Choose your treatment: Superficial bacterial pyoderma in dogs

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Wed, 06 Apr 2016 15:04:34 GMT

Within the second article it states:

In general, topical therapy is helpful in all patients with SBF. Topical therapy alone (without co-administration of systemic AMDs) is encouraged as a desirable and recommended approach to the treatment of SBF unless precluded by owner and/or patient factors.

It can take some work to get owners on board that not all infections, even bacterial, need oral antibiotics.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Beats — Tue, 05 Apr 2016 23:18:40 GMT

[quote user="Francisco Gomez"]Forgive my ignorance and grasp of the English language. I always considered 'hotspot' a slang term for pyoderma..? probably I'm wrong there , dermatology definitely not my forte...[/quote]

Compare pictures in:

http://vetmedicine.about.com/cs/dogdiseasesh/a/hotspots.htm

and

http://www.wormsandgermsblog.com/files/2008/03/vde121181.pdf

I'm no expert on the jargon, but think bacterial pyoderma generally refers to any any bacterial infection of the skin.

Some folk split this by depth of infection, I don't really know how helpful this is:

1) "Surface" pyoderma: where the bacterial infection is confined to the superficial layers of the epidermis as a result of self-trauma to the surface of the epidermis. This is variously termed "pyotraumatic dermatitis", "acute most dermatitis", "hotspot" etc

2) "Superficial" pyoderma: where the bacterial infection is confined to the epidermis, generally used to refer to bacterial infection with staph pseudintermedius of the hair follicles, hence "superficial bacterial folliculitis".

3) "Deep" pyoderma: where the bacterial infection affects epidermis and dermis. Some folks would colloquially call a self-trauma leading to deep pyoderma a "hotspot" too I suspect just to add to the confusion!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Francisco Gomez — Tue, 05 Apr 2016 22:46:05 GMT

[quote user="Bob Russell"]

The discussion has morphed away from superficial pyoderma to acute hotspots! Superficial pyoderma generally is more smelly than itchy so I would agree dexafort is not a treatment of choice!

[/quote]

Forgive my ignorance and grasp of the English language. I always considered 'hotspot' a slang term for pyoderma..? probably I'm wrong there , dermatology definitely not my forte...

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Anthony Todd — Tue, 05 Apr 2016 18:04:44 GMT

[quote user="Evelyn Barbour-Hill"]The single initial dexamethasone has just been a refinement I've applied in the last few years.[/quote]

Why?

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Tue, 05 Apr 2016 15:33:49 GMT

The discussion has morphed away from superficial pyoderma to acute hotspots! Superficial pyoderma generally is more smelly than itchy so I would agree dexafort is not a treatment of choice!

The vetrecord guidelines (above) suggest that systemic antibiotics are given if topical treatments have failed or the infection is more severe and 'deeper'.

We are probably all visualising a slightly different case so opinions may well be influenced by the case!

My case is mildly itchy, spotty with some crusts. It has mild hair loss but overall the owner is more worried than the dog!

It will start with chlorhexidine shampoo's left on for ten minutes, then thorough rinsing. Every other day until it improves.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Iva Mayer — Tue, 05 Apr 2016 14:51:48 GMT

With all my respect but there are pretty good guidelines for treatment of superficial pyoderma and I don't think that Dexafort would ever be the treatment of choice.

Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 2— antimicrobial choice, treatment regimens and compliance

L. Beco, DVM, DipECVD¹, E. Guaguère, Doct.Vét., Dip.ECVD, DESV, DV², C. Lorente Méndez, Lic Vet, PhD, DipECVD³, C. Noli, DVM, DipECVD⁴, T. Nuttall, BSc, BVSc, CertVD, PhD, CBiol, MSB, MRCVS⁵ and M. Vroom, DVM, DipECVD⁶

http://veterinaryrecord.bmj.com/content/172/6/156.full

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Tue, 05 Apr 2016 09:55:36 GMT

I don't think Evelyn or anyone else has been going wrong! These options are doing pretty much the same thing but from slightly different angles.

Clipping does make the cleaning and fuciderm/isoderm easier and more effective but I would not use clippers (apart from anything else it makes the clippers mucky!). I change my mind a bit and will agree that careful clipping with scissors removes a lot of the smelly stuff and I will do this sometimes.

Dexafort reduces the need for owner compliance issues. It breaks the cycle.

There is always more than one way to skin a cat but antibiotic use is not a very effective one IMO.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Evelyn Barbour-Hill — Tue, 05 Apr 2016 00:21:21 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]One can almost sense the patient's relief when that horrid crusty scabby gummy stuff, and all those thorn-sharp gummed-up cones of hair, are all gone and a cool breeze is playing across the clean gel-coated surface.[/quote]

Try one next time without the. single initial dose of dexamethasone.

I'll bet there's very little change, or it'll be worse even overnight.

Then try one with just the single initial dose of dexamethasone.

My bet is the results will be as you quoted. The "gel-coat" or "varnished" was the clue, exactly as I would describe the steroid effect on it's own.

[/quote]

Sorry, no.

The single initial dexamethasone has just been a refinement I've applied in the last few years. Before that it was clip, cleanse and Fuciderm and that was all.

When I referrred to the gel-coated surface, I meant the surface coated with Fuciderm gel, not any "effect".

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Anthony Todd — Tue, 05 Apr 2016 00:01:22 GMT

Try one next time without the. single initial dose of dexamethasone.

I'll bet there's very little change, or it'll be worse even overnight.

Then try one with just the single initial dose of dexamethasone.

My bet is the results will be as you quoted. The "gel-coat" or "varnished" was the clue, exactly as I would describe the steroid effect on it's own.

One thing nobody has yet mentioned is that if the irritation starts again [usually in cats] then you have to repeat the steroid, or use a longer acting one or, within 12 hours, it's worse than it was the first time!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Evelyn Barbour-Hill — Mon, 04 Apr 2016 23:16:40 GMT

[quote user="Gillian Mostyn"]Don't even try when they are red raw and painful....OUCH!!![/quote]

Be very patient, use scissors not clippers (of course), soak well with Hibiscrub froth, take it gently, be patient.

Use sedation if really necessary.

One can almost sense the patient's relief when that horrid crusty scabby gummy stuff, and all those thorn-sharp gummed-up cones of hair, are all gone and a cool breeze is playing across the clean gel-coated surface.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Evelyn Barbour-Hill — Mon, 04 Apr 2016 23:10:15 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]I treat hotspots with steroids [/quote]

+1 to all of it. "hot spots" that is.

No topicals except a spray or aerosol [new development]. Ointments and/or creams won't stick or get licked off in 5 seconds or less and had no effect or increased the irritation.

Most shampoos seemed to increase irritation.

[/quote]

Curious, really. For as long as Fuciderm (Isaderm) has existed (35years?) I have clipped extremely close and carefully, meticulously cleansed with gentle but well frothed application of Hibiscrub, applied Fuciderm, given single initial dose of dexamethasone and sent Fuciderm home with owner. On review 2-3 days later the majority are well on the way to healing and simply require Fuciderm continuing for as long as it takes. Some require a repeat cleansing. Only a rare exception needs systemic glucocorticoid and antibiotic course, usually because of dog's temperament.

I wonder where I've been going wrong?

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

mariette asselbergs — Mon, 04 Apr 2016 17:47:48 GMT

I looked through your list several times to look for malaseb, which is a combination of chlorhexidine and a yeast/fungus treatment (miconazole) and since I didn't see it but it is my first line treatment in these cases I voted for "other".

I suppose many people would have voted for chlorhexidene and meant malaseb?

Mariette[quote user="Beats"]

Thanks for all responses!

I'd love to know what the "something else" that someone voted for was - I'll add it to the list if you either post or send me a private message.

To clarify couple of points brought up:

1) I'm thinking of your most common choice - I appreciate treatment choices will likely be individualised in most cases based on a number of patient and owner factors. So for a simple real life example, if you treat mild cases with chlorhexidine washes and more severe cases with systemic amox/clav, then it depends which cases you see more commonly - if you see more mild cases then you are treating more with chlorhexidine washes so select this option. ( I think you can change your vote if this changes things?)

2) What conditions we're talking about:

The poll was intended for "superficial bacterial pyoderma" / "superficial bacterial folliculitis" as the dermatologists classify it (I apprectiate the description below is not that helpful and many will choose treatment on experience of visual appearance rather than geeky classifications but I don't have photos to post):

"Superficial pyoderma is characterized by focal, multifocal, or generalized areas of papules, pustules, crusts
and scales, or epidermal collarettes, or circumscribed areas of erythema and alopecia, that may have hyperpigmented centers. Short-coated dogs often present with a “moth-eaten” patchy alopecia, small tufts of hair that stand up, or reddish brown discoloration of white hairs. In long-coated dogs symptoms can be insidious and may include a dull, lusterless hair coat, scales, and excessive shedding. In both short- and long-coated breeds, primary skin lesions are often obscured by remaining hairs but can be readily appreciated if an affected area is clipped. Pruritus is variable, ranging from none to intense levels. Bacterial infection secondary to endocrine disease may cause pruritus, thereby mimicking allergic skin disease." (from Ch.3 Bacterial Skin Diseases, Small Animal Dermatology: A Color Atlas and Therapeutic Guide, 3rd edition, Hnlica 2011)

Specifically, I had not meant to include:

"surface pyoderma" / "pyotraumatic dermatitis" / "acute moist dermatitis" / "hotspots"

"impetigo" / "superficial pustular pyoderma" / "juvenile pyoderma" / / "pre-pubertal pyoderma" "hairless skin pyoderma"

"chin pyoderma" / "canine acne"

Feel free to change your answer accordingly!

[/quote]

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Gillian Mostyn — Mon, 04 Apr 2016 17:30:24 GMT

[quote user="Robin Grimmer"]That's interesting. So even for a really extensive moist hotspot (eg a labrador, Rottie) where normally I would clip which can require sedation, you would just give steroids?[/quote]

I agree with Bob. I give steroids (topical or systemic, depending on size/severity of lesion) and recheck in 2-3 days. They are almost always dry and non-painful. - if they need clipping, do it then. Don't even try when they are red raw and painful....OUCH!!!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Mon, 04 Apr 2016 17:06:04 GMT

Yes. Dexafort would be my drug of choice. I don't clip as I think it often increases the irritation. ReX 3 days later and almost invariably doing better.

A few might get a longer course of preds. Once in a blue moon, if there is evidence that infection was causing systemic signs, I might go for antibiotics but this is rare.I do encourage owners to use chlorhexidine on wet cotton wool and clean it off after.

I cannot remember the last one I had to clip up but there was one that was seen by another practice so I clearly did not impress that client!

As soon as dogs stop scratching, they starts healing!

(Edited for clarity! This is for hotspots!)

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Robin Grimmer — Mon, 04 Apr 2016 16:53:34 GMT

[quote user="Bob Russell"]

I treat hotspots with steroids not antibiotics (plus isoderm/fusiderm if necessary). I don't clip them either.

The infection is secondary to self-trauma so the self-trauma gets addressed!

No resistance to steroids.

But I am visualising general superficial pyoderma, no hot spots. Talking and explaining to owners is necessary.

[/quote]

That's interesting. So even for a really extensive moist hotspot (eg a labrador, Rottie) where normally I would clip which can require sedation, you would just give steroids?

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Anthony Todd — Mon, 04 Apr 2016 16:09:34 GMT

[quote user="Bob Russell"]I treat hotspots with steroids [/quote]

+1 to all of it. "hot spots" that is.

No topicals except a spray or aerosol [new development]. Ointments and/or creams won't stick or get licked off in 5 seconds or less and had no effect or increased the irritation.

Most shampoos seemed to increase irritation.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Mon, 04 Apr 2016 10:16:22 GMT

I treat hotspots with steroids not antibiotics (plus isoderm/fusiderm if necessary). I don't clip them either.

The infection is secondary to self-trauma so the self-trauma gets addressed!

No resistance to steroids.

But I am visualising general superficial pyoderma, no hot spots. Talking and explaining to owners is necessary.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Thomas Johnson — Mon, 04 Apr 2016 10:05:09 GMT

[quote user="Francisco Gomez"]

Nevertheless, I know it isn't an excuse and I thoroughly agree that we do need to get down to business and try limit ab usage as much as possible. I just wonder if there could be some short term financial (i.e government or practice finances or both) help that could be applied to cases as the one above. Or should it be left to the client solely? I say client purposely here, because the vet can refuse to prescribe them if they are asked upfront, but the client will decide if stays being a client or find somebody else who will prescribe. And you know full well, that if we leave things to market forces, there will always be someone who will take full advantage of you not prescribing so:

1. - You lose clients.

2.- Your job as antiboitic guardian becomes a waste because somebody else is doing the prescribing.

[/quote]

Interestingly in human medicine there is some evidence that GPs who prescribe fewer antibiotics are rated more poorly by their patients:

http://www.kcl.ac.uk/newsevents/news/newsrecords/2015/December/Antibiotic-prescribing-and-patient-satisfaction.aspx

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Francisco Gomez — Mon, 04 Apr 2016 09:02:30 GMT

[quote user="Bob Russell"]

My clients are starting to understand the many good reasons for not dishing out antibiotics!

[/quote]

I think there's an important message here.

Unfortunately in large practices where you see some people only once or twice, education of the broad public becomes a bit more difficult. In a world where everyone wants a fix right now and waste spend as little as possible in money and time, I've found myself in difficult situations for giving non systemic ab treatment in certain conditions as a first line approach.

I.e Consult1 - Hotspot

Wash with shampoo EOD, topical fusidic acid

Consult2 - Hotspot

Didn't work - poor compliance - not getting better - needs to prescribe Systemic Abs-

Bill = £££

Vs.

Consult 1 - Hotspot

Systemic Abs - Resolved.

Bill = ££

1. - You lose clients.

2.- Your job as antiboitic guardian becomes a waste because somebody else is doing the prescribing.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Beats — Mon, 04 Apr 2016 07:45:39 GMT

Thanks for all responses!

More topical than I expected, but I wonder if lack of clarity in original question to specifically exclude "hotspots" might have skewed survey results a bit?

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Bob Russell — Sat, 02 Apr 2016 11:11:58 GMT

So start with chlorhexidine shampoos every other day and introduce valuable antibiotics only if there is a poor response.

We should be trying every non-antibiotic option first as a routine!

Mild to moderately itchy or sore patients can cope for a bit longer until the washes work or don't!

My clients are starting to understand the many good reasons for not dishing out antibiotics!

Obviously checking T4 etc!!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Beats — Fri, 01 Apr 2016 20:46:21 GMT

Thanks for all responses!

I'd love to know what the "something else" that someone voted for was - I'll add it to the list if you either post or send me a private message.

To clarify couple of points brought up:

2) What conditions we're talking about:

Specifically, I had not meant to include:

"surface pyoderma" / "pyotraumatic dermatitis" / "acute moist dermatitis" / "hotspots"

"impetigo" / "superficial pustular pyoderma" / "juvenile pyoderma" / / "pre-pubertal pyoderma" "hairless skin pyoderma"

"chin pyoderma" / "canine acne"

Feel free to change your answer accordingly!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Martin Atkinson — Fri, 01 Apr 2016 16:51:49 GMT

[quote user="emma o'connor"]well many teenagers would use a regular antibacterial face wash![/quote]How did we survive in the past I wonder with a few spots?!

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

emma o'connor — Fri, 01 Apr 2016 16:27:45 GMT

[quote user="Martin Atkinson"]After all do you treat teenage acne apart from for vanity [/quote]

well many teenagers would use a regular antibacterial face wash! I do advise using chlorhexidine topically as a wash in young dogs with ventral or chin pyodermas.

RE: Choose your treatment: Superficial bacterial pyoderma in dogs

Martin Atkinson — Fri, 01 Apr 2016 13:34:32 GMT

[quote user="emma o'connor"] I was thinking more generalised lesions ie entire ventral abdomen [/quote]Mind you a lot of these are self limiting, especially in puppies, and need no treatment if they are not pruritic. After all do you treat teenage acne apart from for vanity or it is out of control?