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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice 69 DERMATOLOGY DETAILS Peer Reviewed certain skin diseases universally present diagnostic and/or treatment dilemmas for general practitioners and specialists alike, and opinions abound on the "best" way to handle these conditions. This uncertainty largely refects our lack of knowledge about these skin diseases and our relative inability to make evidence-based statements. This article presents 5 dermatologic conditions that raise plentiful questions, inspire a variety of opinions, and result in contentious discussion; often there is no one correct answer. The aim of the following presentations is to help you formulate your own approach to these dilemmas, and they are accompanied by key points on each topic, questions to be considered, and useful references for further study. DILEMMA 1. I've diagnosed methicillin- resistant staphylococcal pyoderma. Now what? s taphylococcal pyoderma is one of the most common dermatologic conditions in dogs. in addition, over the past 10 years, prevalence of antibiotic resistance in canine staphylococcal infections has substantially increased. 1 if methicillin-resistant Staphylococcus (Mrs) is present, the laboratory report will indicate that the organism is resistant to all beta-lactam antibiotics, including all penicillins and cephalosporins. Many strains of Mrs are resistant to multiple classes of antibiotics, leaving the practitioner with few good options for treatment. Clinical Pearls The clinical pearl here is topical antiseptic therapy . We're used to thinking of topical products as adjunct treatments (ie, used in addition to systemic antibiotics), but the thought process has changed. now dermatologists are advocating that topical therapy be used instead of systemic antibiotic therapy in both resistant and nonresistant strains of Staphylococcus when possible. reducing systemic antibiotic use helps minimize risk for antimicrobial resistance. Topical antiseptic products kill even highly antibiotic-resistant strains. Most research in this area has been done with chlorhexidine, which is an excellent choice for topical therapy. 2,3 Mild to moderate superfcial pyoderma responds very well to daily topical application of 2% to 4% chlorhexidine (the percentage does not seem to matter), generally for 3 to 4 weeks (Figure 1). Key points are: • Medication must be applied daily. • To ensure daily application, provide the client with a spray, mousse, or other "leave-on" product to make frequent application easy for the client; whole-body chlorhexidine shampooing can still be done weekly. More severe cases, or cases of deep pyoderma, still require systemic antibiotic treatment; choice of antibiotic is based on Dilemmas in Dermatology: Pearls & Pitfalls Douglas J. DeBoer, DVM, Diplomate ACVD University of Wisconsin FIGURE 1. Abdomen of a dog with papules, pustules, and epidermal collarettes indicative of superfcial pyoderma. The treatment of choice for this localized disease is 2% to 4% chlorhexidine, applied once daily by spray, mousse, or other formulation, for 3 weeks or longer.