Product Focus:
Heat & sun protectionThe rise of dermocosmetics in dogs: Do they need skin care?
by Dr Ineke Meredith, MBChB and Amaury Briand, DVM
TIME to take wound care back to basics
by Essity
Product Focus
Ensure your practice is fully stocked with essential heat and sun protection products to help your clients' keep their pets cool, comfortable, and safe during the (hopefully!) hot summer months. Our range includes cool mats and cooling beds, perfect for lowering dogs' temperatures and providing a refreshing spot to relax. Cooling vests offer a practical solution to prevent overheating, while freezable toys keep dogs entertained and refreshed. Additionally, pet-friendly sun protection sprays and wipes shield pets from harmful UV rays, ensuring they stay healthy and happy in the sun.
View NVS Summer & Travel range
Activated by weight, these mats will maintain a temperature slightly lower than the ambient for up to three to four hours of constant use. They automatically recharge themselves as the pet moves.
Code: 623465, Lemon 65 x 50cmCode: 623489, Lemon round 60cmCode: 623453, Watermelon 65 x 50cmCode: 623477, Watermelon round 60cm
A simple idea that cools a dog down by gently drawing heat away from its body. There's no need to refrigerate the mat before use, as it contains an innovative completely safe cooling gel.
Code: 798794, 30 x 40cmCode: 798800, 40 x 50cm
A clever and efficient way to ensure a dog is kept cool and comfortable in warm weather, the bed is filled with cooling gel that is comfortable to lie on and quickly reduces the temperature of the dog. The cooling effect lasts several hours and it can be placed on the floor, on a bed, or in a crate.
Code: 950762, large 68 x 91cmCode: 950750, small 56 x 66cm
Hot and bothered dogs will be instantly refreshed. The vest can be plunged into water and put onto a hot dog to reduce the risk of overheating, a process that can be repeated whenever the vest dries out. The vest has a belly strap to ensure a snug fit.
Code: 950774, XS, Length 25cm / Girth 50cmCode: 950786, S, Length 30cm / Girth 60cmCode: 950798, M, Length 40cm / Girth 70cmCode: 950804, L, Length 50cm / Girth 80cmCode: 950816, XL, Length 60cm / Girth 90cmCode: 950828, XXL, Length 70cm / Girth 100cm
Filled with water, these toys can be frozen for a cooler playtime.
Code: 950749, Large Ice LollyCode: 950737, Mini Ice LollyCode: 950725, OrangeCode: 950713, Polar BearCode: 950701, Watermelon
A versatile, treat and chew toy with two treat cavities for added interaction, which can be filled with water and frozen for a cooling chew. Gum massaging technology takes care of a dog’s dental hygiene, while its odd shape and rubbery material gives it an erratic bounce to keep a dog entertained.
Code: 395742, Blue MediumCode: 395754, Lime MediumCode: 395729, Orange MediumCode: 395717, Pink MediumCode: 395730, Red MediumCode: 398287, Shipper x 15 pieces
Doggy Sunmist and wipes provide the fastest, most convenient way to protect a dog from the sun's harmful ultraviolet rays whenever they're outdoors. The gentle, non-greasy formula was developed especially for dogs and compares to SPF 15-rated sunscreens for people. Simply spray or wipe all over anytime a dog is out in the sun, especially on ears, nose, muzzle, pink skin areas and entire coat of light-coloured or short-haired dogs.
Code: 715955, Sunscreen Spray, SP15, 120mlCode: 608452, Sunscreen Wipes, SP15, pk 20
Compact and portable, ideal for food and water, simply collapse the bowls and zip-up after use. Perfect for travel, road trips or pets on the move. Dishwasher safe.
Code: 386546, Dual Bowls
A portable drinking dispenser with an added carabiner, perfect for attaching to leads, bags and travel crates. The leaf lid is dishwasher safe.
Code: 386534, Travel Bottle
By Dr Ineke Meredith, Founder of Fur Love, MBChB, Melanoma and Breast Surgeonand Dr Amaury Briand, DVM
Traditionally, cosmetics are considered to be powders, creams and products like lipsticks, designed to enhance personal appearance. Beautification. It's because of this multi-billion -dollar beauty industry, with its investment in research, that we now have increasingly sophisticated knowledge of the skin barrier and its physiology, in addition to new technology and ‘actives’ that improve its function.
Dermocosmetics has evolved as a result, and such products are widely used and recommended by (human) dermatologists to support pharmacological treatment for conditions such as xerosis, acne, psoriasis and atopic dermatitis (AD). In short, dermocosmetics is part of the therapeutic arsenal for many skin disorders.
Similarities between human and animal diseases are valuable bidirectional sources of knowledge from which one can improve the understanding of pathogenesis and treatment. These similarities exist strongly in AD with canine AD (CAD) proposed as the naturally occurring animal model of human AD (HAD).1 CAD affects up to 30% of dogs worldwide2 and is one of the most common reasons to visit a companion animal vet. For both canines and humans, atopic disease is becoming increasingly common, which is probably a result of both environmental and lifestyle changes.
The skin barrier plays a central role in the pathogenesis of CAD.3 One of the skin's most important functions is providing a barrier between the environment and the body. In its ‘healthy’ state, it is almost impermeable to water. In CAD, abnormalities in proteins, lipid organisation in the stratum corneum and enlargement of intracellular spaces result in excessive water loss, desiccation, and penetration of exogenous substances including external allergens.
CAD affects up to 30% of dogs worldwide and is one of the most common reasons to visit a companion animal vet.
Furthermore, allergen exposure can worsen this disorganisation of lipids in the stratum corneum, further impacting the 2 intracellular spaces. The resultant trans-epidermal water loss (TEWL) is another sign of the impairment of this barrier between the internal and external environments. For atopic dogs, measured TEWL is higher in both lesional and non-lesional areas than that seen in healthy dogs.4
In HAD, moisturisation is pivotal, and regardless of the severity of the disease, it is the mainstay of treatment. It is established to have a steroid-sparing effect, and it has been demonstrated to be just as effective as steroid therapy in mild to moderate skin flares, resulting in a lower dependence on medication.5 6 This is due to the direct effect that moisturisation has on the structural layers of the skin. In more recent studies in both children and adults, the ‘proactive’ application of moisturisation results in lengthening periods between skin flares, again reinforcing its importance in maintenance.7 8
Given the similarities in pathology for both HAD and CAD, it is reasonable to conclude that AD in dogs should respond to the same treatment principles as HAD. However, in dogs, lack of clarity around simple things like frequency of washing means that the introduction of skin care routines in dogs who would benefit from it is out of the ordinary. Furthermore, it is unclear which dermocosmetics on the market might be effective, and how and when these should be administered.
So, what do we know about the role of dermocosmetics in dogs and how can they exist in the veterinary therapeutic arsenal? One might guffaw at the idea of a ‘cosmetic’ need in dogs, but dogs who nibble and chew excessively might have matted, poorly kept coats; their constant licking leads to malodour and they can develop bald patches which are distressing for dog owners.
The simple application of a carefully chosen shampoo, and its immediate impact, can be reassuring for an owner who rightly or wrongly believes that it is normal for dogs to nibble and that a dog should not be washed more than once every 3 months.
For canine skin which requires veterinary attention, dermocosmetics should form part of the therapeutic toolbox for a wide range of these disorders. These include xerosis, seborrhea and other seborrheic conditions, hyperkeratosis, skin infections, hair loss,3 and finally allergic or irritated skin.4 Although dermocosmetic products do not have a ‘therapeutic’ function per se, they have many benefits in skin diatheses and in particular for allergic skin disease where the body of evidence for efficacy is the strongest. Specifically for CAD, the use of dermocosmetics portends one of the key pillars of management: skin rehydration and restoration of the skin barrier defect. It is not the role of this article to discuss the intricacies of dermocosmetics in each disorder, but rather to provide an overview of the application of dermocosmetics in dogs.
There are a handful of studies which examine the benefit of moisturisation in dogs with AD. Two of these studies demonstrated that daily moisturisation in dogs with AD and high TEWL resulted in increased SC thickness and improved hydration (Fig. 1). 3 9 The constituents of these moisturisers include propylene glycol and combinations of cholesterol, ceramides and fatty acids.
Figure 1. (click to zoom in)On the left a schematic diagram of a skin barrier belonging to patient with CAD. The stratum corneum is seen to have reduced lipid bilayers within the stratum corneum resulting in widened extracellular spaces. On the right is the same dog who has had moisturising treatment for 28 days. There is replenishment of the stratum corneum and restoration of the extracellular spaces preventing penetration of exogenous material including allergens.
The mode of application can be a potential challenge for dog owners who might find the idea of weekly cleansing particularly onerous. It is also a potential challenge for the veterinarian to offer a solution that the owner is not happy to use. For this reason, it is important to offer different options.
Dermocosmetics for canines (and humans) exist in many different topical forms: wipes and pads, spot-on treatments, patches, sprays, lotions, foams, gels, balms, powders, and of course, shampoos. It is probably the shampoo which is the most beneficial and it is uniformly recommended for all dogs.
The mechanical effect of a bath removes dirt, debris, crusts and other loose areas of skin. It is the simplest product to apply over hairy skin and the effect is usually immediate. Shampoos are becoming increasingly sophisticated, but across the board, there is increasing scientific input into the choice of evidence-based ingredients.
To date, research around the application and use of topical products has centred around the reduction of symptoms and improvement in skin lesions during an acute episode. We lack good evidence for the long-term use of these products, and the ability of these products to maintain skin health and reduce flare-ups. However, it is reasonable to conclude that if these microscopic changes in the quality of the skin barrier are maintained through regular moisturising washes and ointments, then vulnerability to allergens and flare-ups would be less frequent.
One recent study has, in fact, reported a longer-lasting remission when moisturising treatments are combined with the administration of Lokivetmab.10 Whilst this is likely to be the direct effect of moisturisation on the integrity of the skin barrier, cleansing and moisturising may play a role in the regulation of the skin flora. It is known that the microbial diversity found on the skin of atopic dogs is reduced with an increase in populations of Malassezia sp. and Staphylococcus sp.11
Treatment ‘escape’ is not an uncommon phenomenon. This might be where a patient, previously well controlled on Lokivetmab, experiences a reduction in efficacy, and in some cases, this is due to ‘superinfection’ (superficial pyoderma or Malassezia dermatitis). Regular cleansing and moisturising using appropriate dermocosmetics, with or without antiseptic use, is likely to aid the regulation of microbial flora and should be recommended even with systemic medication.
Skin care is relevant for even dogs with ‘normal’ skin. Just like humans, there exists a wide variety of skin phenotypes influenced by the combination of race, genetics, and external factors such as environmental exposures, climate, diet and lifestyle. Due to this heterogeneity, ‘normal’ becomes less helpful, and it might be more useful to consider the skin or coat as dry, oily, sensitive or irritable. Nonetheless, for this spectrum of ‘normal,’ maintenance is still very important.
A focus on maintaining hygiene and reducing odour is a good goal. Such a routine might consist of regular cleansing (for example, a shampoo once a week), wiping high-risk areas (perioral, skin folds and interdigital spaces) and moisturisation. One must not forget that sunscreen is also important in dogs although consumers should be advised to look for high SPF products that block both UVA and UVB.
As we observe the humanisation of dogs and their increasing importance and place in the modern family, it is easy to assume that a ‘cream’ for dogs is another part of this phenomenon. Dogs have been outdoor creatures for centuries. Twenty years ago, they barely took a bath. Do they need ‘skincare’? The answer is yes. Regularity of this care will make a difference for dogs who need it, and again this is where the human beauty industry can help. Any consumer of human skincare knows that routines matter. Good skin does not happen overnight, and persistence eventually pays off.
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Fur Love, is a canine dermocosmetic company dedicated to maintaining skin care routines for dogs with canine atopic dermatitis. It was founded in New Zealand in 2020 by Dr Ineke Meredith and is sold through vet clinics in New Zealand and Australia. It is now available in the UK through NVS.
Find out more…
by Essity, manufacturers of the Cutimed® wound management range
Traumatic open wounds are a common occurrence all year round for veterinary professionals, but as the weather improves with the summer months, pet owners and their animals will be venturing out on more adventures in nature. It is during this time of year we may start to notice a rise in certain traumatic wounds; stick injuries, lacerations caused by unknown foreign objects, and bite wounds.
Management of open wounds should ideally follow a systematic and holistic approach, that incorporates evidence-based basic wound management techniques, which together should improve healing outcomes and minimise complications.
When presented with an open wound it can be easy to become distracted by the large open deficit in front of us but stepping back and viewing the bigger picture can help to shift attention to a patient/client-centric focus when creating a wound management plan. The basis of a wound management plan should include an assessment of extrinsic and intrinsic factors that could delay wound healing (See Table 1 below)
Intrinsic
Extrinsic
Concurrent disease (diabetes, anaemia, heart disease, dermatological conditions)
Client concordance / compliance
Increased age
Client Finances
Body condition score (Malnutrition, obesity)
Patient interference
General health status
Restricting expression of normal behaviours
Surgical history
Moisture imbalances
Hydration status
Infection
Pain
Certain factors can be mitigated or eliminated, but others can be more challenging. Successful client concordance relies on effective communication and education of pet owners.
Concordance differs from the more traditional idea of client compliance in that a treatment plan is created based on shared decision-making between the veterinary professional and the pet owner1. Client compliance, which is a term more of us may be more familiar with, is the pet owner’s agreement to adhere to a treatment plan that has been outlined to them1. Where we would expect client compliance in wound care is around bandage care, if the client does not follow a set of instructions it could end in complications for the animal in the form of bandaging injuries. So, we must look at how we can merge these two concepts to try and maximise outcomes. The use of a holistic wound assessment and getting the pet owner on board with the idea that the wound-healing process is dynamic and may need to be altered at different stages2. Pair this with setting small step goals that are re-assessed at each presentation of the animal can aid in helping to improve client compliance and concordance. Once factors that may affect wound healing have been established, a full wound assessment can be performed, followed by wound bed preparation and placement of an appropriate dressing.
The utilisation of a standardised wound assessment framework, such as T.I.M.E.S (Figure 1, above), can help to identify certain clinical observations seen within the wound bed and surrounding skin and how we can correctively manage certain aspects to maximise wound bed preparation, which promotes healing and improved patient outcomes3.
Determine if there is viable or non-viable tissue present within the wound bed. Presence of nonviable or deficient tissue (slough/necrosis /eschar Figure 2a ) can all potentially impact healing4.
Non-viable provides a focus microbial replication leading to wound infection, it can prolong the inflammatory response, and mechanically obstruct contraction and impede re-epithelialisation4.
Debridement is the most appropriate way to manage non-viable tissue, the type of debridement should be based on what is most appropriate for the individual case3. If tissue is viable, granulation tissue (Figure 2b), ensure to support the moist wound environment using a hydrogel, such as Cutimed® gel.
Find out more about the range…
Inflammatory exudate is released naturally during the first phase of healing and makes up part of the body’s wound-cleansing process. We mustn't confuse normal inflammatory signs to be signs of wound infection. There are a few key clinical observations we are looking out for to differentiate between the two.
In normal inflammatory signs, we should see these peak at approximately day 3 and during this time proliferation will begin. Viable tissue should be created simultaneously while the body is wound cleansing and managing bioburden. Bear in mind that every wound is going to have a degree of contamination so keeping this at a level where the body can handle microbes itself is important.
Consider the use of alternative topical products that work through a physical mode of action rather than reliance on systemic antibiotics to try to combat antimicrobial resistance. Cutimed® Sorbact® works through a physical mode of action to bind, inhibit, and remove bioburden when placed in direct contact with the wound bed5. This is then removed when the dressing is changed effectively minimising bioburden and aiding to potentially lower the requirement for systemic antibiotics7 (Figure 3).
Because of the physical mode of action, Cutimed® Sorbact® can be used prophylactically or during active wound infection to inhibit the growth of common wound pathogens5, including Methicillin Resistance Staphylococcus Aureus (MRSA) and Vancomycin Resistance Enterococci (VRE)8, and as it is non-cytotoxic and does not release active agents into the wound bed it facilitates the normal wound healing process9. (Figure 4).
We have discussed how inflammatory exudate is produced as part of the body’s natural inflammatory response, but the level of exudate produced can depend on pressure gradients applied to the affected tissue10.
Increases in movement, friction, and pressure can lead to imbalances of moisture within the wound bed, the body will under normal circumstances produce enough fluid to promote cell proliferation and autolysis within the wound bed10.
If our exudate production is not managed or other factors lead to increases in exudate incorrect management can lead to chronic wound healing and increased risk of wound infection and moisture-related injuries, for example, maceration of the surrounding skin10 (Figure 5).
Application of moisture balancing dressing or
use of sub-atmospheric electronic pumps, such as vacuum-assisted compression (VAC) or negative-pressure wound therapies, can aid in managing moisture imbalances.
Wounds contract from the circumferential edges’ inwards, the body will choose the path of least resistance when epithelising. For a wound to epithelialize several factors need to be present for this to take place, a well-vascularised granulation bed for cells to migrate over that also provides a good oxygen supply and nutrients to support tissue regeneration10.
If the cells are not supported, they slow down and lose functionality. Where we see non-advancement from the edge of the wound is usually due to poor quality cell proliferation, cellular DNA damage or prolonged inactivity of the cells from desiccation of the wound bed.
The simplest method of supporting and maintaining cell functionality is to promote a moist wound-healing environment10.
The surrounding skin should be monitored, and the skin’s integrity maintained. Prolonged exposure of fluid on intact skin can lead to peri-wound moisture-associated skin damage, and wound exudate that contaminates the peri-wound area for prolonged periods of time can lead to skin damage. This causes inflammatory response and erythema and can be seen with or without erosions11.
Protecting the surrounding skin using an appropriate medical skin barrier product can help prevent moisture-associated skin damage.
Cutimed® PROTECT cream moisturises the skin preventing it from dying out while maintaining permeability to water vapour and oxygen (Figure 6). As a preventative Cutimed® PROTECT barrier spray can protect intact skin from irritation caused by friction and maintain its barrier function for up to 96hours12.
Performing effective wound management requires more than just being able to assess the visual observations seen within the wound bed. A solid understanding of cellular aspects of the healing process can aid in ensuring that as veterinary practitioners we understand why we may be using a type of wound management technique.
Performing a holistic assessment and re-assessment at each dressing change using a standardised framework such as T.I.M.E.S and conducting appropriate wound bed preparation that maximises the wound healing processes can improve patient outcomes and client satisfaction.
