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Chronic Dermatophytosis - Ringworm
Last updated: 07 Nov 2003

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The father wanted to put the ringworm-Schnauzer to sleep

Rashes and bald ring-worm lesions on hands and thighs"He is losing hair and getting bald" said Ms Jasmine Chan, a 12-year old girl with a heart-shaped face, cropped black hair. She had just completed her Primary Six School Leaving Examination and her father had bought her a 3-month-old miniature Schnauzer imported from Australia by a pet shop.

This puppy was a hyperactive ball of fun. Full of circular patches of hair loss, some bigger than a 50-cent coin, presented all over the body.   Its appetite was excellent and its hyperactive energy level did not diminish though. It just could not stand still. 

"Your puppy has a ringworm infection." I said,  as I took some hair samples to examine under the microscope.

"You mean he's got worms all over the body?" queried Jasmine. 

"No, it is a fungus which causes ring-like bald patches on the head, ears, paw and back," I explained.

"What options are available?" the Daddy enquired. He was concerned about the veterinary cost as he had already consulted two vets earlier and had been retrenched at short notice by the multinational company.  The winds of recession hit Singapore hard post 9/11, Iraqi War, SARS and the movement of multinational companies from Singapore to China had led to retrenchment.

Jasmine was wearing shorts, a practical and popular attire in hot and humid Singapore. 
"Did you consult your doctor about the red spots on your daughter's right thigh?" I asked her father.

Bigger ringworm lesion on right forearm"Oh, those are mosquito bites," he said nonchalantly. Mosquitoes have been considerably eliminated by the monthly insecticide fogging in his condominium, but they are still around.  There is another ringworm infection of your daughter's right hand near the wrist," I pointed to the area.

Mr Chan widened his eyes and frowned. A canine disease infecting people is a serious matter. 

"I should put the puppy to sleep as two other members of the family have similar skin lesions." he said.

"Ringworm is a contagious disease, but it does not kill the puppy or people in the vast majority of cases," I said.

"How much it would cost to treat ringworm? I had already paid for 2 visits to a veterinarian," Mr Chan asked.

"Chronic dermatophytosis or long-standing ringworm skin diseases are costly to treat as they require several consultations. It takes a long time, sometimes several weeks to get a cure," I explained to Mr Chan. 

Many Singaporeans dislike paying for more than one veterinary treatment.  Preferably a one-visit-cure. I guess this would be the universal feeling.  If one treatment was not sufficient, so be it.

But this puppy was bought for $1,200. A lethal injection would mean writing off   a lot of money and maybe traumatic to Jasmine who had looked after the dog for a month.  

"Ringworm fungal spores invade the outer layer of the skin and hair shafts," Groomer Ken said. "In your puppy, some infected hair follicles had ruptured and the fungal spores had invaded the tissues beneath the skin. They produce a firm, painful and itchy nodules called "pseudomycetoma."

The puppy had been licking its ringworm lesions to relieve itself of the intense itchiness.

Mr Chan was not impressed with medical terms. What he wanted to know was whether there was a cure and how much would be the treatment.  No technical jargon.

"Is it a curable skin disease and how much it would cost to treat the Schnauzer? I have some itchy rashes on my arms and my wife has them too."

If Mr Chan had his way, he would rather put the puppy to sleep. After all, he could buy another one.   

He was one of those New Age sensitive guys who would need to consult his wife and he phoned her using his mobile.  The older patriarchs in the Singaporean Chinese family of the 1970s don't consult the wife.

Jasmine did not say anything. Chinese daughters at this age usually don't voice their comments unlike their Caucasian counter parts. 

Treatment was decided. 

First of all, the hair had to be shaved off to reduce the amount of infected hair. 

The Schnauzer would be given anti-fungal drugs daily for at least 42 days and an anti-fungal shampoo wash thrice a week for 3 weeks first.

The grooming brushes, cage and sleeping blankets for the puppy need to be de-contaminated by washing with hot water and the anti-fungal solution.   

Singapore has an all-year round hot and humid equatorial climate which is conducive to the growth of fungus.

"Is it that serious? Do you mean the whole condo has ringworm spores flying around?" asked Mr Chan.

"The puppy had an extensive skin infection of ringworm and your condo will have several areas which needed to be cleaned up." I said.

"Will my brother and mother get infected?" asked Jasmine.

"There may be similar balding ring-like skin spots in any one of you. Your doctor will be able to help you," I said.

"As to the cost, it would be less expensive if you treat the puppy at home. Or leave it with Groomer Ken for 2 weeks," I said. "In 2 weeks, we could eliminate most of the fungus and it would cost you less.  This is one of the bad cases."

Mr Chan decided that Groomer Ken should treat the puppy.

"Is the examination table de-contaminated?" asked Jason, my 11-year nephew. He was listening in to the consultation and was at an age where disease has a significant meaning to him. 

He would ask his mum whether he would die if infected by the various diseases he read about. Now, he felt that the examination room was radio-active with invisible ringworm spores.

He was not taking chances and left the room just in case he got infected by the ringworm fungal spores from the table. 

As for Jasmine, there weren't such worries as she cuddled the puppy before saying good bye. The big bald patches of ringworm lesions on the back,  elbows, legs, belly and back even after being told that the ringworm was contagious to human beings. 

This was true puppy love.

7-month-old Miniature Schnauzer - fully recovered from ringworm It took 3 months and many anti-ringworm shampoos and medication before the Schnauzer recovered fully from the parasitic infection. If it had not been treated in time, it would now be a very bald dog and might be put to sleep as the fungi established firmly in the hairs all over the body. 

Ringworm advice to pet shop owners

1. The Pet Shop Manager, usually inexperienced in disease treatment,  should be involved in the management of ringworm and should monitor the progress of treatment weekly. She should keep the anti-fungal tablets and dispense them correctly as the dosage is important and to inform the vet if there is diarrhoea or loss of appetite in pets under treatment.  

2. The groomer may be the one doing the treatment. However, the groomer should have a picture written record of the various areas infected so as to prevent misunderstanding between the employee (groomer) and the boss (shop owner)/manager. Handing over to another groomer - it is best to have a written record to skin diseases to avoid blame.

3. It is best that the Manager is able to discuss the progress with a veterinarian she is comfortable with, rather than simply use pet shop products to treat ringworm to reduce overhead costs. She will not have the technical knowledge of the side effects of treatment.  Early ringworm lesions can be treated just using anti-fungal washes without the need for oral mediation. Often, the Manager may not have the correct shampoo. One manager thinks that the sulpha shampoo will be useful.  

4. If ringworm is not treated early, it spreads to other animals like guinea pigs, rabbits, kittens and other dogs in the pet shop. Most Singaporeans will not buy such pets as they are more sophisticated and demanding in 2003.

5. A good client-veterinary relationship benefits the pet shop manager gets good advices. The vet will need to do house calls weekly and see the premises in order to understand the management on the ground. This may be possible if the pet shop owners is willing to pay the professional fees.  Every pet marketed skin-disease free early means more revenue but this is hard for the owner to quantify.   

6. Singaporeans love young 8-week-old puppies.  Ringworm infections delay the marketing of the pets by 2 - 4 weeks. By then, they are not "attractive" to Singaporean buyers and do not command a premium price

7. Pet shop owners may want to reduce veterinary costs. To do that, his Pet Shop Manager must be very good in disease control and treatment and they are seldom available for employment.  If they are that good, they want to start their own pet shop as they can find "investors".  It is hard to find an experienced veterinarian interested in doing house-calls regularly.  A monthly retainer fee may be the answer for the pet shop owner.
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