An adult male, vasectomized white-faced saki monkey (Pithecia pithecia) presented with dry skin and alopecia over the distal tail, stifles, tarsi, and cubiti. Keepers had noted a potential seasonality, as the signs coincided with dry environmental conditions in the winter ecosystem housing.
The severity of the clinical signs increased in the year after initial presentation. The glabrous skin of the manus and manual digits was thickened, swollen, cracked, and bleeding. Oral avocado oil,a an oral antibiotic,b and antihistaminesc were administered, but unsuccessful in resolving the lesions. The patient also experienced progressive, severe rhinitis. No specific seasonal trigger had been identified, and the enclosure location had not changed for several years. The monkey was anesthetized for diagnostic assessment, including deep nasal cultures, advanced imaging of the sinuses and nasal cavity, and ultimately a consultation with a dermatologist.
This latter assessment included intradermal skin testing and a biopsy of the glabrous skin of the manus. Test results showed strong reactions to wool, house dust mites, Curvularia, Cladosporium, dandelion, mugwort, Acremonium, and walnut tree pollen, which were interpreted as atopy caused by winter seasonal allergens. Additionally, skin histopathology was consistent with atopy including hyperplasia of the epidermis and superficial follicular epithelium. Due to chronicity of the presentation, fibrosis was also noted. The consulting dermatologist recommended oral hyposensitizationd which was commenced on a graduated schedule from 0.1 protein nitrogen units (PNUs) to 3 PNUs of the targeted antigens over four weeks.
Although the rhinitis improved with oral hyposensitization, the manual skin cracking persisted. Topical ointments were discussed, but the difficulty of application made this option impractical. Additionally, unintended ingestion of topical treatments was a concern. Non-toxic topical emollientse used previously had reduced skin dryness, but did not resolve the clinically apparent signs of atopic dermatitis. Aquasorb®,f a topical cream, was elected as a novel approach. To ensure compliance with the prescription, keepers created enrichment activities to encourage consistent and voluntary treatment application. Within a month, the patient had minimal dry skin on its manus.
The main active ingredients of Aquasorb® are sphingolipids (ceramides and sphingomyelin) and glycosaminoglycans. Ceramides are found in the lipid bilayer of the stratum corneum.3 By improving the epidermal barrier formation, they help the skin retain moisture. Patients with atopic dermatitis often have decreased ceramides.3 Topical application has been shown to replenish ceramides in the stratum corneum in dogs.4 Sphingomyelin is a natural precursor to ceramides, and has been shown to initiate ceramide creation.1,5 Topical use of sphingomyelin has been correlated with decreased inflammation by inhibiting the production of prostaglandin E2.2
Aquasorb® also contains the glycosaminoglycans chondroitin sulfate (CS) and hyaluronic acid (HA). A polysaccharide that occurs naturally in cartilage and joints, CS reduces inflammatory cytokine production, thereby reducing inflammation, and may help treat chronic diseases where inflammation is an essential component.7 Combination therapy with HA and sphingomyelin has been shown to significantly reduce the production of prostaglandin E2.2 The combination of sphingolipids and glycosaminoglycans diminishes signs of atopic dermatitis as measured by canine atopic dermatitis and extent severity (CADESI) scores.6
After one year of treatment with Aquasorb®, the patient’s manual skin condition was markedly improved on clinical assessment, and has remained so during current visual veterinary assessment. Further, a recent skin biopsy has confirmed decreased epidermal thickening and no inflammation, consistent with atopic dermatitis remission. After 16 months of daily treatment, the patient’s prescription Aquasorb® was altered to three times weekly to maintain voluntary compliance with the product long-term.
a. Massimo Gusto®, BMA USA Inc., Van Nuys, CA 91406, USA.
b. Trimethoprim/sulfadiazine 400mg/ml paste, Monument Pharmacy, Monument, CO 80132, USA.
c. Diphenhydramine HCl, CVS Pharmacy Inc., Woonsocket, RI 02895, USA.
d. Oral hyposensitization sheep epithelium, Dermatophagoides farinae and D. pteronyssinus, Curvularia, Cladosporium, dandelion, mugwort, Acremonium, and walnut tree pollen, hickory, pine mix, grain smut, Hormodendrum, Penicillium notatum, and red clover, MedVet Chicago, Chicago, IL 60618, USA.
e. Bag Balm®, Vermont’s Original LLC., Lyndonville, VT 05851, USA.
f. Bioiberica S.A.U, pl. Francesc Macià, 7. 08029 Barcelona, Spain.
The authors thank the keepers at the Regenstein Small Mammal and Reptile House who played a major role in the patient’s recovery by ensuring treatment compliance.
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