The Product
Pyoderma is a common secondary problem in pets affected by allergies and other dermatologic conditions. Many veterinarians choose systemic antibiotics to treat pyoderma, but this isn’t always the best choice with increasing antibiotic resistance.
BioHex™ Shampoo is an antiseptic, soap-free cleanser for dogs, cats and horses that provides broad-spectrum coverage for managing certain dermatological conditions. The proprietary formulation combines:
- MicroSilver BG™ — This special microparticle deposits on the skin surface, prolonging the antimicrobial effect. It can also disrupt biofilm when present.
- Chlorhexidine gluconate 2% — A topical antiseptic solution
- Miconazole — Miconazole has broad-spectrum antifungal activity and most importantly has a synergistic antimicrobial effect with chlorhexidine.
- Ceramide III — Ceramides moisturize the skin and replenish those lost by diseased skin.
Presentation and History
Rufus is an 11-month-old Newfoundland. On presentation to the dermatologist, he had a body condition score of 3/9; expanding alopecic areas; a dull, foul-smelling coat; pododermatitis in the interdigital spaces; hyperkeratotic and hyperpigmented areas; severe neck fold dermatitis and an unresponsive itch. Rufus was 3 months old the first time he exhibited dermatologic lesions. His owner contacted the breeder and was told to switch Rufus to a raw diet and to apply topical ointments and an antiseptic mouthwash for humans to the lesions. When these treatments didn’t suffice, Rufus’ owner sought help from four different veterinarians over several months. During this time, Rufus’ treatments included two courses of systemic antibiotics, itraconazole for an extended period, multiple doses of lokivetmab, a failed oclacitinib course and a low-dose prednisone trial that also failed. Topical therapy included baths with benzoyl peroxide shampoo.
Diagnostic Picture
After a careful and complete physical exam, cytology samples were taken from different lesions on the skin surface, and evidence of a secondary bacterial infection (pyoderma) was found. Rufus’ ears were examined using a video otoscope; extensive proliferative changes and abundant exudate were found. A cytology sample from the ear exudate revealed a yeast and bacterial infection involving cocci and Malassezia. Rufus was diagnosed with secondary pyoderma and otitis associated with allergic disease.
Treatment
Rufus’ owner is devoted to her dog, but she was also frustrated since the extensive treatments did not work previously. The dermatologist spent time discussing the treatment options to ensure Rufus’ owner was able and willing to commit to the plan, which included:
- Bathing with BioHex™ Shampoo — After shaving Rufus down (which was recommended due to the breed and size of the patient, but not necessary in every case), the veterinary team demonstrated proper bathing. They degreased his coat to remove the excess debris, thoroughly wetted him down to the skin, applied the shampoo to his skin and massaged the product on the entire skin surface, focusing on more affected areas. They left the product on for about 10 minutes and rinsed and dried him well. Daily bathing was recommended for the first few days, then reduced gradually to 48 hours and then every 72 hours.
- Prednisone — Rufus’ owner was reluctant to use oclacitinib, since the medication had previously been ineffective, so the dermatologist prescribed prednisone at 1 mg/kg SID.
- Ear cleaning — Ear cleaning is critical to success regardless of the product selected. In this case, after thorough cleaning with Otodine™, an otic suspension containing orbifloxacin, mometasone furoate and posaconazole was applied to both ears. The owner was instructed to perform daily cleaning and medication of both ears with these products.
- Diet changes — Since Rufus had a history of intermittent diarrhea and poor stool quality, the veterinarian recommended a food trial to diagnose a food allergy by switching to a hydrolyzed diet (Purina Pro Plan® Veterinary Diets HA).
- Flea prevention — Year-round flea prevention was prescribed to prevent ectoparasites that interfere with the diagnostic process.
Follow-up
At Rufus’ two-week recheck, he was significantly improved. The dermatologist started tapering him off the prednisone, cleaned his ears and administered a deposit ear treatment to allow the owner to stop daily ear cleaning. Additionally, the dermatologist recommended reducing bathing to twice weekly with BioHex™ Shampoo to reduce the workload and spot treatments of the neck folds and anal area with BioHex™ wipes or BioHex™ mousse. Rufus showed continued improvement at his four-week recheck; the dermatologist tapered down the prednisone treatment and started him on successful oclacitinib treatment at the recommended 0.6 mg/kg SID. By week six, no lesions were present, and oclacitinib was discontinued.
6 months after treatment with BioHex™ products
At week 8, a dietary challenge was performed, and intense itchiness caused skin lesions, so he was put back on the same hydrolyzed diet. The owner performed additional diet challenges that caused relapse until she decided to continue to feed Rufus his hydrolyzed diet, and after 24 months, he hasn’t relapsed.
Conclusion
BioHex™ Shampoo is an effective topical treatment for pyoderma in companion animals and horses. It helps prevent antimicrobial overuse, which can lead to antimicrobial-resistant pathogens.
The proprietary formula, which includes chlorhexidine, miconazole and MicroSilver BG™, provides enhanced antiseptic properties, and the inclusion of Ceramide III promotes healthy skin.