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skin. Methicillin-resistant S pseudintermedius (MRSP) successfully prevent the canine from inflicting further self-
is increasing in prevalence and importance in canine trauma. Early and appropriate treatment leads to the best
superficial pyoderma. For cases involving a secondary prognosis with rapid improvement and resolution usually
9
superficial pyoderma in which topical antiseptics have within 3–7 days. If the lesion is not allowed to fully heal or if
failed to resolve the infection, consider application the primary underlying problem is not addressed or managed
of topical mupirocin, an antibacterial agent effective appropriately, there is high likelihood that the itch-scratch cy-
against most MRSP isolates. Due to the increasing cle will recur and the hot spot will relapse.
9
resistance to methicillin-resistant S aureus (a pathogen
of concern in people), it is recommended to reserve the Prevention
use of mupirocin for targeted therapy and when based
on culture and susceptibility testing. 9 Prevention is based on understanding why hot spots occur,
what primary underlying conditions may lead to self-inflicted
Important notes: trauma, and what measures are required to prevent these un-
• Whenever possible, topical agents are best applied as derlying causes from spiraling out of hand. The risk for devel-
nonocclusive vehicles (e.g., sprays, rinses, gels). Avoid oping a hot spot is substantially reduced by keeping up with
1
medications formulated in occlusive vehicles (e.g., oint- grooming, bathing, and environmental hygiene; maintaining
ments, creams) because these may clog hair follicles and ectoparasite control; routinely inspecting and cleaning the
promote formation of bacterial folliculitis. canine’s ears; and routinely examining and expressing anal
• Combination therapy: One study revealed that use of a glands as needed. If the OpK9 has a known history of allergic
product combining an antimicrobial with a corticosteroid skin diseases, ensure they remain up to date on their prescrip-
(namely, neomycin-prednisolone) provided faster resolu- tion medications/diet and avoid exposures to potential trig-
tion than either agent used alone. Betagen (gentamicin gers that may exacerbate these conditions. For OpK9s with
®
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sulfate/betamethasone valerate; Med-Pharmex, https:// a history of hot spots, be alert to excessive licking, chewing,
www.medpharmex.com) is a commonly used commercial and or scratching. Preemptively consult a veterinary behavior-
veterinary product used for pyotraumatic dermatitis. ist to use appropriate behavior modification techniques (e.g.,
desensitization) for OpK9s that display or have a high risk of
Systemic Therapy 1,2,5,8–10 suffering self-directed behavior due to environmental or social
Topical therapy alone (particularly daily cleaning and dry- stressors.
ing) in conjunction with physically blocking additional self-
inflicted trauma is generally effective for resolving mild cases Disclosure
of pyotraumatic dermatitis. Moderate to severe cases and The author has indicated he has no financial relationships rel-
cases involving a secondary superficial or deep pyoderma of- evant to this article to disclose.
ten require additional systemic therapy.
References
1. Rosenkrantz WS. Web Chapter 42: Pyotraumatic dermatitis
• Corticosteroids reduce inflammation and pruritus. Due
to the intensely pruritic and inflammatory nature of the (‘Hot Spots’). In: Bonagura JD and Twedt DC., eds. Kirk’s Cur-
rent Veterinary Therapy XV. St. Louis, MO: Elsevier Saunders;
hot spots, some dogs benefit from a short course of an 2014:e206.
oral antiinflammatory drug. Avoid long-acting cortico- 2. Miller WH, Griffin CE, Campbell KL. Chapter 16: Environmen-
steroids (e.g,. injectable repositol); instead, use short- to tal skin diseases. In: Muller and Kirk’s Small Animal Dermatol-
intermediate-acting drugs (e.g., prednisone 0.5mg/kg/ ogy. 7th ed. St. Louis, MO: Saunders Elsevier; 2013:677–678.
day administered every 12–24 hours orally [PO] for 3–5 3. Virga V. Self-directed behaviors in dogs and cats. 2015. http://
days). veterinarymedicine.dvm360.com/self-directed-behaviors
-dogs-and-cats?id=&pageID=1&sk=&date= Accessed 17 Febru-
• Antimicrobial medications are used to treat known or ary 2018.
highly suspected bacterial pyoderma, pyotraumatic fol- 4. Hoffmann AR, Patterson AP, Diesel A, et al. The skin microbiome
liculitis, or furunculosis. Ideally, selection of an appropri- in healthy and allergic dogs. PLoS One. 2014;9(1):e83197.
ate systemic antimicrobial agent is based on culture and 5. Holm BR, Rest JR, Seewald W. A prospective study of the clinical
sensitivity testing; however, this is not readily available in findings, treatment and histopathology of 44 cases of pyotrau-
matic dermatitis. Vet Dermatol. 2004;15:369–376.
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common pathogenic skin bacterium associated with pyo- combination in the treatment of pyotraumatic dermatitis in dogs.
derma in dogs, initial empirical therapy should target this Vet Dermatol. 1996;7:163.
genus of gram-positive bacteria. In a study in which 44 7. DeBoer DJ. Skin scraping for external parasites. Clinicians Brief.
cases of pyotraumatic dermatitis in dogs were evaluated, 2016;April:43–47.
there was a high rate of Staphylococcus resistance to pen- 8. Kersey KM, Rosales M, Roberts BK. Dermatologic emergencies:
icillin and ampicillin but a very low rate of resistance to identification and treatment. Compend Contin Educ Vet. 2013;
35(1):E2.
cephalexin. For empirical therapy, consider a cephalo- 9. Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis
5
sporin (cephalexin 20–30mg/kg PO every 12 hours for and antimicrobial therapy of canine superficial bacterial folliculi-
7 days) or potentiated aminopencillin (amoxicillin-clavu- tis (Antimicrobial Guidelines Working Group of the International
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Prognosis systemic antimicrobial treatment in canine superficial and deep
pyoderma: a systematic review. Vet Dermatol. 2012;23:305–e61.
Prognosis depends on the (1) compliance, commitment, and 11. Reinke SI, Stannard AA, Ihrke PJ, et al. Histopathologic features
ability to keep up with daily treatments; (2) success in deter- of pyotraumatic dermatitis. J Am Vet Med Assoc. 1987;190(1):
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