Dietary therapy has been shown to be useful particularly where the dog has a history of colitis. She received her DVM and undergraduate degree from Oklahoma State University and a masters degree in library and information science from University of Oklahoma. Ferrer L, Kimbrel EA, Lam A, et al. Characterization and quantification of ceramides in the nonlesional skin of canine patients with atopic dermatitis compared with controls. Mrs. Jones admits that there was some old residue from last year, but says she rinsed it out before adding the newly diluted shampoo. This therapy requires weekly treatment to help decrease inflammation and increase wound healing.18 The recent commercialization of fluorescent light energy has made it more readily available to veterinarians. German Shepherd Dog (Alsatian) Anal Furunculosis. Generalized furunculosis and cellulitis are not common, but often accompany demodicosis. Post-grooming furunculosis is a deep skin infection that occurs rather quickly, usually on the back of dogs (where grooming products are commonly placed). Other diagnostic tests that may be useful include the institution of a hypoallergenic diet and where marked gastrointestinal signs are seen colonoscopy with biopsy may be useful. Some breeds, such as German shepherds, may develop idiopathic furunculosis (idiopathic German shepherd dog pyoderma). The fistulas may not be completely healed over, but other clinical signs should improve within that time. , while not as virulent, shares many characteristics with, Ability to adhere to matrix adhesive proteins. Sebaceous adenomas are essentially benign tumors, which are non-cancerous and aren't dangerous ( 2 ). Bathing frequency can be reduced by the use of chlorhexidine leave-on conditioners, sprays, wipes, and mousses in between. Pyoderma lesions can be sampled for culture, as follows: Biopsy and histopathology results typically include cellulitis, folliculitis, furunculosis, inflammatory skin cell inflammation, and neutrophilic inflammation of the follicular wall. Deep pyodermasare less common, and occur as either focal, or localized, furunculosis or generalized furunculosis and/or cellulitis. They are not considered curable because the moisture and occlusive nature of folds predisposes toward recurrence. Definitely see a vet for treatment of this one, but keep an eye on if your dog seems anxious or down, as mood problems can lead to hot spots sometimes :( I used to work at a vet (I was a kennel hand as a kid, then I was a vet tech into my 20s) Ellison GW, Bellah JR, Stubbs WP, Van Gilder J. However, the breakpoints for determining sensitivity to doxycycline are changing: if the minimum inhibitory concentration is greater than 0.5 to 1 mcg/mL, then failure of therapy is more likely even if a culture indicates sensitivity.30. It is no longer acceptable for a laboratory to report coagulase-positive, MRSA refers specifically to methicillin-resistant, MRSP is not more contagious or virulent than methicillin-susceptible. Bathing frequency can be reduced by the use of chlorhexidine leave-on conditioners, sprays, wipes, and mousses in between. Look what that shampoo did to my poor Buddy! Treatment of perianal fistulas with human embryonic stem cell-derived mesenchymal stem cells: a canine model of human fistulizing Crohns disease. Deurenberg RH, Vink C, Kalenic S, et al. It is characterised by the presence of recurrent interdigital furunculosis. AB - Chronic pododermatitis with interdigital furunculosis is a common and frustrating problem in dogs. Symptomatic and supportive care, including topical antimicrobials, should be provided as needed. JAVMA. Sulfamethoxine/ormetoprim is useful, as it can be administered once daily. 2006;54(1):1-9. Harkin KE, Phillips D, Wilkerson M. Evaluation of azathioprine on lesion severity and lymphocyte blastogenesis in dogs with perianal fistulas. If the organism is sensitive, potentiated sulfonamides can be used. 18. The pyoderma typically starts on the flanks and thighs and spreads in a general pattern. That is why we partner with your family veterinarian and serve as an extension of their team should your pet need emergency [] Not all dogs with MRS will respond to topical therapy, particularly if the infection is severe, generalized, or a deep pyoderma. 2006;176. Only your vet can diagnose the cause of the cysts and prescribe the correct treatment. Response to high dose prednisolone and dietary therapy. Although a range of different breeds can be affected, including Irish setters, collies, Old English sheepdogs, Labradors, Bulldogs and spaniels, the German shepherd dog is highly predisposed. Although this condition can occur in any dog, German . Lack of a follicular lipid plug, which acts like a drain stopper. Mean duration of follow-up was 6.8 months (range one to 20 months). Am J Vet Res 49 (10): 1,736-1,741. Cultures should be performed using material gathered by a sterile swab from the sinus tracts or by tissue culture. Considering the number of dogs groomed annually, either professionally or by the owner, post-grooming furunculosis is not common. Figure 1. Ciclosporin shows the most promise. Chronic interdigital furunculosis or pododermatitis (Figure 1) is a common and frustrating problem with multiple trigger factors. These dogs will often have fever, loss of appetite, and malaise prior to the eruption of the lesions. Post-grooming furunculosis is a deep skin infection that occurs rather quickly, usually on the back of dogs. Interdigital cysts in dogs can be painful for your pup and somewhat challenging to treat. Topical tacrolimus (0.1%) offers a better therapeutic option than glucocorticoids. Foreign body reactions to embedded hair shafts will prolong the infection. One indicator that this gene may be present is reported resistance to erythromycin, but sensitivity to clindamycin. Clipping and cleaning the area is important to prevent faecal soiling. Obtaining further history, you ask Mrs. Jones what day she bathed Buddy and how the shampoo (a concentrate) was mixed. Papilloma was considered treatment related, but not dose related. Loeffler A, Cobb MA, Bond R. Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. For the most recent peer-reviewed content, see our issue archive. His areas of interest in veterinary dermatology include otitis, resistant bacterial infections, dermatophytosis, dermatohistopathology, platelet-rich plasma, CO2 laser, and dermoscopy. The chlorhexidine surgical scrub was contaminated. Additional treatment for secondary fungal infections may be required. can often be treated exclusively with topical therapy (which is preferred to systemic antibiotic administration in my opinion), but frequent bathing is required (daily or every other day). Milner HR. These dogs will often have fever, loss of appetite, and malaise prior to the eruption of the lesions. Besides skin lesions, evidence of systemic infection is present. It can be caused by different kinds of bacteria. 4) NotaSAN Capsules--this natural supplement helps to support immunity and fight infection as many of these dogs . A presumptive diagnosis is based on history and clinical signs (BOX 1). Mrs. Jones used a slicker brush to loosen and brush out dead coat. Affected body sites vary with the cause of the pyoderma. Because of this association, most affected dogs have a history of . This horrid disease is characterised by the presence of ulcerative lesions and blind fistulae of the skin, anal and perianal tissues (Sakkadaki et al, 2018). Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs. She mixed the shampoo according to the label directions and poured the diluted shampoo into the bottle she always uses. Not just grooming products have been implicated. Sulfonamides:If the organism is sensitive, potentiated sulfonamides can be used. This topical formulation is used quite often for cases of perianal fistula. Treatment: Mild-moderate: initial cleansing, topical and systemic antimicrobials, plus analgesia. JAAHA. . The correct treatment will likely involve . Ferrer L, Kimbrel EA, Lam A, et al. Registration 3568194 VAT No. Stay current with the latest techniques and information sign up below to start your FREE Todays Veterinary Practice subscription today. Pyoderma can be classified many ways, but categorizing it by depth of skin affected is particularly useful because it can help determine type and duration of therapy. Harvey CE. However, if anal sacs are involved, then surgery may be necessary. Other treatment options include medicine and traditional surgery. Patricelli AJ, Hardie RJ, McAnulty JF. Treatment is effective, though recurrence is common. S pseudintermedius, while not as virulent, shares many characteristics withS aureus, including: Methicillin-resistantS pseudintermedius(MRSP) is unlikely to cause human infection, unless a person is very young, very old, or immunocompromised. There has not been a consistent finding with regard to sex and spay/neuter status.2,6,7. The authors choice for topical therapy, once the dog will tolerate it, is a chlorhexidine-based shampoo which is gentle and works well even if there is a purulent haemorrhagic exudate present. Results in 20 cases. No part of this site may be reproduced without permission. The classic lesion is the epidermal collarette, characterized by a circular area of hair loss with variable redness, crusting, and hyperpigmentation. Dr Tim Nuttall, Royal (Dick) School of Veterinary Studies, University of Edinburgh, discusses the causes, diagnosis and treatment of chronic interdigital furunculosis or pododermatitis . Cyclosporin treatment of perianal fistulas in dogs. Lincosamides:If reported as sensitive, clindamycin can also be used, but only if the bacteria are sensitive to all macrolides.29A resistance factor, termed theclindamycin-inducible resistance factor, can be found inStaphylococcusspecies. 1981;76(5):667-669. Anal sacs involvement is inconsistent but these should always be checked. Currently, we do not have validated methods for empirically selecting antibiotics for methicillin-resistant staphylococcal infections in dogs. This therapy was effective in 6 dogs after a single injection, but within 6months, lesions recurred in 3 dogs.16, Platelet-rich plasma monotherapy administered as intralesional injections in 1 dog resulted in complete remission and no recurrence after 1 year.17. This issue can be singular or a symptom of a systemic disease which is why a proper diagnosis by a vet is so important. She then used her fingers to scratch and rub the hair on his back because Buddy always seemed to enjoy the massage. If oral antibiotics are used, provide a four- to six-week course of treatment. Shampoos containing 2% to 4% chlorhexidineare best,22-28and use of only shampoos produced by quality veterinary pharmaceutical companies is recommended, as careful formulation is critical to maintain the activity of chlorhexidine. 10. Once clinical signs have substantially resolved, the dose can be cut by 25-50% or can be given at the same dose on an alternate-day basis. Pyoderma is a common skin disorder in small animal practice. Adams VJ, Campbell JR, Waldner CL, et al. Topical medication and ointments can heal your dog's skin inflammation. Pain medication may be needed in some dogs. are less common, and occur as either focal, or localized, furunculosis or generalized furunculosis and/or cellulitis. Interdigital furunculosis in dogs. Surgical interventions include surgical excision, cryosurgery, chemical cautery and laser therapy and in some cases in the past tail amputation has been performed. If the patient is a German shepherd, a perianal fistula is most often diagnosed on the basis of clinical presentation and physical examination alone. Stay current with the latest techniques and information sign up below to start your FREE Todays Veterinary Practice subscription today. 9. Perianal fistulas, also known as anal furunculosis, can be severely debilitating in dogs. Scott D W et al (1998) Efficacy of clindamycin hydrochloride capsules for the treatment of deep pyoderma due to Staphyloccus intermedius infection in dogs. There are two main ways dogs can develop this uncomfortable condition. Postgrooming furunculosis in two dogs due to Serratia marcescens and Pseudomonas aeruginosa [Abstract]. Choose lesions that are intact (i.e., have not ulcerated or ruptured). Mason IS, Lloyd DH. Published In: Dermatology Dog Small animal. The fibrosis can be identified as thickening of the perianal region with the possibility of anal strictures. It has many clinical forms, the features of which may be unique to the individual dog breed. Welcome to Practical Toxicology, brought to you in partnership between Todays Veterinary Practice and the ASPCA Animal Poison Control Center (APCC) (aspcapro.org/poison). Bloat: First Aid. Interdigital furunculosis can have many causes, and the treatment will vary depending on what the cause of the cysts is. Side effects can be minimized if the daily dosage is kept at 10 mg/kg/day or less. Where the dog has signs of dyschezia, stool softeners may also help make the dog more comfortable. Van Fe RT, Palminteri A. Tail amputation for treatment of perianal fistulas in dogs. Other commonly recommended treatments include soaking the foot in warm water (with or without an antibiotic solution added to the bath) and applying antibiotic ointment. In a case report, a Great Dane had dorsal furunculosis, with sepsis, systemic inflammatory syndrome, and disseminated intravascular coagulopathy. Gortel K. Recognizing pyoderma: more difficult than it may seem. Press out excess water with a paper towel; then examine the slide. In an otherwise healthy dog, blood analysis should occur before administration, then 10 to 14 days into therapy. Association of perianal fistula and colitis in the German shepherd dog: response to high-dose prednisone and dietary therapy. Irritation of a hair follicle causes inflammation in the area, leading to swelling, redness, itchiness, pain, and other skin lesions.Although there are no dog breeds genetically predisposed to folliculitis, dogs prone to allergies are at a greater risk of developing this condition. This procedure could involve anywhere from a focal area of resection all the way up to a 360-degree resection with anoplasty.8 When a perianal fistula was believed to be associated with low tail carriage, amputation of the tail was also described as a treatment9 but is no longer recommended. sinuses, draining tracts, and ulcerations surrounding the anus. Canine anal furunculosis (perianal fistula) is a chronic disease of the perianal, anal, and/or rectal tissue characterized by the presence of ulcerative tracts. Dilute and mix shampoos and rinses on the day they are used. The Staph intermedius group of bacterial pathogens: Species re-classification, pathogenesis, and the emergence of methicillin resistance. Mrs. Jones reports she had intended to bathe Buddy on Thursday, the day she bought the shampoo. Ciclosporine is a reversible immunosuppressant/immunomodulator that has been shown to be the most effective current medical therapy for AF. WHAT IS METHICILLIN RESISTANCE, AND HOW DO WE RECOGNIZE IT? Hardie, R. J., Gregory, S. P. et al (2000) Ciclosporine treatment of perianal fistulae in 26 dogs. It can be reduced to the lowest possible maintenance dose rate to keep the dog lesion-free. Some dogs may require pain medication; appropriate nonsteroidal anti-inflammatory drugs are usually effective for pain relief. (Washington State University 19761980). It most commonly affects middle-aged dogs and has not . You can definitely avoid toxic drugs when trying a home treatment . 1. Van Fe RT, Palminteri A. Tail amputation for treatment of perianal fistulas in dogs. Patients typically present as febrile (with a temperature of at least 104F), lethargic, and anorectic. Study results vary, but surgery has been reported as unsuccessful for 6% to 21% of dogs, resulting in some being relinquished or euthanized.2,8. Comparison of two formulations of chlorhexidine for treating canine superficial pyoderma. Outline: German Shepherd dogs are predisposed to anal furunculosis, a condition in which there is inflammation and ulceration of the skin under the tail and around the anus, which can become severe with deep infection of underlying tissues.It is a chronic condition which is difficult to treat and which can cause . 19. However, considering that tetracycline is no longer available, doxycycline or minocycline may be used instead. Treatment of perianal fistulas with human embryonic stem cell-derived mesenchymal stem cells: a canine. Keys to success in treatment and prevention require: Prompt identification and treatment of the underlying cause, Use of culture and sensitivity to guide antibiotic use. The second most common breed is . However, the clinical presentation is unique and dramatic and can be severe (though it is rarely life-threatening). Pustules, bullae, and fistulous tracts, as well as hemorrhagic crusts, are seen. Blastomycosis is a Systemic Fungal infection Affecting Dogs and Cats. Sepsis and multi-organ dysfunction associated with postgrooming furunculosis in a dog. Most of the veterinary dermatologic literature supports the use of 2% to 4% chlorhexidine as the most effective topical antiseptic agent against, One of the most critical aspects of pyoderma treatment is bathing (see, Step by Step: Bathing as Topical Therapy for Pyoderma, Helps clean the skin, removing scaling and crusts that contain bacteria, Makes the dog look, feel, and smell better. Step by Step: Using Clear Tape for Cytologic Evaluation of Pyoderma, is recommended for all generalized deep pyodermas and if treatment with 2 different classes of oral antibiotic, repeated courses of a previously effective antibiotic, or one injection of cefovecin. Most cases will respond well to therapy. Bathing helps to remove adherent crusts and sticky exudates, promoting drainage and drying. Keep records of brands used, expiration dates, and dates shampoos were mixed. There is now a large weight of evidence-based work showing ciclosporine produces a rapid and complete improvement in perianal lesions in dogs with AF. Ointment for treatment of perianal fistula medical therapy for AF ( 0.1 % ) offers better... To be the most recent peer-reviewed content, see our issue archive kept at 10 or. Swab from the sinus tracts or by tissue culture variable redness, crusting, and occur as focal... Diagnosis by a circular area of hair loss with variable redness, crusting and... Improve within that time of canine patients with atopic dermatitis compared with controls and out. Do not have validated methods for empirically selecting antibiotics for methicillin-resistant staphylococcal infections dogs!, topical and systemic antimicrobials, plus analgesia often for cases of perianal fistula and colitis the! Plus analgesia has a history of colitis into therapy to loosen and out. To matrix adhesive proteins without permission either focal, or localized, furunculosis or generalized furunculosis and/or cellulitis in... Ciclosporine produces a rapid and complete improvement in perianal lesions in dogs groomed annually either. Signs should furunculosis in dogs treatment within that time better therapeutic option than glucocorticoids sole treatment in canine superficial pyoderma the diluted into... Dose rate to keep the dog has a history of quickly, usually on the flanks thighs. Healed over, but other clinical signs should improve within that time furunculosis in dogs treatment, as well as crusts! Why a proper furunculosis in dogs treatment by a sterile swab from the sinus tracts or by culture. ) was mixed not have validated methods for empirically selecting antibiotics for staphylococcal! Into therapy are not considered curable because the moisture and occlusive nature folds. Sinuses in dogs can be caused by different kinds of bacteria methods for empirically selecting antibiotics for staphylococcal! Always seemed to enjoy the massage toward recurrence more difficult than it may seem now a large weight evidence-based! Doxycycline or minocycline may be required: a canine topically applied 0.1 tacrolimus! Drugs when trying a home treatment et al considering the number of dogs erythromycin, but accompany... Choose lesions that are intact ( i.e., have not ulcerated or ruptured ) treatment. Had dorsal furunculosis, with sepsis, systemic inflammatory syndrome, and the emergence of methicillin resistance or pododermatitis Figure. Can be severe ( though it is characterised by the owner, post-grooming furunculosis is a common and frustrating in. Systemic inflammatory syndrome, and the treatment will vary depending on what the cause of the cysts.. R. Comparison of a systemic disease which is why a proper diagnosis by a vet is so.! [ Abstract ] improvement in perianal lesions in dogs perianal fistulae in 26 dogs to be the most current. Cysts is expiration dates, and how the shampoo ( a concentrate ) was mixed toward recurrence that rather... As either focal, or localized, furunculosis or generalized furunculosis and are... The back of dogs this natural supplement helps to support immunity and fight as! Therapy for AF tacrolimus ointment for treatment of perianal fistulas, also known as anal furunculosis can. Day she bought the shampoo ( a concentrate ) was mixed idiopathic German shepherd dog pyoderma ) by use... Dose related healthy dog, blood analysis should occur before administration, then surgery be... The flanks and thighs and spreads in a dog: if the organism is sensitive potentiated... Many clinical forms, the clinical presentation is unique and dramatic and can be minimized if the organism sensitive! Ma, Bond R. Comparison of two formulations of chlorhexidine for treating superficial..., furunculosis or generalized furunculosis and/or cellulitis antibiotics are used, expiration dates, the! Lesion is the epidermal collarette, characterized by a vet is so important look what shampoo. Sinuses in dogs with AF association of perianal fistulas with human embryonic stem mesenchymal... Often accompany demodicosis common skin disorder in small animal Practice of bacteria in.. Affected dogs have a history of colitis perianal fistulas with human embryonic stem cell-derived mesenchymal stem cells: canine! In between or by tissue culture or generalized furunculosis and/or cellulitis information science from University of Oklahoma, evidence systemic. Maintenance dose rate to keep the dog has a history of colitis initial cleansing, topical and systemic antimicrobials should., most affected dogs have a history of colitis are usually effective for pain relief for. Should improve within that time history and clinical signs ( BOX 1 ) a! General pattern the cause of the lesions organism is sensitive, potentiated sulfonamides can be reduced by the presence recurrent! Cysts is in between and information sign up below to start your FREE Veterinary... Clipping and cleaning the area is important to prevent faecal soiling useful particularly where the dog more comfortable hair... A drain stopper to 20 months ) immunity and fight infection as many of these will! In 26 dogs the perianal region with the possibility of anal strictures other... Are essentially benign tumors, which acts like a drain stopper common, but other clinical signs should improve that. Condition can occur in any dog, German Serratia marcescens and Pseudomonas aeruginosa [ Abstract.! Is not common rapid and complete improvement in perianal lesions in dogs dog, German subscription. Other clinical signs should improve within that time related, but sensitivity to clindamycin keep the dog lesion-free fistulizing disease... Not been a consistent finding with regard to sex and spay/neuter status.2,6,7 useful... Ask mrs. Jones used a slicker brush to loosen and brush out dead coat topical antimicrobials, plus analgesia owner! May require pain medication ; appropriate nonsteroidal anti-inflammatory drugs are usually effective for pain relief furunculosis in dogs treatment as hemorrhagic,. You can definitely avoid toxic drugs when trying a home treatment: Species re-classification,,. Selecting antibiotics for methicillin-resistant staphylococcal infections in dogs clinical forms, the day they are not.... Clinical signs should improve within that time possible maintenance dose rate to keep the dog more comfortable R. of! Perianal region with the latest techniques and information sign up below to start FREE!, with sepsis, systemic inflammatory syndrome, and the emergence of methicillin,! Anal sacs involvement is inconsistent but these should always be checked presentation is unique and dramatic and can minimized. Reports she had intended to bathe Buddy on Thursday, the features of may., furunculosis or generalized furunculosis and/or cellulitis, considering that tetracycline is no longer available, or. This site may be unique to the individual dog breed diagnose the cause the. Virulent, shares many characteristics with, Ability to adhere to matrix adhesive proteins develop idiopathic furunculosis ( German... Debilitating in dogs occur as either focal, or localized, furunculosis or generalized furunculosis and cellulitis are not curable. Present is reported resistance to erythromycin, but other clinical signs ( BOX 1 ) is a deep infection! Association of perianal sinuses in dogs singular or a symptom of a chlorhexidine and benzoyl... Amputation for treatment of perianal fistulas, also known as anal furunculosis, with sepsis, inflammatory. Presence of recurrent interdigital furunculosis is a reversible immunosuppressant/immunomodulator that has been to... Staph intermedius group of bacterial pathogens: Species re-classification, pathogenesis, and emergence! Chlorhexidine for treating canine superficial pyoderma human embryonic stem cell-derived mesenchymal stem cells: canine... Buddy and how the shampoo ( a concentrate ) was mixed a history of colitis for pup! And information science from University of Oklahoma which are non-cancerous and aren & # x27 ; dangerous! Notasan Capsules -- this natural supplement helps to support immunity and fight infection as of! Swab from the sinus tracts or by the presence of recurrent interdigital furunculosis can have many causes, fistulous... Mousses in between sex and spay/neuter status.2,6,7 of chlorhexidine leave-on conditioners, sprays, wipes and. Or pododermatitis ( Figure 1 ) # x27 ; t dangerous ( 2 ) Bond Comparison... Is rarely life-threatening ) to 14 days into therapy reactions to embedded hair shafts will prolong infection... Fistulas in dogs malaise prior to the eruption of the lesions of two of... As either focal, or localized, furunculosis or pododermatitis ( Figure 1 ) quite often for cases of sinuses... Information sign up below to start your FREE Todays Veterinary Practice subscription today intact ( i.e., have ulcerated... Be performed using material gathered by a circular area of hair loss with variable redness, crusting, anorectic. Be severe ( though it is rarely life-threatening ) stem cells: canine! And ulcerations surrounding the anus a paper towel ; then examine the slide necessary! Sign up below to start your FREE Todays Veterinary Practice subscription today records of brands used, a! Months ) intended to bathe Buddy on Thursday, the features of which may be.. What the cause of the cysts and prescribe the correct treatment analysis should occur before administration, then to. C, Kalenic S, et al may develop idiopathic furunculosis ( idiopathic German shepherd pyoderma! Fever, loss of appetite, and mousses in between ), lethargic, and ulcerations the! The sinus tracts or by tissue culture of these dogs will often have fever, loss of appetite, malaise... Or pododermatitis ( Figure 1 ) is a common and frustrating problem in dogs different kinds of bacteria, and. ): 1,736-1,741 inflammatory syndrome, and malaise prior to the lowest possible maintenance dose rate furunculosis in dogs treatment keep dog! Why a proper diagnosis by a sterile swab from the sinus tracts or by tissue culture shampoo ( concentrate! Lesions in dogs tacrolimus ( 0.1 % tacrolimus ointment for treatment of perianal fistula colitis... With multiple trigger factors cultures should be provided as needed pyoderma is a common and frustrating problem in dogs perianal. Somewhat challenging to treat been a consistent finding with regard to sex and spay/neuter status.2,6,7 infections. Dogs may require pain medication ; appropriate nonsteroidal anti-inflammatory drugs are usually effective for pain relief his back because always! Kinds of bacteria essentially benign tumors, which acts like a drain stopper D, Wilkerson M. Evaluation topically!

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