Professional Documents
Culture Documents
Colonize normal skin and may be found in the superficial epidermis and hair follicles
of normal skin. These commensal microflora play an important role in inhibiting
colonization by pathogenic organisms.
B. Skin infection: Pathogenic bacteria are causing clinical signs in the host.
5. Oral antibiotics
a. Role
Oral antibiotics are necessary to reach effective antibiotic levels in the
skin in most pyodermas (as stratum corneum is a major barrier to
effective topical penetration).
b. Dose and duration of therapy
i. Use maximal therapeutic dose
Antibiotic levels in skin are often much less than that in blood.
Must insure complete surface (look at) as well as deep (palpate)
healing before discontinuing antibiotics.
ii. First-time pyoderma
Treat for minimum of 3 weeks (at least one week past clinical
cure).
iii. Complicated or deep pyoderma
Typically treated for minimum of 8 weeks (at least 2 weeks past
clinical cure). Early relapses (< 7 days) are likely due to
inadequate initial treatment. Later relapses (weeks to months) or
likely due to unresolved underlying cause.
c. Selection of appropriate antibiotics (see table)
i. First line antibiotics: used initially in the treatment of most
superficial pyodermas. These antibiotics are typically narrow
spectrum, preserve endogenous flora, and are effective against
Staph intermedius (B-lactamase producer).
ii. Second line antibiotics: used in recurrent, deep, or non-
responsive pyodermas. These antibiotics are often effective against
resistant Staphylococcus and have an extended spectrum (to
include gram negatives). Culture and sensitivity is best means by
which to determine antibiotic selection.
**Important note: not all antibiotics noted above are approved for use in the
cat. Consult drug insert prior to use. Significant side effects (and precautions)
may be associated with use.**
6. Immunostimulation therapy
May be helpful in the treatment of idiopathic recurrent pyoderma (no
underlying causative factors identifiable). Staphage Lysate is a bacterial-
derived product given by injection (on a longterm basis - detailed protocol)
and may help boost CMI to resolve pyoderma. Controversial benefit.
Bacterial colonization or overgrowth is present on the skin surface - but the skin is
not infected.
V. DEEP PYODERMA
A. Overview
1. Definition
Skin infection is deeper and often serious, extending further down into
the hair follicle, dermis or subcutis. May be associated with systemic signs of
illness. Less common than superficial pyoderma. Rare in cat.
2. Pathogenesis
Deep pyodermas do not occur spontaneously - they usually are a continuation
of superficial pyoderma associated with underlying disease.
3. Skin lesions
Several clinical syndromes exist, but characteristic lesions include red/purple
nodules, hemorrhagic bullae, ulcerative lesions, and draining purulent
fistulous tracts.
a. Furunculosis: rupture of an infected hair follicle with release of
keratin and bacteria in dermis, often associated with a
pyogranulomatous response.
b. Bacteria: Staph intermedius, and other potential invaders (Proteus
spp, Pseudomonas, E. coli).
c. Bacteremia and sepsis are potential systemic complications of deep
pyoderma.
4. Treatment principles (applies to clinical syndrome's noted below)
a. Identify and treat underlying disease (see above)
b. Whirlpool soaks with antiseptic agents (where applicable)
c. Antibacterial shampoos (particularly those shampoos with follicular
penetration)
d. Appropriate antibiotic therapy (second line antibiotic) for a minimum
of 8 - 10 weeks and at least two weeks beyond clinical cure.
e. Surgical excision of focal lesions, or debridement as indicated.
f. Biopsy and culture (aerobic, anaerobic and fungal) should be pursued
in all non-responsive cases.
B. Localized forms of deep pyoderma
1. Callus pyoderma: occurs when calluses become secondarily infected.
2. Nasal folliculitis and furunculosis (nasal pyoderma)
Painful, localized, deep infection of the nose found most often in German
Shepherds and other dolichocephalic breeds. May be associated with "rooting"
behavior. Uncommon.
3. Muzzle folliculitis and furunculosis (canine chin acne)
a. Initial sterile inflammatory folliculitis that may progress to a deep
bacterial furunculosis. Found most often in short-coated breeds.
b. Follow treatment principles noted above. Local benzoyl peroxide
shampoo and topical antibacterial therapy (such as mupirocin).
4. Acral lick furunculosis: infected lick granuloma
Initial lesions often incited by boredom or other underlying trigger. Infected
lesions are more likely to exhibit surface ulceration.
5. Pododermatitis (interdigital pyoderma)
a. Clinical signs
Painful, red, swollen feet with nodules and exudative draining fistulas.
Variable pruritis, lameness, and lymphadenopathy. Males of short-
coated breeds are predisposed.
b. Etiology: *Q: What other diseases may cause these signs? What if
only one foot is affected?
Bacterial infections are secondary - look for underlying cause (mites,
FB's, allergies, etc.). Many cases are idiopathic. *What additional
diagnostics should be pursued if only one foot is infected?
C. Generalized forms of deep pyoderma
1. Deep folliculitis, furunculosis, and cellulitis.
a. Clinical signs
Note folliculitis, nodules, crusts, and open deep purulent fistulas with
ulceration. Lesions may be found distributed over trunk, abdomen, and
pressure points.
b. Deep pyoderma of G. Shepherds
i. Clinical signs as above but occurs in middle-aged German shepherd.
Initial lesions frequently noted over rump and lumbosacral area.
ii. Pruritis, regional lymphadenopathy, pain, and fever may be
present.
iii. Evaluate for underlying disease (particularly hypothyroidism,
allergies, etc.)
2. Anaerobic cellulitis
a. Deep suppurative infection within subcutaneous tissue planes often
initiated by trauma or FB's, and secondary inoculation of microbes.
Systemic illness, fever, crepitant cellulitis (gas-producing anaerobes),
tissue discoloration and malodor may be present.
b. Treatment: surgical debridement, antiseptic lavage and appropriate
antibiotics.
3. Cat bite abscess (less common in dogs)
a. Etiology
i. Bite wound abscesses are most frequently noted in head or tail
region. The skin seals over puncture site trapping bacteria inside,
and abscess develops within 2 - 4 days (causative organisms are
usually anaerobes from oral microflora).
ii. Commmon inoculated oral microflora include Pasteurella multocida
(also B-hemolytic Strep., Bacterioides, and Actinomyces spp.).
b. Treatment
Surgical debridement, antiseptic lavage, and appropriate antibiotics
(penicillin, amoxicillin, cephalosporins for 1 - 2 weeks). *Q: How is
this disease prevented? *Q: What other disease(s) may be transmitted
by this behavior?
References (for all dermatology lectures): Muller & Kirk's Small Animal Dermatology
5th edition 1995. Kirk's Current Veterinary Therapy XII. Bonagura. W.B. Saunders
Co. 1996. WB Saunders Co. Selected excerpts from ACVIM 1995 and 1996
proceedings, and JAVMA, JIVM, and Compendium 1992-2006. Small Animal
Dermatology Secrets: Karen L. Campbell 2004. Skin Diseases of the Dog and Cat
Richard Harvey, Patrick McKeever 2003. Small Animal Dermatology A Color Atlas and
Therapeutic Guide Linda Medleau, Keith Hnilica 2001 and Small Animal Ear Diseases
An Illustrated Guide 2nd edition. Gotthelf 2005. Supplemental information also
provided courtesy of Dr. Danny Scott and Dr. Miller, Cornell University.