Clinical Management of Generalised Pyodemodicosis with Warts

Compendium of clinical cases 2023-24

PM 06 Clinical Management of Generalised Pyodemodicosis with Warts

Deepak Sharma, Jitendra Singh Gandhar and Harsh Vashishth

Department of Veterinary Medicine, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Evam Go Anusandhan Sansthan, Mathura (DUVASU)

Abstract

Pyodemodicosis was diagnosed in 3 year old Pomeranian dog based on clinical signs like alopecia, severe erythematous lesions, scaling all over body including on face, periorbital area and forelimbs as well as laboratory diagnosis of skin scraping and superglue slide impression test. Warts were also present around neck and near hind leg. Deworming was not done from last 1 year. Dog was treated by combination of allopathic (Simparica Trio containing sarolaner, moxidectin and pyrantel. Omega 3,6,9 supplement, hydroxyzine hydrochloride, cephalexin), homeopathic (Thuja 200, Drops Dermisule) and ayurvedic medicines (Mahamanjisthadi Karha", Gandhak Rasayan*). Skin scraping using superglue slide impression method was done at 20-day interval. Dog recovered completely after 2 months with complete absence of mites. There was great improvement in hair regrowth, smooth body coat and overall health.

Keywords: Demodicosis: Ethnoveterinary medicine, Warts, Sarolaner: Cephalexin

Introduction

Canine demodicosis is very commonly found skin disease in veterinary practice and is caused by a mite Demodex. It is common, non-contagious, inflammatory parasitic dermatosis caused by overpopulation of host specific follicular mites of various demodex species. In dogs two demodex species occur, the shorter D. canis and the longer D. injai. Demodex is normally present in skin but over proliferation of mite occur when there is immune alteration (Horne, 2010). Young dogs have a genetic basis for demodicosis. There are two forms of demodicosis -Localized and Generalized. Dogs with generalized demodicosis and their parents should not be bred.

History and Clinical Signs

A three year old female Pomeranian weighing 10.5 kg was presented with history of alopecia, erythematous lesion and itching mainly on periorbital area, face, forelimbs, hindlimbs and inner aspect of thigh and inguinal region. Dog was treated with antibiotics and some other

 Compendium of clinical cases 2023-24

medicines for many months. There was no clear history of medicines used. Warts were also present near neck and near hind leg. Owner was believing that her dog condition cannot be treated as she had approached many doctors. Alopecia was very severe and almost no hairs were present beyond neck region. All clinical pararneters temperature -102.1°F, respiratory rate-29/minute, pink mucus membrane, pulse rate-84/ minute were within normal range

Diagnosis

Skin scrapping was done by Superglue Slide Impression (SSI) method which is unique. Traditional methods like deep skin scrapping, acetate tape method, hair pluck method can also be used. SSI method revealed Demodex canis mites. We require very basic things for this test like fevikwik, slide, immersion oil and microscope. The selected areas were squeezed and add 1 drop superglue (fevikwik) on slide. The slide was pressed on selected area for 30 second and then removed. A lot of hair follicles attached with the slide. Immersion oil was poured on hairs and placed a cover slide. The slide was observed under 10x. We have recorded good number of demodex mites in this case. Diagnosis was based on clinical signs and laboratory finding.

Treatment and Discussion

Dog was treated by unique combination of allopathic, homeopathic and ayurvedic medicines as case was very severe and chronic and owner was unoptimistic about improvement in her dog condition.

In allopathic medicines sarolaner (2-4 mg/kg), moxidectin and pyrantel combination (Simparica trio) every 35 days for 70 days, Omega 3,6,9 fatty acid (Canishine)@ 5ml twice daily, Cephalexin @20 mg/kg (Lixen palatable) and hydroxyzine hydrochloride (Atarax) @ 1 mg/kg twice daily were prescribed for treatment.

In homeopathic medicines combination of sulphur 200, graphites 200, psorinum 200 and thuja 30 (Dermisule)@15 drops thrice daily were used for mange. Thuja 200 @10 drops twice daily was used for warts.

In ayurvedic medicines Mahamanjisthadi Kadha@ 5ml twice daily and Gandhak Rasayan @ 1 tablet twice daily were prescribed to the patient.

Skin scrapping using superglue slide impression method was done at 20 days intervals. Recovery of pup was characterized by complete absence of mites on 60th day post treatment. Clinically tremendous improvement was noted from 10th day and erythematous lesions and

 Compendium of clinical cases 2023-24

pustules started to regress after 15 days of treatment. Alopecia almost recovered after 50 days

of treatment. Finally, dog recovered completely after 2 and half month.

In this case we did not use traditional approach of using ivermectin, amitraz as if they are not used in correct dose it may lead to their toxicosis. Traditional use of ivermectin showed complete recovery of 12 dogs from generalized demodicosis when given at 0.4 mg/kg orally (Medleau et al., 1996). Ivermectin @ 400microgram/kg subcut every 7 days also cured demodicosis (Scott and Walton 1985). Amitraz is first effective topical treatment for demodicosis. Topical application of 3ml amitraz 12.5% in 1 litre of water every week for minimum 12 week also showed good result in demodicosis. But there is always risk of their toxicity. Sarolaner or fluralaner had the highest efficacy rate of 99.8 percent mite reduction on 28/29 day (Six et al., 2016). If based solely on efficacy sarolaner or fluralaner would be the preferred choice for treatment of demodicosis.

Acute ivermectin toxicity has been seen in collie and herding breeds prone to MDR-1 mutation even at low doses with severe neurological Sid effects like seizures, tremors, coma, lethargy and tremors. The mutation results in abnormal P glycoprotein transcription which allows ivermectin to penetrate central nervous system and cause neurotoxicity (Mealy et al., 2001). However, evidence shows that dogs who do not possess mutation are still susceptible to ivermectin toxicity (Bissonnette et al., 2009).

Use of isoxazoline class drugs (sarolaner, fluralaner, afoxolaner is highly efficacious and safest approach to treat demodicosis. Fluralaner works for 3 month, sarolaner works for 35 days and afoxolaner works for 30 days.

Before treatment of demodicosis, if pyoderma is present, we should treat it first with help of antibiotics like cefpodoxime@5-10 mg/kg q 12-24-hour, cephalexin@15-30 mg/kg. enrofloxacin@5-10 mg/kg. The antihistamine drugs like hydroxyzine@0.5-2 mg/kg (atarax), fexofenadine@2-5 mg/kg or cetirizine @Img/kg can be used to control pruritus.

 Compendium of clinical cases 2023-24

Homeopathic medicines like graphitis 200 works great in treating demodicosis (Rajan et al., 2014). Few reports published in past also reported good efficacy of homeopathic drugs in treatment of canine atopic dermatitis (Schnabl et al., 2006, Scott et al. 2002). Drops Dermisule (Goel vet pharma) containing graphitis, sulphur, psorinum have provided excellent

 

 

Fig.1 A. Demodex canis mites under microscopy, B. Cigar shaped mite with four pairs of stumpy legs, C. Alopecia and erythema on face before treatment, D. Recovery after treatment with full grown hairs.

results in all skin related issues Graphites were used to treat hypertrophic burn scars successfully in humans and canine demodicosis (Rajan et al. 2014). Combination of Sulfur, Psorinum, and Graphites with other homeopathic drugs was used in dogs for treating various skin conditions such as seborrhea, pruritus, allergic dermatitis, and Hot Dog Syndrome (Scott et al, 2002). Sulfur, Psorinum, and Graphite in combination are used to treat canine mange (Singh et al., 2011). Ayurvedic medicines like Mahamanjisthadi kadha containing neem, anant mool etc. purifies blood and hence provides excellent result in redness, itching, allergy and infection. Personally, we have used combination of homeopathic and ayurvedic medicines with routine medicines in skin cases and have found miraculous result.

 Compendium of clinical cases 2023-24

Conclusion

As this disease is common in dogs, treatment is more challenging when there is generalized condition. Complete cure was possible through owner compliance and regular follow up. From present case it was found that simultaneous use of sarolaner@2-4 mg/kg containing product along with antihistamines, antibiotic and combination of homeopathic drops containing graphites, psorinum, sulphur and ayurvedic medicines containing neem and anant mool resulted in complete recovery of dog after 2 and half month. This was a miracle for owner. There was complete turnover in her appearance.

References

Bissonnette, S., Paradis, M., Daneau, L. and Silversides, D. W., 2009. The ABCBI-1A mutation is not responsible for subchronic neurotoxicity seen in dogs of non-collie breeds following macrocyclic lactone treatment for generalized demodicosis. Veterinary Dermatology. 20(1): 60-66,

Horne, K., 2019. Canine demodicosis. Small Animal Dermatology for Technicians and Nurses, pp.147-157.

Mealey, K.L., Bentjen, S.A., Gay, J.M. and Cantor, G.H., 2001. Ivermectin sensitivity in collies is associated with a deletion mutation of the mdr! gene. Pharmacogenetics and Genomics, 11(8): 727-733.

Medleau, L., Ristic, 2. and McElveen, D.R., 1996. Daily ivermectin for treatment of generalized demodicosis in dogs. Veterinary Dermatology. 7(4): 209-212.

Ranjan, R., Dua, K., Turkar, S., Singh, H. and Singla, L.D., 2014. Successful management of refractory cases of canine demodicosis with homeopathy medicine Graphitis. Journal of parasitic diseases. 38: 417-419.

Schnabl, B., Bettenay, S.V., Dow, K. and Mueller, R.S., 2006. Results of allergen-specific immunotherapy in 117 dogs with atopic dermatitis. Veterinary Record. 158(3): 81-85.

Scott, D.W., Miller Jr, W.H., Senter, D.A., Cook, C.P., Kirker, J.E. and Cobb, S.M., 2002. Treatment of canine atopic dermatitis with a commercial homeopathic remedy: a single-blinded, placebo-controlled study. The Canadian Veterinary Journal. 43(8): 601.

Scott, D.W, and Walton, D.K., 1985. Experiences with the use of amitraz and ivermectin for the treatment of generalized demodicosis. J. Am. Anim. Hosp. Assoc. 21: 535-41.

 Compendium of clinical cases 2023-24

Singh, S.K., Kumar, M., Jadhav, R.K. and Saxena, S.K., 2011. An update on therapeutic management of canine demodicosis. Veterinary World. 4(1): 41.

Six. R.H., Becskei, C., Mazaleski, M.M., Fourie, J.J., Mahabir, S.P., Myers, M.R. and Slootmans, N., 2016. Efficacy of sarolaner, a novel oral isoxazoline, against two common mite infestations in dogs: Demodex spp. and Otodectes cynotis. Veterinary Parasitology. 222:62-66.