By Dr. Cliff Faver
Often in medicine and critical thinking, we follow a line of theory and we enhance and expand on that idea. But what if we took the wrong pathway to begin with?
kin problems in animals would be a good example. We find that so many of these skin issues in our pets stem from the breakdown of the skin barrier. This often leads to an inflammatory response followed by secondary infections. The inflammatory response causes the pet to scratch or rub, which drives the owner to seek out relief for their four–legged friend from their veterinarian. The veterinarian will reach for drugs like Apoquel, which blocks the allergen from creating the increased irritation, or Cytopoint, which blocks the channel that allows the irritant into the body. Although both drugs are very effective, both are defensive drugs to stop the process once the irritant has already passed through the body’s protective barrier (sebum or mantle).
Typically, by the time the veterinarian assesses the pet, they have been rigorously scratching or rubbing and have already broken down this barrier, which has allowed bacteria and fungus into the deeper levels, leading to an infection. At this point, most vets will prescribe Apoquel or a steroid, an antibiotic (usually without a culture) and some type of antibacterial/antifungal shampoo (2%–4% of chlorhexidine is most common).
The goal or theory of the whole treatment is to settle the inflammation and to dilute the bacteria and fungus to a point that the body can now repair itself and return to a normal state. The problem with the antibiotic part of the theory is that the fungus and bacteria are in competition. In fact, most antibiotics are based on natural products synthesized by fungus to give them the upper hand in the competition. So, by killing or suppressing the bacteria, we give the fungus a chance to thrive (antibiotics and yeast infections syndrome).
By nature, chlorhexidine is drying, which works well to weaken the bacteria and fungus, but it leaves the skin compromised and vulnerable. The recommended frequency of baths are three times weekly to daily for a minimum of ten minutes of contact time. The regularity of the baths, although very effective for diluting the infection load, creates a progressive drying of the tissue. In mild cases, this approach can be successful and resolve the problem, but for many cases, it exacerbates and escalates the problem.
During follow–up visits to the veterinarian, they will frequently increase anti–inflammatories, change the antibiotics, and change or increase the frequency of the chlorhexidine baths without ever taking a culture or addressing the yeast issue. The results from all of this? Commonly, we see chronic yeast infections, elephant skin and drug–resistant infections, often leading to lifetime treatments.
To circle back to the beginning, we discussed the fact that a majority of these problems began with a compromised sebum or mantle (dry skin). We need to rethink this issue, and instead of playing defense, let’s work on being proactive—because not one of the veterinary recommended treatments from above is designed to replace or repair the sebum/mantle.
First and foremost, the best way to solve the problem is prevention. Studies in humans show that maintaining a healthy sebum layer can lessen or prevent many of the signs of atopic dermatitis (allergies). By using high–quality conditioners that hydrate the skin versus just creating a barrier (emollients), we can preserve the hydration and health of the skin (often in 1–3 baths).
Good nutrition also plays a factor but takes a lot longer to be effective (often 4–6 months). So, by keeping pets on quality diets and increasing frequency and quality of hydration, especially if we are aware that a pet has seasonal issues, so many of these issues can be avoided.
Once a pet is in this cycle, instead of implementing things that add to the scenario, we should be focusing on returning the skin back to its normal state. First, “the solution to pollution is dilution”, so we need to increase our frequency of bathing to dilute the infection burden, making it easier to deal with. Second, we should be using products designed to be antibacterial and antifungal, but not harsh. Chlorhexidine, bleach, alcohol, vinegar and iodine are great at killing or slowing growth of bacteria and fungus in a petri dish, but are not skin friendly. Products consisting of sulfur (anti–fungal, anti–parasitic) and honey (antibacterial) in mild shampoos, followed by a hydrating conditioner, are often very effective as antimicrobials and work even better when a condition–shampoo–condition technique is used.
The most important part is re–establishing normal skin, so conditioning is critical in resolving these cases. Often, we get excited that our pets are getting significantly better by bathing them three times per week. The true test is when we stop the protocol.
As veterinarians, we often have accepted recurrence as normal. So, the questions should be, “Did we really ‘fix it’ if it reoccurs?” For fungal infections, typically we need to be thinking in the line of weekly baths for a minimum of 6–8 weeks versus 1–2 weeks for success with any treatment we use.
Therefore, we need to rethink our approach! To “fix it” means we returned it to normal, not just “diluted” the problem for the short term. As groomers, if we do this correctly, we should be able to prevent many, if not most of these issues from ever reoccurring. Which, in turn, saves the pets from suffering and our clients thousands of dollars.
This requires us to be knowledgeable about the science, techniques and the products, with the focus being on the pet and solving its issues without getting lost in standard protocols, products and techniques which continue to produce poor or inconsistent results. ✂️
Dr. Cliff Faver graduated with a BS in Biology/BA in Chemistry before getting a Veterinary degree in 1987. He is the past owner of Animal Health Services in Cave Creek, Arizona and now the US distributor for Iv San Bernard products, teaches the ISB Pet Aesthetician Certification program, and speaks internationally on hair and skin. His passion is to merge groomers and veterinarians to aid in helping and healing pets. He is also a member of AVMA, AAHA, AZVMA, Board member with Burbank Kennel Club, and has served on Novartis Lead Committee, Hill’s International Global Veterinary Board, and a Veterinary Management Group.