Klox Fluorescence Biomodulation System for the management of canine anal furuncolosis Marchegiani A, Tambella AM, Cerquetella M., Fruganti A. Dini F., Spaterna A. Introduction Canine anal furuncolosis (AF) is a chronic, painful, usually progressive and debilitating disease of dogs, characterized by histological lesions similar to those found in the perineum in human Crohn’s disease patients.1-4 Clinical signs of the condition include tenesmus, haematochezia and an ulcerated malodorous perianal region with draining fistulous tract, resulting in pain and discomfort, which in turn can lead to anorexia, weight loss and changes in temperament.2,3 The disease affects usually medium- to large-breed dogs, with German Shepherd’s being overrepresented. Traditional medical treatments consisting of systemic antimicrobial drugs and often lifelong immunomodulatory or immunosuppressive therapy (such as cyclosporine, glucocorticoids, tacrolimus) have shown some clinical success, while surgical management has no long-term effectiveness.5 These traditional treatment options have, however, their drawbacks: side effects associated with immunomodulators and immunosuppressive drugs are well described and not uncommon, and the prolonged use of systemic antibiotics is discouraged because of an increased risk for developing drug-resistant bacteria colonization. Therefore, the search for alternative therapies is important to help improve clinical outcomes and reduce the potential side effects of management of patients with this debilitating chronic condition. Photobiomodulation (PBM) is a technique that uses light to stimulate cells. Fluorescence Biomodulation (FB), a type of PBM, is based on the unique ability of special compounds (light absorbing molecules, LAMs) to convert light emission from light emitting diodes (LEDs) into a different photon emission spectrum including broader wavelengths and lower energy (fluorescence). The Klox Fluorescence Biomodulation System (KFBS) consists of a LEDs activator lamp and a topical photo-converter gel containing LAMs, which uses low-energy fluorescent light to promote bacterial control and healing of tissues.6-9 The aim of this study is to describe the clinical effect of KFBS in the management of canine AF. Description of Clinical Cases Five dogs (four German Shepherd and one English Setter, aged between 3 and 10 years, three males and two intact females) affected by recurrent AF received KFBS therapy. At the time of the presentation, dogs showed inflammation, ulceration and draining fistulous tracts surrounding the anus, pain and dyschezia. All dogs were previously treated with immunosuppressant agents and antimicrobial drugs, but only showed slight to moderate improvement. Thereafter, these 5 patients were provided with the KFBS (no concomitant drug treatment) regimen, which consisted of the application of a two-millimetre-thick layer of a photo-converter gel spread on the affected area and thereafter illuminated with a LED lamp for two minutes at an approximately five-centimetre distance; the regimen was applied once a week, two consecutive applications in the same session. After each application, the gel residue was gently cleaned with a gauze dipped in sterile saline solution. After 14 days of starting KFBS therapy, in all 5 cases, the inflammation disappeared and owners reported absence of pain and dyschezia. All dogs achieved complete clinical healing with total disappearance of lesions in 4.8±1.8 weeks and adverse events were not reported. No reoccurrence was observed within the first six months after cessation of the therapy and visual inspection of the treated areas after a period of six months showed a good quality of skin. Discussion and Conclusion AF is a progressive and debilitating clinical condition, which requires lifelong monitoring and management. Successful use of immunosuppressant drugs in dogs is associated with increased risk of complications, significant costs and frequent relapses, even if therapy is not discontinued.9 Moreover, immunosuppressant therapy cannot always be considered appropriate in the case of underlying diseases causing immune compromising patients (i.e. Leishmaniosis), making the exploration of alternative therapies desirable.11-15 Recently, a canine model of human fistulising Crohn’s disease has been successfully treated with embryonic-derived mesenchymal stem cells and canine AF was successfully treated with autologous platelet-rich plasma.14,15 KBFS is an innovative therapy that has proven to be very well tolerated and efficacious in the treatment of wounds in humans and recent clinical studies in dogs have also shown safety and efficacy in the management of pyoderma and otitis. The benefits of the therapy can be attributed to triggering of intracellular photobiochemical reactions that create anti-inflammatory signalling, stimulate the wound healing process as well as limiting bacterial growth.6-9 In these case reports, dogs with recurrent AF managed with KFBS achieved complete clinical healing in equivalent time to what is reported for traditional therapy (three to ten weeks)2,10 but sparing the use of immunosuppressant and systemic antimicrobial drugs, without the occurrence of adverse events. The KFBS topical therapy is easy to perform, not invasive, and appears to be a safe and effective option for successful management of AF, possibly eliminating or reducing the need for administering drugs. Further, larger clinical studies are desirable to confirm these findings. Bibliography 1. Denovo RC, Bright RM. Rectoanal disease. In: Textbook of Veterinary Internal Medicine, 5th edn. Eds S. J. Ettinger and E. C. Feldman. W. B. Saunders, Philadelphia. 2000 pp 1257-1270. 2. Patterson AP, Campbell KL. Managing Anal Furunculosis in Dogs. Compendium 2005; 27 (5):339-355. 3. Jamieson PM, Simpson JM, Kirby BM, Else RW. Association between anal furunculosis and colitis in the dog: preliminary observations. JSAP 2002; 43 (3):109–114. 4. Day MJ. Immunopathology of anal furunculosis in the dog. JSAP 1993; 34 (8):381-388. 5. Ellison GW. Treatment of perianal fistulas in dogs. JAVMA 1995; 206 (11):1680-1682. 6. Schnedeker AH, Cole LK, Lorch G, Diaz SF, Bonagura J, Daniels JB. In vitro bactericidal activity of blue light (465 nm) phototherapy on meticillin-susceptible and meticillin resistant Staphylococcus pseudintermedius. Vet Dermatol 2017; 28 (5):463-e106. 7. Opel DR, Hagstrom E, Pace AK et al. Light-emitting diodes: a brief review and clinical experience. J Clin Aesthet Dermatol 2015; 8 (6):36–44. 8. Gupta A, Avci P, Dai T, Huang YY, Hamblin MR. Ultraviolet radiation in wound care: sterilization and stimulation. Adv Wound Care 2013; 2 (8):422–437. 9. Dai T, Vrahas MS, Murray CK, Hamblin MR. Ultraviolet C irradiation: an alternative antimicrobial approach to localized infections? Expert Rev Anti Infect Ther 2012; 10 (2):185–195. 10. O'Neill T, Edwards GA, Holloway S. Efficacy of combined cyclosporine A and ketoconazole treatment of anal furunculosis. J Small Anim Pract 2004; 45 (5):238-43. 11. Mathews TA, Ayres SA, Tano CA, Riley SM, Sukhiani HR, Adams C. Cyclosporine treatment of perianal fistulas in dogs. Can Vet J 1997; 38 (1):39-41. 12. Mathews TA, Sukhiani HR. Randomised controlled trial of cyclosporine for treatment of perianal fistulas in dogs. JAVMA 1997; 211 (10):1249-1253. 13. Tisdall PL, Hunt GB, Beck JA, Malik R. Management of perianal fistulae in five dogs using azathioprine and metronidazole prior to surgery. Austr Vet J, 1999; 77 (6):374-378. 14. Ferrer L, Kimbrel EA, Lam A, Falk EB, Zewe C, Juopperi T et al. Treatment of perianal fistulas with human embryonic stem cell-derived mesenchymal stem cells: a canine model of human fistulizing Crohn's disease. Regen Med 2016; 11 (1):33-43. 15. Perego R, Spada E, Baggiani L, Moneta E, Proverbio D. Clinical efficacy of autologous platelet-rich plasma (PRP) in treatment of perianal fistulas in a German Shepherd dog. AIVPA Journal 2017; 3:29-33.

Klox Fluorescence Biomodulation System for management of canine anal furuncolosis

Marchegiani, Andrea;Tambella, Adolfo Maria;Cerquetella, Matteo;Fruganti, alessandro;Dini, Fabrizio;Spaterna, Andrea
2018-01-01

Abstract

Klox Fluorescence Biomodulation System for the management of canine anal furuncolosis Marchegiani A, Tambella AM, Cerquetella M., Fruganti A. Dini F., Spaterna A. Introduction Canine anal furuncolosis (AF) is a chronic, painful, usually progressive and debilitating disease of dogs, characterized by histological lesions similar to those found in the perineum in human Crohn’s disease patients.1-4 Clinical signs of the condition include tenesmus, haematochezia and an ulcerated malodorous perianal region with draining fistulous tract, resulting in pain and discomfort, which in turn can lead to anorexia, weight loss and changes in temperament.2,3 The disease affects usually medium- to large-breed dogs, with German Shepherd’s being overrepresented. Traditional medical treatments consisting of systemic antimicrobial drugs and often lifelong immunomodulatory or immunosuppressive therapy (such as cyclosporine, glucocorticoids, tacrolimus) have shown some clinical success, while surgical management has no long-term effectiveness.5 These traditional treatment options have, however, their drawbacks: side effects associated with immunomodulators and immunosuppressive drugs are well described and not uncommon, and the prolonged use of systemic antibiotics is discouraged because of an increased risk for developing drug-resistant bacteria colonization. Therefore, the search for alternative therapies is important to help improve clinical outcomes and reduce the potential side effects of management of patients with this debilitating chronic condition. Photobiomodulation (PBM) is a technique that uses light to stimulate cells. Fluorescence Biomodulation (FB), a type of PBM, is based on the unique ability of special compounds (light absorbing molecules, LAMs) to convert light emission from light emitting diodes (LEDs) into a different photon emission spectrum including broader wavelengths and lower energy (fluorescence). The Klox Fluorescence Biomodulation System (KFBS) consists of a LEDs activator lamp and a topical photo-converter gel containing LAMs, which uses low-energy fluorescent light to promote bacterial control and healing of tissues.6-9 The aim of this study is to describe the clinical effect of KFBS in the management of canine AF. Description of Clinical Cases Five dogs (four German Shepherd and one English Setter, aged between 3 and 10 years, three males and two intact females) affected by recurrent AF received KFBS therapy. At the time of the presentation, dogs showed inflammation, ulceration and draining fistulous tracts surrounding the anus, pain and dyschezia. All dogs were previously treated with immunosuppressant agents and antimicrobial drugs, but only showed slight to moderate improvement. Thereafter, these 5 patients were provided with the KFBS (no concomitant drug treatment) regimen, which consisted of the application of a two-millimetre-thick layer of a photo-converter gel spread on the affected area and thereafter illuminated with a LED lamp for two minutes at an approximately five-centimetre distance; the regimen was applied once a week, two consecutive applications in the same session. After each application, the gel residue was gently cleaned with a gauze dipped in sterile saline solution. After 14 days of starting KFBS therapy, in all 5 cases, the inflammation disappeared and owners reported absence of pain and dyschezia. All dogs achieved complete clinical healing with total disappearance of lesions in 4.8±1.8 weeks and adverse events were not reported. No reoccurrence was observed within the first six months after cessation of the therapy and visual inspection of the treated areas after a period of six months showed a good quality of skin. Discussion and Conclusion AF is a progressive and debilitating clinical condition, which requires lifelong monitoring and management. Successful use of immunosuppressant drugs in dogs is associated with increased risk of complications, significant costs and frequent relapses, even if therapy is not discontinued.9 Moreover, immunosuppressant therapy cannot always be considered appropriate in the case of underlying diseases causing immune compromising patients (i.e. Leishmaniosis), making the exploration of alternative therapies desirable.11-15 Recently, a canine model of human fistulising Crohn’s disease has been successfully treated with embryonic-derived mesenchymal stem cells and canine AF was successfully treated with autologous platelet-rich plasma.14,15 KBFS is an innovative therapy that has proven to be very well tolerated and efficacious in the treatment of wounds in humans and recent clinical studies in dogs have also shown safety and efficacy in the management of pyoderma and otitis. The benefits of the therapy can be attributed to triggering of intracellular photobiochemical reactions that create anti-inflammatory signalling, stimulate the wound healing process as well as limiting bacterial growth.6-9 In these case reports, dogs with recurrent AF managed with KFBS achieved complete clinical healing in equivalent time to what is reported for traditional therapy (three to ten weeks)2,10 but sparing the use of immunosuppressant and systemic antimicrobial drugs, without the occurrence of adverse events. The KFBS topical therapy is easy to perform, not invasive, and appears to be a safe and effective option for successful management of AF, possibly eliminating or reducing the need for administering drugs. Further, larger clinical studies are desirable to confirm these findings. Bibliography 1. Denovo RC, Bright RM. Rectoanal disease. In: Textbook of Veterinary Internal Medicine, 5th edn. Eds S. J. Ettinger and E. C. Feldman. W. B. Saunders, Philadelphia. 2000 pp 1257-1270. 2. Patterson AP, Campbell KL. Managing Anal Furunculosis in Dogs. Compendium 2005; 27 (5):339-355. 3. Jamieson PM, Simpson JM, Kirby BM, Else RW. Association between anal furunculosis and colitis in the dog: preliminary observations. JSAP 2002; 43 (3):109–114. 4. Day MJ. Immunopathology of anal furunculosis in the dog. JSAP 1993; 34 (8):381-388. 5. Ellison GW. Treatment of perianal fistulas in dogs. JAVMA 1995; 206 (11):1680-1682. 6. Schnedeker AH, Cole LK, Lorch G, Diaz SF, Bonagura J, Daniels JB. In vitro bactericidal activity of blue light (465 nm) phototherapy on meticillin-susceptible and meticillin resistant Staphylococcus pseudintermedius. Vet Dermatol 2017; 28 (5):463-e106. 7. Opel DR, Hagstrom E, Pace AK et al. Light-emitting diodes: a brief review and clinical experience. J Clin Aesthet Dermatol 2015; 8 (6):36–44. 8. Gupta A, Avci P, Dai T, Huang YY, Hamblin MR. Ultraviolet radiation in wound care: sterilization and stimulation. Adv Wound Care 2013; 2 (8):422–437. 9. Dai T, Vrahas MS, Murray CK, Hamblin MR. Ultraviolet C irradiation: an alternative antimicrobial approach to localized infections? Expert Rev Anti Infect Ther 2012; 10 (2):185–195. 10. O'Neill T, Edwards GA, Holloway S. Efficacy of combined cyclosporine A and ketoconazole treatment of anal furunculosis. J Small Anim Pract 2004; 45 (5):238-43. 11. Mathews TA, Ayres SA, Tano CA, Riley SM, Sukhiani HR, Adams C. Cyclosporine treatment of perianal fistulas in dogs. Can Vet J 1997; 38 (1):39-41. 12. Mathews TA, Sukhiani HR. Randomised controlled trial of cyclosporine for treatment of perianal fistulas in dogs. JAVMA 1997; 211 (10):1249-1253. 13. Tisdall PL, Hunt GB, Beck JA, Malik R. Management of perianal fistulae in five dogs using azathioprine and metronidazole prior to surgery. Austr Vet J, 1999; 77 (6):374-378. 14. Ferrer L, Kimbrel EA, Lam A, Falk EB, Zewe C, Juopperi T et al. Treatment of perianal fistulas with human embryonic stem cell-derived mesenchymal stem cells: a canine model of human fistulizing Crohn's disease. Regen Med 2016; 11 (1):33-43. 15. Perego R, Spada E, Baggiani L, Moneta E, Proverbio D. Clinical efficacy of autologous platelet-rich plasma (PRP) in treatment of perianal fistulas in a German Shepherd dog. AIVPA Journal 2017; 3:29-33.
2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11581/416565
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