Vde(02)_734.fm

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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