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Dr. Louis Gotthelf
Dr. Louis Gotthelf, Veterinarian
Category: Dog
Satisfied Customers: 2438
Experience:  Doctor of Veterinary Medicine, Owner of a small animal clinic and an ear/skin clinic 35 years
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My 8.5 year old yellow lab, Maggie has a skin infection or

Customer Question

My 8.5 year old yellow lab, Maggie has a skin infection or pyoderma on her back. Some history, she is recovering from a IMHA relapse and is currently on 25 mgs of prednisone along with 150 mgs of cyclosporine daily. The Infection has spread throughout her back, red inflammed skin, absesses, pus and pealing with some fur loss. She otherwise is doing well energy wise, is eating and drinking well and relatively tolerant of exercise. The vet prescribed Clyndamycin and Duoxo shampoo with which I am bathing her regularly. After 3 weeks, biopsies were performed in 5 different locations last Tuesday and I am cleaning the sites as well as the absesses with Vetericyn. The infection so far is on her back with one spot on her head. Is there anything you could suggest that could better clean/remove pus without aggravating her condition? Am I stuck on defense until we await the results of the biopsies?
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Louis Gotthelf replied 1 year ago.

Dr. Louis Gotthelf :

Hi. I'm Dr. Gotthelf. I have been a vet for 33 years and I would like to use my experience to help you with your pet's medical problem.

Customer:

Hi

Customer:

I'd like to know what else I can be doing while I await the results of the "punch" biopsies.

Customer:

I'd also like to know what kind of answers a dermatologist and histopathologist will provide from the punch biopsies. My dog's vet took samples from five different locations off my dog's back.

Expert:  Dr. Louis Gotthelf replied 1 year ago.
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Expert:  replied 1 year ago.
Pyodermas can be caused from a number of reasons. They are usually a Staph infection and clindamycin a OK to use in an infection like this. But there are other bacteria that can cause pyodermas when dogs are on high levels of anti-inflammatory drugs that the Clindamycin cannot cover. If there was not a culture done,then I would ask the vet if you could add something for Aerobic Gram negative bacteria, like cephalexin. That way you will have most of the bacterial infections that affect the skin covered. If you want to use something on the skin to kill bacteria, ask the vet if they have a 4% Chlorhexidine shampoo or a 4% chlorhexidine conditioner spray to use.
Dr. Louis Gotthelf, Veterinarian
Category: Dog
Satisfied Customers: 2438
Experience: Doctor of Veterinary Medicine, Owner of a small animal clinic and an ear/skin clinic 35 years
Dr. Louis Gotthelf and 2 other Dog Specialists are ready to help you
Customer: replied 1 year ago.

Is Cephalexin ok to use on a dog with a history of IMHA in remission?


 


 


She has had this infection for weeks now and the clindamycin has not halted it. Can it at least provide protection so it won't be systemic?

Customer: replied 1 year ago.

Just a follow up... Maggie has calcinosis cutis resulting from iotragenic hyperadrenocortism mostly likely caused by prolonged use of prednisone.


 


She is on Zeniquin which is drying up her infection nicely and we will soon be tapering the prednisone as well as using DMSO gel to help re-absorb the calcium. Any further feedback on your end is appreciated.

Expert:  Dr. Louis Gotthelf replied 1 year ago.
If she is on high levels of prednisone, then it may be time to have her allergy tested and to start hyposensitization to overcome the allergic reaction causing the pyoderma in her skin. Testing dogs on high levels of steroids is very difficult, but there is a lab in Austin, Texas, called Spectrum that does a good allergy test for dogs on steroids. Most of the tests check for antibodies called IgE and when steroids are given, it decreases the amount of IgE in the system so the allergy tests are usually not good.

In addition, for the calcinosis cutis, it may never completely go away even with the DMSO treatments.

As far as using Zenequin in the skin...that class of antibiotics is called the and they do not get very high levels i in the skin, So after a period of time, with low levels, the susceptible Staph bacteria are killed, but any resistant ones are still growing because of the low levels. The resistant bugs proliferate and then the Zenequin will no longer work. Without a bacterial culture and sensitivity it is hard to tell specifically which antibiotic may work the best.
Customer: replied 1 year ago.

Maggie is currently on 25 mgs prednisone daily; she's just beeen on it for over a year. It has been higher and we had tapered from 30 to 25 about three weeks ago. Biopsies were performed and sensitivities tested. Three bacterium were found and all three tested sensitive to Zeniquin, in addition to Clavamox and Cephalexine which were excluded due to Maggie's history with IMHA and IMHA in remission. I'd just be happy to get the calcinosis cutis under control. It's not bad now but it's spreading. The derm pathology review lists the prognosis as "good" provided the prescribed protocol of reducing the prednisone and using DMSO. I'll talk to my vet about the allergy testing and mention Spectrum.

Expert:  Dr. Louis Gotthelf replied 1 year ago.
IMHA can be caused by both Clavamox and Cephalexin. There is a dosing range for Zenequin and if the dog's bacteria were all sensitive, then I would tend to want to use the highest dose possible, which is 5 mg/kg. In addition, continue the shampoos with antibacterial ingredients like chlorhexidine or the newest way to disinfect the skin is with a 1:30 dilution of bleach used as a rinse after bathing twice weekly. They way many of the bacteria can be killed without having to rely on the antibiotics to do it.
Customer: replied 1 year ago.

I am going to bathe her today using Duoxo chlohexidine shampoo. I like the diluted bleach rinse idea, thanks, that's very helpful. I also like the idea of attacking the bacteria from two fronts. Maggie weighs 81 lbs and she is taking 200 mgs Zeniquin daily. I am also mindful of avoiding giving her antacids and supplements with calcium, magnesium, etc. as I read that they can interfere with the absorption of Zeniquin. Thanks, I am a bit short on money with all the recent vet expenses but will rate your response highly and pay for another question soon. Hopefully our discussion can be of benefit to others as well. It certainly has been so for me.

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