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34 CHAPTER 3 Bacterial Skin Diseases
Superficial Pyoderma (superficial bacterial folliculitis)
Features emerging as a common canine isolate in patients with
Superficial pyoderma is a superficial bacterial infection chronic infections and previous antibiotic exposure. Ad-
involving hair follicles and the adjacent epidermis. The ditionally, methicillin-resistant Staphylococcus aureus
infection usually occurs secondary to an underlying (human MRSA) may be becoming more common
cause; allergies and endocrine disease are the most among veterinary species.
common causes (Box 3-3). Superficial pyoderma is
common in dogs and rare in cats.
Superficial pyoderma is characterized by focal, mul- Top Differentials
tifocal, or generalized areas of papules, pustules, Differentials include demodicosis, dermatophytosis,
crusts, and scales, epidermal collarettes, or circum- scabies, and autoimmume skin diseases.
scribed areas of erythema and alopecia that may have
hyperpigmented centers. Short-coated dogs often
present with a “moth-eaten” patchy alopecia, small Diagnosis
tufts of hair that stand up, or reddish brown discol- 1. Rule out other differentials
oration of white hairs. In long-coated dogs, symptoms 2. Cytology (pustule): neutrophils and bacterial cocci
can be insidious and may include a dull, lusterless hair 3. Dermatohistopathology: epidermal microabscesses,
coat, scales, and excessive shedding. In both short- and nonspecific superficial dermatitis, perifolliculitis,
long-coated breeds, primary skin lesions are often and folliculitis. Intralesional bacteria may be diffi-
obscured by remaining hairs but can be readily appre- cult to find
ciated if an affected area is clipped. Pruritus is variable, 4. Bacterial culture: Staphylococcus species
ranging from none to intense levels. Bacterial infec-
tions secondary to endocrine disease may cause pruri-
tus, thereby mimicking allergic skin disease. Treatment and Prognosis
Staphylococcus intermedius is the most common bac- 1. The underlying cause should be identified and
terium isolated from canine pyoderma and is usually corrected.
limited to dogs. Staphylococcus schleiferi is a relatively 2. Systemic antibiotics (minimum 3-4 weeks) should
new bacterial species in dogs and humans that is be administered and continued 1 week beyond
complete clinical resolution (see Box 3-1).
3. Concurrent bathing every 2 to 7 days with an
BOX 3-3 antibacterial shampoo that contains chlorhexidine,
ethyl lactate, or benzoyl peroxide is helpful.
Causes of Secondary Superficial and 4. If lesions recur within 7 days of antibiotic discon-
Deep Pyoderma tinuation, the duration of therapy was inadequate
and antibiotics should be reinstituted for a longer
■ Demodicosis, scabies, Pelodera time period.
■ Hypersensitivity (e.g., atopy, food, flea bite) 5. If lesions do not completely resolve during antibi-
■ Endocrinopathy (e.g., hypothyroidism, otic therapy, or if they recur weeks to months later,
hyperadrenocorticism, sex hormone imbalance, an underlying cause should be sought (see Box
alopecia X)
■ Immunosuppressive therapy (e.g., glucocorticoids,
3-3).
progestational compounds, cytotoxic drugs) 6. No response to antibiotic therapy suggests anti-
■ Autoimmune and immune-mediated disorders biotic resistance or a nonbacterial skin disease.
■ Trauma or bite wound 7. If lesions resolve but pruritus persists, underlying
■ Foreign body ectoparasitism or an allergy is probably present.
■ Poor nutrition 8. The prognosis is good if the underlying cause can
be identified and corrected or controlled.
N
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Superficial Pyoderma 35
FIGURE 3-24 Superficial Pyoderma. The alopecia, FIGURE 3-25 Superficial Pyoderma. The papular
papules, and crusts around the eye of this allergic Irish rash on the abdomen of an allergic dog caused by multi-
setter are typical of bacterial folliculitis. drug-resistant Staphylococcus schleiferi. The papular rash
typical of pyoderma persisted despite high high-dose
antibiotic therapy, suggesting the antibiotic antibiotic-
resistant nature of the organism.
FIGURE 3-26 Superficial Pyoderma. FIGURE 3-27 Superficial Pyoderma. This papular
Close-up of the papular rash in figure Figure 3-25. dermatitis forms coalescing lesions as demonstrated by the
erythematous plaque. Note the early epidermal collarettes
associated with some papules.
FIGURE 3-28 Superficial Pyoderma. Severe FIGURE 3-29 Superficial Pyoderma. Close-up of the
N
erythematous dermatitis with large epidermal collarettes dog in figure Figure 3-28. The erythematous dermatitis
caused by a multi-drug-resistant infection. with epidermal collarettes formation is apparent.
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Mucocutaneous Pyoderma 29
Mucocutaneous Pyoderma
Features Box 3-1
Mucocutaneous pyoderma is a bacterial infection of
mucocutaneous junctions. It is uncommon in dogs; Oral Antibiotics for Bacterial
German shepherds and their crosses are possibly Skin Infection
predisposed.
Lesions are characterized by mucocutaneous Antibiotic-Dose
swelling, erythema, and crusting that may be bilater- First-Line Drugs
■ Cefadroxil 22 mg/kg q 8-12 hours
ally symmetrical. Affected areas may be painful or
■ Cefpodoxime 5-10 mg/kg q 12-24 hours
pruritic and self-traumatized, and they may become
■ Cephalexin 22 mg/kg q 8 hours, or 30mg/kg q 12 hours
exudative, eroded, ulcerated, fissured, and depig-
■ Cephradine 22 mg/kg q 8 hours
mented. The margins of the lips, especially at the com-
■ Clavulanated amoxicillin 12.5-22 mg/kg q 8-12 hours
missures, are most frequently affected, but the nares
■ Ormetoprim/sulfadimethoxine 55 mg/kg once on day 1,
and, less commonly, the eyelids, vulva, prepuce, and
then 27.5 mg/kg q 24 hours
anus are sometimes involved. Concurrent axillary or
■ Oxacillin 22 mg/kg q 8 hours
inguinal ulcerations may be present.
■ Trimethoprim/sulfadiazine 22-30 mg/kg q 12 hours
■ Trimethoprim/sulfamethoxazole 22-30 mg/kg q 12 hours
Top Differentials Second-Line Drugs
Differentials include superficial pyoderma, lip fold ■ Chloramphenicol 50 mg/kg q 8 hours
dermatitis, demodicosis, dermatophytosis, Malassezia ■ Ciprofloxacin 5-15 mg/kg q 12 hours
dermatitis, candidiasis, autoimmune skin disorders, ■ Clindamycin hydrochloride 5.5-11 mg/kg q 12 hours
and epitheliotropic lymphoma. ■ Enrofloxacin 10-20 mg/kg q 12-24 hours
■ Erythromycin 10-15 mg/kg q 8 hours
■ Ibafloxacin 15mg/kg q 24 hours
Diagnosis ■ Marbofloxacin 2.75-5.5 mg/kg q 12-24 hours
1. Usual basis: history, clinical findings, and rule out ■ Orbifloxacin 5-7.5 mg/kg q 24 hours
other differentials
2. Cytology (impression smear): bacterial cocci or rods
3. Dermatohistopathology: epidermal hyperplasia, 2. For severe lesions, in addition to topical therapy,
superficial epidermal pustules, crusting, and appropriate systemic antibiotics should be admin-
lichenoid dermatitis with preservation of base- istered for 3 weeks (Box 3-1).
ment membrane. Dermal infiltrates are often 3. Prognosis is good, but lifelong maintenance therapy
predominantly composed of plasma cells, with is often needed. If regularly-applied, topical anti-
varying numbers of lymphocytes, neutrophils, and biotics do not maintain remission; however, pulse
macrophages. therapy with systemic antibiotics may be effective.
Cephalexin 30 mg/kg PO every 12 hours, or clavu-
lanated amoxicillin 22 mg/kg PO every 12 hours,
Treatment and Prognosis should be administered until lesions have com-
1. For mild to moderate lesions, affected areas should pletely resolved (for approximately 3-6 weeks, then
be clipped and cleaned with shampoo that con- with long-term twice-weekly pulse therapy of
tains benzoyl peroxide or chlorhexidine. Topical either cephalexin 30 mg/kg PO every 12 hours, or
mupirocin ointment or cream should be applied clavulanated amoxicillin 22 mg/kg PO every 12
every 12 to 24 hours for 1 week, then every 3 to 7 hours, on 2 consecutive days each week [see Box
days for maintenance therapy, as needed. 3-1]). 1
