long-term resolution

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14
Q

What are the first steps in managing bite and traumatic wounds in small animals?

A

Decontaminate & debride (lavage ± surgical debridement ± dressings)

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15
Q

When should further investigation or surgical exploration be considered for bites and traumatic wounds in small animals?

A

If wound is located over abdomen or thorax, imaging &/or surgical exploration may be required

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16
Q

When are systemic antibiotics indicated in small animals with bites or traumatic wounds? What antibiotics would you use?

A

If animal is systemically unwell, pyrexic, or if cavity penetration is suspected

Recommended antibiotics:
Cefuroxime ± cefalexin.
Amoxicillin/clavulanate

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17
Q

How is surface pyoderma treated in small animals

A

Topical treatment
- 2-4% chlorhexidine or other antiseptic

If not responsive or very severe:
- Fusidic acid +- glucocorticoid (cocci)
- Silver sulphadiazine (rods)

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18
Q

What is the preferred first-line treatment for superficial pyoderma in small animals?

A

Topical treatment

2–4% chlorhexidine q1–3 days

Review after 2–3 weeks & continue until underlying cause is controlled

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19
Q

When should systemic antibiotics be used for superficial pyoderma in small animals?

A

If topical therapy fails or infection is severe

Always use systemic antibiotics in combination with topical antiseptics

Treat for 2 weeks, then reassess

Investigate resistance if poor response (via cytology, culture & susceptibility testing)

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20
Q

What systemic antibiotics can be used for superficial pyoderma if topical treatment fails?

A

Clindamycin (first choice due to narrowest spectrum)

Trimethoprim/sulphonamide

Cefalexin

Amoxicillin/clavulanate

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21
Q

When should culture and sensitivity testing (C&S) be performed in small animals with superficial pyoderma?

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A

If there is a history of MRSP/MRSA

If patient has had prior antibiotic courses

If rods are seen on cytology

22
Q

When should systemic antibiotics be started for deep pyoderma in small animals?

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A

ONLY if infection is painful OR if there is risk of septicaemia

Always perform culture & susceptibility testing before starting systemic antibiotics

23
Q

What is the recommended topical treatment for deep pyoderma in small animals?

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A

Concurrent topical treatment with 2–4% chlorhexidine q1–3 days

Topical therapy should always be used alongside systemic antibiotics when indicated

24
Q

What is the primary approach to treating otitis externa in small animals?

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A

Topical treatment ONLY

Assess tympanic membrane integrity – avoid ototoxic products if ruptured

25
How is cocci-associated otitis externa treated in small animals?
First-line treatment → Antiseptic ear cleaner + topical steroids If no response after 7 days, ADD topical antibiotics: Fusidic acid/framycin. Florfenicol
26
How is rod-shaped bacteria-associated otitis externa treated in small animals?
First-line treatment → Antiseptic ear cleaner while awaiting culture results If culture confirms rods, ADD: Gentamicin. Framycetin
27
What additional steps are needed for Pseudomonas-associated otitis externa in small animals?
ADD TrisEDTA + topical antibiotics to treatment Continue treatment until cytology is negative & underlying cause is corrected
28
How are superficial bacterial skin infections treated in horses?
Topical antibacterial (e.g. chlorhexidine, silver sulphadiazine) if possible Correct underlying cause
29
How are deep pyodermas/cellulitis treated in horses?
Systemic antibiotics Ideally base on bacterial C&S testing TMPS where possible – only licensed oral antibiotic available! 7-10 days for mild-moderate, 3 weeks if severe
30
How should small, superficial bacterial skin infections be treated in farm animals?
Use topical anti-bacterials/antiseptics E.g.: Chlorhexidine-based products, tetracycline/thiamphenicol spray
31
How should large or more severe bacterial skin infections be treated in farm animals?
Use non-critically important systemic antibiotics: - Penicillin - Cephalosporins - Oxytetracycline Treat for 5 days, then reevaluate
32
How are abscesses treated in all species except rabbits?
Avoid use of antibiotics initially --> allow to mature & ‘point’– poulticing/hot compresses may help to accelerate Once mature --> lance, drain & flush Give NSAIDs as needed Give appropriate antibiotic if patient systemically unwell, pyrexic or cellulitis present
33
How are abscesses treated in rabbits?
Rabbit pus caseous so can’t lance & drain Antibiotic unlikely curative – normally used in conjunction with surgical management Ideally C&S on section of abscess wall (not pus) Investigate cause (e.g. dental disease) as needed
34
How is dermatophytosis treated?
1. Identify fungus & any predisposing conditions 2. Remove infective fungal spores from coat (topical antifungal rinse/shampoo +/- clip hair) --> reduce environmental contamination 3. +/- Systemic therapy 4. Clean environment as far as possible 5. Monitor response to therapy NB Also can use fungal vaccines for cattle for prevention
35
Name some topical antifungal shampoos/rinses
Miconazole - Licensed (in combination with chlorhexidine) as adjunctive treatment for dermatophytosis in cat (Malaseb shampoo) - Licensed for dogs for bacterial pyoderma Enilconazole (Imaverol) rinse - Licensed for cattle, horses, dogs Human fungal creams (e.g. clotrimazole) occasionally used for local adjunctive treatment, where wash inappropriate (e.g. near eyes) –unlicensed
36
What are some systemic antifungals?
Itraconazole - Licensed for cats - Oral liquid given daily on alternate weeks - Sometimes used in ‘small furries’ Ketoconazole - Licensed for dogs – daily oral tablet - Never for cats
37
What are the main side effects of itraconazole and ketoconazole (systemic antifungals)?
GI upset & hepatotoxicity (esp. ketoconazole) Ketoconazole requires hepatic parameter monitoring Not for animals with liver failure Ketoconazole may temporarily affect male fertility
38
What are the treatment options for Malassezia infections?
Topical antifungals - Shampoos, foams, wipes, ear preparations - e.g. Miconazole, clotrimazole, posaconazole, nystatin, terbinafine - Chlorhexidine 2–4% Systemic antifungals (used in some cases, but often unlicensed) - e.g. Ketoconazole (dogs, not cats), Itraconazole
39
When should fungal culture and susceptibility testing be considered in veterinary dermatology?
Subcutaneous (deep) & systemic mycoses
40
What is the multimodal therapy for atopic dermatitis?
1. Control of inflammation & pruritus 2. Allergen avoidance & allergen-specific immunotherapy (ASIT) 3. Improving skin barrier 4. Control of flare factors
41
What are the advantages and disadvantages of using glucocorticoids to control inflammation & pruritus in atopic dermatitis?
Advantages: Rapid, cheap, strong anti-inflammatory action Disadvantages: Significant side effects with long-term use
42
Give examples of glucocorticoids & other drugs that can be used to control inflammation & pruritus in atopic dermatitis?
Prednisolone (GC) - Oral; used in dogs, cats, horses - Start at anti-inflammatory dose, then taper to lowest effective dose (ideally q48h) Dexamethasone (GC) - IV/IM; used in horses - Longer-acting than prednisolone Oclacitinib (Apoquel) - Oral; dogs only - JAK-1 inhibitor → blocks itch signaling - Rapid onset, good antipruritic effect - Safe for long-term use Lokivetmab (Cytopoint) - Monthly SC injection; dogs only - Monoclonal antibody targeting IL-31 - High specificity = excellent safety profile Ciclosporin - Oral; dogs and cats - Potent immunosuppressant - Slow onset, not ideal for acute flares - Expensive
43
How can allergens be identified in atopic dermatitis cases?
Intradermal testing or IgE serology
44
Describe allergen-specific immunotherapy (ASIT) for atopic dermatitis cases.
Administer small amounts of relevant allergen to try to induce tolerance Only option that addresses underlying cause If effective (70% of cases - takes 12m to assess), long term treatment usually required
45
Name three ways to improve the skin barrier in atopic dermatitis.
Topical moisturisers (e.g. colloidal oatmeal, aloe vera) Essential fatty acids (oral/topical) Essential oils
46
What are some common flare factors that should be controlled in atopic dermatitis?
Microbial populations (antimicrobial shampoos/wipes) Ectoparasites Environmental factors (avoid overheating)
47
What are the aspects of therapy for autoimmune disease?
1. Induction 2. Titration 3. Maintenance 4. Monitoring
48
What is the goal of induction therapy for autoimmune skin disease, and what drugs are used?
Goal: Rapid lesion control. Drugs: - Systemic treatment with GCCs at immunosuppressive doses - Prednisolone (dogs/cats), Dexamethasone or Prednisolone (horses) Continue induction treatment until: - Most lesions healed - No new lesions for 2 weeks If no response after 10 days, add adjunctive therapy
49
Why is a slow taper required in titration therapy, and what adjunctive drugs can be used? | Autoimmune skin disease
Slow taper reduces relapse risk & side effects However as lesions often recur as GCC dose reduces, adjunctive treatments are added to help maintain clinical control. Common adjuncts: - Azathioprine (not for cats) - Chlorambucil - Mycophenolate mofetil - Ciclosporin (for T-cell-mediated diseases) - Oclacitinib (emerging evidence)
50
What is the goal of maintenance therapy, and how is prednisolone tapered?
Goal: Maintain remission with minimal side effects Tapering: - Taper until clinical signs just recur to establish lowest effective dose regime, then increase dose to regain control & taper back to lowest effective dose for maintenance - Reduce prednisolone to alternate-day therapy if possible. Many cases require lifelong treatment
51
What aspects should be monitored in autoimmune skin disease therapy?
Lesion control, side effects of drugs, blood tests (monitor for hepatotoxicity, bone marrow suppression in azathioprine use)
52
What are some alternative treatments for autoimmune skin disease?
For localised lesions: Topical GCCs, Tacrolimus Other options: Pentoxifylline (vasculitis), Oclacitinib alone (emerging)

LEAH FCP (151 decks)

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