In industrialized nations, S. aureus is the most common cause of superficial pyodermas (Box 176-1), but group A Streptococcus continues to be a common cause of pyoderma in developing countries. Copyright © 2021 Elsevier B.V. or its licensors or contributors. The existence of a real bacterial allergy is presumed and debatable. After MRS pyoderma is documented by culture, simple hygienic measures can be offered to the owner to help reduce fear and enhance patient care (Box 3-3). Pyoderma has three different types. Large pustules within an erythematous papular rash are an uncommon lesion in association with pyoderma. The most common underlying skin diseases are allergic dermatitis and endocrine diseases, but a variety of other skin diseases can also predispose to pyoderma. Pyoderma vegetative (this: ulcerative-inflammatory pyoderma) is characterized by the presence of septate foci, covered with sluggish granulations, vegetations located on the hands, legs and skin folds; Shankriform pyoderma usually manifests as a single ulcer of small dimensions with compaction in the base, which gives it a resemblance to syphilitic chancre, especially since its most frequent localization … Pyoderma is almost always secondary to an underlying disease process, mainly demodicosis, allergic skin disease, and endocrinopathies (Box 3-1). What are the Symptoms of Pyoderma in Dogs? In thick-coated breeds, it may be difficult to see the underlying cutaneous lesions. Regional lymphadenopathy may be present in up to 90% of patients with prolonged, untreated infection. In the cat, bacterial pyoderma is less common. In fungal infections, hairs are usually broken or loosened, and there are suppurative or granulomatous nodules rather than pustules. Treatments may include corticosteroids, ciclosporin, infliximab, or canakinumab.. An unusual pyoderma lesion on the head of a dog with allergies. This uncommon clinical presentation is mainly seen on the ventral body. This is the most common type of pyoderma. Deep bacterial infections usually affect the hair bulb and may also involve the dermis and subcutaneous tissue. Three broad classifications of pyoderma exist, based on the depth of skin and follicle involvement: surface pyoderma, superficial pyoderma, and deep pyoderma. Constitutional symptoms are absent. Most children (81%) developed skin infection. Secondary pyodermas can be caused by: It includes superficial bacterial folliculitis, superficial spreading pyoderma, and “puppy pyoderma” (also known as impetigo or juvenile pustular dermatitis). Superficial folliculitis has also been termed follicular or Bockhart impetigo. 2 regions where staph like to hang out. RosserJr., in Saunders Manual of Small Animal Practice (Third Edition), 2006. However, S. aureus also has the ability to thwart the immune system in several ways. Colonization by S. aureus is found at some body site in up to 37% of patients presenting with purulent community associated methicillin resistant S. aureus (MRSA) infections.2. There was a tendency for more frequent episodes of pyoderma in children 2 to 5 years of age as compared to older children. Erosions and/or ulcers. All three types of Staphylococcus may be zoonotic, moving from human to canine or from canine to human; immunosuppressed individuals are at greatest risk. Sycosis barbae. Multifocal, punctate lesions on the dorsum are a typical feature of postbathing folliculitis and furunculosis. Regardless of the presence of methicillin resistance, patients should be reexamined near the end of the treatment schedule to ensure clinical resolution of pyoderma or lack thereof. Superficial spreading pyoderma is characterized as erythematous macules that enlarge centripetally and create expanding coalescing macules and epidermal collarettes. The lesions tend to spread out before they go away. 176-2). S. aureus belonging to phage group II can be cultured from the contents of intact bullae. Among the acute streptococcal pyodermas are impetigo, diffuse superficial streptococcal pyoderma, and ecthyma, an ulcer that forms beneath a dried phlyctena. Superficial bacterial pyoderma is one of the most common disorders in the dog. Bullous pyoderma gangrenosum is also a superficial variant that affects the upper limbs and face more than the lower extremities. Staphylococcus schleiferi is a bacterial species in dogs and humans that is emerging as a common canine isolate in patients with chronic infection and previous antibiotic exposure. Sycosis barbae is a deep folliculitis with perifollicular inflammation occurring in the bearded areas of the face and upper lip (Fig. A mild exudate can be observed at the edge of the collarettes. S. aureus can cause secondary infection in these inflammatory disorders. If antibiotic resistance is suspected or confirmed, frequent bathing (up to daily) and frequent application of topical chlorhexidine solutions, combined with simultaneous administration of two different classes of antibiotics at high doses, seem to produce the best results. Due to damage to blood vessels in the dermis, bloody discharge or haemorrhagic crusts are common with a risk of haematogenous spread and bacteraemia. • Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Staphylokinase and aureolysin bind and cleave antimicrobial peptides, respectively, resulting in increased survival in vitro and probably in vivo.1, A major problem in treating staphylococcal infections has been the emergence of antibiotic-resistant strains. Vets tend to label pyoderma as either “superficial” or “deep.” Again, no great mystery here. Pyoderma gangrenosum is a rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow. It includes superficial bacterial folliculitis, superficial spreading pyoderma, and “puppy pyoderma” (also known as impetigo or juvenile pustular dermatitis). Pyoderma tends to affect haired skin, repeatedly traumatized skin (e.g., pruritus, pressure points), body folds and creases, and skin of the trunk and often is distributed asymmetrically on the body. Carriage is transient or intermittent in other individuals. Cutaneous cytology is necessary. In veterinary medicine, MRS are becoming more common for reasons such as repeated systemic antibiotic exposure (especially fluoroquinolones), subtherapeutic administration of systemic antibiotics (dose or duration), long-term treatment with steroids, failure to identify and manage the underlying cause for repeated infection, and patient contact with human health care workers or facilities. Most of these are superficial and secondary to a variety of other conditions, such as allergies or parasites. Symptoms : It is mostly associated with hematological conditions . In cats, pyoderma is uncommon to rare, although feline acne can be classified as a pyoderma. Deep pyoderma involves all the portions of the hair follicle and the dermis ( Fig. Normal human skin is colonized soon after birth by a large number of bacteria that live as commensals on the epidermis and epidermal appendages (the skin microbiome). Less commonly seen than superficial pyoderma, deep pyoderma breaks through hair follicles to involve the deep layers of the skin, resulting in furunculosis and cellulitis. See Box 176-3 for differential diagnosis of bullous impetigo. Mild erythema and crusting papules on the abdomen of a male dog. Periporitis staphylogenes refers to secondary infection of miliaria of the neonate by S. aureus. Bacterial culture: Staphylococcus species. A mild exudate can be observed at the edge of the collarettes. Preexisting tissue injury or inflammation (surgical wound, burn, trauma, dermatitis, retained foreign body) is of major importance in the pathogenesis of staphylococcal disease. Until the underlying problem is identified and corrected, the infection usually responds only temporarily to therapy and subsequently recurs. In long-coated dogs, symptoms can be insidious and may include a dull, lusterless hair coat, scales, and excessive shedding. Superficial pyoderma is one of the most common skin diseases in dogs and almost always has an underlying cause (allergies or endocrine disease). Papular rash on the abdomen of an allergic dog caused by multidrug-resistant Staphylococcus schleiferi. 176-4). Also, “hot tub” folliculitis may be caused by P. aeruginosa (see Chapter 180). Chronic streptococcal pyodermas include lichen simplex of the face, perlèche, and chronic paronychia. Deep pyoderma can be seen with any underlying trigger or acquired immunodeficiency, and it is commonly associated with demodicosis. Staphylococci are classified into two major groups: (1) the coagulase-negative Staphylococci and (2) coagulase-positive (S. aureus) Staphylococci. Linda Medleau DVM, MS, Diplomate ACVD, Keith A. Hnilica DVM, MS, Diplomate ACVD, in Small Animal Dermatology (Second Edition), 2006. superficial spreading melanoma Dermatology A melanoma, 70% of which affect Pts from age 30 to 60, especially ♀ in lower legs or trunk, as a flat lesion–radial growth phase that may be present for months to yrs, average 5-yr survival 75% Etiology Recreational suntanning. Recently, intermediate-level resistance of MRSA to vancomycin has emerged and constitutes a potential further problem in treatment. In superficial spreading pyoderma, nummular areas of alopecia and erythema are centrifugally expanding, with epidermal collarettes and crusts. These infections are most likely the result of a transient and non-recurrent insult to the skin. 176-7). pyoderma gangrenosum A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. Untreated staphylococcal or streptococcal impetigo can extend more deeply, penetrating the epidermis, producing a shallow crusted ulcer (Fig. It proliferates in humid external conditions. Pyoderma is a cutaneous infection with pyogenic (pus-forming) bacteria. Although the term pyoderma literally means “pus in the skin,” the pus may not always be visible to the naked eye. Problems of spread by autoinoculation or by insect vectors and of poststreptococcal sequela (glomerulonephritis) are the same as with impetigo. Premature discontinuation of therapy, inability to completely control the primary disease, and the use of fluoroquinilone antibiotics will likely perpetuate the resistant infection. If untreated, the lesions may slowly enlarge and involve new sites over several weeks. Within several weeks after birth, the microbiome of neonatal skin is similar to that of adults and includes many species of bacteria and fungi (see Chapter 175). Other symptoms are superficial folliculitis, which are puss filled pimples at the base of the hair follicles and pyoderma that is spreading across the surface of the skin. Superficial spreading pyoderma Superficial spreading pyoderma is characterised by large, spreading and coalescing epidermal collarettes, erythema and exfoliation (Fig 5). We use cookies to help provide and enhance our service and tailor content and ads. The majority of the primary and secondary pyodermas (cutaneous bacterial infections) are caused by either S. aureus or group A Streptococcus.These bacteria cause a broad clinical spectrum of infection ranging from superficial pyodermas to invasive soft-tissue infections (STIs; see Chapter 179) depending on the organism, the anatomic location of infections, and on host factors. While the condition is not generally hugely serious or life-threatening, pyoderma can be uncomfortable, itchy and cause localised pain in affected dogs. There is extensive erythema, with large, spreading and coalescing epidermal collarettes, and exfoliation. Alopecic dermatitis with a purulent exudate on the lip of a dog. These peptides can be found in various locales and include dermicidin, LL-37, protegrin, α-defensins and β-defensins, lactoferricin, and cascocidin. The majority of the primary and secondary pyodermas (cutaneous bacterial infections) are caused by either S. aureus or group A Streptococcus. DIAGNOSIS Some strains produce one or more exoproteins, including the staphylococcal enterotoxins (SEA, SEB, SECn, SED, SEE, SEG, SEH, and SEI), and the exfoliative toxins (ETA and ETB), TSS toxin-1 (TSST-1), and leukocidin. Secondary pyodermas are far more common and are associated with a persistent or recurrent underlying problem that alters the skin's resistance to infection. Multiple pustules confined to the beard area. Severe erythematous dermatitis with large epidermal collarettes caused by a multidrug-resistant infection. The prognosis is good if the underlying cause can be identified and corrected or controlled. However, these antibodies are not the primary determinants of resistance to such infections. At this time, routine screening for MRS in clinically healthy pets is not necessary or recommended unless patient or human health implications exist. Lesions commonly arise on the skin of the face (especially around the nares) or extremities after trauma. This uncommon clinical presentation is … They may activate B cells, leading to high levels of immunoglobulin E (IgE) or autoantibodies.8 Also, there is evidence that superantigens selectively induce cutaneous lymphocyte-associated antigen on T cells, thereby “homing” them to the skin.8, There are several other mechanisms by which S. aureus evades immune clearance. in most cases of superficial pyoderma as S. pseudintermedius resistance was low. Superficial pyoderma; Deep pyoderma; Surface and superficial pyoderma can cause severe itching in your dog and can also be the cause of hair loss near the infected area or the redness in skin. The papular rash typical of pyoderma persisted despite high-dose antibiotic therapy, suggesting the antibiotic-resistant nature of the organism. Maximize the dose of antibiotics, and consider using two antibiotics simultaneously to prevent additional resistance from developing. Surrounding erythema may be present. What is unique about this clinical form of superficial pyoderma is the lack of pustules; lesions are extensive and pustules are conspicuously absent. In many areas, the prevalence of CA-MRSA strains is over 50%.9. If untreated, invasive infection can complicate S. aureus impetigo with cellulitis, lymphangitis, and bacteremia, resulting in osteomyelitis, septic arthritis, pneumonitis, and septicemia. This moth-eaten texture of the hair coat is a characteristic finding in short-coated breeds with pyoderma. Thus, in acute superficial pyoderma, accompanied by the formation of surface pustules on the skin, they should be opened with subsequent immediate treatment with external antiseptics. Cutaneous cytology is necessary to determine whether the cause is a bacterium, Demodex, or a dermatophyte. Staphylococcus aureus: nasal carriage with impetigo. You may also find some pimple like pustules on the affected skin. In chronic, recurrent, or deep pyodermas, secondary bacterial invaders may also be present, especially Pseudomonas spp., Proteus spp., and Escherichia coli. The infection is almost always secondary to an underlying cause; allergies and endocrine disease are the most common causes (Box 3-3). Superficial spreading pyoderma is characterized as erythematous macules that enlarge centripetally and create expanding coalescing macules and epidermal collarettes. In general, topical formulations that are not rinsed off will have a longer treatment effect. However, with the increasing frequency of methicillin-resistant and multi-drug resistant Staph.organisms, bacterial culture and sensitivity testing would be recommended for those patients who had received systemic antibiotics within the past 6 months. Today, MRSA can be divided into Hospital-Associated (HA) or Community-Associated (CA) MRSA. Exfoliative toxin A acts as a serine protease of desmoglein 1, the desmosomal cadherin that is also the target of autoantibodies in pemphigus foliaceus.12. Pyodermas caused by MRS are clinically indistinguishable from susceptible opportunistic staphylococci. Jane E. Sykes, ... Stephen D. White, in Canine and Feline Infectious Diseases, 2014. Severe erythematous dermatitis without the typical papular, crusting rash, which is more typical of pyoderma. Involved skin in individuals with atopic dermatitis, Superficial folliculitis (follicular or Bockhart impetigo), Foreign body (intravascular catheter, prosthetic device), Impetiginization of dermatoses such as atopic dermatitis, herpes simplex (superinfection), Pyodermas associated with systemic disease, Disseminated intravascular coagulation associated with staphylococcal bacteremia, Superficial (follicular or Bockhart impetigo), Deep (sycosis) [may progress to furuncle (boil) or carbuncle], Gram-negative folliculitis (occurs at the site of acne vulgaris, usually the face, with long-term antibiotic therapy), Syphilitic folliculitis (secondary; acneiform). Cytology (pustule, skin impression): neutrophils and bacterial cocci. When planning therapy, consider local and current antimicrobial resistance patterns. Pyoderma associated with hair follicles causes hair loss (alopecia) as the pustules rupture. Partial alopecia and mild papular rash on the foreleg of this dog were caused by secondary bacterial folliculitis associated with hypothyroidism. See Box 176-4. Lesions are often swollen, haemorrhagic and pain-ful. Deep pyodermas (Fig 4) penetrate below the basement membrane into the dermis and deeper tissues. 176-1). 176-4), and the granulating base extends deeply into the dermis. • Cocker spaniels may present with crusted plaques and follicular casting as a manifestation of pyoderma that can be mistaken for idiopathic or primary seborrhea (a far rarer diagnosis) and lead to inappropriate diagnosis and therapy. Some strains of S. aureus also produce exotoxins, which can cause constellations of cutaneous and systemic symptoms such as staphylococcal scalded-skin syndrome (SSSS) and staphylococcal toxic shock syndrome (TSS). The initial lesion is a transient vesicle or pustule (see Fig. These toxins have unique potent effects on immune cells and other biologic effects as well, ultimately inhibiting host immune response. Superficial pyoderma or bacterial folliculitis extends into the follicular ostium and epidermal tissue. In an adult with extensive or bullous lesions, dicloxacillin (or similar penicillinase-resistant semisynthetic penicillin), 250–500 mg orally (PO) four times daily (qid), or erythromycin (in the penicillin-allergic patient), 250–500 mg PO qid, should be given. In both short- and long-coated breeds, primary skin lesions are often obscured by remaining hairs but can be readily appreciated if an affected area is clipped. The lesions caused by the bacteria appear most frequently on areas exposed to humidity or rain and on areas in which water accumulates, such as the croup, the back, the neck, the head and the legs. Differentials include demodicosis, dermatophytosis, scabies, and autoimmune skin diseases. Systemic reactions include: staphylococcal toxic shock syndrome and scarlatiniform eruption. Additionally, methicillin-resistant Staphylococcus aureus (human MRSA) is becoming more common among veterinary species. Short-coated dogs often present with a “moth-eaten” patchy alopecia, small tufts of hair that stand up, or reddish brown discoloration of white hairs. All three represent varying cutaneous responses to extracellular exfoliative toxins (“exfoliatin”) types A and B produced by these Staphylococci (see Chapter 177). Conspicuously absent will recur or benzoyl peroxide is helpful ingredient with good superficial spreading pyoderma against Staphylococcus intermedius ) is the common! Spreading pyoderma diffuse, large, spreading and coalescing epidermal collarettes with antiseptic. Screening dogs that visit the elderly or the sick to prevent zoonosis which inhibits neutrophil.... 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