The latest in topical therapy

Sponsored by Nextmune

Adam Christman, DVM, MBA: Hey everyone, welcome to Product360. We want to thank our friends from Nextmune, because we're gonna be chatting all things topicals and ear related with the one and only board-certified veterinary dermatologist Doctor Valerie Fadok. Morning, my friend. Thanks for being here. 

Valerie Fadok, DVM, PH.D., DIP., ACVD: Thank you. 

Christman: This is a lot of fun, so you're gonna learn a lot today. So a little bit of information about wonderful colleague. Dr. Fadok is a graduate of Washington State University and the University of Colorado Health Sciences Center. She's worked in multiple academic settings as a clinician and researcher, as well as in private specialty practice. She recently retired from Zoetis as a field specialist and now provides case consultations for Zoetis diagnostics, the Veterinary Information Network, and Nextmune. And ohh me. Yes, I'm Adam Christman, chief veterinary officer here at DVM360. And we're gonna be chatting about some of the things that can actually be a struggle sometimes for pet owners. So let's talk about bathing for a moment, because I just know as a general practitioner we talk about spectrum of care a lot. And we say gosh, you able to do it? It could be challenging, right? 

Fadok: Absolutely, absolutely. And in this day and age, when we are dealing with resistant bugs, topical therapy becomes more important than ever.

Christman: And sometimes I feel like I don't know if you agree with me out there, but we sometimes forget as general practitioners to say, oh, shoot forgot about the topicals, right? It's a huge thing. But look at this wonderful portfolio that's out there and you know, frequency of bathing is equally important depending on the type of infection that might be present. And I tend to recommend, correct me if I'm wrong, but if we can get at least eight minutes of contact time, I figured that would be a home run. What are your thoughts on that?

Fadok: I think that's perfect, and it is so important that the materials in our products have time to sit on the skin and contact those pathogens. So, eight minutes is good. It's hard to do that, but it's a good time.

Christman: And sometimes you'll see things as like three times a week, which may not be very easy to accomplish, but that's why we're chatting about certain things that we have here as well as the mousses and shampoos and otics. So OK, let's get into it. We have a lot to cover. So let's go into the first one that we have here. This is the BioHex shampoo. Tell me a little bit more about this. 

Fadok: So, dermatologists and general practitioners have loved this shampoo, and I'm so glad it's back. This is the flagship of the VetBioTek line and it is ideal for infections. It contains chlorhexidine and miconazole. So, we can kill bacteria and yeast. And actually those two synergize together so they help to kill both organisms, but the real magic in this line comes from the microsilver. This is the only veterinary topical line that contains microsilver and microsilver is a wonderful antimicrobial agent. It's also a biofilm buster. So you think about those Westies with the real greasy exudate on their skin, that's biofilm. And these products will help bust through it.

Christman: Oh yes. Excellent. And there's also ceramide 3. 

Fadok: Yes. One of the things we know about dogs that have any kind of inflammation in their skin is that that skin barrier is broken and the skin barrier is the very surface of the skin. It's meant to keep out allergens. It's meant to keep out microbes, and it gets broken down, particularly in allergic dogs. But you know, whenever a dog gets an infection, that barrier is disrupted. Ceramide 3 is one of the many ceramides that's in normal skin actually, and by applying it to the skin, we can repair that barrier. And so to me, the magic of using these topicals is that we can prevent the infection from coming back in the long term.

Christman: Yeah. Yeah, it is the goal. And now in general, does this affect the microbiome at all then when we're chatting about this?

Fadok: That's a great question and we all know that our lives are run by our little microbial friends. So there have been studies to show that microsilver is really good at killing pathogens. But it tends to leave that resident microbiome alone, and so that allows them to emerge and do their job.

Christman: OK, so in this section here we have—I love a good mousse, by the way—so I'm sure some of you just love giving this out to your patients. So talk to me about using mousses. 

Fadok: I think a lot of dermatologists really love mousses. It allows us to provide the medicated product on the skin without necessarily having to bathe the dog. My favorite use of mousses is actually for cats because cats don't like baths. But you can massage this mousse into their skin and they think it's a spot treatment. I like the whole-body bath. I think that's really important, but a moose can be used in between on trouble spots. So, let's say feet that are infected with yeast or bacteria or facial folds. I used to put this in my Frenchies’ folds all the time.

Christman: And a big misconception I know that a lot of pet owners say is I need to use a lot of shampoo, and a dollop will do it. Just a little bit in the palm of your hand goes a long way.

Fadok: Yes, absolutely. You know, I wanted to say a couple more things about the microsilver, too. People worry sometimes about silver penetrating the body. This is a very large particle and it's porous, so it's got a huge surface area and that allows the silver to be generated slowly over time. It reduces the need for those super frequent bathings. So maybe a bath once a week will do the job of a product that doesn't have microsilver where they would need three times a week. The mousse can be used in between. You have the wipes there. Every bully breed should be born with a bucket of wipes. You know, it'll prevent those dogs from getting pain in their facial folds. It'll clear out the infection, and the ceramides will help to repair the barrier in that fold. And so, it's really exciting. 

Christman: Right. Yeah. Excellent. I love that. OK, let's kind of travel down over here if you will. We have the BioSeb shampoo. 

Fadok: The BioSeb shampoo also has microsilver. It has about half the percentage that our cadillac shampoo has, but this would be for those dogs with seborrhea. Maybe they don't have active infection. It contains ethyl lactate and salicylic acid. We know that those are really good to help normalize the skin turnover. It has the microsilver to help inhibit infection from developing and it has the ceramide 3 to repair the barrier. So maybe your greasy Cocker spaniels, they might not be infected, but they would really benefit and dry scaly dogs too. 

Christman: That's a good thing, because you hear that a lot from pet owners. And again, we have also the mousse that's available. And then we also have it in two different sizes. I always have to recommend shake well before you use. Over here we have the aloe oatmeal shampoo. Oh, this is a good one. 

Fadok: Yes, this is a good one. So, this product does not contain the microsilver. This would be a great product for those pets that might have sensitive skin, you know, sometimes get a little irritated. It'll make the skin and the coat look really well, and it has the ceramides in it. 

Christman: OK, again a big thing out there for pet owners to understand is use the medicated shampoo first and then follow through with the oatmeal. And over here we have BioCalm.

Fadok: This product is well beloved by a lot of dermatologists. It is meant to soothe irritated skin, so this is great for dogs with atopic dermatitis when they're just kind of hot and red and itchy, but they're not infected. It's got pramoxine in it, which is a topical anesthetic, but it also has the microsilver and the ceramides. One of the things that that I used to do in my practice is treat active infections with the BioHex and then maybe follow up with BioCalm. Again, we were talking about frequency of bathing. I think once we clear active infection, people could consider an all over body bath, maybe even once a month and use the mousse or the spray in between if they need to. 

Christman: That’s a great point because we have so many atopic dogs that are out there and they have these flare ups and this could be on the weekend, maybe they run out of potential medications that they might need to settle down the itch. But you have something like this on board and it really helps calm them down, right?

Fadok: Yes, in fact, I always like my clients who have dogs that get hotspots to have the spray, especially at home. If they start to see the dog chew at a particular place, you know a hot spot is coming. If they wait until the office is open to get in, it's going to be bad. If they could start spraying that right as soon as they see the dogs start to chew, we can inhibit the development of those hotspots, so I used to love using that for that reason. 

Christman: Oh, nice. This has 2.4%. lidocaine in there. A fun fact for these sprays as some dogs just do not like to have a spray on them, so I'll tell pet owners to either use like a napkin or paper towel to spray first and then apply.

Fadok: Yeah, I like that, especially around their face and feet. Having a spray is not popular. 

Christman: So, we're going to travel over here and we now have the HexaDerm Max shampoo. 

Fadok: So this product, it contains again half the percentage of silver as the BioHex, but a lot of people like a 4% chlorhexidine shampoo. It’s effective against pyoderma. That percentage of chlorhexidine will actually kill malassezia yeast too. For folks who like, you know, just a bit higher, it's a great product. 

Christman: It's nice that you get more bang for your buck with the chlorhexidine percentage in there, and then it comes in two different sizes for the shampoos. And then we have a spray. So, we covered a lot of the topicals which are so important, but we can't forget about the ears, and we have a boatload of great products over here. So, let's get into it. We got VetOtic.

Fadok: VetOtic is a product that is acidifying. And so, for those dogs, let's say, who get recurrent yeast infections in their ears, they can use this flush and inhibit the regrowth of the yeast. It lowers the pH and that can be effective against the yeast. 

Christman: It has salicylic acid and lactic acid over in there too. We’ll have some pet owners that will get some things that they just should not be putting in the ears, but they don't realize how costly that could be to the ear canal itself.

Fadok: Yes, one of my favorite labrador patients, his owner, unbeknownst to me, was cleaning his ears with straight up alcohol, which is so painful. He was trying to do the right thing. So, it's a matter of having products that you can recommend that are safe and effective. 

Christman: And you know what I love about ear cleaners? A little bit goes a long way. This lasts so long. Even for your clinic or hospital. You got two different sizes that I see here and then we have this one here which is milytic otic.

Fadok: It is meant to help dewax ears. I think this could be a great Cocker Spaniel ear cleaner. We were talking about how hard it is to spray. Sometimes when you come at your patient or pet with a bottle of flush, they run. So, something that makes it easy is put it on a cotton ball and put that cotton ball in the outer ear canal and just gently massage. It gets the liquid down there and then they can shake, and they don't feel that fleshy sensation.

Christman: Right. Yeah, that's true. They do see the nozzle and go running away. Okay, we also have BioTris. Good one. What's in this one? 

Fadok: We know Tris EDTA is an excellent key layer and it helps other products when they contain an antibiotic work better. And so, this does have miconazole in it. This might be something if you can't keep the yeast under control with the acidifying wash, people could consider using this as a maintenance therapy maybe twice a week. 

Christman: Yeah. Excellent. These are great ear products here. I was looking at the ingredients. I don't see any microsilver in there, right? 

Fadok: No microsilver yet, but it's possible to be in in the future. You know, whenever you compound liquid things or shampoos, you have to look at how all the chemicals play with each other. In the future, that's going to be huge.

Christman: Wow, that will be huge. So microsilver does play a huge role in the skin barrier it sounds like?

Fadok: Well, the nice thing about microsilver is when it is in a product like this, it sticks to the skin and coat. And it is able to release silver ions overtime. So silver ions have been detected on the skin for up to four days after one application. And that's very different from our other ingredients, which we tend to rinse off. So, the safety profile is excellent because the particles are so large. They're 10 microns and so nothing gets absorbed into the skin and avoids some of the toxicity problems that colloidal silver and nanosilver have had in the past.

Christman: I understand microsilver can kill pathogens in three ways. Right?

Fadok: This is why it's going to be extraordinarily difficult for these microbes to become resistant. First, it's going to disrupt the cell wall. And when we disrupt the cell wall, the bacteria kind of blows up, but it also affects the DNA in a way that prevents the bacteria from being able to replicate. It also has some inhibitory effects on some of the intracellular enzymes. So, it's kind of this mega potent but incredibly safe way to kill microbes. 

Christman: Wow, that's impressive. It really is. 

Fadok: Yeah, the technology is amazing. 

Christman: In veterinary medicine, like many of you out there, we want to match the bug to the drug and use our antimicrobial stewardship. And this is an excellent way of doing so. 

Fadok: Yes. I think so. You know, I don't have a published data on this, but I was always impressed in practice. Particularly with the resistant bugs, we often have to choose toxic antibiotics, and I could get away with a shorter course of antibiotics if people could commit to bathing. And, you know mousses and sprays, whatever can get the job done for them. 

Christman: Yeah. I also understand with microsilver too, it's been shown effective against resistant pathogens for MERSA.

Fadok: Yes, MERSA, the veterinary methicillin resistant staph, malassezia, pseudomonas. So, you know when microsilver goes into ear products, it's going to be awesome and a whole slew of human pathogens, many of which cause death in people because of their resistance. 

Christman: Wow, excellent information here my friend. So hopefully we learned quite a bit about this fantastic portfolio that's here courtesy of Nextmune. And Dr. Valerie Fadok, thank you so much for being here too.

Fadok: Such a pleasure. You're my hero. 

Christman: Thank you for the great work you do in our profession. Thank you for joining us on Product360 and we'll see you next time right here DVM360. Take care everybody.