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.
