Attack of the Face Eating Thing

Hi Dr. H,

My beautiful, crazy, Grand dog, Ginger, developed the most horrific, runny, itchy, gooey, face eating, thing on her cheek and our local vet called it a Hot Spot. In all my years, I have never seen anything like it. She is on oral antibiotics, and Gentocin Topical Spray. The spray seems to really burn. She is miserable and has convinced Boudreaux and Coco (our other two dogs)to constantly lick it, so I have tried to separate them, but that’s not working out. We started the meds two days ago and it may be a little bit better today, but not much. Are we on the right course?

Mary R.

Yup - sounds like you're on the right course. Hot spots are areas of moist skin infection. They usually come up suddenly. There may be a bite/sting/scratch that starts it. The area gets wet, infection starts to go wild, and within 12 hours they can turn from a small spot to a huge, wet, stinky, sticky, nasty, red, itchy mess. Really impressive. They also hurt like the dickens.

Key to these guys is clipping them up, cleaning, and getting them to air out. At the same time we use antibiotics to control the infection and then usually a steroid - either by mouth or topically. Antihistamines like Benadryl are usually helpful, but not strong enough to help an active hot spot feel better. The more common antibiotics to use are cephalexin or cefpodoxime (Simplicef). Topical medications commonly used include NeoPredef powder, gentamycin/betamethasone (Gentocin, Gentaved), and a newer product called Calm Gel (part of the Douxo line by Sogeval - very nice stuff!). The goal is to get the nasty thing to calm down.

I'll typically have an owner clean them gently with warm soapy water twice daily and then gently blot dry. In the summer time you MUST MUST MUST not let these wounds go untreated and have the dogs outside much - especially when the wounds are fresh. Hot spots are a favorite of flies and you'll get maggots in the wound nearly immediately. Make sure these get clipped up and cleaned right away. Hot spots smell badly enough without being full of maggots.

Good news is that they usually heal up about as fast as they come on. It'll take a week or two to look normal, but the majority of the pain, discharge, moisture should resolve in the first couple of days.

These type of wounds are common in dogs with seasonal allergies. Their skin is already inflamed and is "ripe" for bacterial overgrowth. Additionally, they are usually scratching and chewing. That combination makes a moist dermatitis easy to flair up.

AMH

Allergies #2

If you are the proud owner of one of these unfortunate souls, you can approach their allergies much like you would your own. First line treatments are usually antihistamines. Benadryl (diphenhydramine) is typically the first choice. Given at about 1mg per pound of body weight every 8-12 hours. (25mg capsule to a 25lb dog). Chlorpheneramine can also be used - most dogs get a 4mg tablet every 6-8 hours unless they are very small (<10lb) or very large (<80lb) in which case they may get 1/2 or 2 tablets respectively.

Second line treatments include medications like steroids or cyclosporine. Steroids (like prednisone) aren't all that bad. They can be excellent for short-term use at a modest dose. The problem with allergy dogs is that these guys are rarely being treated for just a couple of weeks. They are usually itchy for an entire summer and you really shouldn't keep a pet on steroids that long.

Cyclosporine (Atopica) is a very cool drug that basically gives you the same benefits of steroids but without the side effects for long-term use. That's an oversimplification, but basically the idea. Atopica isn't perfect, it makes some animals puke, but it can be an awesome alternative to prednisone. Biggest downside is that it's expensive. It's worth the money if you can afford it. Prednisone is very, very cheap, so it's not a fair comparison.

Regular bathing with a hypoallergenic shampoo once a week or so during the bad season can also help. This rinses the pollens off the skin and can be very useful. You must use an appropriate shampoo - it must be mild, made for pets, and not contain any pesticides. I'll post more on shampoos later. Because the skin is inflamed and abnormal during an allergy outbreak many patients end up developing secondary skin infections or overgrowth with yeast or bacteria. These infections may require special shampoos or oral medications to treat them. The allergy may be part of the itch, but the secondary infection may be what causes the itch to be severe.

In some breeds, specifically hounds like bassets or coon hounds, they are likely to have an allergy to the yeast or bacteria growing on their skin. This means that as the yeast that normally live there start to grow, the poor dogs are actually allergic to them and develop a significant itch. Many atopic dogs are allergic to "staph" bacteria and the overgrowth of bacteria can actually make a little itch suddenly turn into a huge, horrible itch.

Last thing to mention is that the only way to truly treat the immune response of the allergy is to see a veterinary dermatologist. Testing can be done to determine what your pet is allergic to. We can then give your pet injections of that compound and hopefully get the itch to stop. This is precisely how it is handled in people.

The veterinary dermatologist can be your pet's best friend if they are suffering from chronic allergy, skin, ear, infection problems. The testing may seem expensive, but the savings in the long run from not having to treat as many infections or spend as much on anti-itch medications can be substantial.

AMH

Allergy Season

This will be my first post on allergies. There's lots of information to be said and even more bunk out on the internet.

When people "get allergies" to thinks like pollen, grass, dust, etc, we typically think of the runny nose, eyes, and asthma. When dogs have inhalant allergies, they tend to have skin symptoms of itching, redness, and then secondary infection. There's plenty of crossover - some people get eczema, some dogs get runny eyes.

So the typical "allergy" dog is a foot licker, armpit scratcher, and face rubber. They also tend to have ear problems (itching, secondary infection). Some individuals only have ear problems or only lick their feet. Some have the whole list of symptoms and are miserable.

"Allergies" are caused when the body's immune system sees something like a pollen and reacts to it instead of ignoring it. The cells in the body that are responsible for reacting to antigen (antigen meaning anything, usually a protein, that the immune system reacts to with an antibody) are full of all kinds of fun chemicals designed to spread havoc. Histamine is the major player. Histamine causes blood vessels to dilate, causes itch, and swelling. Histamine is what makes that mosquito bite swell into a little bump.

Not everything is known about why this happens in certain individuals. Genetics is involved. Offspring of an allergic individual are more likely to have allergies, but it's not a guarantee. We now know that there are some really cool changes in the way the skin of an allergic individual is put together. As it turns out, the "cement" that holds all of the "bricks" of the skin cells together isn't quite right in these people and pets. As a result, the skin isn't as effective a barrier as it's supposed to be. This allows the body to absorb some antigens that you wouldn't normally absorb (like pollen) and the immune system gets all upset and you develop "allergies."

Allergies are also something that develop over time. The typical atopic dog shows signs during their 2nd or 3rd year of life. Sometimes earlier, but usually it's not their first summer. They also get worse over time, so the 8th summer is usually worse than the 2nd summer.

I'll post again with a discussion on treatments. There's TONS of stuff to talk about, so I'll break it up.

AMH