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

E-mail contact fixed

Folks have commented that the e-mail me feature hasn't worked. I fixed it. PLEASE PLEASE send me e-mail. I want comments, criticism, critique, and questions. It helps me make sure my blog is helpful and relevant.

E-mails gushing with praise and affection are also appreciated. ;)

AMH

Discoid Lupus (aka Crusty Booger Nose)

Also known as Cutaneous Lupus, is an autoimmune disease that occurs when the immune system begins to attack the skin around the nose. Autoimmune means that the bodies own immune system begins to attack “self” instead on only attacking “non-self.” The body usually makes antibodies to attack foreign invaders like bacteria or virus. If the body makes a mistake and begins to make antibodies to itself, the immune system is directed to damage tissues it should normally leave alone.

Discoid lupus (DL) is most common in collie dogs, Shetland sheepdogs, German shepherds, and Alaskan malamutes (and crosses of these breeds). Because there is such a breed predisposition, this probably has a genetic component to its cause. The disease is also heavily influenced by ultraviolet light. Increased exposure to direct sunlight will worsen disease, so these patients need to avoid mid-day sun as much as possible.

Discoid lupus should NOT be confused with systemic lupus erythematosis (SLE) which is the type of “lupus” that most people are familiar with. SLE is much more dangerous and affects the entire body. DL is much more limited in its affect.

Most owners first notice problems along the moist portion of the nose or on the tissues immediately adjacent to the edge of the nose. This area is known as a mucocutaneous junction (an area where moist skin transitions to dry skin). The pigment of the nose or skin starts to fade and turn pink. The same area usually becomes angry, crusted, and often some mucous is seen collecting in the nostril (Thus, my other name for the disease - Crust Booger Nose). The lesions can also extend up the bridge of the nose and along the lips in more severe cases. Some of these guys have ulcerations and are fairly painful, but they are usually more uncomfortable/irritated - like with a cold sore.

Diagnosis is often made based on breed, history, and appearance in mild cases. However, since many different immune conditions can mimic each other, biopsy is required to confirm the diagnosis. If there are lesions found on other portions of the body (ears, feet, prepuce, vulva, anus, eyelids) then other autoimmune conditions are more likely.

We treat all autoimmune diseases by using medications to suppress the immune response. Sometimes these medications have to be used systemically (to effect the entire body), but it is much more desirable if we can use the medication ONLY at the site of disease. Topical steroids are usually our first line treatments. Oral steroids may be necessary if the condition is severe enough. Tacrolimus (Protopic) is amazingly effective in most patients. I love using it, but since it is usualy $90 per bottle, we often start with simple topical steroids. Other medication options include cyclosporine, niacinamide, doxycycline, and prednisone. The choice of one medication over another is made based on severity of disease and what the patient will allow the owner to do.

Topical sunscreen can also be used. Moisturizing products with an SPF of 15 can be used in sparing amounts. I've had owners use Nutrogena or Oil of Olay daily moisturizing creams with SPF and be pretty happy with it. It only takes a small amount, but that additional protection from UV light seems to help tremendously when we have the disease under control and are trying to keep it that way.

Autoimmune diseases are controlled, not cured. You have to keep ahead of the disease. It is always easier to keep it under control than it is to try and get it back under control. With successful response to medications and continuing treatment, most DL patients live long, happy lives.

AMH

Environmental Flea Control

The most important concept to get in flea control is that 90-95% of the total flea population is made up of juveniles. Only the last 5-10% are the adults that we see! Adult fleas are obligate to stay on their host and rarely get off. The flea life cycles begins when a mommy flea and a daddy flea love each other very much, and they may decide to make a few hundred baby fleas.

The female will take blood meals on the host and use that energy to produce tons of eggs that she lays on the host. The eggs dry up a bit and fall off the pet and into the environment.

Eggs hatch and little larva crawl out and start feeding on the little bits of dirt, dander, fungi, etc in the carpet base, couch cushions, topsoil, or pet bedding that they happen to be hatched into.

After a couple of weeks, the larva spin this cool cocoon and begin to pupate. Pupae usually hatch out in another 10-14 days but can remain dormant in this state for a very, very long time.

There are two general classes of chemicals to use for environmental flea control. Adulticides (permethryn, Advantage, Frontline) all kill adults. The larva and eggs require something different. There are compounds called Insect Growth Regulators (IGRs) that will halt the development of these stages. The egg then dries up and goes away. The most common IGRs seen are methoprene (Precor) and pyriproxifen (Nylar). As a general rule, IGRs aren't very stable in the environment, so companies have had to develop delivery systems that help protect the chemical from light so that they will last long enough. Most preparations of Nylar for use in the home list a 3 to 4 month duration of action.

Don't waste your time putting down tons of chemicals on the lawn assuming that there are hoards of adult fleas waiting to invade. There aren't. The adulticide stuff you put down washes away and the flea larva continue to develop. The story is a bit different in the house where you have the opportunity to use a product that may bind to the carpet fibers and stick around for a while. A newly hatched adult may come in contact with the stuff and promptly die.

Apply a product including an IGR. I have seen one outdoor product that contains Nylar. There are several indoor products designed for use in carpets/furniture. Other IGR products are going to be designed to use ON the pet (Frontline Plus, Sentinel, Knockout).

Adulticide products for indoor use are usually of the permethryn/pyrethryn family. These usually last for a period of days to weeks and will kill newly hatched adults before they have a chance to get very far.

Borate powders are also popular amongst some folks. These powders can be worked into the carpets where they will dry out and kill the flea eggs and larva. They are seen by many as a "safer" alternative to chemicals. They are quite safe, but are a bit of a mess to apply.

One final word: Notice I haven't mentioned anything that kills pupae? There really isn't anything short of fire. That'll kill 'em. This is important to keep in mind because it means that no matter how effective our adulticide and IGR program is, there is a population of fleas waiting to hatch out over the next couple of weeks. This is why you must remain diligent and expect that it will take some time to resolve the problem. One treatment on the dog and the house won't do it.

AMH

Attack of the Killer Grass Awns

This poor little dog managed to get these 4 little grass awns trapped in the sac under the upper eyelid on the left eye. The foreign bodies then proceeded to wear a little ulceration on the cornea. In the images above, the neon green thing is the ulcer after it has been stained and looked at with ultraviolet light. The grass awns (or seeds) are in the picture at the bottom.

Grass awns are dangerous because they are barbed in only one direction and are very, very good at migrating around the body if they ever get up under the skin. As they travel along they deposit bacteria of various degrees of nastiness. There are many cases of these little buggers entering a wound on the chest, for instance, and then migrating around until they actually end up in the chest cavity causing horrid infection.

The cornea is the clear part of the surface of the eye. It is composed of dozens of layers of cells in a laminar, or onion, type configeration. The cornea is transparent because the thickness of the cells is a very specific measurement (even multiples of the wavelength of visible light) and so light passes right through. In the case of trauma or ulceration of the cornea, it takes on an opaue appearance due to swelling of the cells. This opacity resolves as the swelling resolves.

Since the cornea doesn't have its own blood supply for nutrition (blood vessels wouldn't be transparent so the body choose not to put them there) then it depends on the tear film on the outside and the fluid in the front chamber of the eye from behind. So in the case of damage or ulceration of the cornea, any medications you give must be given frequently or they simply wash away.

In the case of a scratch to the cornea, we assume that it either is or is about to be infected. Again, without blood flow, there are few white blood cells there to help fight the normal exposure to bacteria.

This poor little guy should do fine in the long run. If we can get the infection under control and get the cornea to heal cleanly, we will hopefully only have a thin, nearly transparent scar on the cornea. As long as he doesn't have to read or drive a car, he'll never notice.

AMH