Itchy puppy

RE: Itchy puppy

Beats — Thu, 24 Aug 2017 11:13:12 GMT

[quote user="Martin Atkinson"][quote user="Beats"]it was listed as a first-line systemic antibacterial in review for pyoderma (from memory) whilst TMPS was not, so I do wonder if I should switch to this when using systemic antibacterials for pyoderma in dogs? [/quote]Do you mean erythromycin or Clindamycin[/quote]

clindamycin

RE: Itchy puppy

Martin Atkinson — Thu, 24 Aug 2017 11:06:45 GMT

[quote user="Beats"]it was listed as a first-line systemic antibacterial in review for pyoderma (from memory) whilst TMPS was not, so I do wonder if I should switch to this when using systemic antibacterials for pyoderma in dogs? [/quote]Do you mean erythromycin or Clindamycin. I recall being advised to use the former in dermatology CPD eons ago (it might have been David Grant* before he went to the RSPCA) so I tried but gave up.

*PS He is a very good skier and a good man to share a cold lift with as he carried a flask of whisky!

RE: Itchy puppy

Anthony Todd — Thu, 24 Aug 2017 11:00:57 GMT

[quote user="Beats"]for avoidance of doubt, read "canine superficial bacterial folliculitis" where I have written pyoderma in this thread.[/quote]

Yes, sorry, that's what I called a pyoderma, easy to diagnose visually, responds to antibiotics alone, well, and is surprisingly un-itchy.

Sometimes gets a sort of ringworm like ring around the pustule so it looks like ringworm, as discovered to my chagrin......

RE: Itchy puppy

Beats — Thu, 24 Aug 2017 10:17:26 GMT

[quote user="Anthony Todd"]labeling them as a "pyoderma"[/quote]

for avoidance of doubt, read "canine superficial bacterial folliculitis" where I have written pyoderma in this thread.

RE: Itchy puppy

Anthony Todd — Thu, 24 Aug 2017 10:13:21 GMT

[quote user="Beats"]systemic antibacterial in review for pyoderma[/quote]

Back in the day we used generic human drugs rather than the few vet POMs available as they were so much cheaper, all changed now with the ridiculous and unnecessary cascade.

I've got a funny feeling that people are swabbing what we called "hot spots" or "moist eczema" and labeling them as a "pyoderma" whereas they always respond to the devil's drug alone and in 24 hours too.

RE: Itchy puppy

Beats — Thu, 24 Aug 2017 09:53:39 GMT

[quote user="Martin Atkinson"]I would have used erythromycin[/quote]

interesting - never used it in dogs, but it makes me vomit :-) . have used clindamycin (Clinacin 300mg mainlly) without obvious vomiting problems but £££

it was listed as a first-line systemic antibacterial in review for pyoderma (from memory) whilst TMPS was not, so I do wonder if I should switch to this when using systemic antibacterials for pyoderma in dogs? The price would put me off, but if it is supposedly more responsible then i guess that shouldn't feature.

I've been following the trend to use topical treatment instead of systemic antibacterials for pyoderma in dogs over recent years, but it is a lot more effort for owners, and I do wonder about the wisdom of all the chlorhexidine products given the central importance of chlorhexidine in human healthcare...

[I look for phagocytosed cocci on cytology to see if significant bact pyoderma present]

RE: Itchy puppy

Martin Atkinson — Thu, 24 Aug 2017 09:40:56 GMT

[quote user="Beats"]i find trimethoprim effective for pyoderma,[/quote]I routinely use pot amox for most things based mostly on the experience that it is effective and in the interests of keeping the minimal amount of different antibiotics on the shelf. However, once upon a time I would have used erythromycin for pyoderma on the basis that we should not be using broad spectrum antibiotics for something as simple as a superficial skin infection but it has a tendency to make patients vomit.

RE: Itchy puppy

Anthony Todd — Wed, 23 Aug 2017 23:29:47 GMT

[quote user="Beats"]i find trimethoprim effective for pyoderma,[/quote]

so did I.

I must add that "post-op infections" would just reflect the flora of the tongue as 99/100 there's something wrong with the suturing or the surgery.

RE: Itchy puppy

Anthony Todd — Wed, 23 Aug 2017 23:27:06 GMT

[quote user="villagevet"]Only anecdotal and n=1[/quote]

I don't think Village Vet is making this up, so I accept what he/she says yet when I make an observation or two based on some years of some experience I get one star with no explanation....

Simple pyodermas are minimally pruritic, I mean discrete pustules as I described.

I think the one starrer is thinking of something else.

RE: Itchy puppy

Beats — Wed, 23 Aug 2017 20:25:09 GMT

[quote user="Malcolm Ness"]

[quote user="Robin Grimmer"]Synulox is not an effective antibiotic for skins [/quote]

Is that true? Why?

[/quote]

I don't know if it's true or not, but I think the suggestion is that a fair number of dog-skin-staphs are resistant to amoxicillin (actually I have not found this when we briefly swabbed any post op infections for a time - a fair proportion of staph pseudintermedius thus swabbed ffom infected surgical wounds was sensitive to everything including amoxicllin).

The argument then is that clavulanate may not have great skin penetration. [Indeed, the general lack of pharmacokinetic/pharmocodynamic info on clavulanate in the dog that I could find last time I tried looking surprised me, but I might have been looking in wrong places but was struggling to find a half-life etc. in the dog]

i find trimethoprim effective for pyoderma, but was surprised to see its absence from the latest consensus publication on first-line choices for pyoderma where systemic drugs are being used - I'm left unsure if this is because it is being reserved now for more important infections in people and shouldn't be thrown around as much by us vets or not?

RE: Itchy puppy

Malcolm Ness — Wed, 23 Aug 2017 15:44:45 GMT

[quote user="Robin Grimmer"]Synulox is not an effective antibiotic for skins [/quote]

Is that true? Why?

RE: Itchy puppy

Bob Russell — Wed, 23 Aug 2017 14:31:00 GMT

One of the first weapons I reach for with pretty much any non-specific eczema/dermatitis/skin 'infection' is chlorhexidine surgical scrub.

Generally allows time for proper parasite control to kick in.

Skin scrapings follow soon after as necessary!

It takes time and exposure to become atopic so less likely. Long since stopped thinking things never happen in veterinary practice but common things happen commonly!

RE: Itchy puppy

Lindsey Edwards — Wed, 23 Aug 2017 13:34:39 GMT

Only anecdotal and n=1 but had a seriously pruritic, moist dermatitis in a temperamental yorkie on a Fri which was not going to be cooperative with skin scrapes etc without full staff on hand. Boss sent it home over weekend with malaseb washes q48hours and return fasting for scrapes and possible biopsy after the bank holiday...owner returned with Yorkie in hand for Wed appointment (5days/3 washes); no stink, no itch and skin dry but slightly flaky! Sent back home with instructions to wash weekly and had no further issues? No other treatments prescribed initially for fear of false negative tests...

RE: Itchy puppy

Anthony Todd — Fri, 18 Aug 2017 18:38:17 GMT

[quote user="Robin Grimmer"]I remember a derm specialist saying don't underestimate the itchiness of bacterial infection.[/quote]

PS. If that is so, why are bacterial infections so easy to diagnose, just on a glance, which usually shows a pustule or many, discrete with perhaps a ring of irritation or exfoliation....

Basically because there is no irritation.

I suspect this belief is because modvets swab any broken skin, get a bug, and diagnose a pyoderma......

And the diagnose is confirmed by a course of your favorite derm. AB without even a bath let alone steroids which won't happen if you're wrong.

RE: Itchy puppy

Anthony Todd — Fri, 18 Aug 2017 18:09:06 GMT

[quote user="Robin Grimmer"]I remember a derm specialist saying don't underestimate the itchiness of bacterial infection.[/quote]

I would suggest that one of the characteristics of a simple primary pyoderma is the lack of irritation, as compared with an allergic or contact aetiology [wish we could just say "cause"]!

That is the ones that respond to your favourite AB without any steroid.

RE: Itchy puppy

Martin Atkinson — Fri, 18 Aug 2017 15:36:22 GMT

[quote user="Robin Grimmer"]I remember a derm specialist saying don't underestimate the itchiness of bacterial infection. [/quote]Well I do agree with that but then we come to the question why the dog has pyoderma: is it primary or secondary to an immune mediated/deficient process?

RE: Itchy puppy

Robin Grimmer — Fri, 18 Aug 2017 14:50:09 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]I stand to be corrected but skin allergies don't happen in 5 month old puppies. [/quote]Oh yes they can. Maybe not commonly and parasites and pyoderma are more likely but it would be a dangerous assumption to dismiss this possibility completely.

Addison's it not supposed to occur in 4 month old pups or diabetes in 5 month old cats but I've seen both and even the specialists I talked were sceptical until it was proven.

[/quote]

I don't think atopy can occur this young? As I said, I stand to be corrected. Have we got any derm specialists on here?

I remember a derm specialist saying don't underestimate the itchiness of bacterial infection. Also, idexx recommended tx for infection (bacterial and yeast), tx for parasites before considering immunotherapy.

RE: Itchy puppy

Martin Atkinson — Fri, 18 Aug 2017 13:54:12 GMT

Addison's it not supposed to occur in 4 month old pups or diabetes in 5 month old cats but I've seen both and even the specialists I talked were sceptical until it was proven.

RE: Itchy puppy

Robin Grimmer — Fri, 18 Aug 2017 12:41:40 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]

In this age I think allergy is unlikely. Having ruled out ectoparasites, I think the most likely cause is pyoderma or impetigo. I would treat with 3 weeks of cephalexin, no steroids.

[/quote]

What on earth made you come to that conclusion?

[But photographs would have helped.]

To be fair though, perhaps "allergy" should be removed and just "contact dermatitis" inserted.

[/quote]

I stand to be corrected but skin allergies don't happen in 5 month old puppies. Whereas parasites and pyoderma are common and cause pruritus. Synulox is not an effective antibiotic for skins which is why I recommended cephalexin. I would do a 3 week course without any steroid so you can see if the pruritus resolves with the antibiotic alone.

RE: Itchy puppy

Anthony Todd — Thu, 17 Aug 2017 19:31:56 GMT

[quote user="Robin Grimmer"]

In this age I think allergy is unlikely. Having ruled out ectoparasites, I think the most likely cause is pyoderma or impetigo. I would treat with 3 weeks of cephalexin, no steroids.

[/quote]

What on earth made you come to that conclusion?

[But photographs would have helped.]

To be fair though, perhaps "allergy" should be removed and just "contact dermatitis" inserted.

RE: Itchy puppy

Robin Grimmer — Thu, 17 Aug 2017 12:38:30 GMT

In this age I think allergy is unlikely. Having ruled out ectoparasites, I think the most likely cause is pyoderma or impetigo. I would treat with 3 weeks of cephalexin, no steroids.

RE: Itchy puppy

Anthony Todd — Thu, 17 Aug 2017 09:31:08 GMT

[quote user="Lucy Fleming"] it may have started with the stove,[/quote]

You guys keep making my point!

Fix the stove and there won't be a fire at all so there won't be any need even to buy new curtains......!!

RE: Itchy puppy

Anthony Todd — Thu, 17 Aug 2017 09:02:32 GMT

[quote user="Martin Atkinson"]Erm....because in cases where it is considered pathogenic it is in vastly greater numbers than a normal commensal load and by treating the the Malassezia it magically gets better. [/quote]

Ah but that's the crux; it's always "accompanied" by a load of other treatments and/or changes yet the malassezia is always quoted as the primary cause and therefore pathogenic.

As I said, just treat the malassezia, if it is the pathogen, and therefore the cause and I'll bet the results aren't good.

I suppose I'm turboing because I never treated for it, ever, in the past; I don't think it was even recognised and my otitis cases and derm cases got better unless there was obvious bacterial infection or other identifiable causes.

Once you control the excess sebum on the skin or ear the "pathogen" miraculously fades away which doesn't happen with real pathogens.

RE: Itchy puppy

Martin Atkinson — Thu, 17 Aug 2017 09:01:21 GMT

[quote user="Emma Middleton"]So back to the pruritus - Martin do you think Malaseb would be worthwhile to relieve symptoms if nothing else?[/quote]As we've argued already Malaseb will reduce the microflora and although it used to be thought that this had little pruritogenic (is that a word?) effect, IME by controlling it you will reduce the pruritis and it is also a nice shampoo which may have a soothing effect. It is doubtful this would work alone but it is the aggregation of marginal gains: reduce the overall immunological load and you might get it to an acceptable level. I suggest to owners that they will never achieve 0 on and itch/scratch score, but if they can reduce it to 2-2.5/5 i.e. its not making itself sore, only scratches occasionally and can then be easily distracted then that is acceptable.

So I use it (or more likely Adaxio now) in 90% of my atopy cases regardless as to whether there is seborrhoea or not. IMO It has been the single most important advance in the control of canine skin disease until Apoquel.

RE: Itchy puppy

Lucy Fleming — Thu, 17 Aug 2017 08:33:59 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Todd"]

No one yet has proved that malassezia is a pathogen and, as I may have turboed, I never diagnosed it or treated it in my life, yet seemed to fix bad ears and itchy dogs.

As it is present in normal ears I can't understand why it is regarded as pathogenic and not just present, like bacteria in the bowel...

[/quote]Erm....because in cases where it is considered pathogenic it is in vastly greater numbers than a normal commensal load and by treating the the Malassezia it magically gets better. Of course I admit that could have been to any number of factors that alter the environment in the ear canal even the presence of fairies in the garden at the same time time but like the presence of large numbers of pathogenic bacteria in a case of diarrhoea it is a reasonable assumption that they may well be, in some way at least, partly implicated.

[/quote]

I rather think of it as though my kitchen were on fire - it may have started with the stove, but now that the curtains, ceiling etc are on fire, if no-one extinguishes that then the house will still burn down...