The number of yeast organisms seen in cytology should not guide the treatment of a Malassezia skin infection. One can be tempted to use only topical therapy if there is a few yeast on cytology, but those few yeasts on a particular patient may be enough to cause a significant amount of itchiness.
My recommendation is to take into consideration the pet’s level of itchiness and the extent and severity of the infection to make your decision on how to treat the yeast infection. Systemic antifungals in combination with a topical antifungal will make the patient feel relief much faster.
Systemic antifungals to consider using are the azole drugs like ketoconazole, itraconazole and fluconazole. Terbinafine is another option as well. Antifungal ingredients to look for in topicals are miconazole, ketoconazole, climbazole, clotrimazole and selenium sulfide. Selenium sulfide is found in Selsun Blue shampoo, but caution that this ingredient can also be drying to the skin. Chlorhexidine also has antifungal properties, but this works best at greater than 2% for Malassezia.
Topical antifungals come in a variety of forms: shampoos, leave ons, sprays, mousses, wipes, and creams/ointments. My preference for topical treatment of Malassezia is using shampoos. Malassezia is an organism that is superficial on the skin and bathing a dog with a shampoo that has antifungal ingredient will help remove the infection better.
And finally, it is important to control or resolve the underlying cause for the yeast infection. Allergies to food or environmental (atopy) are the main causes. However, endocrine, or hormonal disorders like hypothyroidism is another. If the underlying cause is not addressed, then there will be a reoccurrence of the Malassezia infection.
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