Help Needed! Recurring edema in paw

[JenniferMac]

Went to our regular vet today and they agreed with referral to specialist at UGA vet hospital with recommendation for a culture and biopsy. Should be receiving a call from UGA to schedule in the next couple of days. Fingers crossed they can get to the bottom of it.

 

[helsonwheels]

Went to our regular vet today and they agreed with referral to specialist at UGA vet hospital with recommendation for a culture and biopsy. Should be receiving a call from UGA to schedule in the next couple of days. Fingers crossed they can get to the bottom of it.

IC has absolutely nothing to do with allergies. Duke had zero allergies, so does Nyala n Jake. It’s simply one of them annoying thing that just happens to some webfeet dogs. And they’re not good swimmers either so go figure that one out. I tried everything even alums spice. That white powder that gives you that bitter taste to pickles. Mixed it with rubbing alcohol n sponged it in. Yes dries up the cyst but does take a few days. Personally I still find the bag balm did the exact same job n less messy. My vet did say and was really honest with me that IC either they disappear for good or comes back on n off. Never got antibiotics either as it won’t get rid of them. Why we shouldn’t bother with antibiotics, no point. We’ll just screw up their immune system for no reason.

 

[JenniferMac]

IC has absolutely nothing to do with allergies. Duke had zero allergies, so does Nyala n Jake. It’s simply one of them annoying thing that just happens to some webfeet dogs. And they’re not good swimmers either so go figure that one out. I tried everything even alums spice. That white powder that gives you that bitter taste to pickles. Mixed it with rubbing alcohol n sponged it in. Yes dries up the cyst but does take a few days. Personally I still find the bag balm did the exact same job n less messy. My vet did say and was really honest with me that IC either they disappear for good or comes back on n off. Never got antibiotics either as it won’t get rid of them. Why we shouldn’t bother with antibiotics, no point. We’ll just screw up their immune system for no reason.

Ordered some NuStock but haven't tried it yet. His foot "popped" and then dried up so it's ok now until the next time, usually once a week. I'm going to wait until he can be seen by the UGA vet so they can see what it looks like and does when it's inflamed. I'll have to check into the bag balm too. Thanks for the suggestions.

 

[helsonwheels]

Ordered some NuStock but haven't tried it yet. His foot "popped" and then dried up so it's ok now until the next time, usually once a week. I'm going to wait until he can be seen by the UGA vet so they can see what it looks like and does when it's inflamed. I'll have to check into the bag balm too. Thanks for the suggestions.

They are very annoying them IC. Sometimes it’s like hair follicle or skin pore gets blocked by dirt etc... NuStock is good stuff. That works great. Smells but good... Keep us posted!

 

[Dollys Owner]

I'm going to post a lot of data from my vet manual, which is what University of Georgia will be looking into, so you will have some insight ahead of time, plus I bolded the food allergy to show that it can be a contributing factor:
RISK FACTORS
Some forms of pyoderma, particularly superficial bacterial folliculitis (SBF) and bacterial overgrowth syndrome (BOGS) are
often secondary to underlying etiologies such as hypersensitivity skin disease (atopic dermatitis, food allergy, flea bite
hypersensitivity), endocrinopathies (hypothyroidism, hyperadrenocorticism), parasitic skin disease (Sarcoptes, Demodex
spp.), immune-mediated diseases, or cornification disorders.
Deep pyoderma may be associated with underlying immunoincompe-tence.

DIFFERENTIAL DIAGNOSIS
Demodicosis
Dermatophytosis
Pemphigus foliaceus
Cutaneous epitheliotropic lymphoma
Subcutaneous mycoses (deep pyoderma)
Atypical mycobacterial infections (deep pyoderHookworm (deep pedal pyoderma)
Foreign-body granulomas (deep pyoderma)

INITIAL DATABASE
Skin scrapings to confirm or rule out Demodex and Sarcoptes
Skin cytologic examination: direct smear from pustule reveals bacteria, neutrophils in varying stages of degeneration, and
active bacterial phagocytosis.
Fungal culture (for dermatophytes and possibly for deep mycosis if draining tracts are present)
ADVANCED OR CONFIRMATORY TESTING
Culture and sensitivity (C&S): not normally employed in superficial pyoderma cases unless there has been a failure to
respond to rational antibiotic therapy or bacilli are noted on skin cytologic examination.
Skin biopsy and histopathologic exam: normally not performed unless cases are not responding to appropriate antibiotic
therapy. Findings include intraepidermal neutrophilic pustules, folliculitis, or furunculosis ± underlying cause (e.g., Demodpemphigus foliaceus, epitheliotrophic lymphoma).
Endocrine status: thyroid function and adrenal function tests
Allergy testing: intradermal or serum allergy testing for environmental allergies, and elimination diet trial for food allergy

Usual cause is staphylococcus.

TREATMENT
TREATMENT OVERVIEW
The main goals are to treat the infection and determine the underlying cause(s).
ACUTE GENERAL TREATMENT
Topical Therapy:
Most commonly used: mupirocin (Bactroderm) and fusidic acid (Fucidin). Silver sulfadiazine and benzoyl peroxide 5% gels are
also available.
Shampoo therapy very effectively decreases bacterial skin colonization (adjunctive therapy). Shampoo therapy (10-15
minutes contact time) with products containing benzoyl peroxide, chlorhexidine, ethyl lactate, and povidone-iodine may
improve the condition.
Clip the fur off affected areas.
Deep pyoderma: bathe animal or soak lesion with Epsom salts solution (magnesium sulfate, 2 tablespoons/liter of lukewarm
Systemic Antibiotic Therapy:
Bactericidal antibiotics are generally recommended for skin infections; however, bacteriostatic drugs may be effective in an
immunocompetent animal. The chosen drug should have a narrow spectrum to limit the effects on the normal flora of both the
skin and gastrointestinal (GI) tract.
Cases should be treated for a minimum duration of 3-4 weeks, or 7-14 days beyond clinical cure. Deep pyoderma may take
as long as 12 weeks to resolve.
The most commonly used antibiotics include (generally monotherapy):
Cephalexin, 22-30 mg/kg PO q 12 h (most common choice in dogs)
Clavulanic acid-potentiated amoxicillin, 12.5-25 mg/kg PO q 12 h
Clindamycin, 5.5-11 mg/kg PO q 12 h
Cefovecin injectable, 8 mg/kg SQ q 14 days
Other suggested drugs/dosages include (generally monotherapy; all PO): cefpodoxime, 5-10 mg/kg q 24 h; cefadroxil, 22
mg/kg q 12 h; oxacillin, 22 mg/kg q 8 h; erythromycin, 10-20/ kg q 8 h (vomiting and diarrhea common); lincomycin, 15-25
mg/kg q 12 h; azithromycin, 5 mg/kg q 24 h; tylosin, 10-20 mg/kg q 12 h; trimeth-oprim-sulfa, 15-30 mg/kg q 12 h; difloxacin,
5-10 mg/kg q 12 h (not in immature animals); enrofloxacin, 5-20 mg/kg q 24 h (not in immature animals); marbofloxacin,
2.75-5.5 mg/kg q 24 h (not in immature animals); orbifloxacin, 2.5 mg/kg q 24 h (not in immature animals); doxycycline, 5
mg/kg (day 1), then 2.5 mg/kg q 12 h
Appropriate pain management
CHRONIC TREATMENT
In face of an idiopathic recurrent pyoderma (generally SBF) that recurs less than three or four times a year, it is often more
economical and reasonable to treat each event with an appropriate course of antibiotics. Moreover, when an antibiotic (e.g.,
cephalexin) is effective in treating an episode of pyoderma, there is no need to change for another antibiotic when the
pyoderma recurs later on.
In cases of idiopathic recurrent pyoderma where several episodes occur annually and/or when total annual antibiotic
administration is more than 12 weeks, adjunctive immunomodulatory therapy or extended antibiotic regimens (both
controversial in veterinary dermatology) may be needed to maintain clinical remission.
Immunomodulatory therapy: Staphage Lysate (SPL [Delmont Laboratories]) may help decrease recurrences of pyoderma in
up to 35% of dogs. The dog should initially receive a 4- to 6-week course of oral antibiotic in conjunction with a 20- to
30-week course of SPL (0.5 mL twice weekly SQ). If the pyoderma does not recur during that period of time, the frequency of
injections is gradually reduced to once weekly, then every other week.
Extended regimens of antibiotic therapy (or pulse therapy). Pyoderma has to be eliminated by standard appropriate, safe,
bactericidal antibiotic therapy (e.g., cephalexin) before extended regimen is used. Many different treatment regimens have
been recommended. Pulse therapy implies using full therapeutic doses on an intermittent basis. One proposed regimen
involves 1 week at full recommended daily dose, followed by 1 week off medication, and so on. If recurrence is prevented, the
duration of the time off the antibiotic can be extended to up to 3 weeks. Two days per week dosing (at full daily dose) is
another popular regimen. A third recommended regimen involves once-daily to once-every-other-day dosing.
Antimicrobial shampoo or lotions used on a regular basis may assist in the prevention of relapses by limiting the bacterial
surface flora.

 

[Dollys Owner]

^^^ Note in bolded section above that vet manual only recommends blood or skin testing for environmental allergies and elimination diet for food allergies. All the posters who say they've done saliva and hair testing for allergies- not considered reliable.

 

[cefe13]

Castor (who says hi to Gumbo!) has had interdigital cysts and we have been successful with chlorehexidine footbaths (leave on chlorehexidine shampoo for ten minutes and then rinse and pat dry) and also a Swedish tar ointment/oil. Not sure if the latter is something vets in the US would recommend but it was very efficient (the cyst disappeared within days).

Looking at the photos of Gumpo's foot it doesn't really look like the cysts Castor has had. Great that you have got a referral to a research vet hospital; hope they can help your boy soon!

 

[JenniferMac]

Castor (who says hi to Gumbo!) has had interdigital cysts and we have been successful with chlorehexidine footbaths (leave on chlorehexidine shampoo for ten minutes and then rinse and pat dry) and also a Swedish tar ointment/oil. Not sure if the latter is something vets in the US would recommend but it was very efficient (the cyst disappeared within days).

Looking at the photos of Gumpo's foot it doesn't really look like the cysts Castor has had. Great that you have got a referral to a research vet hospital; hope they can help your boy soon!

I hope they can help too. It's sort of a last resort as we've tried just about everything else. I do have chlorehexidine shampoo which I've had to use on Gumbo when he's had a staph infection in the past and have used that on his foot as well but it didn't seem to help. I'm still not convinced that what he's got is an actual cyst but the UGA vet is supposed to do a culture and a biopsy to confirm. We'll see what they determine and hope they can provide a good treatment plan. Thanks for the suggestions and good thoughts.

 

[JenniferMac]

They are very annoying them IC. Sometimes it’s like hair follicle or skin pore gets blocked by dirt etc... NuStock is good stuff. That works great. Smells but good... Keep us posted!

I'll update after his appointment and when we get the results of the culture and biopsy. I'll be especially interested to see if they determine it's a cyst or something else.

 

[JenniferMac]

I'm going to post a lot of data from my vet manual, which is what University of Georgia will be looking into, so you will have some insight ahead of time, plus I bolded the food allergy to show that it can be a contributing factor:
RISK FACTORS
Some forms of pyoderma, particularly superficial bacterial folliculitis (SBF) and bacterial overgrowth syndrome (BOGS) are
often secondary to underlying etiologies such as hypersensitivity skin disease (atopic dermatitis, food allergy, flea bite
hypersensitivity), endocrinopathies (hypothyroidism, hyperadrenocorticism), parasitic skin disease (Sarcoptes, Demodex
spp.), immune-mediated diseases, or cornification disorders.
Deep pyoderma may be associated with underlying immunoincompe-tence.

DIFFERENTIAL DIAGNOSIS
Demodicosis
Dermatophytosis
Pemphigus foliaceus
Cutaneous epitheliotropic lymphoma
Subcutaneous mycoses (deep pyoderma)
Atypical mycobacterial infections (deep pyoderHookworm (deep pedal pyoderma)
Foreign-body granulomas (deep pyoderma)

INITIAL DATABASE
Skin scrapings to confirm or rule out Demodex and Sarcoptes
Skin cytologic examination: direct smear from pustule reveals bacteria, neutrophils in varying stages of degeneration, and
active bacterial phagocytosis.
Fungal culture (for dermatophytes and possibly for deep mycosis if draining tracts are present)
ADVANCED OR CONFIRMATORY TESTING
Culture and sensitivity (C&S): not normally employed in superficial pyoderma cases unless there has been a failure to
respond to rational antibiotic therapy or bacilli are noted on skin cytologic examination.
Skin biopsy and histopathologic exam: normally not performed unless cases are not responding to appropriate antibiotic
therapy. Findings include intraepidermal neutrophilic pustules, folliculitis, or furunculosis ± underlying cause (e.g., Demodpemphigus foliaceus, epitheliotrophic lymphoma).
Endocrine status: thyroid function and adrenal function tests
Allergy testing: intradermal or serum allergy testing for environmental allergies, and elimination diet trial for food allergy

Usual cause is staphylococcus.

TREATMENT
TREATMENT OVERVIEW
The main goals are to treat the infection and determine the underlying cause(s).
ACUTE GENERAL TREATMENT
Topical Therapy:
Most commonly used: mupirocin (Bactroderm) and fusidic acid (Fucidin). Silver sulfadiazine and benzoyl peroxide 5% gels are
also available.
Shampoo therapy very effectively decreases bacterial skin colonization (adjunctive therapy). Shampoo therapy (10-15
minutes contact time) with products containing benzoyl peroxide, chlorhexidine, ethyl lactate, and povidone-iodine may
improve the condition.
Clip the fur off affected areas.
Deep pyoderma: bathe animal or soak lesion with Epsom salts solution (magnesium sulfate, 2 tablespoons/liter of lukewarm
Systemic Antibiotic Therapy:
Bactericidal antibiotics are generally recommended for skin infections; however, bacteriostatic drugs may be effective in an
immunocompetent animal. The chosen drug should have a narrow spectrum to limit the effects on the normal flora of both the
skin and gastrointestinal (GI) tract.
Cases should be treated for a minimum duration of 3-4 weeks, or 7-14 days beyond clinical cure. Deep pyoderma may take
as long as 12 weeks to resolve.
The most commonly used antibiotics include (generally monotherapy):
Cephalexin, 22-30 mg/kg PO q 12 h (most common choice in dogs)
Clavulanic acid-potentiated amoxicillin, 12.5-25 mg/kg PO q 12 h
Clindamycin, 5.5-11 mg/kg PO q 12 h
Cefovecin injectable, 8 mg/kg SQ q 14 days
Other suggested drugs/dosages include (generally monotherapy; all PO): cefpodoxime, 5-10 mg/kg q 24 h; cefadroxil, 22
mg/kg q 12 h; oxacillin, 22 mg/kg q 8 h; erythromycin, 10-20/ kg q 8 h (vomiting and diarrhea common); lincomycin, 15-25
mg/kg q 12 h; azithromycin, 5 mg/kg q 24 h; tylosin, 10-20 mg/kg q 12 h; trimeth-oprim-sulfa, 15-30 mg/kg q 12 h; difloxacin,
5-10 mg/kg q 12 h (not in immature animals); enrofloxacin, 5-20 mg/kg q 24 h (not in immature animals); marbofloxacin,
2.75-5.5 mg/kg q 24 h (not in immature animals); orbifloxacin, 2.5 mg/kg q 24 h (not in immature animals); doxycycline, 5
mg/kg (day 1), then 2.5 mg/kg q 12 h
Appropriate pain management
CHRONIC TREATMENT
In face of an idiopathic recurrent pyoderma (generally SBF) that recurs less than three or four times a year, it is often more
economical and reasonable to treat each event with an appropriate course of antibiotics. Moreover, when an antibiotic (e.g.,
cephalexin) is effective in treating an episode of pyoderma, there is no need to change for another antibiotic when the
pyoderma recurs later on.
In cases of idiopathic recurrent pyoderma where several episodes occur annually and/or when total annual antibiotic
administration is more than 12 weeks, adjunctive immunomodulatory therapy or extended antibiotic regimens (both
controversial in veterinary dermatology) may be needed to maintain clinical remission.
Immunomodulatory therapy: Staphage Lysate (SPL [Delmont Laboratories]) may help decrease recurrences of pyoderma in
up to 35% of dogs. The dog should initially receive a 4- to 6-week course of oral antibiotic in conjunction with a 20- to
30-week course of SPL (0.5 mL twice weekly SQ). If the pyoderma does not recur during that period of time, the frequency of
injections is gradually reduced to once weekly, then every other week.
Extended regimens of antibiotic therapy (or pulse therapy). Pyoderma has to be eliminated by standard appropriate, safe,
bactericidal antibiotic therapy (e.g., cephalexin) before extended regimen is used. Many different treatment regimens have
been recommended. Pulse therapy implies using full therapeutic doses on an intermittent basis. One proposed regimen
involves 1 week at full recommended daily dose, followed by 1 week off medication, and so on. If recurrence is prevented, the
duration of the time off the antibiotic can be extended to up to 3 weeks. Two days per week dosing (at full daily dose) is
another popular regimen. A third recommended regimen involves once-daily to once-every-other-day dosing.
Antimicrobial shampoo or lotions used on a regular basis may assist in the prevention of relapses by limiting the bacterial
surface flora.

Wow! This is fantastic information and very helpful. It supports a lot of the possible causes and treatments that have been mentioned by others and our current vet. Gumbo has had several staph infections over the past couple of years and they seem to clear up quickly on antibiotics, along with his foot as well. He'll be on a 30-day course of antibiotics for the staph and during that time, his foot will completely clear up and not have any recurrences. Then, within the first week of being off of the antibiotics, his foot issue will return. But, the vet wasn't comfortable with putting him on a long term regimen of antibiotics due to the side effects which I understand and agree with. I'm actually excited about the appointment because I'm really hoping that they can get to the bottom of it and figure out the cause and a treatment plan. I'll post an update when I know more. Thanks again for all of the information and assistance!

 

[Tyson55]

Hello any updates?

 

[oscarmayer]

Hello any updates?

Probably not...it's been 2.5+ years since last post and the patient was 11 yo in Sept 2019. You might try a private message including the thread location.
With our one boy that had recurrent interdigital cysts...I would lance the cyst(with a clean scalpel) and squeeze Panalog into the hole. The cyst would go away within a few days. They always came back however...sometimes weeks, sometimes months. Panalog is no longer manufactured but I think you can use a similar product, Animax.