pyoderma - where now?

RE: pyoderma - where now?

Linda Filshie — Thu, 30 Mar 2017 22:05:58 GMT

Thanks for all the helpful comments. When I spoke to the owner re next steps she said that the skin has improved (! )since I saw it earlier in the week - had stopped AB at this stage and had its scheduled flea tx applied. So we're going for EOD chlorhex bathing and will reassess in 10-14d and if still pustular then will work our way through C&S, scrapes then biopsy as needed, +/- T4 antibody.

RE: pyoderma - where now?

Simon Tai — Thu, 30 Mar 2017 08:55:32 GMT

I'd second the C+S option. But if we're dealing with a non antibiotic responsive pustular dermatosis in an older animal , then consider Pemphigus foliaceous. Definitive diagnosis by biopsy. Could be a drug eruption 2ndry to a systemic flea product.

RE: pyoderma - where now?

Linda Filshie — Thu, 30 Mar 2017 07:39:46 GMT

[quote user="Anthony Todd"]

[quote user="Kara Gibson"]I would C&S a pustule and skin scrape first and then if sterile biopsy.[/quote]

Back in the day it would get a week of Ceporex and see.

My bet is it would be better [except the embarrassing one that looked like ringworm, for certain, and was a superficial pyoderma].....]

[/quote]

Did you read my post Anthony? It's had 2wks of noroclav and 2 of cefalexin already. And yes, you can get sterile pustular disease.

RE: pyoderma - where now?

Anthony Todd — Thu, 30 Mar 2017 00:29:33 GMT

[quote user="Kara Gibson"]

I would C&S a pustule and skin scrape first and then if sterile biopsy.

[/quote]

Do you ever get a sterile skin pustule??

RE: pyoderma - where now?

Anthony Todd — Wed, 29 Mar 2017 22:42:12 GMT

[quote user="Kara Gibson"]I would C&S a pustule and skin scrape first and then if sterile biopsy.[/quote]

Back in the day it would get a week of Ceporex and see.

My bet is it would be better [except the embarrassing one that looked like ringworm, for certain, and was a superficial pyoderma].....]

RE: pyoderma - where now?

Kara Gibson — Tue, 28 Mar 2017 18:45:20 GMT

I would C&S a pustule and skin scrape first and then if sterile biopsy.

RE: pyoderma - where now?

Linda Filshie — Tue, 28 Mar 2017 18:25:42 GMT

The dog is non-pruritic - pretty happy to put atopy at the bottom of the list.

T4 moderately depressed, normal TSH, no alopecia, no weight gain, plenty of energy.

She has been bathed q3d with a tea tree shampoo for the last couple of weeks - not chlorhex though.

Does fungal infection ever show up as pustules?

RE: pyoderma - where now?

Linda Filshie — Tue, 28 Mar 2017 18:19:03 GMT

[quote user="Anthony Todd"]

Love to see a picture, geez they are worth a thousand variable, descriptive, or diagnostic words.

Most, at least many, skin conditions, with a good picture are diagnosable every time!!

And the close up lens aren't that expensive on e-Bay [and would be tax-deductable]

[/quote]

It looks like superficial pyoderma, Anthony. A photo would show you occasional pustules and collarettes on the trunk of a dog of normal body condition with no alopecia and a normal looking hair coat.

RE: pyoderma - where now?

Anthony Todd — Tue, 28 Mar 2017 18:08:30 GMT

Love to see a picture, geez they are worth a thousand variable, descriptive, or diagnostic words.

Most, at least many, skin conditions, with a good picture are diagnosable every time!!

And the close up lens aren't that expensive on e-Bay [and would be tax-deductable]

RE: pyoderma - where now?

Anthony Dennison — Tue, 28 Mar 2017 17:30:30 GMT

If you can't see any bacteria I would biopsy and culture one of the samples, just in case this is the start of something more extensive.

RE: pyoderma - where now?

Clive Ansell — Tue, 28 Mar 2017 17:29:00 GMT

[quote user="Linda Filshie"]What would you do next? Biopsy? Thyroid antibody? Skin scrapes (despite cytology)? Bravecto trial? C&S? Finances are not limitless so I would like to prioritise.[/quote]

I think I would try and reach a diagnosis in a stepwise process if funds are limited, rather than just guesswork "trial therapies".

If sedation is not needed, start off with several careful skin scrapes, fungal cultures, and swab for C&S, fairly inexpensive and non invasive. If sedation/ga is required maybe biopsy at the same time.

Maybe revisit the thyroid diagnosis?

Skin biopsies

Allergy testing

RE: pyoderma - where now?

Bob Russell — Tue, 28 Mar 2017 16:23:03 GMT

Chlorhexidine shampoo's every two to three days leaving on coat for about 10 minutes before thorough rinsing. Surprising number of people will have a bottle of the stuff left over from previous hospital stays! Cheap for clients but sometimes poor compliance!

Can work as well as some courses of antibiotics and can continue long term if necessary.

Always go through methodical work up if possible. Skin scrapings are easy and inexpensive. I use Stronghold in the cases where itchiness comes out of the blue.

Non/minimal-pruritic ones check the thyroid (worth doing anyway) as you will get nowhere fast if this is a factor.

RE: pyoderma - where now?

Linda Filshie — Tue, 28 Mar 2017 15:33:44 GMT

Computer playing up: continued thoughts!

She does not LOOK like a hypoT4 dog.

So it could be sterile pustular condition or resistant bacterial infection or conceivably demodex though none seen on smear. What would you do next? Biopsy? Thyroid antibody? Skin scrapes (despite cytology)? Bravecto trial? C&S? Finances are not limitless so I would like to prioritise.