Malassezia Dermatitis (MD) Protocol

Steve Melman VMD

Malassezia Dermatitis (MD) is a common, most often pruritic, disease that has many recommended therapies. The following is a 3-phase MD treatment plan. Conventional therapy has been to treat with drugs, which often cause severe side effects especially affecting the liver and ideally requiring lab tests to monitor liver function. This method allows for the practitioner to treat the majority of cases at a limited expense without using those risky drugs or doing liver function testing.

STEP 1: Topical Therapy
Mal-A-Ket Shampoo or MalAcetic ULTRA Shampoo, rinse then apply MalAcetic ULTRA Conditioner and allow to dry. You may also choose to use the Mal-A-Ket Wipes focally to the affected areas as often as daily and/or MalAcetic Wet Wipes or MalAcetic HC Wet Wipes. The use of our acetic acid/boric acid shampoo has proven effective in-vivo in treating Malassezia (Gotthelf and Young, Vet Forum, 8/97) and in-vitro (Benson, ACVD/AAVD Proceedings, 1998). (Both papers are on our web site. http://www.dermapet.com). I suggest a frequency of bathing 3 times weekly and daily MalAcetic ULTRA Conditioner spray or MalAcetic/MalAcetic HC or Mal-A-Ket Wet Wipe application. The addition of ketoconazole and chlorhexidene in Mal-A-Ket gives more emphasis as a combined antibacterial and antifungal. MalAcetic ULTRA has added ketoconazole and hydrocortisone, the latter should reduce pruritis which is often present. MalAcetic HC wipes also contain hydrocortisone to help reduce pruritis.

The selection of the product will depend upon the severity and location of the lesion. For generalized MD the use of a shampoo and conditioner is required. For focal MD, topical Wet Wipe application should be adequate. In both cases, clipping the patient to allow better access to the skin is imperative.

Often ears must be treated separately. The above mentioned article (Gotthelf and Young) describes the use of MalAcetic Otic (2% acetic/2% boric acid in an aqueous base) eliminates Malassezia successfully by cleansing the ear once daily for 7 days. MalAcetic ULTRA Otic can be used initially in inflamed ears. TrizULTRA + 0.14% Ketoconozole can also be used. See "Seven Steps to Treating Ears" at our web site.

Systemic Therapy:

Antibiotics. Cephalexin 10 mg/#/bid/minimum 21 days or 10 days post symptoms.

STEP 2: The same Topical and Systemic therapy as STEP 1, Plus Systemic Antifungal Therapy
Ketoconazole 5-10 mg/kg/qd/3-4 weeks. Give with an acid meal for best absorption. The side effects, especially hepatotoxicity, of this drug are legend. Since it is now generic, it is a much less expensive alternative. I treat most cases for a 10-day trial period to test efficacy before continuing the prescription for 4 weeks total. One beneficial side effect of ketoconazole is it's anti-inflammatory effect, which sometimes quickly leads the patient to be less pruritic

STEP 3: The same Topical and Systemic therapy as STEP 1, Plus Iatraconozole
Although not universally accepted as having efficacy against Malassezia, Sporonox (iatraconazole) is a much more expensive alternative at 5 mg/kg. One beneficial effect of Sporonox is it's epithelial persistence.