Superficial Mycoses

2 in Dogs and Cats

ESCCAP Guideline 02 Fourth Edition – February 2019

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 ESCCAP
Malvern Hills Science Park, Geraldine Road, Malvern,
Worcestershire, WR14 3SZ, United Kingdom

First Edition Published by ESCCAP in March 2008

© ESCCAP 2008–2019

All rights reserved

This publication is made available subject to the condition that any redistribution or
reproduction of part or all of the contents in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise is with the prior written
permission of ESCCAP.

This publication may only be distributed in the covers in which it is first published
unless with the prior written permission of ESCCAP.

A catalogue record for this publication is available from the British Library.

ISBN: 978-1-907259-73-9

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TABLE OF CONTENTS

INTRODUCTION 5

1. CONSIDERATION OF PET HEALTH AND LIFESTYLE FACTORS 6

2. CONTROL OF DERMATOPHYTOSIS IN DOGS AND CATS 8

2.1. Diagnosis 8

2.2. Treatment Procedures 10

2.3. Prevention 11

3. ENVIRONMENTAL CONTROL OF DERMATOPHYTE TRANSMISSION 12

4. CONTROL OF MALASSEZIA DERMATITIS IN DOGS AND CATS 12

4.1 Diagnosis 12

4.2. Treatment Procedures 13

5. OWNER CONSIDERATIONS IN PREVENTING ZOONOTIC DISEASES 14

6. STAFF, PET OWNER AND COMMUNITY EDUCATION 14

APPENDIX 1 – BACKGROUND 17

Superficial Mycoses
2 in Dogs and Cats
ESCCAP Guideline 02 Fourth Edition – February 2019

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 TABLES

Table 1: Characteristics of major dermatophyte species infecting dogs and cats in Europe 14

Table 2: Characteristics of Malassezia species recovered from the skin of animals 15

Table 3: Systemic antifungal drugs for the treatment of dermatophytoses in dogs and cats 15

Table 4: Topical antifungal drugs for the treatment of superficial mycoses in dogs and cats 16

FIGURES

Figure 1: Typical circular scaly lesion in a dog infected by Microsporum canis 8

Figure 2: Facial lesions in a dog infected by Microsporum (Nannizzia) persicolor 8

Figure 3: Dermatophytosis around a cat’s claw 8

Figure 4: Facial lesions in a cat infected by Microsporum canis 8

Figure 5: Positive Wood’s lamp examination 9

Figure 6: Infected cat hair 9

Figure 7: Developing colonies of Microsporum canis 9

Figure 8: Spindle-shaped Microsporum canis macroconidia 9

Figure 9: Malassezia dermatitis in a dog 12

Figure 10: Malassezia dermatitis in a cat 12

Figure 11: Malassezia yeast colonies 13

IMAGE ACKNOWLEDGEMENTS

ESCCAP would like to thank the following for permitting their images to be reproduced within this guideline:

„„ L’Ecole Nationale Vétérinaire d’Alfort (ENVA).

„„ Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University.

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INTRODUCTION

Dermatophytosis, and Malassezia otitis and dermatitis, represent the superficial mycoses of greatest
significance in companion animals. Although the dermatophytes and yeasts belonging to the genus
Malassezia1 both develop in the stratum corneum of mammalian skin, there are important differences in the
epidemiology, pathogenesis and clinical consequences of infection.

Dermatophytes are significant due to their zoonotic potential and the concern of owners of pets with sometimes
severe inflammatory skin disease. They encompass ecologically and phylogenetically related filamentous
fungi belonging to the family Arthrodermataceae which are able to use keratin as a sole nutrient source. Some
of these organisms are parasites; they develop in skin and hair and cause cutaneous lesions. The disease is
called dermatophytosis or “ringworm” and is recognised as one of the most common infectious dermatoses
in pets. More than 20 different dermatophyte species have been isolated from dogs and cats. The most
commonly isolated pathogens are Microsporum canis (especially in cats), Trichophyton mentagrophytes,
Microsporum gypseum and Microsporum (Nannizzia) persicolor (Table 1).

Malassezia yeasts are normal commensals and occasional pathogens of the skin for many warm-blooded
animal species. The non-lipid-dependent species M. pachydermatis is a very common cause of otitis externa
and pruritic dermatitis in dogs, either primary or secondary to an underlying disease. The same species is
regularly recovered from the skin of cats along with other Malassezia species (Table 2).

This guideline aims to give an overview of dermatophytes and yeasts belonging to the genus Malassezia, their
significance and, importantly, suggests rational control measures to treat pet carnivores and prevent animal
and/or human infection.

The guideline is divided into six sections:

1. Consideration of pet health and lifestyle factors

2. Control of dermatophytosis in dogs and cats
3. Environmental control of dermatophyte transmission
4. Control of Malassezia dermatitis in dogs and cats
5. Owner considerations in preventing zoonotic disease
6. Staff, pet owner and community education

1
The name Malassezia is used to designate all the yeasts of the genus.

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 1: CONSIDERATION OF PET HEALTH AND LIFESTYLE FACTORS

The occurrence of dermatophytosis or Malassezia dermatitis is influenced by a vast number of factors relating
to the animals themselves and environmental issues including overcrowding. Some factors may dictate more
intensive monitoring and/or treatment, while others may suggest a less aggressive approach.

When recommending a management programme for dermatophytosis, veterinarians should consider the
following:

„„ Kittens, puppies and aged animals are at greater risk than other animals. Pregnant or lactating bitches and
queens are frequently infected by dermatophytes without symptoms and may transmit the infection to the
offspring. The number of antifungal drugs that can be used safely in pregnant animals is limited.

„„ All breeds of dog and cat are susceptible to the infection. However, Dalmatians, poodles, Jack Russell terriers,
Manchester terriers and Yorkshire terriers may be at an increased risk for generalised dermatophytosis.
Persian and other long-haired cats also have a predisposition to dermatophytosis. In fact, no racial factors
have been evidenced at present but contamination is more frequent in long-haired cats.

„„ Familial predisposition has been suggested in cats.

„„ Any debilitating disease may play a role by making dogs and cats more susceptible to dermatophyte
infection. This kind of disease should be systematically identified and, if possible, treated before
commencing specific antifungal treatment. In cats, an association between retrovirus infection (feline
immunodeficiency virus (FIV) or feline leukaemia virus (FeLV)) and dermatophytosis has been suggested.

„„ Ectoparasites (such as fleas, ticks or mites of the genus Cheyletiella) or pruritus (associated with
secondary infections) may be sources of cutaneous microtrauma that can predispose dogs and cats to
dermatophytosis.

„„ Increased temperature, humidity and behavioural changes due to stress are predisposing factors for
dermatophytosis.

„„ Cats living in catteries or shelters, stray or feral cats and cats living with other cats or dogs may be at
greater risk of acquiring dermatophytes and may require special consideration.

„„ Dogs in kennels, living outdoors, stray dogs and hunting dogs may be at greater risk of acquiring
dermatophytes and may require special consideration.

„„ Cats and dogs which regularly attend shows or field trials may be easily contaminated.

„„ Too frequent washing and/or the use of harsh soaps can predispose to dermatophytosis.

„„ Common dermatophyte species (Microsporum canis, Trichophyton mentagrophytes, M. gypseum and

M. persicolor) have a very wide distribution in all European countries. Dermatophytosis is probably
more prevalent in least developed countries or in areas in which there are large populations of free-
roaming dogs and cats.

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When recommending a management programme for Malassezia dermatitis and/or otitis externa, veterinarians
should consider the following elements:

„„ All breeds of dogs and cats are susceptible to Malassezia dermatitis. However, several investigations
indicated that some breeds are predisposed to the development of abnormally high numbers of Malassezia
yeasts. In dogs, this includes basset hounds, dachshunds, cocker spaniels, Shar Pei, poodles, bulldogs
and West Highland white terriers. In cats, Devon Rex, peterbald and Sphynx are more frequently colonised
by Malassezia yeasts.

„„ Atopic dermatitis is the most frequently diagnosed concurrent disease in dogs with Malassezia dermatitis.
However, it seems important to appreciate that not all dogs with atopic dermatitis have Malassezia
dermatitis, and that Malassezia dermatitis occurs in association with disorders other than atopic dermatitis.

„„ Ectoparasites (such as ear mites or fleas) or pruritus associated with secondary infection may lead to
Malassezia overgrowth. Malassezia yeasts are sometimes isolated from cats with head and neck pruritus
syndrome.

„„ Any debilitating disease may play a role in making dogs and cats more susceptible to Malassezia dermatitis.
In cats, the isolation of Malassezia has been associated with retrovirus infections, paraneoplastic
syndromes, thymoma, and diabetes mellitus. Based on these findings, Malassezia overgrowth may be
considered as a marker of (sometimes life-threatening) underlying diseases in some cats.

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 2: CONTROL OF DERMATOPHYTOSIS IN DOGS AND CATS

2.1. Diagnosis

Dermatophytes invade hair shafts and cornified epithelium. Consequently, dermatophytosis

usually presents as patchy areas of alopecia on the face, ears or forelegs (Figures 1 to 4).
The condition is typically considered non-pruritic but some animals (especially adult cats) may be moderately
to intensely pruritic. Uncommon clinical manifestations include folliculitis, feline miliary dermatitis, feline acne,
pemphigus-like syndromes and pseudomycetoma.

Dermatophytosis should be considered in the differential diagnosis of many skin diseases and diagnostic aids
are required.

Figure 1: Typical circular scaly lesion in a dog infected by Figure 2: Facial lesions in a dog infected by
Microsporum canis Microsporum (Nannizzia) persicolor

Figure 4: Facial lesions in a cat infected by

Figure 3: Dermatophytosis around a cat’s claw Microsporum canis

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Examination of the haircoat with an ultraviolet lamp
(Wood’s lamp) is a good screening method for
dermatophytosis in dogs and cats. When exposed
to the light, hairs invaded by some dermatophyte
species, including M. canis, glow yellow–green
(Figure 5). Hairs infected by other dermatophyte
species never fluoresce and some topical medications
may mask fluorescence. Thus, negative results
following Wood’s lamp examination do not rule out
dermatophytosis. The observation of fluorescence
should be confirmed by microscopic examination of
hairs (even though the recognition of infected hairs
is not always easy and may require an experienced
eye). Hairs should be collected through skin scrapings Figure 5: Positive Wood’s lamp examination
(from the edge of an alopecic area or fluorescent area
during Wood’s lamp examination). After digestion
with a clearing solution (such as potassium hydroxide
or chlorolactophenol), infected hairs present as
enlarged and swollen structures with a rough and
irregular surface (Figure 6). The hair surface typically
demonstrates clusters or chains of fungal spores (2–4
µm for M. canis).

Mycological culture remains the most reliable

technique for confirming dermatophytosis in dogs
and cats. Sample collection may be obtained
through skin scrapings, plucking hairs (under
Wood’s lamp) or brushing the haircoat with a sterile
toothbrush, a little piece of sterile carpet or a dust- Figure 6: Infected cat hair
catching cloth. Several media (like Sabouraud
dextrose agar) are suitable for mycological cultures.
Colonies of dermatophyte species such as M. canis
may develop in a few days (Figure 7). Dermatophyte
test media (DTM) are regularly used in veterinary
medicine. However, only a very few attempts have
been made to evaluate the performance of such
media with samples collected from animals and the
use of DTM alone without microscopic identification
of macroconidia (Figure 8) is not recommended
for the diagnosis of animal dermatophytoses. The
material collected from the animals should be sent to
a laboratory with an expertise in veterinary mycology.
In the laboratory, specific identification is made by
microscopic examination of the fungal colonies.
The number of fungal colonies may help distinguish Figure 7: Developing colonies of Microsporum canis
between mechanical carriers and infected animals.
Mechanical carriage is due to the contamination
of/from the environment and is usually associated
with a limited number of dermatophyte colonies
in culture. Infection leads to a massive production
of spores (arthroconidia) and is usually associated
with a very high number of dermatophyte colonies
in culture.

The detection of dermatophytes by PCR is

now possible for dogs and cats in Europe. The
commercially available panel includes Microsporum
spp., Microsporum canis and Trichophyton spp. real-
time PCR tests and it performs with high sensitivity
and specificity. The results might be available in a Figure 8: Spindle-shaped Microsporum canis macroconidia
few days.

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 2.2. Treatment Procedures

Antifungal treatment should be systematically recommended to shorten the course of the infection and to
reduce dissemination of infective material into the environment. Infective material is composed of small
pieces of hair covered by microscopic fungal spores (called arthroconidia). Infective material is easily spread
and can remain viable in the environment for up to 18 months under optimal conditions of temperature and
humidity. Infected animals (with or without clinical signs) and contaminated environments represent long-term
sources of exposure to other animals and owners. Systemic antifungals are supposed to contribute to speed
up the resolution of the infection, whereas topical antifungals are required to reduce the risk of transmission
and environmental contamination.

Important therapeutic measures include:

„„ The combination of systemic and topical treatment. Conventional systemic treatment relies on oral
antifungal drugs: griseofulvin, itraconazole or terbinafine (Table 3). Griseofulvin is no longer licensed for
animal use in most European countries. The micronised formulation of griseofulvin should be administered
orally at 25 mg/kg bodyweight twice daily with a fatty meal, to promote drug absorption. Haematological
and gastrointestinal adverse effects may occur and are probably more common in cats. Griseofulvin is
teratogenic and should not be given to pregnant animals. The principal licensed alternative for systemic
therapy of dermatophytosis is itraconazole. Itraconazole is safer than ketoconazole, which may cause
anorexia, vomiting, hepatotoxicity as well as interfering with steroid hormone metabolism. Itraconazole is
licensed for use in cats with M. canis dermatophytosis using an alternate-week dosing schedule, reflecting
its incorporation rate into stratum corneum and hair. For concurrent topical treatment, many products have
been proposed (Table 4). The decision to use topical therapy should be based upon the owner’s ability and
willingness to pour or sponge the product over the entire hair coat of the infected animal. Spot treatment
of lesions is not recommended. The frequency of topical treatment should be at least twice a week.
„„ An appropriate duration of treatment. Combined systemic and topical treatment should be continued
for at least 10 weeks. However, longer treatment regimens are used purely off-license and need to be
carried out at the vet’s discretion on a case-by-case basis. The general recommendation is to stop
antifungal administration after two negative cultures (2 weeks and 6 weeks after the end of the treatment).
If lesions persist after 8 weeks of treatment, veterinarians should suspect (i) that the treatment is not being
administered correctly by the owner (ii) that an underlying disorder is interfering with the normal action
of the immune system, or (iii) that the animal has a genetic background that makes it more susceptible
to dermatophyte infection. The presence of resistant strains is regularly suspected but resistance of
dermatophytes to antifungal drugs has only been proved in very few instances and this hypothesis should
not be considered as the most likely in cases of treatment failure. Lack of or insufficient environmental
control is most often the reason for the recurrence.
„„ The clipping of the hair coat, especially in severely infected animals, long-haired cats or in multi-animal
households. Clipping makes topical therapy application easier by allowing better distribution to the skin.
In households with one or two pets, spot clipping of lesions may be enough. Clipping must be performed
carefully to prevent spreading of the infection via skin wounds and in an area that can be easily disinfected
(see Section 3). Infected hairs should be burned or placed in a plastic biohazard bag and autoclaved.
Disposable clothing should be worn to limit infection from animal to human. In cats, clipping the coat may
require sedation. All whiskers should be clipped.
„„ Complete separation of infected animals from non-infected ones.
„„ Hygiene measures especially environmental decontamination (see Section 3).

Susceptibility to currently available antifungal drugs may vary according to the dermatophyte species.
Consequently, the specific identification of the dermatophyte is important to guide the choice of the drugs
and for a better understanding of the epidemiology of the infection and for preventing new contamination.

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In catteries and animal shelters, dermatophyte infection is very difficult to eradicate and creates a significant
health hazard for personnel and any other in-contact individuals. The cost of antifungal drugs and the
reluctance of the breeders to admit that their colony is infected usually account for lack of compliance with
treatment. Most recommendations for the control of dermatophytosis in catteries are based on the concept
of a total treatment programme, which associates the use of reliable diagnostic tools, both topical and
systemic treatment of all of the cats and environmental decontamination procedures. Interruption of breeding
programmes and showing agendas may also be recommended, as well as the isolation of new animals.

Not all of the drugs discussed in this section are available in the different European countries. Please check
local availability and regulations.

2.3. Prevention

Although the risk of dermatophyte infection is greater for puppies, kittens and aged or debilitated animals,
the infection is not strictly age- or health status-related, and so the risk continues throughout life (see Section
1). Consideration should be given to provide all dogs and cats with appropriate dermatophyte management
throughout their lives.

The main risk of infection is from contact with infected animals or contaminated environments. The best
way to avoid infection is to prevent this contact. This prophylactic strategy is very simple but not always
feasible because infected animals do not necessarily show obvious clinical signs. Asymptomatic carriers are
frequently observed in feline populations. These animals may correspond to mechanical carriers or infected
cats that could develop clinical signs in a few days or weeks.

To protect in-contact animals, the use of antifungal drugs has been proposed. Oral antifungal drugs have not
proved to be appropriate. Topical treatments are more valuable. Rinses or shampoos containing enilconazole
or miconazole are licensed for dogs and cats in most European countries. The general recommendation is to
apply an antifungal shampoo or rinse to the entire body of any dog or cat, which has been in contact with an
infected animal or a contaminated area. Under optimum conditions, infective fungal spores germinate within
6 hours on the skin of dogs and cats, so the preventive application of antifungal drug should be performed in
the day following the presumptive contamination.

Efforts to develop vaccines to prevent dermatophytosis in dogs and cats continue. There are only a few
products which are currently commercialised in some central and eastern European countries. These
vaccines may contain different dermatophyte species (Microsporum canis and Trichophyton mentagrophytes
for example). Investigations proving that these vaccines are protective against challenge exposure are still
lacking. Consequently, the use of these vaccines for the prevention of dermatophytosis in dogs and cats
should not be recommended.

In dog and cat breeding establishments as well as in animal shelters, the main risk is represented by the
introduction of an infected animal. Management plans usually include screening, monitoring and treatment
procedures. At the point of entry, animals should be carefully examined, vaccinated against major (life
threatening) infectious disease and treated for ectoparasites and intestinal worms. The animals should also
be screened for dermatophytosis via Wood’s lamp examination, fungal culture or PCR. Animals should then
be transferred to a quarantine ward until the results of the cultures or PCR are known. The provision of a
separate area for the treatment of animals with dermatophytosis is preferable. Treatment decisions should
be made according to the results of the fungal cultures. Colony-forming unit counts combined with clinical
examination can help to differentiate mechanical carriers from infected animals. A positive culture can result
from contaminated fur. Spores are everywhere in the environment and therefore also on the fur of healthy
animals, sometimes qualified as mechanical carriers. Careful interpretation of the quantified result is required:
‘sporadic’ or ‘some’ colonies may be contamination while ‘many’ to ‘very high numbers’ is mostly associated
with mechanical carriers.

Mechanical carriers should be treated with a single topical application of an antifungal drug before introduction
to the colony. Infected animals are kept in quarantine and treated using a combination of systemic and topical
antifungal drugs. These animals are not introduced to the colony until two negative fungal cultures have been
obtained.

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 3. ENVIRONMENTAL CONTROL OF DERMATOPHYTE TRANSMISSION

Dermatophytes are transmitted through microscopic spores, which are formed via fragmentation of fungal
hyphae on the infected skin or hair. The presence of these spores in the environment increases the risk of
exposure, potential reinfection and prolonged treatment of humans and animals. Minimising contamination
of the environment can be obtained via clipping of affected lesions, topical antifungal therapy and routine
cleaning.

Vacuuming alone will not decontaminate the surfaces but is recommended to remove gross debris including
hairs covered by infective spores.

Recent studies demonstrate that undiluted bleach and 1% formalin could kill all dermatophyte spores in the
environment. However, because of its caustic properties, undiluted sodium hypochlorite (household bleach)
is not recommended for use in households. Sodium hypochloride solution at 1:10 dilution and enilconazole
solution were also proven to be active. None of the other products tested demonstrated sufficient efficacy.

An enilconazole smoke fumigant formulation for disinfection of farm buildings, including poultry houses, is
available in most European countries. This kind of formulation is not licensed for household use and should
not be used with humans or animals present. Use of this formulation would be completely off-label and
therefore may not comply with animal shelter and cattery laws.

Brushes, combs, rugs and cages should be carefully washed and if possible, treated with a solution of
enilconazole or 1:10 dilution of sodium hypochlorite.

Vehicles used for transporting animals should also be treated.

In animal shelters or breeding establishments, contact plates or air samplers can be used to sample
environmental surfaces and check that disinfection has been effective. Commercially available dust-catching
cloths may also be used to monitor the environment for contamination.

Further information about environmental decontamination is available in the review from Moriello et al. (Vet
Dermatol 2017; 28: 266–e68).

4. CONTROL OF MALASSEZIA DERMATITIS IN DOGS AND CATS

4.1 Diagnosis

Malassezia dermatitis should be suspected in animals

with inflammatory skin diseases characterised by
erythematous and/or greasy lesions, especially when
lesions involve intertriginous areas. In dogs, it may
mimic or complicate atopic dermatitis and dietary
sensitivity. Hyperpigmentation and lichenification are
frequently observed in animals with chronic disease
and are particularly common in West Highland
white terriers. Atopic dogs with otitis externa show
erythematous vertical ear canals and pinnae with
varying degrees of lichenification and scaling,
accompanied by a yellow or brownish ceruminous
discharge. Although skin lesions may be confined
to one area, multiple regions are usually affected,
especially the limbs, ventral neck, abdomen, ears Figure 9: Malassezia Figure 10: Malassezia
dermatitis in a dog dermatitis in a cat
and face (Figures 9 and 10).

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The diagnosis of Malassezia dermatitis is based on
clinical signs, presence of elevated numbers of yeast
organisms in lesioned skin (Figure 11) and a clinical
and mycologic response to antifungal therapy. The
tape strip technique is convenient and reliable:
clear adhesive tape is pressed onto the surface of
the skin, to collect stratum corneum cells and any
superficial microbes. Because a small population of
yeasts might create disease in sensitised animals,
and in view of the variations in the numbers of yeasts
between different canine breeds and anatomic sites,
trial therapy should be given whenever Malassezia
yeasts are readily identified in cytologic specimens Figure 11: Malassezia yeast colonies
obtained from skin lesions.

4.2. Treatment Procedures

Topical treatments licensed for canine Malassezia otitis externa in veterinary medicine generally contain
either azole antifungal drugs (principally clotrimazole, miconazole, ketoconazole or posaconazole, nystatin
or terbinafine). These are normally combined with antibiotics and a glucocorticoid, reflecting the need to
control concurrent bacterial infection and reduce inflammation and proliferative pathologic changes (e.g.
stenosis) of the ear canal. Combined antibacterial and antifungal drug administration may also prevent
the switch from bacterial to yeast infection, or vice versa, that may be encountered when antibacterial or
antifungal monotherapy is used in dogs with otitis externa or otitis media. When there is excessive cerumen,
the ears should be cleaned with an appropriate cleanser prior to commencing topical treatment. Animals with
Malassezia otitis should receive a complete dermatologic evaluation, because failure to identify and correct
predisposing, primary and perpetuating factors may result in persistent or recurrent disease, or look like
treatment failure.

Because Malassezia is located within the stratum corneum, topical therapy alone may be sufficient to resolve
the clinical signs of infection, provided the pet owner is able to administer the treatment appropriately
and according to the veterinarian’s instructions. An evidence-based review of the treatment of Malassezia
dermatitis in dogs concluded that there was good evidence for the twice-weekly use of a 2% miconazole/2%
chlorhexidine shampoo. There was fair evidence for the use of oral ketoconazole (10 mg/kg bodyweight,
once daily) and oral itraconazole (5 mg/kg bodyweight, once daily) for 3 weeks. Itraconazole is preferable to
ketoconazole because it is better tolerated. As in dermatophytosis, the keratinophilic and lipophilic properties
of this drug enable intermittent administration, with the advantage of reducing both costs and the potential
for adverse effects and potentially improving compliance. Severe claw fold infections may require longer
treatment or higher doses, and otitis externa cases may not respond adequately. As with otitis externa,
identification and correction of predisposing, primary and perpetuating factors is essential for successful
management. Many dogs or cats with Malassezia dermatitis require regular maintenance therapy to prevent
relapse. Clinical and cytologic assessments should be repeated to determine the efficacy of antifungal
therapy and to establish whether there is evidence of concurrent diseases. Relapsing infection is common
when primary causes and predisposing factors are not identified or corrected.

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 5. OWNER CONSIDERATIONS IN PREVENTING ZOONOTIC DISEASES

In cases of dermatophytosis, important preventive measures for pet owners include:

„„ Practicing good personal hygiene (dermatophytes are zoonotic)

„„ Controlling dermatophyte infection through regular diagnostic testing and/or repeated proper treatments
(see under 2.2.)
„„ Minimising exposure, especially of children or immunocompromised people, to potentially contaminated
environments or infected animals

People in contact with infected animals should be advised of the risks and made aware that there are specific
risk groups.

Although M. pachydermatis is not normally isolated from human skin, there have been several reports
of M. pachydermatis-associated fungaemia in infants in neonatal intensive care units and in adults with
serious internal diseases. Heightened awareness of the potential for the transfer of Malassezia yeasts to
humans and the application of molecular typing methods might lead to the recognition of more cases
in the future. The renewed emphasis on hand hygiene in hospitals after the emergence of nosocomial
infections with multidrug-resistant bacterial pathogens should help prevent the development of zoonotic
Malassezia infections.

6. STAFF, PET OWNER AND COMMUNITY EDUCATION

Protocols for the control of dermatophyte infection should be communicated to the entire veterinary practice
team and applied consistently. Awareness of dermatophyte infection, including clinical manifestations in
people and particularly children, should be created in the medical profession through information brochures.
Cooperation between the medical and veterinary profession ought to be encouraged and its benefits
underlined in the case of zoonosis.

Pet owners should be informed about the potential health risks of dermatophyte infection, not only to
themselves but also to family members and all people living in regular contact with their pets. Brochures in
veterinary practices, pet shops, posters or specific websites are useful tools to achieve this. Responsible dog
and cat ownership can help to prevent some public health concerns.

Table 1: Characteristics of major dermatophyte species infecting dogs and cats in Europe

Dermatophyte species Potential hosts Source of contamination Zoonotic agent

Microsporum canis Cats, dogs and many other Cats most frequently Yes
mammals (including humans)
Microsporum gypseum Dogs, horses Soil (geophilic dermatophyte) Yes (but very rare)
Microsporum (Nannizzia) Small rodents (moles), Small rodents Yes (but very rare)
persicolor dogs and cats
Trichophyton mentagrophytes Small rodents, rabbits, Small rodents Yes
dogs and cats
Trichophyton erinacei Hedgehogs, dogs Hedgehogs Yes
Trichophyton rubrum Humans, dogs (very rare) Humans (pet owner) The dog is contaminated by its
owner (and not the opposite)

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Table 2: Characteristics of Malassezia species recovered from the skin of animals

Species Potential animal hosts Related diseases Potential zoonotic agent

Non-lipid-dependent species*
Malassezia pachydermatis** Dogs, cats and many Otitis and dermatitis Yes
other mammals, birds in dogs and cats
Lipid-dependent species*
Malassezia sympodialis Cats and other mammals Otitis Status unknown
Malassezia globosa Cats and other mammals Otitis Status unknown
Malassezia slooffiae Cats, pigs and other mammals Otitis, dermatitis Status unknown
Malassezia nana Cats and cattle Otitis No
Malassezia caprae Goats Dermatitis No
Malassezia equina Horses Dermatitis No
Malassezia cuniculi Rabbits Unknown No

* Non-lipid-dependent Malassezia yeasts grow on routine mycological media (like Sabouraud dextrose agar) without lipid
supplementation whereas lipid-dependent yeasts require lipid-supplemented media (like Dixon’s medium). Thirteen lipid-dependent
species are now recognised: M. furfur, M. sympodialis, M. globosa, M. obtusa, M. restricta, M. slooffiae, M. dermatis, M. japonica,
M. yamatoensis, M. nana, M. caprae, M. equina and M. cuniculi
** Some strains of M. pachydermatis have shown lipid-dependent characteristics

Table 3: Systemic antifungal drugs recommended for the treatment of dermatophytoses in dogs and cats

The availability and recommended dose of the drugs may vary according to the European countries.

Antifungal Dosage and frequency

Antifungal drugs Comments on use Adverse effects
groups of administration

Itraconazole Azole • 5 mg/kg bodyweight • the drug is registered for • at regular dosages, adverse
administered every 24h use in cats but not in dogs effects are very seldom observed
• because of its high • the drug should not be
lipophily, the drug has been administered to pregnant dogs
proved to be effective in and cats (even if teratogenic
an alternate-week regimen effects have been reported
(one week off and one only in rodents and at very high
week on) doses)
• the absorption is improved
if given with food
Griseofulvin Polyene • 25 mg/kg bodyweight • in many countries, the drug • the drug is highly teratogenic
administered every 12h is no longer used and is and must not be administered to
(micronised form) not registered for use in pregnant dogs and cats
• 5 mg/kg bodyweight dogs and cats • gastrointestinal disorders are
administered every 12h • the drug should be sometimes observed
(ultramicronised form) administered with a fatty • myelosuppression has been
meal (the fat enhances documented in FIV-infected cats
absorption)
Terbinafine Allylamine • 20–40 mg/kg bodyweight • the drug is commonly • no teratogenicity has been
administered every 24h used for the treatment reported in rodents or rabbits
of dermatophytosis and the drug can be used in
(especially onychomycosis) pregnant women
in humans but it is not • vomiting, facial pruritus, macular
registered for use in cats or papular skin reaction may
and dogs sometimes be observed in cats

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 Other drugs
Ketoconazole (5 mg/kg bodyweight administered every 12h or 10 mg/kg bodyweight SID) is registered
for use in dogs (but not in cats) in some European countries. This drug is considered as a less effective
treatment option (than griseofulvin, itraconazole or terbinafine) and it has more potential for adverse side
effects. Ketoconazole is teratogenic and must not be administered to pregnant dogs and cats. Anorexia,
vomiting and diarrhoea are sometimes observed. Ketoconazole has hepatotoxic effects, including elevated
serum alanine transaminase activity. It interferes with the metabolism of other drugs and with steroid hormone
metabolism.

Lufenuron is a chitin synthesis inhibitor commonly used for the prevention of flea infestations in dogs and
cats. Since chitin is a component of fungal cell walls, several recent studies have investigated whether
lufenuron has useful antifungal activity. The first retrospective study was conducted in Israel and suggested
that lufenuron treatment was strongly associated with recovery in many dogs and cats with a number of
fungal infections, including dermatophytosis. However, the results of other investigations were contradictory
and increasing scepticism about the efficacy of lufenuron rapidly occurred. To date, the use of lufenuron is
not recommended for the treatment of superficial mycoses in dogs and cats. Lufenuron is not registered for
use in the prophylaxis or treatment of dermatophytosis.

Table 4: Topical antifungal drugs for the treatment of superficial mycoses in dogs and cats

The availability and the dose of the drugs may vary according to the European countries.

Dosage and
Antifungal
Antifungal drugs frequency of Comments on use Adverse effects
groups
administration
Shampoos
Miconazole + Imidazole + 2% miconazole • lathering or rubbing process may • no adverse effects have been
chlorhexidine disinfectant and 2% macerate fragile hairs and increase documented
chlorhexidine the release and dispersal of spores
twice weekly
Ketoconazole + Imidazole + 1% ketoconazole • lathering or rubbing process may • no adverse effects have been
chlorhexidine disinfectant and 2% macerate fragile hairs and increase documented
chlorhexidine the release and dispersal of spores
twice weekly

Rinses
Enilconazole Imidazole 0.2% • the entire body must be treated • topical application of
solution twice and the antifungal agent left to dry enilconazole is well tolerated
weekly on the skin (including by cats)
• careful application (using sponges
and by patting rather than rubbing)
is recommended
• after application, the coat and skin
can be dried with a hairdryer
Lime sulphur 1:32 or 1:16 twice • lime sulphur is commonly used in • lime sulphur has an offensive
weekly the USA but is not available in all odour and may stain light-
European countries coloured hair
• the entire body must be treated • oral ulceration has sometimes
and the antifungal agent left to dry been observed in cats therefore
on the skin they should be collared to prevent
• careful application (using sponges them from licking the solution
and by patting rather than rubbing)
is recommended
• it can bleach dark clothing and can
oxidate silver and gold jewellery

Captan, povidone-iodine, and chlorhexidine (alone and at a concentration lower than 3%) have been found to be ineffective against
dermatophytes in both in vitro and in vivo studies.

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APPENDIX 1 – BACKGROUND

ESCCAP (European Scientific Counsel Companion Animal Parasites) is an independent, not-for-profit

organisation that creates guidelines and promotes good practice for the control and treatment of parasites in
and on companion animals. With the proper advice, the risk of diseases and parasitic transmission between
animals and humans can be minimised. ESCCAP aspires to see a Europe where companion animal parasites
no longer threaten the health and wellbeing of animals and humans.

There is a great diversity in the range of parasites and their relative importance across Europe and the ESCCAP
guidelines summarise and highlight important differences, which exist in different parts of Europe and, where
necessary, specific control measures are recommended.

ESCCAP believes that:

„„ Veterinarians and pet owners must take measures to protect their pets from parasitic infections
„„ Veterinarians and pet owners must take measures to protect the pet population from risks associated with
travel and its consequent potential to change local parasite epidemiological situations through the export
or import of non-endemic parasite species
„„ Veterinarians, pet owners and physicians should work together to reduce the risks associated with zoonotic
transmission of parasitic diseases
„„ Veterinarians should be able to give guidance to pet owners regarding risks of parasite infection and
diseases and measures which can be taken to minimise these risks
„„ Veterinarians should attempt to educate pet owners about parasites to enable them to act responsibly
not only for their own pet’s health but for the health of other pet animals and people in their communities
„„ Veterinarians should wherever appropriate use diagnostic tests to establish parasite infection status in
order to provide the best possible advice

To achieve these objectives, ESCCAP produces guidelines in different formats:

„„ A detailed guideline for veterinary surgeons and veterinary parasitologists

„„ Translations, extracts, adaptations and summarised versions of guidelines which address the varied
requirements of European countries and regions
Versions of ESCCAP guidelines can be found at www.esccap.org

Disclaimer:
Every effort has been taken to ensure that the information in the guideline, which is based on the authors’
experience, is accurate. However, the authors and publishers take no responsibility for any consequence
arising from the misinterpretation of the information herein nor is any condition or warranty implied. ESCCAP
emphasises that national, regional and local regulations must be borne in mind at all times before following
ESCCAP advice. All dosages and indications are provided for guidance. However, vets should consult
individual data sheets for details of locally-approved treatment regimens.

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 ISBN: 978-1-907259-73-9

ESCCAP Secretariat
Malvern Hills Science Park, Geraldine Road, Malvern,
Worcestershire, WR14 3SZ, United Kingdom

0044 (0) 1684 585135

info@esccap.org
www.esccap.org

Superficial Mycoses
2 in Dogs and Cats
ESCCAP Guideline 02 Fourth Edition – February 2019

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