Vol. 21, No.
1 January 1999 V 20TH ANNIVERSARY
CE Refereed Peer Review
FOCAL POINT
★Knowledge of shampoo
ingredients and their uses
and contraindications allows
veterinarians to choose the most
appropriate shampoo products
for their patients.
KEY FACTS
■ Benzoyl peroxide is difficult to
manufacture and breaks down
with time; heeding expiration
dates and purchasing these
products from well-known,
reputable companies is
therefore advised.
■ Povidone–iodine has relatively
short residual activity and is
inactivated by organic debris.
■ Tar is an effective antiseborrheic
agent because it has degreasing
as well as keratoplastic
properties.
■ A shampoo ingredient that
was appropriate for a particular
patient once may not be effective
in the future.
Noninsecticidal
Veterinary Shampoo
Components
Texas A&M University
Christine A. Rees, DVM
ABSTRACT: The abundance of veterinary shampoos can make it difficult to decide which to
choose for a particular patient. Becoming familiar with individual shampoo ingredients can
make the decision easier. The chances of obtaining positive results from topical therapy are in-
creased when tactile and visual findings, cytology results, and the primary concerns of owners
are all considered. In addition, patients may benefit from a combination of several different
topical therapies.
N
oninsecticidal shampoos are an essential adjuvant therapy for treating
small animal dermatologic conditions. However, the abundance of
products (more than 100 are listed in the most recent edition of the
Compendium of Veterinary Products1) can cause confusion about which is appro-
priate for a particular patient. The best way to deal with this situation is not to
memorize all of the different products but to become familiar with the ingredi-
ents. There are six shampoo-ingredient categories based on mechanism of ac-
tion, including antibacterial, antifungal, antiseborrheic, moisturizing, antiprurit-
ic (Table I), and residual-extending agents. The first four categories have been
covered extensively in the literature and are therefore only briefly reviewed
here.2–4 Clinical cases illustrate the practical application of the information dis-
cussed.
ANTIBACTERIAL INGREDIENTS
The five main antibacterial shampoo ingredients are benzoyl peroxide,
chlorhexidine, povidone–iodine, triclosan, and ethyl lactate. All are useful for
treating surface and superficial bacterial skin infections2–4; only benzoyl peroxide,
however, is useful for treating deep bacterial skin infections because of its ability
to penetrate deep within hair follicles and sebaceous glands.2–3
Benzoyl Peroxide
Benzoyl peroxide is an excellent antibacterial shampoo ingredient that has de-
greasing and antiseborrheic (keratolytic) properties.2 Its antibacterial action re-
sults from its ability to oxidize substances and has been shown to last for as long
as 2 days.5 Precautions associated with benzoyl peroxide use are excessive drying
and/or irritation of the skin and haircoat, bleaching of fabrics, odor, and lack of
Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

TABLE I
Small Animal Shampoo-Ingredient Information
Activity a
Side Effects
Ingredient Degreasing Antibacterial Antifungal Antipruritic Keratolytic Keratoplastic and Precautions
Aloe vera – + + + – – –
Benzoyl + – – + + – Drying, minimal lather,
peroxide irritating to skin, bleaching;
watch expiration dates,
use reputable companies
Chlorhexidine – + + – – – –
Ethyl lactate – + – – – – –
Iodine – + + – – – Staining, irritating to skin
Miconazole – – + – – – –
Oatmealb – – – + – – –
Salicylic acid – + – + + + –
Selenium + – + – + + Drying, staining,
sulfidec irritating to skin
Sulfur – + +d +d + + Odor, stains jewelry and
light-coated animalsd
Tarc + – – – + + Drying, staining, odor,
irritating to skin,
photosensitive,
superficial necrolytic
dermatitis
Triclosan – + – – – – –
aResidual-extending agents do not provide any of these properties and are thus not included.
bOatmeal shampoos may contain additional antipruritic agents, such as topical anesthetics (e.g., pramoxine), antihistamines (e.g.,
diphenhydramine), and cortisone (e.g., hydrocortisone), or oatmeal alone.
c Tar and selenium sulfide should not be used in cats because they are too irritating to feline skin.
d These effects are only seen with sulfur dip.

latherability. Benzoyl peroxide is difficult to manufac-
ture and breaks down with time; heeding expiration
dates and purchasing these products from well-known,
reputable companies is therefore advised.2 Excessive
drying may be avoided by using a moisturizing spray or
conditioner after benzoyl peroxide application.
Chlorhexidine
Chlorhexidine is a synthetic biguanide with antibac-
terial, antifungal, and antiviral activities.5,6 It exerts its
antibacterial effects by acting on the bacterial cell mem-
brane, precipitating intracellular contents, and inhibit-
ing ATP.7,8 Chlorhexidine differs from iodine-contain-
ing products in that it is not inhibited or inactivated by
organic debris (e.g., dirt, scale, crust).6 Chlorhexidine is
also known for its residual properties, lasting as long as
2 days.5,6 No specific precautions have been document-
ed at shampoo concentrations (4% or less). This prod-
uct is nonirritating, nontoxic, and well tolerated.
Povidone–Iodine
Povidone–iodine is an antibacterial agent with anti-
fungal, antiviral, and antiprotozoal activity 9,10 that
works by iodinating and oxidizing sulfhydryl com-
pounds, peptides, proteins, enzymes, vitamins, lipids,
and cytosine found in the cytoplasm and cytoplasmic
membranes.10,11 Unlike chlorhexidine, povidone–iodine
has relatively short residual activity (4 to 6 hours) and
is inactivated by organic debris (e.g., dirt, crust,
scale).6,12 The main precautions associated with povi-

EXCESSIVE DRYING ■ ORGANIC DEBRIS ■ RESIDUAL PROPERTIES

Compendium January 1999 20TH ANNIVERSARY
done–iodine use are contact dermatitis, skin irritation,
and staining.6,8,12
Triclosan
Triclosan is an antibacterial agent that is added into
antiseborrheic shampoos to extend their spectrum of
activity (i.e., provide more antibacterial properties). Tri-
closan produces its effects by causing loss of plasma-
membrane integrity and cell death through apoptosis in
vitro.13 Allergic contact dermatitis may occur.14
Ethyl Lactate
Ethyl lactate is an antibacterial agent that penetrates
hair follicles and sebaceous glands but has no proven
benefits in treating deep pyoderma.15 This ingredient
becomes effective by breaking down into two com-
pounds within the skin, lactic acid and ethanol. Lactic
acid acts by decreasing the skin’s pH and thus inhibit-
ing bacterial lipases,5 whereas ethanol renders fats solu-
ble and decreases the amount of sebaceous secretions.4
Side effects (e.g., irritation, erythema, pruritus) are in-
frequent.14
ANTIFUNGAL INGREDIENTS
The three main shampoo ingredients known for their
antifungal properties are miconazole, chlorhexidine,
and povidone–iodine. The latter two ingredients have
been discussed previously.
Miconazole
Miconazole is an imidazole derivative that exerts its
antifungal properties by inhibiting ergosterol synthe-
sis.15 Ergosterol is an essential component of the fungal
cell membrane. Inhibition of ergosterol synthesis results
in fungal cell death.15 No specific side effects have been
documented with miconazole shampoo formulations.
ANTISEBORRHEIC INGREDIENTS
Seborrhea is an imbalance in the skin’s keratinization
process in which skin cells (keratinocytes) tend to turn
over more rapidly than usual, resulting in excessive scal-
ing and crusting of the skin. The purpose of antisebor-
rheic ingredients is to try to normalize this process by
working at the skin’s surface to remove the excess scale
(keratolytic properties) and at the basal layer to slow cell
turnover (keratoplastic properties).2,3,5 The two different
forms of seborrhea are seborrhea oleosa (oily form) and
seborrhea sicca (dry form).2 It is important to quantify
the type of seborrhea that is present because different
shampoo ingredients are used for each condition.
A degreasing agent with antiseborrheic properties is re-
quired to gain the most effective control of seborrhea
oleosa. The two ingredients with excellent degreasing
KERATINIZATION ■ SEBORRHEA ■ VASOCONSTRICTION ■ REHYDRATION
Small Animal/Exotics
properties are benzoyl peroxide (discussed previously)
and tar.2 Seborrhea sicca is most commonly treated with
sulfur and salicylic acid combination shampoos. Sulfur
and salicylic acid have been shown to act synergistically
to help remove scale.16 At shampoo concentrations (i.e.,
2% to 3%), these products are safe for use in dogs and
cats. If the amount of scaling is minimal, a moisturizing
spray or shampoo may be effective (see Moisturizing In-
gredients below).
Tar
Tar is an effective antiseborrheic agent because it not
only degreases but also has keratoplastic properties. Tar
has been shown to slow skin-cell turnover by suppress-
ing DNA synthesis at the basal layer.2 Other properties
include its ability to produce vasoconstriction and de-
crease pruritus.2,3 Precautions associated with the topi-
cal use of tar include unpleasant color (brown) and
odor, skin irritation, excessive drying of skin and hair-
coat, photosensitization, and superficial necrolytic der-
matitis.2,3,5,17 Tar is not approved for use in cats because
it is extremely irritating to their skin.2 In addition, be-
cause tar production techniques and refinement may
affect its efficacy, tar shampoos should be purchased
only from reputable companies.2,5
Sulfur
Sulfur is reportedly both keratoplastic and keratolyt-
ic. The keratoplastic properties are thought to result
from either the drug’s cytostatic capabilities or its reac-
tion with cysteine in the skin to form cystine and hy-
drogen sulfide (building blocks for normal keratiniza-
tion). Sulfur’s keratolytic properties, which result from
excess hydrogen sulfide formation, have been detected
at high concentrations.2
Salicylic Acid
Salicylic acid is also keratoplastic and keratolytic;
these effects are produced by decreasing the skin’s pH,
which increases the hydration of the keratin and causes
swelling of the stratum corneal cells. Salicylic acid also
solubilizes the intercellular cement substance that holds
the scale together.2
MOISTURIZING INGREDIENTS
Moisturizing ingredients help to rehydrate the skin
and restore it to a more normal state.2,5 Almost all vet-
erinary shampoos contain one or more of these ingredi-
ents. Moisturizing products have not been associated
with any side effects when used at the recommended
shampoo ingredient concentrations. The two main
groups of moisturizing ingredients include humectants
and emollients/emulsifying agents.
Small Animal/Exotics 20TH ANNIVERSARY
Humectants
Humectants act to rehydrate the skin by attracting
water from deep within the skin toward the surface.
These ingredients are non-oily. Examples include natu-
ral moisturizing factors (e.g., carboxylic acid, lactic
acid, urea), sodium lactate, propylene glycol, glycerin,
and polyvinylpyrrolidone.2
Emollients/Emulsifiers
Emollients and emulsifiers act by filling in the spaces
between keratinocytes with oil. Examples of emollients
include oils (e.g., almond, corn, cottonseed, coconut,
olive, peanut, persia, safflower, sesame), animal fats
(e.g., lanolin [sheep wool]), and hydrocarbons (e.g.,
mineral oil, paraffin, petrolatum2).
Emulsifiers are often added to emollient solutions to
help distribute the oils into a water solution; this makes
the oil solution more effective because it can spread
more evenly over the skin’s surface. Examples of emul-
sifiers include cetyl alcohol, laureth-5, lecithin, PEG-4
dilaurate, stearic acid, and stearyl alcohol.2
ANTIPRURITIC INGREDIENTS
Oatmeal and aloe vera are added to veterinary sham-
poos specifically for their antipruritic activities.18,19 The
antipruritic activity of other shampoo ingredients (dis-
cussed in the text and Table I) probably results from
antibacterial properties.2–4
Oatmeal
The use of oatmeal in topical preparations evolved
from its use in folk medicine, which advocates home-
made topical oatmeal preparations to soothe irritated
skin for as long as 2 days.18,20 The exact mechanism of
action is unknown, but one report suggests that oat-
meal inhibits prostaglandin biosynthesis.21
The only side effect reported with topical oatmeal
use is allergic contact dermatitis in humans.22 A recent
double-blinded study concluded, however, that topical
oatmeal did not induce allergic contact dermatitis in
normal or atopic children.23
Aloe Vera
The stabilized viscous juice from the inner part of
aloe vera leaves is used to produce topical preparations.
This juice has antipruritic, healing properties as well as
antibacterial and antifungal properties in vitro.19
Salicylic acid and magnesium lactate are the two
chemical compounds within topical aloe preparations
that produce its antipruritic effects.18 The mechanisms
of action of these ingredients differ. Salicylic acid in-
hibits the production of prostaglandin from arachidon-
ic acid by inhibiting cyclooxygenase,24 whereas magne-
SALICYLIC ACID ■ MAGNESIUM LACTATE ■ MICROVESICLES ■ CHITOSANIDE
Compendium January 1999
sium lactate has been shown to inhibit the conversion
of histidine to histamine in mast cells via an enzyme
called histidine carboxylase.25
Aloe vera is thought to produce its healing properties
by increasing dermal perfusion and decreasing inflam-
matory mediators (e.g., thromboxane, prostaglandin) in
burn lesions.18 The exact concentration necessary to
produce healing effects in a shampoo preparation is un-
known. Side effects include the production of an
eczematous, papular dermatitis in humans.26 Side ef-
fects from topical aloe vera use in animals have not
been documented.
RESIDUAL-EXTENDING INGREDIENTS
Novosomes®
Novosomes® (Evasco Pharmaceuticals, Buena, NJ)
are extremely stable, specially formulated nonphospho-
lipid microvesicles (i.e., a type of liposome) with five to
seven bilayers and a central holding area, 80% of which
is comprised of water and/or lipids.27 Novosomes® (ap-
proximately 5 µm in diameter) are not susceptible to
degradation by hydrolytic enzymes and are stable at
temperatures as high as 80˚C. They have increased re-
sistance to the autooxidative process when compared
with regular liposomes.27
The particle charge on Novosomes® is formulated to
tightly adhere to the skin and hair. The inner solution
within the cargo area is slowly released as the various
layers break down (requiring 7 to 10 days in average
temperature conditions).27
Spherulites®
Spherulites® (Allerderm/Virbac, Fort Worth, TX) are
composed of multiple layers (10 to 1000) of plant-de-
rived surfactants and are 1 µm in diameter. Spherulites®
contain chitosanide—a multipurpose glycoprotein de-
rived from chitin (crustacean shells)—which helps to
form a film coating over the skin and hair, as well as an
additional shampoo ingredient. Chitosanide also tightly
binds the Spherulites® to the hair and skin by providing
chemical differences in positive and negative charges.
The shampoo ingredient within the Spherulites® is slow-
ly released (over 8 days) as the different layers of the
Spherulite® break down. Moisturizing agents, essential
oils, and water- and fat-soluble vitamins can all be en-
capsulated in the same Spherulite®.28
CASE EXAMPLES
Case 1
Signalment and History
A 2-year-old, spayed female Chihuahua was presented
to the Texas Veterinary Medical Center with generalized
scaling and a 1-year history of nonseasonal moderate
Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

pruritus that was sometimes phyte test media cultures

present without dermatolog- were negative for dermato-
ic lesions. The patient was phytes. An intradermal skin
put on a food-elimination test had numerous positive
diet for 3 months using a reactions (grasses, weeds,
commercially prepared veni- trees, molds, and house dust
son and potato diet. No in- mites; Figure 2).
crease in pruritus was noted
when the original diet was Diagnosis and
reinstituted. Treatment
The diagnosis for this dog
Physical Examination was atopy and seborrhea sic-
Physical examination re- ca with a secondary bacterial
vealed multifocal areas of skin and ear infection. The
alopecia on the dog’s face, topical treatment used in
shoulders, legs, neck, and Figure 1—Alopecia, lichenification, and mild erythema on this case was a shampoo
ventrum (Figure 1). The skin the ventral cervical area of a dog. containing a chlorhexidine
was erythematous, licheni- and sulfur/salicylic acid
fied, and dry with moderate combination with a residu-
amounts of scale. Both ears al-extending agent (Novo-
were slightly erythematous somes®).
with a mild ceruminous dis- The antibacterial proper-
charge. ties of chlorhexidine were
beneficial for treating the
Differential Diagnoses pyoderma, the sulfur/salicylic
The main differential di- acid combination aided in
agnoses for this case were removing scale, and the
food hypersensitivity, aller- Novosomes ® extended the
gic dermatitis secondary to rehydrating properties of the
atopy, and allergic contact bath. Other appropriate
dermatitis. Other differen- choices for this case includ-
tial diagnoses included bac- Figure 2—Intradermal skin test reactions on the lateral thorax ed using a sulfur/salicylic
terial skin infection, fungal of a dog. acid and triclosan shampoo,
skin infection, demodicosis, an ethyl lactate shampoo
Malassezia dermatitis, and with a residual-extending
seborrhea sicca (primary or secondary). The degree of agent (Spherulites®), or a benzoyl peroxide shampoo
pruritus and distribution of lesions helped to eliminate with Novosomes®. A leave-on conditioner containing
scabies from the differential diagnosis list. Because pru- oatmeal and pramoxine was prescribed as a topical
ritus was not exacerbated on food rechallenge, a diag- agent to help relieve the pruritus; any of the topical
nosis of food allergy was less likely. The distribution of oatmeal conditioners or sprays would have been appro-
lesions and the history were not consistent with a diag- priate to use in this case. Other medications used in
nosis of contact allergy. Atopy was therefore the most this case included gentamicin sulfate otic (three drops
probable underlying cause for this case. The other dif- in both ears every 12 hours for 14 days), lincomycin
ferential diagnoses were ruled out with diagnostic tests. (22 mg/kg every 12 hours for 21 days), hyposensitiza-
tion vaccines, and hydroxyzine (2.2 mg/kg every 8
Diagnostic Tests hours for 14 days).
Several diagnostic tests were performed to reach the
diagnosis. Multiple skin scrapings were negative for ec- Case 2
toparasites. Impression smears of the skin revealed nu- Signalment and History
merous surface cocci around and within keratinocytes A 10-year-old, intact, male English springer spaniel
(more than 40 per high-power field). Ear-swab cytology was presented at the Texas Veterinary Medical Center
revealed inflammatory cells (neutrophils) and cocci with a 6-year history of oily, scaling, thickened skin
bacteria. Chlorphenolac preparations and dermato- with alopecia on the dorsum of all four feet, backs of

FOOD-ELIMINATION DIET ■ SKIN SCRAPINGS ■ CYTOLOGY ■ ATOPY

Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

the ears, caudal thighs, and biopsy showed evidence

lateral thorax. This derma- of superficial pyoderma
tologic condition was mildly with an underlying allergy.
pruritic and nonseasonal. The complete blood count
Previous treatment included showed evidence of eosino-
oral and injectable steroids, philia, which was thought
various antibiotics, and ke- to be associated with an in-
toconazole (unknown dose ternal or external parasite
and frequency). According load; however, a fecal exami-
to the owner, steroids, nation and occult heart-
cephalexin, and ketocona- worm test were negative for
zole had somewhat im- parasites. The urinalysis had
proved the dog’s condition abnormal amounts of bacte-
in the past. The dog was fed ria, and neutrophils revealed
a commercially prepared Figure 3—Alopecia, lichenification, erythema, crust, and scale cystitis.
along the back of the left pinna of a dog.
lamb and rice diet.
Diagnosis and
Physical Examination Treatment
Physical examination re- The diagnosis for this
vealed several dermatologic dog was seborrhea oleosa,
abnormalities, including allergic dermatitis, and oti-
alopecia, erythema, licheni- tis externa with a secondary
fication, excess scale, and bacterial skin infection. Top-
some crusts on the face, ical therapy consisted of
caudal aspect of both pinnae twice-weekly baths with a
(Figure 3), ventral neck and benzoyl peroxide shampoo
ventrum, and extremities followed by a leave-on
(especially the stifles and chlorhexidine cream rinse
dorsum of the feet; Figure for the superficial pyoder-
4). The canals of both ears ma. Benzoyl peroxide was
were erythematous with a chosen in this case because
ceruminous discharge. Figure 4—Alopecia, lichenification, erythema, and excoriation on the dog had oily skin with a
the left lateral stifle of a dog. secondary infection. (A 2%
Differential Diagnoses tar shampoo would be an
Several differential diagnoses were considered, in- appropriate alternative therapy because it is also a
cluding allergic dermatitis (e.g., food allergy, atopy, good degreasing agent.) A chlorhexidine leave-on con-
contact allergy, flea hypersensitivity), ectoparasites (e.g., ditioner was selected because it rehydrates the skin
scabies, demodicosis), and a secondary skin infection and provides some secondary residual antibacterial ef-
(e.g., bacterial, fungal). Although the ears and stifle ar- fects. Any moisturizing agent would be appropriate
eas were involved, the possibility of scabies was low be- and was considered necessary because benzoyl perox-
cause pruritus was mild and the condition was present ide tends to be drying. The otitis externa was treated
for a relatively short time (6 years). with gentamicin sulfate otic (three drops every 12
hours for 14 days). A commercially prepared duck
Diagnostic Tests and potato diet was prescribed for an 8-week elimina-
Multiple skin scrapings were negative for ectopara- tion diet.
sites. Impression smears of the skin and crust revealed The dog was markedly improved at the end of the 8-
numerous cocci and some neutrophils and macro- week food trial (pruritus decreased more than 50%). At
phages (more than 30 per high-power field). Numerous the conclusion of the trial, rechallenge with the dog’s
cocci bacteria and neutrophils were noted on the ear- old food confirmed food allergy (pruritus increased
swab cytology. Otoscopic examination of both ears re- more than 50% within several days of food rechal-
vealed patent ears with intact tympanic membranes. lenge). Challenging the dog with individual food ingre-
Chlorphenolac preparation and dermatophyte test me- dients revealed allergies to beef, egg, wheat, soy, and
dia cultures were negative for dermatophytes. Skin chicken.

CHLORPHENOLAC PREPARATION ■ EOSINOPHILIA ■ FOOD ALLERGY

Compendium January 1999 20TH ANNIVERSARY
DISCUSSION
Both of the patients discussed in the case examples
had bacterial pyoderma and allergy, but they were treat-
ed with different topical therapies because their skin
and hair had different tactile properties. The dog in the
first case had dry scale that required a moisturizing ker-
atolytic and keratoplastic agent, whereas the second
dog had oily scale requiring a degreasing and keratolyt-
ic agent. The main complaint of the first dog’s owner
was pruritus, thus a leave-on oatmeal with pramoxine
conditioner was selected. The history of pruritus with-
out any evidence of dermatologic lesions suggested that
allergy was a reasonable differential diagnosis.
The haircoat and skin of the second dog were oily
and the dog was mildly pruritic, thus a degreasing
shampoo (benzoyl peroxide) and leave-on chlorhexi-
dine conditioner were considered appropriate therapy.
Systemic antibiotics were used in addition to the topi-
cal therapy to treat the skin infection. Recheck visits
help determine whether antibiotics have been adminis-
tered for an appropriate length of time (minimum of 3
weeks). As in the first case, the dog in case 2 was still
pruritic even though the pyoderma was cleared. This
clinical information along with the biopsy results indi-
cated that food allergy was a reasonable differential di-
agnostic concern.
These cases demonstrate that tactile and visual find-
ings, cytology results, and the owners’ primary concerns
should be considered when selecting topical therapy to
maximize a patient’s chance of benefiting from it. As
was done in these cases, owners should also be in-
formed that their pets’ skin condition could change
with time and thus a shampoo or conditioner that was
once appropriate may not be in the future. Finally,
these cases demonstrate that more than one topical
therapy may be appropriate for a particular patient.
About the Author
Dr. Rees is affiliated with the Department of Small Animal
Medicine and Surgery, College of Veterinary Medicine,
Texas A&M University, College Station, Texas. She is a
Diplomate of the American College of Veterinary Derma-
tology.
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