Deep pyoderma in dogs is usually deep bacterial folliculitis and furuncle, which also includes some special types, such as perilabial folliculitis and furunculosis (canine acne), purulent traumatic folliculitis, foot folliculitis and furuncle Disease, callus (pressure point) pyoderma, cellulitis. During the onset of the disease, some infections of the hair follicles stay at the opening of the hair follicles, some continue to descend, and some directly infect the entire hair follicle. Deep folliculitis often results in rupture of hair follicles, which later develop into furuncles.

Cause

Any inflammation, obstruction, atrophy, dysplasia, or degenerative disease of the hair follicles can cause secondary bacterial infections in dogs.

Most deep pyoderma has underlying causes, which are often secondary to demodicosis, low immunity or abnormal immunity, etc. (iatrogenic) adrenal sebaceous hyperactivity is more likely to cause deep infection.

Occasionally, the hair shaft can be implanted beyond the range of the hair follicle and into the surrounding dermis, causing damage. Direct trauma to the hair follicle can lead to furuncle. Shaving against the skin or rough grooming can cause traumatic furuncles. Traumatic furuncles can also be self-inflicted by animals. In acrolicking dermatitis, persistent licking can cause traumatic hair follicle rupture. Pressure on bony prominences caused by tilting hard surfaces can cause hair follicle rupture and cause pyoderma callosum.

Pathogens

In addition to Staphylococcus pseudointermedius, Proteus, Pseudomonas, and Escherichia coli are also common pathogenic bacteria in canine profound pyoderma. Co-infection with two or more pathogenic bacteria is often seen.

Purulent traumatic folliculitis is most common in golden retrievers and Saint Bernards, but can also be seen in other long-haired breeds, such as Newfoundlands and Bernese Mountain Dogs, and Labrador Retrievers are also susceptible. Young dogs are more susceptible.

susceptibility characteristics

Different types have different susceptibility characteristics. Generally speaking, long-haired dogs, Tibetan Mastiffs, German Shepherds, Golden Retrievers and Irish Setter dogs may be susceptible to various types of deep pyoderma.

Oral folliculitis and brucellosis occur almost exclusively in short-haired breeds. Represented by Doberman Pinscher, Great Dane, English Bulldog, German Shorthaired Pointer, Boxer, Mastiff, Rottweiler and Weimaraner Hound. The disease usually begins in adolescence and is most common in dogs 5 to 12 months of age. The syndrome often resolves spontaneously in early adulthood but persists in some cases. No gender susceptibility was seen.

Purulent traumatic folliculitis is most common in golden retrievers and Saint Bernards, but can also be seen in other long-haired breeds, such as Newfoundlands and Bernese Mountain Dogs. Labrador Retrievers are also susceptible. Young dogs are more susceptible.

Folliculitis and furuncles of the feet, susceptible to short-haired dogs, including English Bulldogs, Dachshunds, Boxers, Great Danes, Bulldogs, Basset Hounds, German Shorthaired Pointers, Weimaraners and Dalmatians More susceptible.

Pyoderma callosum (pressure point), large or giant dogs are susceptible. Calluses are common in Doberman, Great Dane, Saint Bernard, Newfoundland, and Irish Wolfhounds. Short-legged dogs with insufficient coat protection, such as Dachshunds and Basset Hounds, often develop chest calluses. Calluses can appear at any age and can grow in size over time if left untreated.

Clinical symptoms

The initial site of the lesion manifests as superficial folliculitis, often in the groin, axilla, and between the toes, and may later become systemic, especially if the underlying cause is immunosuppression or demodicosis. Unlike the hair follicle-centered pustules in superficial folliculitis, the pustules in deep folliculitis and furuncle are larger, and discontinuous erythema and nodules at the base of the pustule can be seen. Pustules, scattered nodules, and edematous patchy ulcers, leading to exudative fistulas or hemorrhagic scabs. Blood packets are sometimes seen, more commonly seen in German Shepherds, Bull Terriers and Dalmatians. Canine vermicular disease is more likely to form blood bags. Hyperpigmentation and lichenification occur in chronic conditions. The color of thick juice in a complete pustule or exudate in a flaccid duct ranges from white to grayish-yellow. Pink or red color indicates the presence of bleeding, indicating more serious dermal damage. Common pain or itching, local or systemic lymph node enlargement.

General diagnostic process for skin diseases

The general diagnostic process for skin diseases includes obtaining a systemic and skin history, performing a physical and skin examination, listing differential diagnoses, formulating a diagnosis and treatment plan, confirming the diagnosis or conducting further examinations, and determining a treatment plan.

● Ask about medical history

A detailed medical history can give you diagnostic ideas. Generally speaking, it takes at least 15 minutes for first-time cases and half an hour for referral cases.

● General medical history

Understand the animal's disease and health status and whether it suffers from diseases that may affect the skin. Try to inquire about the general condition of each case as much as possible, including coughing, snorting, polydipsia, exercise intolerance, appetite and defecation status, vomiting, diarrhea, etc.

● Skin history

Investigate the initial symptoms and age of onset. Parasites are more common in younger animals. Atopic dermatitis usually begins at a young age and rarely appears after 7 years of age. Endocrinopathy often occurs in middle age to old age. Tumor diseases are common in the elderly.

Understand the disease process. Whether it is itchy, the order in which itching and other lesions appear, the itching score, the location of itching, and the response to treatment. Feeding and lifestyle. Living indoors or outdoors, whether groomed or fostered, whether other animals or people in the home are showing similar symptoms.

Treatment history and treatment response

Referral cases often have complex treatment histories, and knowledge of their treatment history can help confirm or rule out differential diagnoses. likeEffectiveness of antibiotics suggests pyoderma, response to treatment with antiparasitic drugs suggests or excludes ectoparasites, whether steroids have been used and their reactions, and whether subsequent treatment regimens should be changed. At the same time, customer compliance can be better assessed.

clinical examination

●General physical examination

For every medical case, a general physical examination of the entire body of the animal should be performed before starting the skin examination to understand the disease and health status of the sick animal.

●Skin examination

Perform a complete skin examination, not just the areas where the owner finds it. Don’t miss parts such as the ear canal, auricle, armpit, medial thigh, perianal, nail groove, and between toes.

Differential diagnosis and laboratory tests

● Differential diagnosis

The general clinical differential diagnosis of profound bacterial folliculitis and furuncle includes Demodex mites with or without secondary bacterial infection, subcutaneous and profound mycoses, opportunistic fungal infections, severe dermatophytosis, and sterile granulomatosis. Swelling/chemical granuloma, histiocytosis, idiopathic nodular panniculitis, aseptic granulomatous dermatitis and lymphadenitis in puppies (puppy cellulitis), vasculitis, pythium , epithelial lymphoma, etc.

Based on the listed differential diagnoses, formulate examination directions, select appropriate examination methods, and conduct further laboratory examinations to rule out some differential diagnoses and confirm the diagnosis. The two are inseparable. Laboratory examinations include skin scraping, hair plucking examination, skin cytology examination, blood test, bacterial culture and drug sensitivity test. If necessary, fungal culture, skin biopsy, imaging examination, etc. can also be performed.

● Demodicosis

Hair plucking and deep skin scraping are mainly used to check for vermiformis, dermatophytes, etc. Demotic encephalopathy with or without secondary bacterial infection is the most common differential diagnosis. After demodicosis is diagnosed through microscopic examination, it can be treated with ivermectin or amitrazine. 1% ivermectin 0.04 to 0.06 mlfkg, taken orally daily or 250pbm of amitrazine, immersed in the whole body, once a week. However, attention should be paid to gradually increasing the dose of ivermectin when taking it orally (in the first week). For Collies, if you want to use ivermectin, you can first conduct an MDR-1 gene deletion (ivermectin sensitivity) test. Regular monitoring during treatment, monthly hair plucking/deep scraping inspection, the presence of live worms or eggs during re-examination indicates that the treatment effect is not good, at this time, you should consider changing the treatment plan or increasing the dosage/concentration of the drug. Discontinuation of the drug can be considered only when worm bodies or eggs are seen. Monitor regularly after stopping the drug, 2 months and half a year. Also perform neutering surgery to prevent recurrence, especially for female dogs. When secondary bacterial infection occurs, refer to the skin disease treatment method for treatment.

●Cytological examination

Cytology is a necessary means to rule out differential diagnosis. As a dermatologist, it is essential to do it yourself. If it is difficult to achieve in clinical practice, at least ensure good communication between the sub-test operators and explain the sampling site, method and purpose of sampling. For exudative impotence tract sampling, a moist sterile cotton swab can be inserted into the impotence tract to collect samples.

Cytological examination of deep pyoderma usually shows a large number of red blood cells, inflammatory cells, and bacteria. However, compared with superficial pyoderma, because the lesions are deep and cause bleeding, the blood dilutes the sample, and the relative amount of inflammatory cells and bacteria is sometimes less.

Bacterial culture and drug susceptibility testing

Bacterial resistance results from bacterial mutation after exposure to antibiotics, and bacterial durability is proportional to the selection density. Since the first case of methicillin-resistant Staphylococcus aureus infection was reported in 1961, more and more methicillin-resistant bacteria and multidrug-resistant (three or more) bacteria have been reported.

Selecting antibiotics based on experience requires meeting the following conditions: no or little history of infection before, no treatment failure, and no other recurrent infections; superficial skin disease; cytological examination shows cocci; and foreseeable antibiotic sensitivity. Simultaneous infection by multiple bacteria is common in severe dermatoses and has different sensitivities to drugs. Bacterial culture and drug sensitivity testing are essential for such cases.

Other laboratory tests

Systemic deep haloderma is often accompanied by mild elevation of white blood cells and globulin. Blood tests can help further evaluate the basic health status of sick animals and also indicate potential causes. Ying chooses different tests according to the different conditions of sick animals. Some tests may be done after initial treatment to look for underlying causes, such as allergy (food elimination) tests.

treat

The treatment of deep mesodermosis usually includes symptomatic treatment of systemic symptoms, systemic antibiotic treatment, local antibacterial treatment, shampoo treatment, and finding and treating the underlying cause.

Treat symptomatically and cool down when fever occurs. Infusion support for anorexic animals. Give highly nutritious and easily digestible food, etc. Nutritional support is useful in many skin diseases, especially demoticosis. Give high-protein, easily digestible food, such as lean chicken breast on Sundays, etc., and monitor the amount of defecation to ensure that no loose stools occur. Egg yolk is a nutritious food that is easy to digest and absorb. It is rich in a variety of amino acids that can enhance immunity. Drugs such as immune polysaccharide (yellow polysaccharide) can also be used to improve the body's immunity and promote disease recovery. Reasonable Chinese medicine treatment also has good therapeutic effects.

The duration of systemic antibiotic application should last for at least 4-6 weeks, and the dose of the drug used should be a relatively high dose within the normal range. For example, 20-30mg/kg of ammonia in the head is usually used at a dose of about 25mg/kg. and continue for at least another 2 weeks after l clinical recovery, toThis prevents some invisible lesions from persisting after discontinuation of medication.

During local treatment, the affected area of ​​long-haired animals should be shaved, followed by routine surgical debridement. The affected area can be infiltrated with Juwei Shengfu fluid. To reduce local stimulation, diluted Juwei Shengfu fluid (1:9) can be considered.

Proper use of antibacterial shampoo can also make treatment more effective. Common antibacterial shampoo active ingredients include chlorhexidine, benzoyl peroxide, and ethyl lactate. Do not dilute most antibacterial shampoos when reusing them. Apply them directly after twisting the animal's body and rub them in for 5-15 minutes. Then rinse with warm water for 10-20 minutes, extending to 30 minutes for large dogs. Short-haired dogs or dogs can be dried directly after shaving. If you need to blow dry, you can dry it 80%. Excessive dryness can cause further damage to the skin barrier.

Most deep pyoderma has various underlying causes. Finding the underlying causes and actively treating them are the key to thorough treatment and preventing recurrence. It is also the basis for judging prognosis. Especially for some cases of deep pyoderma with recurrent attacks and failed treatment. For cases of treatment failure, it is more important to understand the reasons for treatment failure, improper selection of antibiotics (drug sensitivity), premature termination of treatment (‘relapse’), and the real relapse—the underlying cause.

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