(Bacterial Infections of the Skin)
It's normal for the skin to contain a certain level and certain types of bacteria. Pyoderma refers to abnormal levels or types of bacteria that cause inflammation and damage to the skin.
I'll briefly discuss some of the more common types of pyoderma:
People are sometimes surprised to learn that dogs and cats get acne. Just like in humans, it is mostly a disease of puberty affecting the sebaceous areas of the chin and lips and sometimes the inner thighs, belly, and tail.
Topical cleansers are usually enough to control the problem, although some cases require antibiotics and short term anti-inflammatory steroid therapy as well.
Hot Spots (Acute Moist Dermatitis, Eczema, Pyotraumatic Dermatitis)
We vets see a lot of these in dense coated dogs, but any type of dog or cat can get these painful, rapidly occurring patches of skin infection.
They are the result of scratching or biting an area of the skin to the point that skin bacteria, or bacteria from the environment establish themselves in the inflamed skin and go "hog wild", causing an incredible amount of surface damage within 12-48 hours.
The initial irritant could be anything that itches from an insect bite, an ear infection, a matted coat, or anal gland irritation, but I think most cases involve a local reaction to fleas and ticks.
The treatment is straight forward, but it's important that you complete the treatment until the lesion is well healed or it might come back. A few of the treatment steps can be omitted for MINOR lesions.
Here we go: What To Expect If You Go To The Vet For Skin Infections:
1. General exam to include skin scraping for mites if suspected, possible ringworm or yeast culture/cytology, and inspection for fleas, ear infections etc.
Possible blood work to check for metabolic and hormone diseases that affect the skin. These include Thyroid disease, Cushing's Disease, and Addison's Disease
2. Sedation or light anesthesia is often necessary to allow clipping and scrubbing of these very tender areas
3. Clipping of the hair around the hot spot. This is critical in all but very small hot spots. If you have a dog going to a show soon and don't want to clip the area, you might get away without clipping, but it really helps.
If your pet has a thick or matted coat and there's skin inflammation over much of the body, you may need to clip the entire pet for best results.
4. Scrubbing with an medicated shampoo that removes the surface crud, sucks out the sebaceous goo from the deeper layers of the skin, and kills bacteria, fungus, and yeast. I personally use a coal tar and sulfur shampoo for this, followed by chlorhexiderm 4%, but many vets like other combinations that also work well. You need to do this 1-2 times daily for the first few days until the skin stops producing the ooze. After that 2-3 times weekly til better. It's important to leave the shampoo on for a minimum of 10 minutes.
5. Treatment of the underlying problem, whether it be an ear infection, fleas, ticks, ringworm, or poor grooming.
6. Antibiotics to kill the bacteria too deep in the tissues for the antibiotic shampoos to reach. In severe cases, I start with an injection of high dose penicillin combined with gentocin, followed by oral cephalexin for a minimum of 10 days. Your vet may choose different antibiotics for various reasons; each choice having advantages and disadvantages. I only mentioned the combination I usually use simply because it's a very common protocol for good reason; these medications are now relatively inexpensive and quite affective for the vast majority of hot spots. More potent antibiotics, however, will be needed in some of the deeper pyodermas that will be discussed below.
7. Something to stop the itching. Choices include different types of antihistamines, very short term courses of prednisone, and a wide range of topical sprays and lotions. Refer to my page about Atopy (skin allergies) for a more extensive list.
8. Sometimes physical or chemical restraint is needed to stop the patient from itching long enough for the lesion to heal. This may be in the form of restraint collars, bandages, or tranquillizers. It depends on the case. Usually none of this is needed if all the other steps are done well.
9.Immune System Stimulants. Staphage Lysate injections both desensitize and boost the canine immune system. The actual effectiveness of this treatment is questionable in our profession, but I've used this medication with some success on a few miserable dogs where antibiotic therapy alone was not enough. There are several other products being used for this purpose with which I have no experience.
Folliculitis, Skin Fold Dermatitis, and Impetigo (superficial pustular pyoderma)
All of these are similar in that they involve flare ups in the local population of otherwise normal skin bacteria and treatment is quite similar to the treatment for hot spots listed above. The only difference is that the cause is more subtle and the outcome usually less dramatic. In the case of the different types of skin fold infections where the problem is where skin touches skin (vulva lips, tail to anal area, lip folds, and breeds and individuals with facial skin folds, or Sharpeis where the whole body is made of skin folds) life- time hygiene is sometimes needed to control the disease. This simply means frequent cleaning of the area.
What is known as Deep Pyodermas are more serious. Underlying causes often include allergic or immunological abnormalities for which there is no cure...just control. Sometimes it's a matter of general poor health and a "run down" immune system, (the terrible skin condition is simply the most obvious problem). This is commonly seen in pets with heavy worm and parasite loads and/or fed discount brands of pet foods or a diet made up mostly of poorly balanced table scraps.
Types of Deep Pyoderma include Intradigital (between the toes), Juvenile (Puppy Strangles), Pressure Point Pyoderma (Callus), Perianal, and Generalized Pyoderma.
Certain breeds of dogs are prone to the various types of Deep Pyodermas, but regardless of that, with the exception of Puppy Strangles which is usually easy to treat (although it can take 2 months to heal), all the deep pyoderma diseases can be frustratingly difficult to treat. And if treatment is successful, then recurrence is often a problem.
Treatment involves ruling out underlying causes, especially demodex (a type of mange mite), hypothyroidism, ringworm, hormonal imbalances, and allergies.
Expect a prescription for long term antibiotics. Your vet may recommend skin biopsies and cultures in order to get a better diagnosis and for choosing the best medication.
Malassezia Yeast Infections
of the Skin
A yeast known as Malassezia is a frequent invader of damaged skin and a common problem in ear infections. It's not usually the original cause of the ear infection or skin problem, but once the skin or ear is inflamed from allergies and/or bacterial infections, then this yeast problem becomes established.
Failure to detect this yeast is a common reason for treatment failure.
Malassezia loves moist, greasy areas of the skin, and is often most obvious on the throat, in ears, armpits, and crotch areas. The skin often becomes blackened and odorous. But often it's not obvious at all, which is why we sometimes fail to detect the problem.
If your vet is diligent (and you're willing to pay for the test) he or she will perform cytology (take surface skin samples on a slide and stain them in the lab and examine them under a microscope) to look for yeast organisms. Other diagnostic choices include a yeast culture and trial treatment.
Treatment includes an appropriate combination of the following depending on the severity of the case:
1. Clipping the coat if the hair is matted or thick
2. Removal of the build up of scum, crud, crust, and greases in the skin by using a good degreasing shampoo. I prefer coal tar and sulfur shampoo but other good choices include Selsun Blue, and Benzyol peroxide based shampoos.
3. Killing the organism. Choices include lowering the pH of the ear environment (there are special ear cleaners that do this) or skin (there are special acetic acid or boric acid shampoos that do this or you can soak your pet in diluted vinegar.
For skin cases, I like to use high strength chlorhexiderm 4% shampoo, but other good choices include shampoos with combinations of 2% miconazole, ketoconazole 1%, sulfur, or salicyclic acid. Each vet seems to have a favorite, but in all cases, for good results you have to work the lather in for a good 10 minutes prior to rinsing and you have to be able and willing to bathe at least twice weekly for 1-4 weeks until the skin is well healed. After that, you may need to bathe once or twice monthly for maintenance.
For tougher cases it may be necessary to use lym sulfur or other dips.
And in really tough cases, it may be necessary to use systemic treatment with oral ketoconazole or itraconazole.
And remember, most yeast cases involve additional problems (underlying allergies and bacterial infections, hormone imbalances, flea sensitivity, and so on) so understand that additional testing and treatment for these problems are usually necessary too.
Seborrhea, Dandruff, and other flaky, scaly skin diseases
Some Cockers and Springers get true seborrhea, which means abnormal sebum secretions which leads to oiliness, scales, increased ear wax, "doggy" odor and dandruff. This is usually a life long problem and requires an owner willing to keep up with life long treatment and management.
Most seborrhea cases, though, in both cats and dogs, are simply secondary to other diseases that affect the sebaceous glands. These include food allergies, atopy, flea irritation, poor nutrition, vitamin deficiencies, thyroid and other hormone imbalances, and all the different parasite, fungal, bacterial, and yeast problems that can cause irritation.
So the main point here is to figure out the underlying problem. Allow your vet to spend a little money and time ruling everything out until the problem is solved. And remember that a lot of these diseases are not exactly curable...but they are controllable with a little effort and understanding about what's going on.
(Supracaudal Gland Infection)
There is a sebaceous gland near the base of the tail in both dogs and cats that sometimes becomes over-active and/or infected. In cats, this condition is called "stud tail" even though the problem sometimes occurs in females and castrated males.
In dogs, the same condition is usually just called by it's medical name: Supracaudal Gland Infection or Supracaudal Gland Hyperplasia.
If no underlying problems (typically fleas) are found, then treatment consists mostly of cleaning with degreasing shampoos and possibly short term steroids and antibiotic therapy. In dogs, every once in a while, surgical reduction or removal of the gland is needed. In cats, castration often helps.
Anal Gland Problems
If you didn't know it, both dogs and cats have little glands (so do skunks mink, and ferrets) just under the skin right beside their anus. The smelly stuff made by these glands is unique to each pet and a little bit of anal gland juice leaks out of it's duct into the anus every time a dog or cat defecates.
As I said, the smell is unique to each pet and that is what all that smelling of hind ends is about...it's what pets do instead of saying "Hi, my name's Bob, what's yours?"
Sometimes these glands produce way too much glandular goo or the ducts get clogged up with goo causing the glandular sacs to swell. This is all very irritating to the pet so they scoot along the ground or carpet and are generally irritated back there. Very distracting.
Goo is not a medical term. So sue me.
Why anal glands sometimes produce too much goo is not really known...but here's what we do know: This is mainly a problem with smaller breeds of dogs, especially overweight ones lacking good muscle tone.
The glands can be overactive due to infection, or they can become infected because they're overactive...but
The most accepted theory is that the glands are overactive and the secretions too thick because of allergies...especially food allergies.
Here's what we can do about it:
Usually we just express the glands as needed. This means we squeeze the crud out gently with our fingers. I recommend gloves. Once or twice monthly for those dogs that need this. It's easy to tell when they need it...they start scooting across the floor. If you or your groomer have trouble getting the goo/crud out with external squeezing, you may need a vet to do it for you. He or she will use a lubed and gloved finger inside the rectum and will be able to do a better job, but it takes experience not to cause damage to the tender rectal tissue or to the inflamed anal gland tissue, so don't try this yourself.
If the goo that comes out looks like it has some pus in it we'll treat with antibiotics
This treatment usually works, but often only for a while...and that's because the infection wasn't the original cause of the dog producing so much goo. It was an additional problem.
Because this trouble is often associated with allergies...either inhalant allergies to pollens, molds, and dust mites, or to food allergies...we often have to treat the allergy to solve the problem:
1. Get effective flea control...the #1 allergen is a flea. Fleas on a sensitive dog or cat are like lice or poison ivy to a human. Very allergenic to the skin and underlying glands. Go to our section on Fleas.
3. Try benadryl or other antihistamines to see if we luck out and it helps.
4. Consider a prednisone (steroid) trial. Usually very helpful and unlikely to cause any serious side effects if not used for more than 4 weeks.
5. Consider trying omega 3 fatty acids supplements since they change the nature of the goo...making it less thick and tacky. This treatment is more preventive than cure.
If all the above isn't helping much:
Put on a higher fiber diet on the theory that more and larger stools will some how cause more muscular eliminations and there-by help empty out the glands on a more regular basis. I don't have a lot of faith in this theory, but it certainly makes sense to put overweight pets on lower calorie, higher fiber diets to get their weight down. That takes time but it will help.
Consider a procedure done under anesthesia where we put a catheter (little tube) up the anal gland duct and flush out the gland and then inject a combination of antibiotics and anti-inflammatories and DMSO directly into the gland. This often works well, but it often doesn't work for long.
And finally, we can surgically remove the anal glands...which you might think simple enough...but what a high risk place for surgery, so we try to avoid this. You see, the anus is full of, well, bacteria, so post op infections can be a big problem. And the anus area doesn't hold sutures well...it's spongy and expandable, and tears easily.
And the animal doesn't like having sutures in this area. But all these problems are minor compared to the problem of getting the glands out without harming the tiny nerves that control the anal sphincter. This is such a high risk that I like to recommend these pets to a specialist so that if anything goes wrong you can blame him (or her).