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recent studies have shown success with topical tacrolimus 0. 1 ointment along with prednisone, metronidazole and a novel protein diet. Dietary changes may be helpful in dogs suffering from fistulas due to a suspected association between perianal fistulae and food allergies. Perianal fistula, also known as anal furunculosis is a serious medical condition that most commonly affects german shepherd dogs. Perianal fistulas are characterized by chronic, purulent, smelly, ulcerating, sinus tracts in the anal region and surrounding skin. More recent studies indicate that the condition is more likely caused by an autoimmune disease. anal furunculosis is a chronic debilitating disease of the perianal, anal and occasionally the rectal tissue. 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. An anal fistula in a dog consists of an abscess in the perianal region, accompanied by fissures that repeatedly drain. In most cases, your vet will start with medical management and proceed to surgery if conservative treatment fails. Paller a et al(2001) a 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. Misseghers b s, binnington a g & mathews k a (2000) clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs. A 2000 study of the effect of topical tacrolimus in 10 dogs (misseghers et al. , clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs can vet j, 41(8), august 2000), daily gentle cleansing of the perianal skin followed by a thin film of 0. tacrolimus is a much stronger immunomodulator than cyclosporine and because it can be applied directly to the fistulae, high tissue levels can be achieved right in the area they are needed. The potential for side effects and expense is also much more favorable than that of cyclosporine but only 50 of dogs experienced resolution with tacrolimus. Tacrolimus costs about 70 for a 30-g tube, so sticker shock can be a problem. Since only enough ointment is needed to cover the lesions, the 30-g tube usually lasts one to three months. Owners should use a cotton-tipped applicator or gloves to avoid contacting the ointment. Tacrolimus for the treatment of fistulas in patients with crohns disease a randomized, placebo-controlled trial william j. Feagan, lloyd mayer, therese johnson, joseph galanko, christopher martin, and robert s.