Treatment for pyoderma involves treatment of the underlying cause and elimination of the resulting infection. Surface pyodermas such as hot spots are best treated by clipping of the wound and cleaning with an agent that kills the surface bacteria. Antibiotics often are not needed since the bacteria is on the skin surface and not within or beneath the skin. The source of the itching that led to the hot spot must be identified and treated (e. g. fleas). Skin fold pyoderma is treated by clipping hair from the fold and cleaning with an agent to kill the bacteria. Recurrence of the problem may require surgical removal of the fold.
Superficial pyoderma is treated with antibiotics that are effective against Staph. intermedius. This type of bacteria does not respond to some of the more common antibiotics such as penicillin, amoxicillin, ampicillin, or tetracycline. Thus, more potent antibiotics must be used. Three weeks of treatment is usually required for effective therapy. The most commonly used antibiotics include cepahlexin, Clavulanic acid-amoxicillin (Clavamox), Clindamycin, and Cefovecin injectable (Convenia). Antiboiics are often given for 3 – 4 weeks or at least 1 to 2 weeks after all symptoms are resolved. Other antibiotics used include cefpodoxine, cefadroxil, azithromycin, erythromycin, doxycycline, oxacillin, lincomycin, tylocin, difloxacin, enrofloxacin, marbofloxacin, orbifloxacin, and trimethoprim sulfa.
Superficial pyoderma often responds to a appropriate antibiotic when it is used long enough. However, unless the underlying cause is also addressed, the infection often recurs soon after treatment is stopped. Diagnosis and treatment of the underlying cause is essential to long-term success.
In cases where the underlying cause can not be determined, antibacterial shampoos may be helpful in preventing recurrence. Examples of antibacterial shampoos are those that contain benzoyl peroxide, ethyl lactate, povidone-iodine or chlorhexidine. It is important to give the shampoo appropriate contact time with the skin which is generally 10 to 16 minutes. Hair should be trimmed or clipped off affected areas. Dogs with deep pyoderma can benefit from bathing or soaks with Epsom salt solutions. Epsom salt solution soaks can be made using 2 tablespoons of magnesium sulfate (Epsom salts) per liter of warm water. Burrows solution applied daily can also help dogs with deep pyoderma.
Creams and lotions that contain the above chemicals may be useful for treatment of small lesions. Most cases of pyoderma affect a large area of the body, making this approach impractical. The most common topical therapy is mupirocin (Bactroderm), fusidic acid (Fucidin), benzoyl peroxide 5% gel and silver sulfadiazine.
Injections of immune stimulants or immune modulators such as Staphage Lysate (SPL) may be helpful. These are usually reserved for cases that do not respond to more traditional treatment. It has been shown to decrease reoccurrences of pyoderma in approximately 35% of dogs. This is generally given as a 0.5 mL subcutaneous injection twice weekly for a 20 to 30 week course. If symptoms do not return during therapy the SPL is gradually tapered down to weekly then every other weekly dosing.
Deep pyoderma must be aggressively treated with antibiotics selected from culture and bacterial sensitivity. The bacteria that are isolated from the lesions are incubated with several antibiotics in culture media to see which ones can kill those particular bacteria. Antibiotics must be given until a few weeks after all lesions are resolved. Often, 6 to12 weeks of treatment is necessary. Once pyoderma is controlled, some dermatologists recommend pulse antibiotic therapy. This consists of a week of full dose antibiotics followed by a week off then a week back on. If symptoms do not return during the week off antibiotics, the time can be extended during the next pulse. For example the dog may go back on antibiotics for a week and off for two weeks. If no symptoms return during the two weeks off therapy, the next interval could be extended to three weeks. Another methods for pulse dosing antibiotics for dogs with pyoderma is giving full doses of antibiotics two days per week. Yet another methods is every other day dosing.
The immune problem that is underlying the deep pyoderma must be determined and treated to achieve success.
Whirlpool baths may be helpful, as an aid in treating deep pyoderma is your vet has this available.