Newsletter - August 2007

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August 2007

Topical Uses For Keto

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Table of Contents

Topical Uses For Keto

Yada Yada

Meetings

Territory Managers

Specials

Technical Bulletins

Lou Gotthelf's Small Animal Ear Diseases

DermaPet Vision Statement

DermaPet Mission Statement

Topical Uses For Keto

The following is edited from "Topical Ketoconazole Antifungal Therapy" by LOU GOTTHELF, VPN, 8/07. For a complete unedited version, click here.

Veterinarians have longed for a broad spectrum antibacterial and antifungal topical to handle those dermatitis cases where either mixed microbes are involved or as a broad spectrum treatment when they are not sure. Recently, (ed note: MalAKet and TrizUltra) containing traditional antibacterial agents have been introduced into the market that are mixed with the antifungal agent, ketoconazole in the form of shampoos and otics.

Shampoo therapy is an integral adjunctive part of the management of skin diseases in dogs and cats. Treating the skin requires TREATING-THE-SKIN; not just giving systemic medications such as steroids, antifungals, and antibiotics. Deciding which shampoo to use and which ingredients the shampoo should contain for a certain skin problem may be confusing.

Rather than just cleansing the dirt off of the skin and haircoat, when left in contact with the skin for 15 minutes or longer, these shampoos actually have beneficial effects on the skin cells. Newer shampoos contain topical pharmaceuticals as a part of their ingredients, so topical antimicrobial therapy in shampoos is now possible. Recently, 1% ketoconazole has been added to Mal-A-Ket, for dogs and cats used in treating Malassezia dermatitis and dermatophytosis/ringworm.

Ketoconazole is an azole antifungal agent that binds to the lipids in fungal cell membranes and interferes with the synthesis of ergosterol, an integral part of the fungus or yeast cell wall. When topically applied in a shampoo, ketoconazole should be used on a skin surface that is degreased because of its lipid affinity. The more lipid that is on the skin, the smaller the amount of ketoconazole that will be available to bind to the yeast or fungus. With some shampoos, a good degreasing shampoo should be used prior to the ketoconazole shampoo. Mal-A-Ket, 2% acetic acid, 2% chlorhexidine and 1% ketoconazole contains acetic acid which actually degreases the skin as the shampoo is working. Chlorhexidine gluconate 2%, an antimicrobial detergent that binds to skin proteins. seems to be a synergistic with the 1% ketoconazole when used topically. Like MalAKet, a product containing ketoconazole should have an even distribution of the drug and it should be a clear solution rather than a suspension. Ketoconazole is not very water soluble, so when using it in a shampoo, the less water dilution there is, the higher the concentration on the skin cells.

Using a topical ketoconazole shampoo for ringworm in cats may preclude the need for systemic antifungal drugs, like itraconazole and fluconazole which are expensive. A ketoconazole containing shampoo has a much less offensive odor than other topicals like lime sulfur, which can be used in conjunction to treat dermatophytosis. In addition, topical therapy for ringworm helps to reduce shedding of spores in the environment. Twice weekly 15-20 minute shampoos are required until a negative DTM culture is obtained.

Malassezia dermatitis results as a secondary complication from allergies or adverse food reactions in dogs. Atopic dermatitis dogs usually have Malassezia yeasts between the toes and results in foot licking and salivary discoloration of the hair. Atopics may also have hyperkeratosis and seborrhea, often with a very bad odor in the axillary, antecubital, pedal and ventral neck region. Of course Malassezia otitis occurs in most of these allergic dogs, too. Shampoo therapy alone may help many of these allergy dogs get relief from Malassezia dermatitis. However, systemic treatment with steroids, cyclosporine, antibiotics and antifungals may be necessary in more severe cases. Allergen specific immunotherapy and food elimination diets may decrease the incidence of Malassezia dermatitis. Initial skin treatment requires a 15-20 minute whole body shampooing every other day for 2 weeks, a total of 7 treatments. In foot lickers, make sure that the shampoo gets between the toes and in the foot pads.

Malassezia otitis often complicates allergic disease, hypothyroidism, and seborrheic conditions in dogs. Antifungal drugs such as nystatin, clotrimazole, miconazole, and thiabendazole have been available in otic preparations for a long time. Systemic ketoconazole does not seem to have good anti-yeast effects in the ear, most likely due to the ear canal's poor blood supply. Ketoconazole is now available in combination with tris-EDTA (TrizUltra/DermaPet). However, prior to using TrizUltra, a deep ear flush should be done using a wax dissolving cerumenolytic detergent (KlearWax, DermaPet) in the hospital, preferably with the dog sedated or anesthetized. Initial deep ear cleaning remains an essential part of good ear therapy. Twice daily application of the tris-EDTA/ketoconazole (TrizUltra) is recommended until negative cytology is obtained. Treatment is used for a minimum of 2 weeks. Unless the primary cause of the ear disease and/or the Malassezia dermatitis (atopy, adverse food reactions, and/or hypothyroidism) are addressed, when topical skin or otic therapy is stopped, the yeasts often return.

Ketoconazole has been used to extend the MalAcetic line making Mal-A-Ket Shampoo, a 2% Acetic Acid, 2% Chlorhexidine and 1% ketoconazole clear, elegant and pleasant smelling shampoo. This product has mixed microbial efficacy and should be helpful in your Malassezia, dermatophyte (and other cutaneous fungal orders), Staphylococcus and other microbial associated cutaneous disorders. It has excellent coat conditioning, degreasing and deodorizing qualities.

TrizULTRA+KETO uses Ketoconazole to extend our patented TrizEDTA line by adding .15% ketoconazole. This broad spectrum product is designed to benefit those cases where Malassezia otitis co-exists or is associated with bacterial ear disease. This product is low viscosity, totally soluble and in solution to better access difficult areas of infection. It combines the best topical antifungal with the best topical and ONLY PATENTED antibacterial, TrizEDTA. Of course, our MalAcetic Otic line is still the best approach towards Malassezia otitis with or without associated bacterial cocci involvement.

TrizPLUS with .15% chlorhexidine is available for your difficult bacterial cases, combining the gram negative merits of TrizEDTA with the gram positive effects of chlorhexidine.

Go to http://dermapet.com/articles/KetoFlyer6.pdf

Yada Yada

AVMA, Washington, DC

PHIL NELSON, Dean at Western University Veterinary School, and his wife, along with a few others visited DermaPet for an informal dinner. LOU GOTTHELF and YT renewed our ongoing Mediocrity Cup golf competition. While I didn't win it this time, it appeared that Lou did lose.

The occasion of a DC meeting brought our inside staff together with our outside staff for a couple meals including one at Café Milano with JACK, CHRIS VON STEIN (COO), DAVE BROWN (CFO) and CHUCK MICHAELS (OWH-old work horse).

Italy was an eating and drinking trip. The Palio was a magnificent horse race in Siena attended by what appeared to be the entire country plus most of the tourists in Italy. Hilights of the trip, if they weren't the wineries and restaurants, were walled cities like San Gimingnano and Orvieta. While tourists need cars to travel through the fabulous countryside of Tuscany, Italy's roads and drivers in cities are not ready for tourists driving. Imagine traveling at a normal speed limit and coming to a one lane underpass with a truck coming through and no discernable warning signs, or mountain roads around Bellagio big enough for two compacts when a bus comes barreling by on the inside lane where it's just the width of a tire between you and dropping off a cliff.

Or in a walled city driving down a street (the only way to go) that is just wide enough to not scrape your side mirrors and have to make a right angle turn into a similar street..I could go on. Bottom line is rent a small car, drive defensively and bring a driver who doesn't drink. Regarding money, the US $ just isn't what it used to be. There are NO BARGAINS in food, wine, lodging or shopping (not even at the outlets which are mandatory visits). The country is VERY pet friendly; ROXY was allowed everywhere but churches (which was fine with me as neither of us particularly like to visit old churches.) WARNING: when walking around the pastures of grapes, they do have poisonous snakes; this previously unknown (to me) fact fortunately was learned in-vivo towards the end of my trip limiting my indulgence in wineries (as well as walking in green pastures) to places where finished wine was actually consumed. Food: The worst gelato place in Italy was as good as any ice cream served in the US and one displaying awards on the main plaza in San Gimingnano was the best. Wine: This is the best bargain for US$$.

Lou Gotthelf, during an August fishing seminar in ALASKA seems to have acutely developed a bear phobia brought out by having a bear "visit" within 50 feet of him while fishing for salmon. In a group without a gun, Lou, also known as "Moose" in recognition of his largesse (pardon the pun), threw rocks and tried to appear big to scare the bear which ran off. In a parallel universe, there is a bear rescue psycho support group with a bear that has a "large human phobia." Lou compares his bear phobia to mine with snakes when golfing; the big difference being it's the snake you don't see that bites you.

Meetings

We will be at the the Banfield Industry Summit August 21-24, the SWVS in Ft Worth August 24-26, CVC in KC, Sept 15-18, the ESVD in Mainz, Germany on Sept 20-22, the ACVC in Atlantic City on Oct 9-11, and CVC West in San Diego on Sept 19-21, SEVC in BARCELONA on October 18-21Great Smokies in Asheville, NC, Oct 26-29, The Muller meeting in Maui in the first week of November and Barbados, the 4th Pan Commonwealth Veterinary Conference, November 4-8 where LOU GOTTHELF and YT lecture.

Back to top

Territory Managers

MICHAEL BURCH is our TM for the Carolinas and Georgia. Michael can be reached at michaeleburch@aol.com, or at 704-728-8204.

BOB MARSHALL handles the Northwest. Bob can be contacted at bob.dermapet@sbcglobal.net, and 916-290-3557.

JEFF SERVE handles the mid-west including Ohio, Michigan and Indiana; Jeff can be reached at serve610@sbcglobal.net and 419-509-2242.

DOTTIE ASMUSSEN handles IL, IA, WI, MN, NE, KS, MO, ND, and SD. Dottie lives in Hannibal, MO and can be reached at dottie.asmussen@gmail.com or 573-406-8616.

ROB CONN handles the southern region of the West Coast. Rob can be reached at 818.585.0632 (Cell) or rob.dermapet@sbcglobal.net

Al LINGUA is in the NE from New Jersey north. Al can be reached at 860-810-7280 or ajlingua@aol.com.

JAY MAIDEN is our TM for the SE US (FL MS, AL, TN, KY) . Jay can be reached at 727-560-2325 or jaymaiden@verizonmail.com .

The "old work-horse" CHUCK MICHAELS fencepostcharlie@yahoo.com or 240-447-7248, works the Middle eastern US, PA, WV, DC, MD, VA and DE.

PATRICK RAYBURN (SW TM) ducks2003@suddenlink.net or 817-559-7878, continues to ride with distributor reps.

All our sales are guided by the capable JACK WHITE jag6410@aol.com or call 866-3376 or 866-DERMAPET.

For the TM nearest you please email, look at our web site or call us.

Specials

3rd Quarter 2007 -Buy any 3 cases of our popular Otics and receive a FREE case of either TrizUltra or MalAKet.

3Q Specials Link

Call your DermaPet Distributor or 800 755 4738 for ordering information.

Technical Bulletins

TECHNICAL BULLETINS are at our web site.

Previously, we showed how our LIME PLUS Dip has 29% more lime sulfur than the new LymDip. The new LymDip is a much weaker formula that has not survived the test of time (neither for efficacy or stability). Despite their citing literature, there is not one refereed publication supporting the use of this substantially diluted product. There also is reason to believe that fragrances used in this product (the addition of which required the dilution from a 97.8% like LimePlus to 76.9% in LymDip) will cause contact irritation/dermatitis.

The LimePlus Dip formula, like all DermaPet products, offers the desired ingredient, undiluted lime sulfur, packaged at an FDA inspected facility under strict cGMP regulations.

Since Lime Plus Dip contains 98% lime sulfur and the "new" LymDip only 76.9%, several questions beg asking:

1) What exactly has been substituted for the effective ingredient?
2) Could the missing 21% be fragrance or alcohol or some unknown heretofore non-functional (except for marketing) excipient?
3) What function could these substitute ingredients possess?
4) Will testimonials of efficacy from "allied experts" convince vets that DECADES of previously refereed papers were wrong about the effective concentration?

Lou Gotthelf's Small Animal Ear Diseases

Lou Gotthelf's Small Animal Ear Diseases 2nd Ed is out. There is a chapter by YT as well as many others. At $64.95 this is a great deal considering all the color photos and the fact that ears represent up to 20% of your business.

MedRx is offering CE with EAR Seminars by LOU GOTTHELF. For more information call 888-392-1234

DermaPet Vision Statement
To be recognized as the leader in developing new and innovative, all natural yet highly effective products for the veterinary community.

DermaPet Mission Statement
To contribute to your growth and that of the veterinary industry by providing excellent, unique, innovative all natural yet highly effective products that embrace the pet, veterinarian, and client relationship.

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Steve Melman VMD
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Steven Melman VMD
DermaPet
Animal Dermatology and Behavior Clinics
Potomac, MD 20854

dermapet@aol.com
http://www.dermapet.com
800-755-4738
fax 301-365-0191

8909 Iverleigh Court Potomac, Maryland 20854
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