Letters to the Editor
To: Editors of Veterinary Dermatology
for descriptions of the human disease and its treatment.
The article in the August 2008 issue of Veterinary Der-
This does not negate the possible benefits for canine
matology by Dr Ural and colleagues: ‘Azithromycin therapy
papillomatosis reported by the publication, but I think it is
of papillomatosis in dogs: a prospective, randomized,
helpful to be clear regarding the comparison of a poorly
double-blinded, placebo-controlled clinical trial’, stated that
understood keratinization defect in humans to papilloma-
azithromycin is used for the treatment of ‘human papillo-
matosis’. This was then used as the basis of a clinical trial
of the drug for ‘canine papillomatosis’. The articles fromhuman journals that the publication referenced were in fact
referring to ‘Confluent and reticulated papillomatosis’ of
Long Green Animal Dermatology Center, P.C.
Gougerot and Carteaud. This is a rare ichthyosiform
dermatosis of humans of unknown aetiology. Responsive-
ness to various antimicrobials (including azithromycin,
minocycline, clarithromycin, etc.) has been reported, and
there is a theory that the disease is caused by an abnormalresponse to infection. The ‘papillomatous’ nature of thedisease refers specifically to its histopathological appearance,
References
not to its gross clinical appearance or a viral aetiology.
1. Fitzpatrick’s Dermatology in General Medicine. 6th Edition, 2003,
Please refer to Fitzpatrick’s Dermatology in General
Medicine1 and Rook Wilkinson Ebling Textbook of
2. Rook/ Wilkinson/Ebling Textbook of Dermatology. 5th Edition,
Dermatology2 as well as the articles cited in the publication
it is well known that histological examination of CRP
We are delighted that so many veterinarians read and
showed evidence of hyperkeratosis, acanthosis and
some of them comment on our article (Vet Dermatol.,
papillomatosis, mimicking some of the histopathological
2008, 19: 194–198). The present authors involved in this
changes we showed in our study. However, this was not
study were specialists in veterinary internal medicine,
the starting point of our study. Many treatment options
indeed are not pathologists, and our goal was to validate
have been used for CRP; and azithromycin has been sug-
therapeutic armamentarium regarding papillomatosis.
gested as a single uniformly effective agent. Given the
However, we are currently besieged with questions on the
efficacy of azithromycin therapy in CRP, we hypothesized
value of the efficacy of azithromycin on canine papilloma-
that azithromycin may also be beneficial in canine
tosis. Dr. Bernstein had some concerns. He stated that
papillomatosis. In addition our study was not an aetiological
the present study was based on azithromycin therapy of
study, as we mentioned above, we designed and detailed
human papillomatosis, and that there are significant differ-
an azithromycin therapeutic protocol and placebo, and
ences between canine papillomatosis and confluent and
The beneficial effect of azithromycin in our study is in
Nowhere in our article did we “lead readers into believ-
keeping with the therapeutic inflammatory potential effect
ing” anything about the similarities between human pap-
of azithromycin reported on CRP. All treated cases showed
illomatosis and canine papillomatosis in general. It should
satisfactory results in response to an azithromycin therapy,
also be mentioned that we did not compare CRP or human
suggesting that azithromycin therapy may be a useful
papillomatosis with canine papillomatosis. We did indicate
choice in canine papillomatosis. Azithromycin may help to
that the efficacy of azithromycin in CRP in human medi-
eradicate an unknown organism involved in predisposition
cine is discussed in many studies with satisfactory results,
to canine papillomatosis or it may be that it could help to
which are “largely proven’’. Dr. Bernstein correctly stated
suppress an autoimmune phenomenon leading to formation
in his letter that CRP is a disorder of keratinization. There
of canine papillomatosis, similarly to CRP cases in humans.
are differences between CRP and canine papillomatosis,as was also mentioned by Dr. Bernstein. CRP remains a
diagnosis of unknown aetiology, with theories suggesting
The Ministry of Agriculture and Rural Affairs,
that this condition might be the result of an exaggerated
Board of High Stewards, Ankara, Turkey
response to fungi or a disorder of keratinization. However,
Faculty of Veterinary Medicine, Kirikkale University,
Correspondence: Dr Kerem Ural, E-mail: [email protected]
2009 The Author. Journal compilation 2009 ESVD and ACVD. 20; 83
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