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SUMMARY: ROYAL CANIN Veterinary Diet^TM/MC canine SKIN SUPPORT SS 21^TM/MC is a complete and balanced diet for adult dogs that has been specifically formatted to aid the management of dogs with allergic skin diseases (atopy, flea bite hypersensitivity, contact allergy), and to help promote recovery from skin disease. SKIN SUPPORT SS 21^TM/MC is a selected protein diet supplemented with Aloe Vera gel, curcumin, vitamin C, taurine, and omega-3 fatty acids.

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RATIONALE:
Allergic skin disease is one of the most common skin problems presented to veterinarians. Causes of allergic skin disease in dogs include atopy, flea-bite hypersensitivity, food hypersensitivity, and contact allergy. The most common manifestation of atopy is a non-seasonal pruritus with erythema and papular eruption. In most cases, secondary lesions and dermatoses such as Malassezia and bacterial pyoderma predominate.

SKIN SUPPORT SS 21^TM/MC has been specifically designed to assist the management of allergic skin diseases by controlling inflammation, reducing pruritus, minimizing secondary bacterial infections, optimizing an effective skin barrier, and promoting the recovery of skin.

Atopy refers to a genetic pruritic dermatitis in which the patient becomes sensitized to antigens. Atopy is a type I hypersensitivity reaction in which inhaled, ingested or absorbed allergens present to antigen presenting cells in the skin and provoke allergen-specific IgE, and less commonly, IgG antibody production. The IgE antibodies bind to and sensitize mast cells. Following re-exposure to the offending allergen, the mast cells degranulate and release mediators and cytokines such as histamine, prostaglandins and leukotrienes and the development of pruritus and cutaneous inflammation.

Treatment requires identification of the offending allergen and subsequent immunotherapy. Immunotherapy typically provides relief to 40% of patients. The remaining patients require symptomatic relief to minimize clinical signs.

The skin provides a barrier to protect the body from potentially damaging environmental influences including contact with allergens. The cornified stratum corneum plays the principal role of barrier defense. The stratum corneum consists of protein rich corneocytes held together with a lipid matrix consisting of fatty acids, sterols and ceramides, analogous to bricks and mortar.

In terms of barrier function, Ceramide-1 is thought to be a key component. Ceramide-1 contains linoleic acid and it is in this respect that linoleic acid is believed to play a crucial role in barrier function of the skin. In addition, Waltham Science has shown that enhancing the diet with a synergistic combination of nicotinamide, pantothenic acid, histidine, choline, and inositol increases the synthesis of ceramides and lipids. When fed to dogs, this combination of nutrients was shown to significantly decrease the trans-epidermal water loss (TEWL) compared to a control diet. TEWL describes the total amount of water lost through the skin, a loss that occurs via passive diffusion through the epidermis. TEWL is commonly used to assess skin barrier function and an elevated TEWL is generally regarded as an indicator of compromised barrier function. The data from this study suggests that inclusion of the supplemental levels of nutrients in the diet resulted in improved barrier function in the dogs.

With respect to skin disease, both long chain omega-3 fatty acids and omega-6 fatty acids are anti-inflammatory however the mechanisms of action are different.

The anti-inflammatory effect of the omega-6 fatty acids is related to the synthesis of dihomo-zeta-linolenic acid (DGLA) from dietary GLA (found in high concentrations in borage oil). DGLA can be converted to the less inflammatory PGE1, and to a potent anti-inflammatory hydroxy fatty acid that blocks the lipoxygenase pathway.

Long chain omega-3 fatty acids, such as eicosapentaenoic and docosahexaenoic acid, directly compete with arachidonic acid for the lipoxygenase and cycloxygenase enzymes. Subsequent metabolism of eicosapentaenoic acid generates less inflammatory mediators such as LTB5, and PGE3 compared to the metabolism of arachidonic acids. In addition, the metabolism of eicosapentaenoic acid produces hydroxy fatty acids that block the production of LTB4, a potent chemotatic factor, from arachidonic acids.

The skin needs a local and sufficient supply of key nutrients to optimize skin healing. These nutrients are needed to meet the energy demands of cellular proliferation, migration, phagocytes and the production of matrix, connective, endothelial, and epithelial tissues.

The diet for allergic dogs should thus meet the normal requirements for protein, fat, carbohydrate, vitamins, and minerals. In addition, zinc, vitamin A, and vitamin C have been shown to have specific roles in skin healing by stimulating collagen synthesis, improving immune function and promoting tissue recovery after damage. Therefore, SKIN SUPPORT SS 21^TM/MC has been enriched with zinc, vitamin A, and vitamin C to promote skin recovery.

It has been suggested that there is a threshold for pruritus and for the development of atopic dermatitis. The concept of a threshold relates to the presence of multiple stimuli that contribute to the development of clinical symptomology. The theory hypothesizes that the pet is able to tolerate a given stimulus, and only manifests clinical disease once that threshold is exceeded. The threshold may be obtained more rapidly when multiple stimuli are acting in concert. Likewise, it has been suggested that there is an allergen threshold such that there are no clinical signs with a low allergen load. Conversely a high allergen load will trigger clinical disease. Furthermore, atopic dogs have a greater risk of developing additional hypersensitivities including flea bite hypersensitivity, Staphylococcal hypersensitivity, and food hypersensitivity. Hence the management of the atopic dog should be designed to minimize the allergen load and to control occult food hypersensitivity.

Studies have shown that feeding a selected protein diet can result in significant clinical improvement in dogs with atopy and reduce their requirements for anti-inflammatory drugs. Control of concurrent food hypersensitivity may cause the pet to better tolerate the offending antigen triggering atopic dermatitis. SKIN SUPPORT SS 21^TM/MC has been designed using protein sources of Menhaden fish meal and rice which are rarely associated with food hypersensitivity in dogs.

Antioxidants such as beta-carotene, Vitamin E, taurine and vitamin C have been reported to improve the immune response in healthy dogs and cats, and hence may have application for the management of the atopic pet. In addition, Vitamin E has been reported to decrease the production and release of inflammatory mediators by mast cells.

Aloe Vera gel contains pharmacologically active ingredients such as carboxypeptidase, salicylic acid, magnesium lactate, and mannose-6-phosphate. These components have been shown to have an anti-inflammatory, anti-pruritic, anti-bacterial, and analgesic effect. Aloe Vera inhibits thromboxane A2 synthetase (a potent vasoconstrictor). This effect can increase blood flow to injured areas to stimulate wound healing and promote skin recovery.

Curcumin, an extract of tumeric, has been shown to have an anti-inflammatory effect by modulating cytokine and eicosanoid production, decreasing mast cell degranulation and inhibiting the release of oxygen derived free radicals.

A blinded cross-over study was performed to evaluate the effect of SKIN SUPPORT SS 21^TM/MC in atopic dogs. Atopy was confirmed in 19 dogs on the basis of history, clinical signs, laboratory tests, positive intradermal skin test, and a negative response to an elimination diet. Dogs were randomized to receive either a control diet or SKIN SUPPORT SS 21^TM/MC for 12 weeks, followed by crossover to the alternative diet.

Structured, regional evaluations of erythema, lichenification, excoriation, and alopecia were conducted at baseline and subsequently at four week intervals. Severity was assessed using a four-point score. Summation of values provided a total clinical score for each dog at each time point. SKIN SUPPORT SS 21^TM/MC was associated with a significant improvement in total clinical scores compared to the control diet. The results of this study suggest that SKIN SUPPORT SS 21^TM/MC is clinically indicated to aid the management of canine atopy.

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REFERENCES:
Watson A, Fray T, Clarke S, et al. Reliable use of the ServoMed Evaporimeter EP-2TM to assess transepidermal water loss in the canine. J Nutr 2002;132:1661S-1664S.

Watson A, Fray T, Clarke S, et al. The influence of chronological age on barrier function properties of the dog epidermis. Proceedings of the Waltham International Symposium: 2002, p27.

Watson A, Fray T, Clarke S, et al. The use of the ServoMed EP-2 Evaporimeter to measure the transepidermal water loss (TEWL) in canine skin. Proceedings of the Waltham International Symposium: 2002 p35.

Watson A, Baker C, Bailey J, et al. Dietary constituents can increase epidermal lipid synthesis by canine keratinocytes in vitro. Proceedings of the Waltham International Science Symposium, 2003, Bangkok, Thailand p10.

Watson A, Baker C, Bailey J, et al. Dietary constituents can improve canine epidermal barrier function in vitro. Proceedings of the Waltham International Science Symposium, Bangkok, Thailand. 2003, p11.

Markwell PJ, Svoboda M, Fray T. Dietary intervention can improve clinical signs in dogs with atopy. Proceedings of the Waltham International Science Symposium, Bangkok, Thailand. 2003, p21.

Watson A, Fray T, and Markwell P. Analysis and characterization of sebaceous and ceramide lipids of canine skin. Proceedings of the Waltham International Science Symposium, Bangkok, Thailand. 2003, p31.

Fray TR, Watson AL, Baker CD, et al. Effects of a novel ingredient blend on canine fibroblast migration and cutaneous barrier function in vitro. Proceedings of the Waltham International Science Symposium, Bangkok, Thailand. 2003, p36.

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