Ditch the itch: overcoming the barrier to skin health

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skin barrier dysfunction
Figure 1. The localisation of various protection functions in the stratum corneum.2

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In Australia, pruritis in dogs is the second most commonly presented complaint to small animal veterinarians. Understanding the roles of the canine skin barrier and how to support its functions is crucial to treat, manage and prevent common skin diseases in dogs seen in practice. 

The ins and outs of the skin barrier

The skin plays a major role in protecting and supporting the life it encloses.  

The permeability barrier, which controls the transcutaneous movement of water and other electrolytes, is arguably the most important of all the skin’s functions.2 This barrier resides in the stratum corneum (SC), the outermost layer of the skin, and is often referred to as the skin barrier.2 

The SC is a resilient layer composed of corneocytes and the inter-corneocyte lipids.2 The three major lipid classes in the SC are ceramides, fatty acids and cholesterol, of which, ceramides are the most important.2,3 

When defences are down: skin barrier dysfunction

Several skin diseases are known to show skin barrier dysfunction as a pathophysiologic factor leading to enhanced penetration of allergens, as is the case for canine atopic dermatitis (CAD).2,3

CAD is complex and the causes and factors involved in the pathogenesis are genetic, immunological and environmental.3 Increased trans epidermal water loss (TEWL) and significant decreases in SC ceramides are characteristic features seen in CAD.2   

CAD is a common chronic inflammatory skin disease affecting 10% of dogs worldwide, typically between 6 months and 3 years of age.3 CAD presents as pruritus with secondary skin lesions such as erythema, papules, excoriations, alopecia and superficial bacterial and/or yeast infections.4 

CAD is a multifactorial chronic disease and therefore requires a multimodal treatment approach to decrease pruritus and inflammation below the threshold of clinical signs. 

Barrier-supporting therapies for long term skin health

Replenishing intercellular lipids in the SC can help repair skin barrier dysfunction.2,3

Oral essential fatty acid supplementation has been reported to decrease inflammation and pruritus that is associated with canine atopy. One proposed mechanism of action is the incorporation of EFA’s into the skin barrier and therefore improvement in skin barrier function.5,6 These benefits have been related to supplementation with omega-6 fatty acids (GLA) in combination with omega-3 fatty acids (EPA and DHA).5 

Moisturisers containing physiologic lipids can improve skin hydration and reduce the risk of cracking of the skin in atopic patients.3 Studies involving dogs with atopic dermatitis show that daily use of a moisturiser containing ceramides improved skin hydration, pruritic scores and the atopy severity index in as little as two weeks.3 

Therefore, due to the ceramide deficiency in the SC of atopic dogs, regular and proper use of a moisturiser or leave-in conditioner containing ceramides is considered the most beneficial, useful and important step for managing CAD and promoting skin barrier repair long-term.3  

Combat antibiotic resistance with topical antimicrobials 

Up to 66% of atopic dogs show evidence of bacterial skin infections.7

The skin barrier is one of the first physical and chemical defenses against microbial infection.8 Due to alterations of the skin barrier and underlying disease, superficial bacterial infections (folliculitis) frequently recur and therefore repeated treatment is necessary.9

The emergence of multi-resistant bacteria highlights the importance of topical antimicrobial therapy over systemic use of antibiotics in appropriate cases. Shampoo therapy that contains an active antimicrobial ingredient such as piroctone olamine, is the best approach to treat superficial bacterial  infections of the skin to help combat antibiotic resistance.8,9,10

Taking a holistic approach to managing skin conditions you commonly see in practice by incorporating topical and oral integrative therapies, means you can help pruritic dogs ditch the itch! 


References

1. Wolf, S & Selinger, J & Ward, MP & Santos-Smith, P & Awad, M & Fawcett, Anne. (2020). Incidence of presenting complaints and diagnoses in insured Australian dogs. Australian Veterinary Journal. 98. 326-332. 10.1111/avj.12981.

2. Lee, Seung Hun et al. “An update of the defensive barrier function of skin.” Yonsei medical journal vol. 47,3 (2006): 293-306. doi:10.3349/ymj.2006.47.3.293

3. Jung, Ji-young et al. “Clinical use of a ceramide-based moisturizer for treating dogs with atopic dermatitis.” Journal of veterinary science vol. 14,2 (2013): 199-205. doi:10.4142/jvs.2013.14.2.199

4. Banovic, Frane. “Canine Atopic Dermatitis: Updates On Diagnosis And Treatment | Today’s Veterinary Practice”. Today’s Veterinary Practice, 2020, https://todaysveterinarypractice.com/continuing-educationdermatologycanine-atopic-dermatitis-updates-diagnosis-treatment/.

5. Mueller RS, Fieseler KV, Fettman MJ, et al. Effect of omega-3 fatty acids on canine atopic dermatitis. J Small Anim Pract. 2004;45(6):293-297. doi:10.1111/j.1748-5827.2004.tb00238.x

6. Forsythe, P. “Dermatological Disorders – WSAVA 2015 Congress – VIN”. Vin.Com, 2020, https://www.vin.com/apputil/content/defaultadv1.aspx?pId=14365&id=7259371&print=1.

7. Saridomichelakis MN, Olivry T. An update on the treatment of canine atopic dermatitis. Vet J. 2016;207:29-37. doi:10.1016/j.tvjl.2015.09.016

8. Fadock, Valerie. “Treating Resistant Skin Infections In Dogs | Today’s Veterinary Practice”. Today’s Veterinary Practice, 2020, https://todaysveterinarypractice.com/treating-resistant-skin-infections-in-dogs/.

9. Hillier, Andrew & Lloyd, David & Weese, J & Blondeau, Joseph & Boothe, Dawn & Breitschwerdt, Edward & Guardabassi, Luca & Papich, Mark & Rankin, Shelley & Turnidge, John & Sykes, Jane. (2014). Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Veterinary dermatology. 25. 10.1111/vde.12118.

10. Forsythe, P. “Dermatological Disorders – WSAVA 2015 Congress – VIN”. Vin.Com, 2020, https://www.vin.com/apputil/content/defaultadv1.aspx?pId=14365&id=7259371&print=1.

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