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, ideally requiring lab tests to assure 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.
MalAcetic Shampoo, Conditioner and/or Wet Wipes.(DermaPet) 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 Conditioner spray or Wet Wipe application.
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 od DermaPet Ear/Skin Cleanser (2% acetic/2% boric acid in an aqueous base) successfully by cleansing the ear once daily for 7 days. In some cases, a "gemish" formulation and systemic corticosteroids may be required. See "Seven Steps to Treating Ears" at our web site.
For topical treatment of MD, others have used the more expensive ketoconazole and miconazole shampoos, rinses and conditioners that have no effect on the concurrent Staph pyoderma that is almost always present. Still others have suggested tar or benzoyl peroxide shampoos which, if effective, seem to work by desiccation.
Systemic Therapy
Antibiotics. I like 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
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.
Plus
The same Topical and Systemic therapy as Step 1.
Steve Melman VMD
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