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May/June 2014 Today's Veterinary Practice 47 TreaTing resisTanT skin infecTions in Dogs DermaTology DeTails | tvpjournal.com • Methicillin resistance is increasing in canine skin infec- tions, and sensitivity results are required to select the correct antibiotic. • Currently, we do not have validated methods for empiri- cally selecting antibiotics for methicillin-resistant staph- ylococcal infections in dogs. HOW DO WE TREAT PYODERMA IN DOGS? Specific to Type of Pyoderma Surface infections are often best treated topically. They are not considered curable because the moisture and oc- clusive nature of folds predisposes toward recurrence. Sur- gical excision may be curative in some cases of vulvar fold pyoderma and tail fold pyoderma in English bulldogs. Superficial pyodermas can often be treated exclusively with topical therapy (which is preferred to systemic antibi- otic administration in my opinion), but frequent bathing is required (daily or every other day). Bathing frequency can be reduced by the use of chlorhexidine leave-on condition- ers, sprays, wipes, and mousses in between. The use of top- ical therapy seems to speed the rate of recovery, and we suspect topical therapy reduces the length of time a dog re- quires systemic antibiotics. Deep pyodermas usually require prolonged (several weeks) courses of antibiotic therapy. While topical therapy alone is unlikely to resolve a deep pyoderma, it is an invaluable tool in the dog's recovery. Bathing helps to remove adherent crusts and sticky exudates, promoting drainage and drying. Topical Treatment Most of the veterinary dermatologic literature supports the use of 2% to 4% chlorhexidine as the most effective topical antiseptic agent against S pseudintermedius, P aeruginosa, and Malassezia species. One of the most critical aspects of pyoderma treatment is bathing (see Step by Step: Bathing as Topical Therapy for Pyoderma), which is beneficial because it: 1. Helps clean the skin, removing scaling and crusts that contain bacteria 2. Makes the dog look, feel, and smell better 3. Frequently helps compress the course of antibiotics, reducing the time for selection of resistant strains. If bathing is combined with systemic antibiotics, mini- mal bathing frequency should be once weekly. However, if Step by Step: Bathing as Topical Therapy for Pyoderma advise owners to: 1. bathe using tepid water. 2. massage the shampoo gently in by hand, first onto the areas most affected (rather than pouring it down the back). 3. Wash the rest of the dog and leave the shampoo on the skin for 10 minutes before rinsing. 4. soak crusts that are tightly adherent, which helps loosen them gently. TVP_2014-0506_DermDetails_Infections.indd 47 5/23/2014 3:24:57 PM