Skin: deep pyoderma Jump to... Pathogenesis Diagnosis Treatment Prevention Sequelae Sources Introduction May be life-endangering dermatoses. Cause : predisposed by demodicosis  , hypothyroidism  , hyperadrenocorticism  , trauma or immunosuppression, eg neoplasia or internal disease, may be idiopathic (especially German Shepherd pyoderma). Signs : papules, pustules, furuncles, discharging sinuses; bacterial infection of dermal and subcuticular tissues. Diagnosis : history, clinical signs, microscopy, histopathology, bacteriology. Treatment : antimicriobial/antibiotic therapy. Prognosis : varied according to bacterial infection. Presenting signs Papules, pustules, furuncles and discharging sinuses. Mucopurulent or hemorrhagic exudate. Erythema, edema, ulceration, malodor, pain. Overlying coat matted with dried exudate. Regional lymphadenopathy. Depression in generalized cases. Age predisposition German Shepherd Dog pyoderma 4-8 years old. Breed predisposition Generalized deep pyoderma German Shepherd Dog . Bull Terrier . Interdigital pyoderma Bull Terrier . French Bull Dogs . Pressure point pyoderma Great Dane . St Bernard . Boxer . Nasal pyoderma German Shepherd Dog . Bull Terrier . Cost considerations Lengthy courses of bactericidal antibiotics may prove expensive. Pathogenesis Top Predisposing factors General Generalized deep pyoderma Demodicosis. Hypothyroidism . Idiopathic. Other causes of immunosuppression, eg neoplasia, hyperadrenocorticism . Interdigital pyoderma Demodicosis. Foreign body. Hypersensitivity. Hypothyroidism . Dermatophytosis. Muzzle and chin pyoderma Idiopathic. Demodicosis. Pressure point pyoderma Poor bedding. Obesity. Hypothyroidism . Anal furunculosis Idiopathic. ?Genetic, anatomical or immunological factors. Nasal pyoderma Idiopathic. ? May not be a form of pyoderma. Pathophysiology Superficial pyoderma  deeper into follicles  rupture of follicular wall  pyogranulomatous perifolliculitis or furunculosis in dermis and subcutis  extension along tissue planes  fistulae on surface or cellulitis and panniculitis in subcutaneous and fatty tissues. Combined infection and foreign body reactions. Anatomic predisposition - short-coated breeds, eg bull dogs are at higher risk for interdigital pyoderma. Diagnosis Top Presenting problems Papules. Pustules. Client history Depends on form of deep pyoderma present and the underlying cause. Localized or generalized pustular or discharging skin lesions. Coat matted with exudate. Anorexia/depression if generalized. Malodor. Clinical signs Deep folliculitis, furunculosis and cellulitis Deep folliculitis . Few infected follicles  discrete papular lesions. Many infected follicles  alopecia, tissue swelling and inflammation. Papules  pustules  hemorrhagic bullae  ulceration +/- fistulae  crusts. More common on pressure points and trunk. Pyotraumatic folliculitis/furunculosis Pyotraumatic folliculitis . Mimics acute moist dermatitits  with satellite lesions and no response to cleansing and glucocorticoid therapy. More common cheek and neck. Breeds affected - Rottweiler  and Golden Retriever . Nasal folliculitis and furunculosis Sudden onset painful, erythematous swelling on bridge of nose. Mainly dolichocephalic breeds. Muzzle folliculitis and furunculosis Papules, pustules, comedones and draining tracts. Chin and lips. Little pain. Interdigital pyoderma Acute: feet swollen, painful, discharge pus, paronychia. Chronic: nodules, ulceration, fistulae and furunculosis. German Shepherd Dog pyoderma Almost exclusively middle-aged German Shepherd Dog. Papules, pustules, furunculosis, hyperpigmentation and alopecia: dorsum, gluteal region, ventral abdomen and thighs. Advanced cases generalized, sparing head and front feet. Acral lick furunculosis Acral lick furunculosis . Distal limbs. Firm, raised, hairless, hyperpigmented at periphery, eroded or ulcerated centrally. Pressure point pyoderma Thickened skin: elbows, hocks, sternum. Diagnostic investigation Histopathology Epidermal changes . Dermal changes: focal to diffuse mixed inflammatory infiltrate, perifolliculitis, folliculitis, furunculosis, pyogranulomatous lesions. Bacteriology Skin swabs should be submitted for bacterial culture and sensitivity testing. Confirmation of diagnosis Discriminatory diagnostic features History. Clinical signs. Definitive diagnostic features Histopathology. Bacteriology. Differential diagnosis Acute moist dermatitis . Non-bacterial infectious skin diseases. Dermatophytosis . Demodicosis . Immune-mediated skin diseases. Drug eruption. Other bacterial skin disease . Treatment Top Initial symptomatic treatment Deep folliculitis, furunculosis and cellulitis, pyotraumatic folliculitis/furunculosis, interdigital pyoderma, German Shepherd Dog pyoderma and pressure point pyoderma Long-term systemic antibiotics  : 8-12 weeks minimum and 21 days after clinical cure. Topical antimicrobial  soaks and cleansing, eg chlorhexidine . Local clipping. Identification and treatment of predisposing factors. May biopsy to confirm resolution before ceasing treatment. Nasal furunculosis Systemic antibiotics  3 weeks; continue 7-10 days after clinical cure. Interdigital pyoderma Focal areas of scarring or individual dermal granulomas: surgical removal. Muzzle folliculitis and furunculosis Initial, when lesions few and sterile: daily cleaning, eg benzoyl peroxide  +/- topical corticosteroids. Later, when ulcerated +/- seropurulent exudate: systemic antibiotics 4-6 weeks +/- topical corticosteroids. Acral lick furunculosis Systemic antibiotics  8 weeks minimum and 2 weeks after resolution of infection. Subsequent management Monitoring Subsequent history and clinical findings. Prevention Top Control Effective treatment of predisposing factor. Sequelae Top Prognosis Deep folliculitis, furunculosis and cellulitis Good if predisposing factors treated. Bacteremia and sepsis are uncommon sequelae. Pyotraumatic folliculitis and nasal folliculitis and furunculosis Good if predisposing factors treated. Muzzle folliculitis and furunculosis Often spontaneous regression at puberty. May need topical corticosteriods to prevent recurrence. Interdigital pyoderma Variable degrees of scarring and sterile dermal granulomas remain, ? protect foot by restricting activity or wearing boots. German Shepherd Dog pyoderma Moderate in general. Many dogs require life-long antibiotic therapy. Tendency to recur. Acral lick furunculosis Large lesions heal leaving thin hairless epithelium which is easily traumatized and re-infected. Important to identify underlying disease. Expected response to treatment Deep folliculitis, furunculosis and cellulitis, pyotraumatic folliculitis, muzzle folliculitis and furunculosis, interdigital pyoderma Regression of clinical signs, usually within 8-12 weeks. Nasal folliculitis and furnunculosis Regression of clinical signs usually within 2-3 weeks. Acral lick furunculosis Formation of thin hairless epithelial layer with no further improvement on antibiotic therapy, usually within 8-12 weeks. Sources Top Publications Refereed papers Carlotti D N, Guaguere E, Pin D, Jasmin P, Thomas E & Guiral V (1999) Therapy of difficult cases of canine pyoderma with marbofloxacin - a report of 39 dogs. JSAP 40 (6), 265-270. Scott D W et al(1998) Efficacy of clindamycin hydrochloride capsules for the treatment of deep pyoderma due to Staphylococcus intermedius infection in dogs. Can Vet J 39 (12), 753-756. Hill P B & Moriello K A (1994) Canine pyoderma. JAVMA 204 , 334-340. Mason I (1993) Selection and use of antibacterial agents in canine pyoderma. In Practice129-134. DeManuelle T C et al(1985) Determination of skin concentrations of enrofloxacin in dogs with pyoderma. Am J Vet Res 59 (12), 1599-1604. Thoday K L (1980) Canine pruritus; an approach to diagnosis - Stage II - Infestations and infections. JSAP 8 , 449-458. Vetstream contributor(s) David H Scarff BVetMed CertSAD MRCVS, Anglian Referrals, 2 Highlands, Old Costessey, Norwich NR8 5EA, UK. Tel/Fax 01603 743415. Dr Rosanna Marsella DVM DACVD , PO BOX 100126, SACS, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA. Back to top © Copyright Vetstream CANIS DIS00107

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