Hair Loss in Dogs (Canine Alopecia)

Hair Loss in Dogs (Canine Alopecia)–An Overview

  • “Alopecia” is the medical term for hair loss
  • Hair loss is a common disorder in dogs
  • Characterized by a complete or partial lack of hair in areas where it is present normally
  • Pattern of hair loss–varied or symmetrical
  • May be the primary problem or be secondary to an underlying cause
  • May be associated with a single cause or multiple causes

Signalment/Description of Pet

  • May be sudden (acute) in onset or slowly progressive
  • Multiple patches of circular hair loss (alopecia)—most frequently associated with inflammation of the hair follicles (known as “folliculitis”) from bacterial infection and/or demodectic mange (known as “demodicosis”)
  • Large, more widespread areas of hair loss (alopecia)—may indicate abnormal development of the hair follicles or hair (known as “follicular dysplasia”) or a more generalized disease
  • The pattern and degree of hair loss are important for establishing a diagnosis

Causes

Multiple Areas (Multifocal) of Hair Loss

  • Localized demodectic mange (demodicosis)—partial to complete hair loss (alopecia) with reddening of the skin (known as “erythema”) and mild scaling; lesions may become inflamed and may have dried discharge on the surface (dried discharge known as “crusts”)
  • Ringworm (known as “dermatophytosis”)—”ringworm” is a fungal infection on the surface of the skin characterized by partial to complete hair loss (alopecia) with scaling; with or without reddening of the skin (erythema); not always “ring-like” in appearance
  • Inflammation of the hair follicles due to Staphylococcus bacterial infection (known as “staphylococcal folliculitis”)—circular patterns of hair loss (alopecia) bordered by scales (accumulations of surface skin cells, such as seen in dandruff) or surface peeling of the skin (the pattern is known as an “epidermal collarette”), reddening of the skin (erythema), dried discharge on the surface of the skin lesion (crust), and darkened areas of skin (known as “hyperpigmented macules”)
  • Injection reactions—inflammation with hair loss (alopecia) and/or thinning of the skin (known as “cutaneous atrophy”) from scarring
  • Rabies-vaccine inflammation of the blood vessels (known as “vasculitis”)—well-demarcated patch of hair loss (alopecia) at the location where the rabies vaccine was administered is observed 2–3 months following vaccination
  • Localized scleroderma (condition in which normal skin is replaced by scar tissue for some unknown cause)—well-demarcated, shiny, smooth skin with hair loss (alopecia); lesion is a thickened, raised, flat-topped area that is slightly higher than the normal skin (known as a “plaque”)
  • Specific condition characterized by multiple patches of hair loss (known as “alopecia areata”)—non-inflammatory areas of complete hair loss (alopecia)
  • Condition characterized by multiple areas of hair loss with reddened skin, scales, and signs of itchiness (known as “pruritus”) with inflammation of the sebaceous glands, the glands that produce oils in the hair coat (condition known as “sebaceous adenitis”) seen in short-coated breeds—ring-like areas of hair loss (alopecia) and scaling

Symmetrical Hair Loss

  • Excessive levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”)—hair loss along the sides of the body (known as “truncal alopecia”) associated with thin skin, plugs of keratin and oil in the follicles of the skin (known as “comedones”), and skin infection characterized by the presence of pus (known as “pyoderma”)
  • Inadequate levels of thyroid hormone (known as “hypothyroidism”)—hair loss (alopecia) is an uncommon presentation
  • Non-inflammatory hair loss (non-inflammatory alopecia, known as “alopecia X”)—symmetrical hair loss along the sides of the body (truncal alopecia) associated with darkened skin (known as “hyperpigmentation”); hair loss often starts along the collar area of the neck; seen in Pomeranians, chow chows, Akitas, Samoyeds, Keeshonden, Alaskan malamute, and Siberian husky
  • Excessive levels of estrogen (known as “hyperestrogenism”) in females—symmetrical hair loss (alopecia) of the flanks and skin between the external genitalia and the anus (perineal skin) and between the rear legs (inguinal skin) with enlarged external genitalia (vulva) and mammary glands
  • Inadequate secretion of female hormones (known as “hypogonadism”) in intact females—hair loss of the skin between the external genitalia and the anus (perineal skin), flank, and hair loss along the sides of the body (truncal alopecia)
  • Testosterone-responsive skin disorder (known as “testosterone-responsive dermatosis”) in castrated males—slowly progressive hair loss along the sides of the body (truncal alopecia)
  • Male feminization from Sertoli cell tumor (a type of tumor in the testicles)—hair loss (alopecia) of the skin between the external genitalia and the anus (perineal skin) and genital region with excessive development of the male mammary glands (known as “gynecomastia”)
  • Castration-responsive skin disorder (known as “castration-responsive dermatosis”)—hair loss (alopecia) in the collar area, rump, skin between the external genitalia and the anus (perineal skin), and flanks
  • Estrogen-responsive skin disorder (known as “estrogen-responsive dermatosis”) in spayed female dogs—hair loss (alopecia) of the skin between the external genitalia and the anus (perineal skin) and genital regions
  • Seasonal flank hair loss/cyclic flank hair loss (alopecia)—creeping hair loss involving the flanks with darkened skin (hyperpigmentation); seen in boxers, English bulldogs, and Airedale terriers

Patchy to Generalized (Diffuse) Hair Loss

  • Demodectic mange (demodicosis)—often associated with reddening of the skin (erythema), inflammation of the hair follicles (folliculitis), and darkened skin (hyperpigmentation)
  • Bacterial infection/inflammation of the hair follicles (folliculitis)—multiple areas of circular hair loss (alopecia) that may join to form large areas of hair loss; circular patterns of hair loss bordered by scales (accumulations of surface skin cells, such as seen in dandruff) or surface peeling of the skin (epidermal collarette)
  • Ringworm (dermatophytosis)—often accompanied by scales (accumulations of surface skin cells, such as seen in dandruff)
  • Sebaceous adenitis (condition characterized by multiple areas of hair loss with reddened skin, scales, and signs of itchiness [known as “pruritus”] with inflammation of the sebaceous glands, the glands that produce oils in the hair coat)—hair loss (alopecia) with thick, adherent scales; predominantly along the back line of the body, including the head
  • Color-mutant/dilution hair loss (alopecia)—thinning of the hair coat with secondary inflammation of the hair follicles (folliculitis) in some blue or fawn dogs
  • Abnormal development of the hair follicles or hair (known as “follicular dysplasia”)—slowly progressive hair loss (alopecia)
  • Hair loss during stages of the hair growth cycle—sudden (acute) onset of hair loss (alopecia)
  • Inadequate levels of thyroid hormone (hypothyroidism)—generalized (diffuse) thinning of the hair coat
  • Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s disease)—hair loss along the sides of the body (truncal alopecia) with thin skin and formation of plugs of keratin and oil in the follicles of the skin (comedones)
  • Epitheliotropic lymphoma (type of cancer in the skin characterized by the presence of abnormal lymphocytes; a lymphocyte is a type of white-blood cell, formed in lymphatic tissue throughout the body)—widespread, generalized hair loss along the sides of the body (truncal alopecia) with scales (accumulations of surface skin cells, such as seen in dandruff) and reddening of the skin (erythema); later small, solid masses (known as “nodules”) and thickened, raised, flat-topped areas that are slightly higher than the normal skin (known as “plaques”) may form
  • Pemphigus foliaceus (a disease in which the body’s immune system attacks its own skin)—hair loss (alopecia) associated with the formation of scales (accumulations of surface skin cells, such as seen in dandruff) and dried discharge on the skin lesions (crusts)
  • Keratinization disorders (disorders in which the surface of the skin is abnormal)—hair loss (alopecia) associated with excessive scales (accumulations of surface skin cells, such as seen in dandruff) and greasy surface texture

Specific Locations of Hair Loss

  • Hair loss involving the ears (pinnal alopecia) or pattern baldness—miniaturization of hairs and progressive hair loss (alopecia); seen in dachshunds, greyhounds, American water spaniels, Portuguese water spaniels, Boston terriers, Manchester terriers, whippets, Italian greyhounds, Chihuahuas
  • Traction hair loss (alopecia)—hair loss on the top and sides of the head secondary to having barrettes or rubber bands applied to the hair
  • Post-clipping hair loss (alopecia)—failure to regrow hair after clipping; may be associated with disruption of the hair-growth cycle
  • Melanoderma (hair loss [alopecia] of Yorkshire terriers)—symmetrical hair loss with darkened skin of the ears, bridge of the nose, tail, and feet
  • Seasonal flank hair loss/cyclic flank hair loss (alopecia)—creeping hair loss of the flanks with darkened skin (hyperpigmentation); seen in boxers, English bulldogs, and Airedale terriers
  • Abnormal development of the hair follicles or hair involving black hairs only (known as “black hair follicular dysplasia”)—hair loss (alopecia) involving only the black-haired areas of the body
  • Inherited inflammatory disorder that affects the skin and muscles of unknown cause (condition known as “idiopathic familial canine dermatomyositis”) in collies and Shetland sheepdogs—hair loss (alopecia) of the face, tip of ears, tail, and digits; associated with scales (accumulations of surface skin cells, such as seen in dandruff) and dried discharge on the skin lesions (crusts), and scarring

Treatment

Health Care

  • Demodectic mange (demodicosis)—amitraz, ivermectin, milbemycin
  • Ringworm (dermatophytosis)—griseofulvin, ketoconazole, itraconazole, lime sulfur dips, terbinafine
  • Inflammation of hair follicles due to Staphylococcus bacterial infection (staphylococcal folliculitis)—shampoo and antibiotic therapy
  • Sebaceous adenitis (condition with hair loss, reddened skin, scales and inflammation of the oil-secreting sebaceous glands)—keratolytic shampoo, essential fatty acid supplementation, retinoids
  • Keratinization disorders (disorders in which the surface of the skin is abnormal)—shampoos, retinoids, vitamin D, cyclosporine

Surgery

  • Biopsy of a tumor or the skin may be indicated in the diagnostic workup for some causes of hair loss (alopecia)
  • Hormonal disorders causing hair loss (treatment determined by specific hormonal disorder)—surgery may include removal of ovaries and uterus (known as “ovariohysterectomy” or “spay”), removal of testicles (known as “castration”), or removal of adrenal glands (known as “adrenalectomy”)
  • Surgical removal of skin cancer or tumors

Medications

  • Vary with specific cause
  • Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s syndrome)—mitotane (Lysodren), trilostane

Follow-Up Care

Patient Monitoring

  • Determined by specific cause

Preventions and Avoidance

  • Determined by specific cause

Possible Complications

  • Determined by specific cause

Expected Course and Prognosis

  • Determined by specific cause

Key Points

  • “Alopecia” is the medical term for hair loss
  • Hair loss is a common problem in dogs
  • Pattern of hair loss varies–may be localized or widespread
  • Skin itself may appear normal or may be abnormal

Risk Factors

  • Intact male
  • Co-existing behavioral problem, such as separation anxiety
  • Owners poorly informed or motivated to properly housetrain their dog

Flea Bite Hypersensitivity & Flea Control

Flea Bite Hypersensitivity & Flea Control – Overview

  • “Hypersensitivity” is an increased sensitivity or reaction in the skin due to the presence of a foreign substance; in flea-bite hypersensitivity, the foreign substance is found in flea saliva; the reaction is immune based and would be considered to be an “allergic” reaction
  • “Dermatitis” is the medical term for inflammation of the skin
  • “Antigens” are substances that induce sensitivity or immune response
  • “Flea-bite hypersensitivity”—hypersensitivity or allergic reaction to antigens in flea saliva, with or without evidence of fleas and flea dirt
  • “Flea-bite dermatitis”—inflammation of the skin due to the flea bite itself; it is not an allergic or hypersensitivity reaction, but rather an irritant response to flea bites

Genetics

  • Flea-bite hypersensitivity—unknown inheritance pattern; more common in breeds with atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Mean Age and Range

  • Flea-bite hypersensitivity—rare in pets less than 6 months of age; average age range, 3–6 years, but may be seen at any age

Signs/Observed Changes in the Pet

  • Determined by the severity of the reaction and the degree of exposure to fleas (that is, seasonal or year-round)
  • Itchiness (known as “pruritus”)
  • Compulsive biting
  • Chewing (“corncob nibbling”)
  • Licking, primarily in the back half of the body, but may include the areas
  • Signs of fleas and flea dirt; finding fleas and flea dirt is beneficial, although not essential, for the diagnosis of flea-bite hypersinsitivity
  • Sensitive pets require a low exposure to fleas to have an immune response and they tend to over groom, removingt evidence of flea infestation, and making identification of parasites difficult
  • Hair loss (known as “alopecia”)
  • Small, raised skin lesions (known as “papules”)
  • Darkened skin (known as “hyperpigmentation”) in dogs
  • Thickening and hardening of the skin, usually associated with hyperpigmentation (known as “lichenification”) in dogs
  • “Hot spots” in dogs
  • Miliary dermatitis (skin inflammation characterized by numerous, small, crusty bumps) in cats)

Causes

  • Fleas
  • Immune response to flea saliva (flea-bite hypersensitivity or flea-allergy dermatitis)

Risk Factors

  • Flea-bite hypersensitivity—intermittent exposure to fleas increases likelihood of development; commonly seen in conjunction with atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems)

Treatment

Health Care

  • Outpatient treatment

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Steroids—to decrease inflammation in the skin for symptomatic relief, while instituting flea control
  • Antihistamines–symptomatic relief
  • Flea control on the pet; examples include dinotefuran/pyriproxyfen (monthly spot treatment; rapid acting; two products—one for cats and one for dogs; dog product contains high dose of the insecticide, permethrin, and should NOT be used on cats); fipronil (monthly spot treatment for dogs and cats and spray treatment for dogs); imidacloprid (monthly spot treatment for cats and dogs); metaflumizone (monthly spot treatment for dogs or cats; product for dogs contains another active ingredient [amitraz] and should not be used on cats)
  • Flea control using medications given by mouth (known as “oral medications”)—nitenpyram (rapid action, but short-acting; kills over 95% of adult fleas on dogs and cats within 4–6 hours of administration, lasts for 48–72 hours); spinosad (monthly oral treatment for dogs only)
  • Other flea control for pets (such as flea sprays and other topical treatments)—usually contain pyrethrins and pyrethroids (synthetic pyrethrins) with an insect-growth regulator or synergist; generally effective for less than 48–72 hours
  • Environmental/indoor treatment—professional exterminator or home-use fogs and premises sprays; products usually contain organophosphates, pyrethrins, and/or insect-growth regulators; apply according to manufacturer’s directions; treat all areas of the house
  • Environmental/indoor treatment using inert substances—boric acid, diatomaceous earth, and silica aerogel; treat every 6–12 months; follow manufacturer’s recommendations
  • Environmental/outdoor treatment—concentrate outdoor treatment in shaded areas; sprays usually contain pyrethroids or organophosphates and an insect-growth regulator; a product containing nematodes (Steinerma carpocapsae) is chemical-free
  • Other products for use include flea powders, dips, sprays, and foams
  • NOTE: Always read all label instructions and follow the manufacturer’s directions when using any flea-control product; ensure that the product is labeled for use on the species (dog or cat) or location (indoors or outdoors) for which you intend to apply it—for example, some products that are safe for dogs are very toxic to cats and should not be used on cats

Follow-Up Care

Patient Monitoring

  • Itchiness (pruritus)—a decrease in itchiness indicates the flea infestation and/or flea-bite hypersensitivity is being controlled
  • Fleas and flea dirt—absence is not always a reliable indicator of successful treatment in very sensitive pets

Preventions and Avoidance

  • Year-round warm climates—year-round flea control is required
  • Seasonally warm climates–begin flea control in May or June, as directed by your pet’s veterinarian

Possible Complications

  • Secondary bacterial infections
  • Sudden (acute) moist dermatitis, also known as “hot spots”
  • Acral lick dermatitis (inflammation of the skin characterized by a firm, ulcerated lesion on a leg, caused by consistant licking)

Expected Course and Prognosis

  • Prognosis is good, if strict flea control is instituted

Key Points

  • Flea control is important for dogs and cats
  • No cure exists for flea-bite hypersensitivity
  • Flea-allergic pets often become more sensitive to flea bites as they age
  • Controlling exposure to fleas is currently the only means of controlling signs; “allergy shots” (known as “hyposensitization”) for flea-bite hypersensitivity are not effective

Exfoliative Dermatoses

Exfoliative Dermatoses – An Overview

  • Excessive or abnormal shedding of skin cells, resulting in the clinical presentation of accumulations of surface skin cells, such as seen in dandruff (known as “scales”)
  • “Exfoliative” refers to the detachment and shedding of surface skin cells; “dermatosis” (plural, “dermatoses”) is the medical term for any skin abnormality or disorder
  • “Primary” refers to a condition that occurs first in the skin; “secondary” refers to changes that occur following the primary disease—for example, the skin may be inflamed due to a nutritional deficiency (primary condition) and become infected by bacteria invading the inflamed skin (secondary condition) or the skin changes are secondary to the presence of some other problem or abnormality (such as the presence of parasites on the skin)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Primary exfoliative dermatoses—cocker spaniels, English springer spaniels, West Highland white terriers, basset hounds, Doberman pinschers, Irish setters, Labrador retrievers, Siberian huskies, Alaskan malamutes, dachshunds, chow chows, Yorkshire terriers, poodles, Great Danes, whippets, salukis, Italian greyhounds, standard poodles, Samoyeds, Akitas, vizslas, golden retrievers
  • Primary seborrhea (excessively oily or dry scaling of the skin)—Persian kittens
  • Secondary exfoliative dermatoses—any breed of dog or cat

Mean Age and Range

  • Primary exfoliative dermatoses—apparent by 2 years of age
  • Primary seborrhea (excessively oily or dry scaling of the skin)—newborn Persian kittens
  • Secondary exfoliative dermatoses—any age

Signs/Observed Changes in the Pet

  • Excessive scaling
  • Smelly or malodorous skin; “rancid fat” odor is common
  • Itchiness (known as “pruritus”)
  • Oily skin and hair
  • Dry or greasy accumulations of surface skin cells, as seen in dandruff (scales); accumulations may be fine or coarse; may be located throughout the hair coat or in localized areas
  • Hair follicles may become filled with oil and skin cells (known as “comedones”)
  • Accumulation of debris that adheres to hair shaft (known as “follicular casts”)
  • “Candle wax”–like deposits on hair
  • Hair loss (known as “alopecia”)
  • Secondary skin inflammation, caused by the yeast Malassezia (known as “secondary Malassezia dermatitis”)

Causes and Risk Factors

Primary Exfoliative Dermatoses

  • Primary excessively dry or oily scaling of the skin (known as “seborrhea”) of unknown causes (so-called “idiopathic seborrhea”) that is a primary disorder in the normal replacement and shedding of skin cells (known as a “keratinization disorder”)—breeds at highest risk: cocker spaniels, English springer spaniels, West Highland white terriers, basset hounds, Doberman pinschers, Irish setters, and Labrador retrievers; dry (known as “seborrhea sicca”) and greasy or oily (known as “seborrhea oleosa”) forms exist, but determination of type has little prognostic value
  • Skin disorder that responds to treatment with vitamin A (known as “vitamin A–responsive dermatosis”)—nutritionally responsive; seen primarily in young cocker spaniels; clinical signs similar to severe idiopathic seborrhea; distinguished by response to dietary vitamin A supplementation
  • Skin disorder that responds to treatment with zinc (known as “zinc-responsive dermatosis”)—nutritionally responsive; results in hair loss (alopecia); accumulations of surface skin cells, as seen in dandruff (scales); dried discharge on the surface of the skin lesion (known as a “crust”); and reddening of the skin (known as “erythema”) around the eyes, ears, feet, lips, and other external orifices; two syndromes are seen: (1) young adult dogs, especially Siberian huskies and Alaskan malamutes, and (2) rapidly growing, large-breed puppies
  • Abnormalities in the development of the skin and related structures (such as hair follicles)—abnormal development of the hair follicles or hair (known as “follicular dysplasia”); seen as hair loss (alopecia) in color mutant or dilution pets; represent abnormalities in deposition of melanin pigments (responsible for the color of the skin and hair) of the hair shaft and structural hair growth; breeds commonly affected: blue and fawn Doberman pinschers, Irish setters, dachshunds, chow chows, Yorkshire terriers, poodles, Great Danes, whippets, salukis, and Italian greyhounds; signs include failure to regrow blue or fawn hair with normal “point” hair growth, excessive accumulations of surface skin cells, as seen in dandruff (scales), hair follicles filled with oil and skin cells (comedones), and skin infection characterized by the presence of pus (secondary pyoderma)
  • Thickening of the skin (known as “hyperkeratosis”) of the nose and pads of the feet of unknown cause (so-called “idiopathic nasodigital hyperkeratosis”)—excessive accumulation of surface skin cells (scales) and dried discharge on the surface of the skin lesion (crusts) on the tough, hairless skin of the nose (known as the “nasal planum”) and footpad margins; possibly an aging change, seen in spaniels and Labrador retrievers; may result in cracking and secondary bacterial infection that can be quite painful
  • Inflammation of the sebaceous glands, the glands that produce oils in the hair coat (condition known as “sebaceous adenitis”)—inflammatory disease; may be of unknown cause (so-called “idiopathic sebaceous adenitis”); three specific syndromes seen: (1) middle-aged standard poodles and Samoyeds—characteristic patchy or widespread (diffuse) hair loss (alopecia) and excessive accumulation of surface skin cells, as seen in dandruff (scales); accumulation of debris that adheres to hair shaft (follicular casts); most dogs are healthy; (2) Akitas—frequently develop severe and deep bacterial skin infection characterized by the presence of pus (pyoderma); (3) vizslas—disease appears distinctly different and is characterized by the presence of nodular, inflammatory lesions (known as “granulomas”); other breeds can be affected but are less likely than the breeds indicated previously
  • Abnormal development of the top surface of the skin (known as the “epidermis”; condition known as “epidermal dysplasia”) and congenital (present at birth) disorders of the normal replacement and shedding of skin cells (keratinization disorder; condition known as “ichthyosis”)—rare and severe congenital disorder of keratinization; reported in West Highland white terriers and golden retrievers; generalized accumulations of surface skin cells, as seen in dandruff (scales) and dried discharge on the surfaces of the skin lesions (crusts) at an early age; secondary bacterial and yeast infections are common
  • Primary excessively oily scaling of the skin (primary seborrhea)—newborn Persian kittens

Secondary Exfoliative Dermatoses

  • Increased sensitivity or reaction in the skin to the presence of a foreign agent (known as “cutaneous hypersensitivity”)—atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems); flea-bite allergy; food allergy; and inflammation of the skin secondary to contact with some substance to which the pet reacts or to which the skin becomes irritated (known as “contact dermatitis”); characterized by itchiness (pruritus) and secondary skin trauma and irritation
  • Parasites of the skin—sarcoptic mange or scabies; demodectic mange (demodicosis) and “walking dandruff” (cheyletiellosis)
  • Skin infection characterized by the presence of pus (pyoderma)
  • Bacterial infection of the hair follicles (known as “bacterial folliculitis”)
  • Skin inflammation due to Malassezia, a yeast
  • A fungal infection affecting the skin, hair, and/or nails (known as “dermatophytosis”)
  • Hormonal disorders (known as “endocrinopathies”)—inadequate production of thyroid hormone (known as “hypothyroidism”) and excessive production of steroids by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”) commonly produce excessive accumulation of surface skin cells, as seen in dandruff (scales); secondary skin infection characterized by the presence of pus (secondary pyoderma) common in both syndromes; other hormonal abnormalities (such as sex-hormone abnormalities, excessive production of thyroid hormone [known as “hyperthyroidism”], and diabetes mellitus [“sugar diabetes”]) also may be associated with excessive scaling
  • Age—senior pets may have a dull, brittle, and scaly hair coat; changes may be caused by natural alterations associated with aging; no specific defect identified
  • Nutritional disorders—skin disorders may occur with malnutrition and feeding generic dog food; result in accumulation of surface skin cells, as seen in dandruff (scales) from abnormalities in the normal replacement and shedding of skin cells (keratinization)
  • Diseases in which the body’s immune system attacks its own skin (known as “autoimmune skin diseases”)—pemphigus complex; cutaneous and systemic lupus erythematosus; often see areas of hair loss (alopecia) and scaling
  • Tumors, cancer, and precancerous disorders of the skin—may produce hair loss (alopecia) and accumulation of surface skin cells, as seen in dandruff (scales) when skin is damaged
  • Miscellaneous—any disease process may result in excessive accumulation of surface skin cells, as seen in dandruff (scales)
  • Exfoliative disorders (“exfoliative” refers to the detachment and shedding of surface skin cells)—rare in cats; include tail-gland hyperplasia or “stud tail,” in which the sebaceous glands at the base of the tail enlarge and overproduce oil secretions, leading to matted hair and scales in the hair coat; exfoliative skin inflammation (known as “exfoliative dermatitis”) associated with thymoma, a type of tumor of the thymus (the thymus is an organ located in the front of the chest, near the neck; it is part of the immune system)

Treatment

Health Care

  • Diagnose and control all treatable primary and secondary diseases
  • Frequent and appropriate treatment applied to the skin directly (known as “topical therapy”)—cornerstone of proper treatment
  • Frequent baths, as directed by your pet’s veterinarian
  • Recurrence of secondary infections may require repeated treatment and further diagnostic testing
  • Maintaining control of these skin disorders is often a lifelong commitment

Diet

  • Depends on underlying cause
  • Dietary modification may be necessary for cases of suspected food allergy and for nutritionally related skin disorders

Surgery

  • Skin biopsy may be necessary to determine diagnosis
  • Surgical removal of skin tumors/cancer

Medications

  • MMedications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Treatment Applied to the Skin Directly (Topical Therapy)

Shampoos

  • Contact time of shampoo (that is, shampoo must be left on body for a certain amount of time)—5–15 minutes generally required, as directed by your pet’s veterinarian
  • Hypoallergenic shampoo—useful only in mild cases of dry scale and to maintain skin condition after the primary disease has been controlled
  • Sulfur/salicylic acid–containing shampoos—soften and loosen crusts and scales on the skin (known as “keratolytic shampoos”) and slow the growth of bacteria (known as a “bacteriostatic property”); excellent first choice for the moderately scaly pet; not overly drying
  • Benzoyl peroxide shampoo—strong action to soften and loosen crusts and scales on the skin (keratolytic shampoo), destroys bacteria or slows their growth and multiplication (known as an “antimicrobial property”), and flushes out the hair follicles; may cause irritation and severe dryness; frequently used for recurrent bacterial infection and/or extreme greasiness
  • Ethyl lactate shampoo—less effective than benzoyl peroxide for flushing out the hair follicles and not as effective against bacteria, but not as irritating or drying; most useful for moderate bacterial infection of the hair follicles (bacterial folliculitis) and dry scale
  • Chlorhexidine—a chemical antiseptic (compounds that kill or slow the growth of bacteria and other microorganisms); mildly drying; useful for moderate bacterial infections of the hair follicles (bacterial folliculitis) and skin inflammation caused by the yeast Malassezia (Malassezia dermatitis)
  • Tar shampoos—soften and loosen crusts and scales on the skin (keratolytic shampoos) and decrease itchiness (known as an “antipruritic property”); less degreasing than benzoyl peroxide; use for moderate scale associated with itchiness (pruritus); can be irritating; might be a substance linked to cancer (known as a “carcinogen”); not widely available in veterinary products

Moisturizers

  • Excellent for restoring skin hydration (frequent shampooing may result in excessive dryness and itchiness [pruritus]) and increasing effectiveness of subsequent shampoos
  • Humectants (moisturizers that attract water into the surface of the skin)—enhance hydration of the skin; at high concentrations may soften and loosen crusts and scales on the skin
  • Propylene glycol spray (50–75% dilution with water) applied frequently as directed by your pet’s veterinarian
  • Microencapsulation (moisturizers are placed in tiny capsules that allow prolonged effect)—may improve the residual activity of moisturizers by permitting sustained release after bathing
  • Emollients (agents that soften and soothe the skin)—coat the skin; smooth the roughened surfaces produced by excessive scaling

Generalized (Systemic) Therapy

  • Specific causes of exfoliative dermatoses require specific treatments (such as thyroid hormone [thyroxine] replacement for pets with inadequate levels of thyroid hormone [hypothyroidism]; zinc supplements for zinc-responsive dermatosis)
  • Antibiotics administered by mouth or injection—always indicated for secondary skin infection characterized by the presence of pus (secondary pyoderma)
  • Retinoid drugs—varied success for seborrhea of unknown cause (idiopathic seborrhea) or primary seborrhea; reports of individual response to retinoids in pets that do not respond to other treatments (known as “refractory” cases); very strict regulations have made it difficult to prescribe and dispense synthetic retinoids
  • Cyclosporine (medication to decrease the immune response) may be used in some cases
  • Ketoconazole (an antifungal drug)—may be used for treatment of severe skin inflammation due to Malassezia, a yeast

Follow-Up Care

Patient Monitoring

  • Antibiotics and treatment applied to the skin directly (topical therapy)—monitor response every 3 weeks; pets may respond differently to the various topical therapies
  • Seasonal changes, development of additional diseases (especially increased sensitivity or reaction in the skin to the presence of a foreign agent [cutaneous hypersensitivity]), and recurrence of skin infection characterized by the presence of pus (pyoderma)—may cause previously controlled pets to worsen; reevaluation critical for determining if new factors are involved and if changes in therapy are necessary
  • Hormonal disorders (endocrinopathies)—bloodwork to monitor thyroid levels following treatment for inadequate levels of thyroid hormone (hypothyroidism), should be performed 4–6 hours following administration of thyroid medication—frequency of thyroid monitoring as recommended by your pet’s veterinarian; adrenocorticotropic hormone (ACTH)-stimulation tests should be performed for proper management of pets with excessive production of steroids by the adrenal glands (hyperadrenocorticism or Cushing’s disease)
  • Some autoimmune disorders—reevaluate frequently during the initial phase of treatment; less often after remission
  • Medications to decrease the immune response (known as “immunosuppressive therapy”)—frequent bloodwork (such as complete blood counts [CBCs] and serum chemistries) and urinalyses with bacterial culture to monitor for complications
  • Retinoid drugs—bloodwork (serum chemistries, including triglycerides); Schirmer tear tests to monitor the eyes for changes in tear production
  • Ketoconazole—bloodwork (serum chemistries)

Preventions and Avoidance

  • Depend on underlying cause

Possible Complications

  • Depend on underlying cause

Expected Course and Prognosis

  • Depend on underlying cause

Key Points

  • Some causes of excessive or abnormal shedding of skin cells, resulting in the clinical presentation of accumulations of surface skin cells (such as dermatophytosis and several parasitic skin diseases), have either zoonotic potential or the ability to produce lesions in people; “potential zoonoses” are diseases that can be passed from animals to people
  • Diagnose and control all treatable primary and secondary diseases
  • Frequent and appropriate treatment applied to the skin directly (known as “topical therapy”)—cornerstone of proper treatment
  • Frequent baths, as directed by your pet’s veterinarian
  • Recurrence of secondary infections may require repeated treatment and further diagnostic testing
  • Maintaining control of these skin disorders is often a lifelong commitment

Eosinophilic Granuloma in Dogs & Cats

Eosinophilic Granuloma in Dogs & Cat – Overview

  • Cats—“eosinophilic granuloma complex” often is a confusing term for four distinct syndromes: (1) “eosinophilic plaque” (circumscribed, raised, round to oval lesions that frequently are ulcerated; usually located on the abdomen or thighs; lesions contain a type of white blood cell, called an eosinophil); (2) “eosinophilic granuloma” (a mass or nodular lesion containing eosinophils; usually found on the back of the thighs, on the face, or in the mouth); (3) “indolent ulcer” (circumscribed, ulcerated lesions; most frequently found on upper lip); (4) allergic miliary dermatitis (skin inflammation characterized by numerous, small, crusty bumps); the four syndromes are grouped together as “eosinophilic granuloma complex” primarily according to their clinical similarities, their frequent simultaneous development and tendency to recur, and their positive response to treatment with steroids
  • Dogs—”eosinophilic granulomas” are rare; not part of the eosinophilic granuloma complex; specific differences from cats are presented in the following information
  • “Eosinophilic” refers to eosinophils, a type of white-blood cell usually involved in allergic responses
  • “Granuloma” is a large inflammatory nodule or solid mass
  • “Complex” is a group of signs or diseases that have an identifiable characteristic that makes them similar in some fashion

Genetics

  • Several reports of related affected individuals and a study of disease development in a colony of cats indicate that, in at least some individuals, genetic susceptibility (perhaps resulting in an inheritable dysfunction of eosinophils) is a significant component for the development of the eosinophilic granuloma and indolent ulcer

Signalment/Description of Pet

Species

  • Cats–eosinophilic plaque, eosinophilic granuloma, indolent ulcer, and allergic military dermatitis
  • Dogs–eosinophilic granuloma

Breed Predilections

  • Cats–none
  • Eosinophilic granuloma in dogs—Siberian huskies (76% of cases), Cavalier King Charles spaniels, possibly German shepherd dogs

Mean Age and Range

  • Eosinophilic plaque (circumscribed, raised, round to oval lesions that frequently are ulcerated; usually located on the abdomen or thighs; lesions contain a type of white blood cell, called an eosinophil)—2–6 years of age
  • Genetically initiated eosinophilic granuloma–less than 2 years of age
  • Allergic disorder–over 2 years of age
  • Eosinophilic granuloma in dogs–usually less than 3 years of age

Predominant Sex

  • Cats—females may be more likely to develop one or more of the syndromes of eosinophilic granuloma complex than are males
  • Eosinophilic granuloma in dogs–males (72% of cases)

Signs/Observed Changes in the Pet

Cats

  • Distinguishing among the syndromes depends on both clinical signs and microscopic findings
  • Lesions of more than one syndrome may occur simultaneously; lesions of all four syndromes may develop spontaneously and suddenly (acutely)
  • Development of eosinophilic plaques (circumscribed, raised, round to oval lesions that frequently are ulcerated; usually located on the abdomen or thighs; lesions contain a type of white blood cell, called an eosinophil) may be preceded by periods of sluggishness (lethargy)
  • A seasonal incidence is possible
  • Signs vary in intensity—they may increase and decrease over time (known as a “waxing and waning” course)
  • Eosinophilic plaque—loss of hair (known as “alopecia”), reddened skin (known as “erythema”), patches of loss of superficial layers of skin (known as “erosive patches”) or well-demarcated, steep-walled thickened, raised, flat-topped areas that are slightly higher than normal skin (known as “plaques”); usually occur in the inguinal or perineal (area between the anus and external genitalia) areas, along the thighs, lower abdomen, and under the front legs, near the chest; frequently moist or glistening; may have enlarged lymph nodes near the area of the eosinophilic plaques
  • Eosinophilic granuloma (mass or nodular lesion containing eosinophils)—occur as (1) a distinctly linear orientation (“linear granuloma”) on the back part of the thigh; (2) an individual lesion or multiple lesions that are coming together, located anywhere on the body; ulcerated with a “cobblestone” or coarse pattern; white or yellow, possibly representing collagen degeneration; (3) lip margin and chin swelling (“pouting”); (4) footpad swelling, pain, and lameness (most common in cats under 2 years of age); (5) ulcers of the mouth (especially on the tongue, palate, and palatine arches)—cats with ulcers of the mouth may have difficulty swallowing (known as “dysphagia”), have bad breath (known as “halitosis”), and may drool
  • Lesion development may stop spontaneously in some cats, especially with the inheritable form of eosinophilic plaque
  • Allergic military dermatitis (skin inflammation characterized by numerous, small, crusty bumps)—multiple brown/black crusted and reddened, small, raised bumps (known as “papules”); lesions more often felt than seen; may be associated with hair loss (known as “alopecia”); usually itchy (known as “pruritus”); lesions frequently felt/seen along the back of the cat
  • Idolent ulcer–classically concave and firm or hardened ulcerations with a granular, orange-yellow color, confined to the upper lips

Dogs

  • Eosinophilic granuloma–ulcerated, thickened, raised, flat-topped areas that are slightly higher than normal skin (plaques) and masses; dark or orange color; most often affects the tongue and the folds of moist tissue extending from the soft palate to the side of the tongue (known as the “palatine arches”); skin lesions on the prepuce and flanks have been reported

Causes

  • Allergy—flea or insect (such as mosquito-bite) allergy, food allergy, and atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems)
  • Inherited dysfunction or eosinophils is a possible cause
  • Eosinophilic granuloma in dogs—unknown cause; genetic susceptibility in certain breeds; increased sensitivity or reaction in the skin to the presence of a foreign material (known as “hypersensitivity”) often suspected (such as to an insect bite) in breeds that do not have a genetic susceptibility

Treatment

Health Care

  • Most pets treated as outpatients, unless severe disease of the mouth prevents adequate fluid intake
  • Identify and eliminate offending allergen(s) before providing medical intervention; “allergens” are substances to which the pet has developed an allergy
  • “Allergy shots” (known as “hyposensitization”) in cats that have tested positive on skin tests for allergies–successful in a majority of cases; preferable to long-term steroid administration
  • Avoid excessive grooming, which may damage the skin lesions

Activity

  • No restrictions

Diet

  • No restrictions, unless a food allergy is suspected

Surgery

  • Skin biopsy to obtain samples for microcopic evaluation of lesions
  • Surgical removal of a lesion may be performed in some cases
  • Eosinophilic granuloma in dogs–individual lesions may be removed surgically if they are being traumatized or are not responsive to medical treatment

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

Eosinophilic Granuloma Complex in Cats

  • Eosinophilic plaque (circumscribed, raised, round-to-oval lesions that frequently are ulcerated) and eosinophilic franuloma (a mass or nodular lesion containing eosinophils)
  • Antibiotics—trimethoprim-sulfadiazine, cephalexin, amoxicillin-clavulanate, clindamycin; effective in some cats
  • Injectable methylprednisolone—most common treatment; not recommended for long-term treatment as response to medication may decrease with repeated treatments
  • Steroids—ongoing treatment with prednisolone required to control lesions; other drugs: dexamethasone and triamcinolone
  • Fluocinolone (a steroid) and dimethyl sulfoxide (DMSO; Synotic lotion)—apply to individual skin lesions (known as “topical treatment”); not practical for cats with many lesions and may cause side effects in these cats
  • Indolent ulcer (circumscribed, ulcerated lesions; most frequently found on upper lip)
  • Steroids administered by injection or by mouth
  • ?-Interferon-administered daily in cycles of 7 days on, 7 days off; limited success; effective in some cats
  • Antibiotics–trimethoprim-sulfadiazine, cephalexin, or amoxicillin-clavulanate; effective in some cats
  • Other therapies
  • Chlorambucil, a chemoterapeutic drug
  • ?-Interferon
  • Megestrol acetate–not recommended because of the severity of possible side effects; however, may be tried in cats that do not respont to any other treatment

Eosinophilic Granuloma in Dogs

  • Steroids administered by mouth–prednisone
  • Injection of steroids into the lesions–methylprednisolone

Follow-Up Care

Patient Monitoring

  • Pets receiving steroids—baseline and follow-up bloodwork (complete blood counts [CBCs] and serum chemistry profiles) and urinalyses with bacterial culture and sensitivity testing of urine
  • Pets receiving medications to decrease the immune response (known as “immunosuppressive drugs”)—frequent CBCs (biweekly at first, then monthly or bimonthly as therapy continues) to monitor for bone-marrow suppression leading to low red-blood cell and low white-blood cell counts; routine serum chemistry profiles and urinalyses with bacterial culture and sensitivity testing of urine (monthly at first, then every 3 months) to monitor for complications (such as kidney disease, diabetes mellitus, and urinary tract infection)

Expected Course and Prognosis

  • Lesions should resolve permanently if a primary cause can be identified and controlled. Most lesions increase and decrease over time (wax and wane), with or without therapy; thus an unpredictable schedule of recurrence should be anticipated
  • Drug dosages should be tapered to the lowest possible level (or discontinued, if possible), once the lesions have resolved; changes in drug dosage should be at the direction of your pet’s veterinarian
  • Lesions in cats with the inheritable disease may resolve spontaneously after several years
  • Eosinophilic granuloma in dogs—may not respond to medical treatment

Key Points

  • Possible allergice or inherited causes
  • Most lesions increase and decrease over time (wax and wane), with or without therapy; thus an unpredictable schedule of recurrence should be anticipated
  • In some cases, a decision may be made to postpone medical intervention, unless severe lesions develop

Bacterial Skin Infections

Bacterial Skin Infections (Pyoderma) – An Overview

  • “Pyoderma” is the medical term for bacterial infection of the skin
  • Skin lesions are characterized by the presence of pus
  • “Superficial pyoderma”—involves the top surface of the skin (known as the “epidermis”) and the hair follicles
  • “Deep pyoderma”—involves the lower layers of the skin (known as the “dermis”) and possibly the tissues under the skin (known as the “subcutis”)

Breed Predilections

  • Dogs—sporting breeds, hounds, working breeds, and mixed-breed dogs (greater than 12 kg [26 lbs] of body weight)

Mean Age and Range

  • Dogs—common in young and old dogs; range, 1 month–15 years; many cases in puppies less than 1 year of age

Risk Factors

  • Contact of animals that have not been vaccinated or have not responded to vaccinations with animals that are infected with canine distemper virus (dogs or wild carnivores)

Signs/Observed Changes in the Pet

  • Cough
  • Fever
  • Labored breathing
  • Exercise intolerance
  • Lack of appetite (known as “anorexia”) and weight loss
  • Sluggishness (lethargy)
  • Nasal discharge
  • Difficult or rapid breathing
  • Abnormal breath sounds on listening to the lungs with a stethoscope (known as “auscultation”)—increased intensity or breath sounds over the bronchi; short, rough snapping sounds (known as “crackles”); and squeaking or whistling sounds (known as “wheezes”)
  • Dehydration

Causes

Dogs

  • Most common primary disease-causing organisms of the respiratory tract— Bordetella bronchiseptica and Mycoplasma.
  • Most common gram-positive bacteria—Staphylococcus, Streptococcus, and Enterococcus; gram staining is a technique in which slides with potential bacteria on them are stained in a sequential manner; gram-positive bacteria stain dark purple while gram-negative bacteria stain pink; gram staining allows differentiation of bacteria into groups (that is, gram-positive or gram-negative).
  • Most common gram-negative bacteria— Escherichia coli, Klebsiella, Pseudomonas, Pasteurella
  • Anaerobic bacteria (bacteria that can live and grow in the absence of oxygen)—found in lung abscesses and various types of pneumonia (particularly with aspiration or foreign bodies); approximately 20% of pets with bacterial pneumonia have anaerobic bacterial infections.

Cats

  • Bacteria—Bordetella bronchiseptica, Pasteurella, and Moraxella most frequently reported; Mycoplasma considered a primary disease-causing microorganism (known as a “pathogen”) in the lower respiratory tract.
  • Carrier state—may exist; periods of shedding Bordetella bronchiseptica after stress; infected female cats (queens) may not shed the organism during pregnancy (prepartum) but begin shedding it after delivering the kittens (postpartum), serving as a source of infection for kittens.

Risk Factors

  • Preexisting viral infection.
  • Regurgitation (return of food or other contents from the esophagus or stomach back up through the mouth), dysphagia (difficulty swallowing), or vomiting (forceful ejection of stomach contents up through the esophagus and mouth).
  • Functional or structural (anatomic) defects—paralysis of the voice box or larynx (known as “laryngeal paralysis”); enlarged esophagus (known as “megaesophagus”); cleft palate; inherited disorder in which the normal secretion clearance mechanism of the lungs is defective (known as “primary ciliary dyskinesia”).
  • Reduced level of consciousness—stupor, coma, or anesthesia.
  • Foreign body in the bronchi (part of the airway).
  • Long-term (chronic) dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (known as “bronchiectasis”).
  • Drugs to decrease the immune response (known as “immunosuppressive drugs”)—such as chemotherapeutic drugs and steroids.
  • Severe metabolic disorders—excess levels of urea and other nitrogenous waste products in the blood (known as “uremia” or “azotemia”); sugar diabetes (diabetes mellitus); excessive production of steroids by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”).
  • Presence of pus-forming bacteria and their poisons in the blood or tissues (known as “sepsis”).
  • Age—very young more susceptible to fatal infections.
  • Vaccination status.
  • Environment—housing, sanitation, ventilation.
  • Abnormal function of cells that normally remove bacteria and foreign materials from the body (known as “phagocyte dysfunction”)—feline leukemia virus (FeLV) infection and diabetes mellitus.
  • Complement (a protein substance in the blood that contributes to the destruction and removal of bacteria from the body) deficiency—rare.
  • Selective immunoglobulin A (IgA) deficiency; immunoglobulin A is an immune protein, found in the intestines; it functions as a protective barrier to prevent limit antigens (substance to which the immune system is responding and producing antibodies) and disease-causing microorganisms from entering the body through the intestines—rare.
  • Combined T-cell and B-cell dysfunction—rare; a lymphocyte is a type of white blood cell, formed in lymphatic tissue throughout the body; lymphocytes are further divided into T lymphocytes (which are involved in cell-mediated immunity), so-called “T-cells” and B lymphocytes (which produce antibodies as part of the immune process), so-called “B-cells”—rare.

Treatment

Health Care

  • Inpatient—recommended with signs involving multiple body systems (such as lack of appetite [anorexia], high fever, weight loss, and sluggishness [lethargy]).
  • Maintain normal hydration—important to aid the normal secretion clearance mechanism of the lungs; use a balanced electrolyte solution.
  • Administration of medication in a fine spray (known as “nebulization”) with saline aerosol—results in more rapid resolution, if used with physiotherapy and antibiotics.
  • Physiotherapy—efforts to dislodge secretions in the lungs and to induce coughing (known as “coupage”); windpipe manipulation to stimulate mild cough; and postural drainage; may enhance clearance of secretions; always do immediately after nebulization; avoid allowing the pet to lie in one position for a prolonged time.
  • Oxygen therapy—for pets with low levels of oxygen in their blood (known as “hypoxemia”) and signs of severe breathing difficulties (known as “respiratory distress”).

Activity

  • Restrict during treatment (inpatient or outpatient), except as part of physiotherapy after administration of medication in a fine spray (nebulization).

Diet

  • Ensure normal intake of food, with foods high in protein and calorie or energy density.
  • Feeding directly into the intestinal tract (known as “enteral feeding”) or through the veins (known as “parenteral nutrition”)—indicated in severely ill pets.
  • Use caution in feeding pets with an enlarged esophagus (megaesophagus); lack of normal function of the voice box or larynx (known as “laryngeal dysfunction”) or surgery on the voice box or larynx; disease of the throat or pharynx (known as “pharyngeal disease”), and pets that are unable to get up (they are recumbent).

Surgery

  • Surgical removal of a lung lobe (known as “lung lobectomy”)—may be indicated with lung abscesses or foreign body in the bronchus with secondary pneumonia; may be indicated if the pet is unresponsive to conventional treatment and disease is limited to one or two lobes of the lung(s).

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Antibiotics

  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing from transtracheal wash (a technique in which samples from the lower airways are obtained for bacterial culture and/or for evaluation through a microscope) or other diagnostic techniques.
  • Reasonable initial antibiotic choices pending culture results include amoxicillin–clavulanic acid, cephalexin, enrofloxacin, or trimethoprim-sulfonamide.
  • Gram-positive cocci—ampicillin, ampicillin-sulbactam; amoxicillin; amoxicillin–clavulanic acid; azithromycin; chloramphenicol, erythromycin; gentamicin; trimethoprim-sulfonamide; first-generation cephalosporins.
  • Gram-negative rods—enrofloxacin; chloramphenicol; gentamicin; trimethoprim-sulfonamide; amikacin; marbofloxacin; carboxypenicillins.
  • Bordetella—doxycycline; chloramphenicol; enrofloxacin; azithromycin.
  • Mycoplasma—doxycycline, enrofloxacin, marbofloxacin, chloramphenicol.
  • Anaerobes (bacteria that can live and grow in the absence of oxygen)—amoxicillin–clavulanic acid; chloramphenicol; metronidazole; clindamycin; ticarcillin-clavulanic acid.
  • Administration of gentamicin in a fine spray (known as “gentamicin nebulization”) for Bordetella—typically used in conjunction with antibiotics given by mouth or injection.
  • Continue treatment for at least 10 days beyond clinical resolution and/or 1–2 weeks following resolution of x-ray (radiograph) evidence of pneumonia.

Antibiotics

  • Recommended by some veterinarians; no objective evidence that they increase movement of mucus or mobilization of secretions.

Bronchodilators

  • Recommended by some veterinarians; used to decrease spasm of the bronchi; bronchodilators are medications that enlarge the bronchi and bronchioles in the lungs.

Follow-Up Care

Patient Monitoring

  • Monitor breathing rate and effort.
  • Complete blood count (CBC) should be performed periodically; CBC should return to normal as the pet responds to treatment.
  • Arterial blood gases, to monitor levels of oxygen and carbon dioxide in the blood—most sensitive monitor of progress.
  • Monitor pulse oximetry; : “pulse oximetry” is a means of measuring oxygen levels in blood.
  • Listen to the pet’s lungs (auscultate) frequently.
  • Chest x-rays (radiographs)—improve more slowly than the clinical signs.

Preventions and Avoidance

  • Vaccination—against upper respiratory viruses; against Bordetella bronchiseptica, if dog is boarded or exposed to large number of other dogs.
  • Catteries—environmental strategies to lower the number of cats or the close proximity in which they are housed (known as “population density”) and improve hygiene help control outbreaks of bordetellosis (infection caused by Bordetella).

Possible Complications

  • Presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Expected Course and Prognosis

  • Prognosis—good with aggressive anti-bacterial and supportive therapy; more guarded in young pets, pets with decreased ability to develop a normal immune response (immunodeficiency), and pets that are debilitated or have severe underlying disease.
  • Prolonged infection—potential for long-term (chronic) inflammation of the bronchi (bronchitis) or chronic dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (bronchiectasis) in any pet.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Key Points

  • Inflammation in the lung as a response to disease-causing bacteria, characterized by accumulation of inflammatory cells and fluid in the lung, conducting airways (bronchi and bronchioles), and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged).
  • More common in dogs than in cats.
  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Pet Dermatology

Common Skin Conditions Seen In Dogs & Cats

Here, we have listed some of the most common skin conditions and provided you with the typical symptoms, and possible treatment. In some instances (when possible), we’ve included information about treatment that can be done with readily available at-home remedies. However, we would like to remind you that most skin conditions can be difficult to treat and will require veterinary assistance.

  • Mange
  • Bacterial Skin Infections (Pyoderma)
  • Inflamed Skin & Allergies
  • Eosinophilic Granuloma In Dogs & Cats
  • Loss of Pigment in Dogs & Cats
  • Flea Bite Hypersensitivity & Flea Control
  • Tick & Tick Control
  • Hair Loss In Cats (Feline Alopecia)
  • Hair Loss In Dogs (Canine Alopecia)
  • Hair Loss Without Inflammation of The Skin In Dogs
  • Nail & Nailbed Disorders
  • Itchiness in Dogs & Cats
  • Inflammation of the Outer & Middle Ear (Otitis Externa)
  • Pemphigus
  • Bumps On Skin (Papulonodular Dermatoses)
  • Skin Disorders Caused by Reactions to Food
  • Pododermatitis (Inflammation of Skin of the Paws)
  • Blisters & Pustules (Vesiculopustular Dermatoses)
  • Sterile Nodular Granulomatous Skin Diseases
  • Ulcers of the Skin
  • Skin Disorders of the Nose in Dogs (Canine Nasal Dermatoses)

We will work closely with you to diagnose, treat and monitor any skin, ear, nail or foot problem your pet may have. We are here to help your pet with problems such as diseases of the skin, dog or cat ear infections or immune-mediated problems.

Dermatology-Immune Related Skin Disorders

Your pet’s immune system plays a large role in many of the dermatology problems in both dogs and cats that we see at Tri-County Animal Hospital. Just like humans who can inherit allergies in the “gene lottery”, our canine & feline counterparts can have this unfortunate trait passed down to them. Pet’s often show allergic reactions to certain grasses, plants, and even certain types of food. While humans generally show allergies through sneezing, dogs and cats usually show through their skin.

In dogs, susceptibility to demodectic mange is another example of an immune related skin problem. This is a skin issue caused my microscopic mites, and can be relatively common in puppies. Diagnosis is determined through a simple skin scraping. Our veterinarians will look under the microscope to see if these mites are the cause of your dog’s skin condition, and recommend the appropriate treatment.

Environmental Related Skin Disorders (Sometimes Physical / Self Inflicted)

Environmental skin disorders are another common problem that we see at our animal hospital. The majority of these conditions are caused by excessive licking or chewing of the skin. In order to solve this challenge, our veterinarian not only treats the visible skin problem, but also determines the underlying problem that is causing your dog or cat to chew on themselves.

Lick granulomas are an example of this type of skin condition. Oftentimes, dogs will lick themselves so excessively that an open wound is left behind. While there could be numerous reasons for this type of self-destructive behavior, it is usually the result of a psychological issue (boredom, stress, anxiety). Our Staff will work to pinpoint the cause and help eliminate the harmful behavior.

Infectious Skin Disorders

Infectious skin diseases occur in both cats and dogs, and can be both contagious or non-contagious. The contagious infections fall under a broad range of viral, parasitic, fungal and bacterial diseases. Ringworm is one common example of this type of skin disorder. This fungal skin infection is contagious to dogs, cats and even humans. Diagnosis is determined through a culture, during which time, Dr. Silberman will advise treatment for your pet accordingly.

Another example of an infectious skin disorder is a staph infection. Staph infection is caused by bacteria belonging to genus Staphylococcus, and usually presents on the skin as scales or severe redness. In these cases, Dr. Silberman will examine your pet and often take cotton swab culture samples and perform cytologic evaluation under the microscope.

Secondary Conditions Caused By Internal Diseases

Sometimes, skin conditions are simply the manifestation of larger, underlying illnesses in your dog or cat. Many hormonal abnormalities have the ability to affect the quality of your pet’s skin and coat. In dogs, thyroid disease and Cushing’s Disease (hyperadrenocorticism), causing skin issues are probably the most common. Among cats, hyperthyroidism and diabetes may cause a dull coat, very matted fur, and in some cases, lose patches of hair from over-grooming. Dr. Silberman will determine which treatment is best for your pet, and discuss all available options with you.

Tooth Fractures

Tooth Fractures – An Overview

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Classified as “uncomplicated” if the fracture does not enter the internal part of the tooth containing the blood vessels and nerves (known as the “pulp”) and “complicated” if the fracture enters the pulp.
  • Both dogs and cats can fracture their teeth, although this is slightly more common in dogs.

Signs/Observed Changes in the Pet

Crown Fractures (Involving the Portion of the Tooth above the Gum Line)

  • Clinical loss of tooth-crown substance; may affect enamel only, or enamel and dentin; the enamel is the hard, shiny white material covering the crown of the tooth; the dentin makes up the bulk of the tooth structure.
  • Uncomplicated fractures with the fracture line close to the pulp (the internal part of the tooth, containing the blood vessels and nerves)—pale pink pulp is visible through the dentin; gentle exploring will not allow the explorer into the pulp cavity.
  • The recent or fresh complicated fracture is associated with bleeding from the pulp.
  • Older fractures may exhibit a dead pulp; clinically the pulp chamber is filled with dark material, and the tooth is often discolored.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • May occur at any point along the root surface; often in combination with fracture of the crown, although root fractures can occur without fracture of the crown.
  • Root segments may remain aligned or may be displaced.
  • Clinical signs indicating a possible root fracture include pain on closure of the mouth or during open-mouth breathing.
  • Abnormal horizontal or vertical mobility of a tooth may raise suspicion of a root fracture.

Causes

  • Generally the result of a traumatic incident (such as a road traffic accident, blunt blow to the face, chewing on hard objects).

Treatment

Dental Care

Uncomplicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line without Entering the Pulp)

  • Dental procedure by the veterinarian in which sharp edges are removed with a bur and the exposed dentin tubules are sealed with a suitable liner or restorative material.

Complicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line with Entering the Pulp)

  • Require treatment of the internal part of the tooth containing the blood vessels and nerves, known as the “pulp”; such treatment is known as “endodontic therapy” and includes root canals and pulpotomy—if the tooth is to be maintained; otherwise, extraction is preferable to no treatment at all.

Mature Tooth

  • Recent fracture in the mature tooth with the pulp still alive (vital)—two options exist, partial pulpectomy and direct pulp capping (vital pulpotomy) followed by restoration or conventional root-canal therapy and restoration.
  • For partial pulpectomy and direct pulp capping to succeed, the procedure should be carried out within hours of the injury; the initial procedure may not be the final treatment—the tooth may require standard root-canal treatment later, if the pulp tissue dies.
  • When the pulp already is inflamed chronically or is dead (known as “necrotic tissue”), standard root-canal therapy and restoration are the treatments of choice, if the tooth is periodontally sound.

Immature Tooth

  • A living (vital) pulp is required for continued root development; as long as the pulp is alive (vital), the treatment of choice is partial pulpectomy and direct pulp capping, followed by restoration.
  • If the pulp tissue is dead (necrotic), no further root development will occur; necrotic immature teeth need endodontic treatment to be maintained; remove the dead tissue and pack the root canal with calcium hydroxide paste; some continued root development and closure of the apex can be stimulated if this procedure is performed; change the calcium hydroxide every 6 months until the apex is closed at which time a standard root canal is performed.
  • Immature teeth may be present in the mature pet, if trauma to the developing teeth caused death of the pulp; such teeth should be treated as “immature teeth”.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • Treatment of crown and root fractures depends on how far below the gum line the fracture line extends.
  • If the fracture line does not involve the pulp (the internal part of the tooth, including the blood vessels and nerves) and does not extend more than 4–5 mm below the gum, restorative dentistry can be performed; if the fracture extends more than 5 mm below the gum and involves the pulp, the tooth usually should be extracted.
  • In some cases, the fractured tooth root may heal, if the tooth can be stabilized; in other cases, extraction of the tooth may be necessary.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • A broad-spectrum antibiotic drug for 5–7 days may be indicated; for example, when long-standing infection is present.

Follow-Up Care

Patient Monitoring

  • Check a partial pulpectomy and direct pulp-capping procedure with dental x-rays (radiographs) 6 and 12 months post-operatively, or at intervals determined by clinical signs, to detect death of the internal tissues of the tooth, including the blood vessels and nerves (pulp) and subsequent changes in the bone around the tips of the root, indicating the need for root-canal treatment.
  • Check the outcome of conventional root-canal therapy by dental x-rays (radiographs) 6–12 months post-operatively; evidence of changes in the bone around the tips of the root at this time indicates the need for further treatment or extraction of the tooth; further treatment consists of redoing the root canal, often using surgical techniques.
  • Check root fractures with dental x-rays (radiographs) 6–12 months post-operatively.
  • Check uncomplicated fractures with dental x-rays (radiographs) at 4–6 months post-operatively.

Preventions and Avoidance

  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Possible Complications

  • Untreated pulpal exposure invariably leads to inflammation of the pulp (known as “pulpitis”) and eventual death of the pulp tissue and subsequent changes in the bone around the tips of the root.
  • Immature teeth stop developing.

Expected Course and Prognosis

  • Vary with vitality of the pulp (the internal structure of the tooth, including the blood vessels and nerves), location of the fracture, and whether the tooth is mature or immature.

Key Points

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Periodontal Disease

Periodontal Disease – An Overview

  • Inflammation of the tissues around and supporting the tooth; the tooth support structures include the gum tissue (known as “gingiva”); the cementum and periodontal ligament (the cementum and periodontal ligament attach the tooth to the bone); and the alveolar bone (the bone that surrounds the roots of the tooth); periodontitis (inflammation/infection of the tissues around and supporting the tooth) indicates some degree of periodontal attachment tissue loss (that is, some loss of the structures [cementum, periodontal ligament, alveolar bone] that attach the tooth to the bone).
  • Both dogs and cats get periodontal disease

Signs/Observed Changes in the Pet

  • Swelling of the gum tissue (known as “gingival tissue”)
  • Bad breath (known as “halitosis”)
  • Redness or fluid build-up (edema) of the gums
  • Variable amounts of plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface)
  • Gum surfaces bleed easily on contact (for example, during play or physical examination)
  • Loose teeth, missing teeth, and exposure of roots of the teeth

Causes

  • Plaque bacteria (bacteria found in the thin, “sticky” film that builds up on the teeth)

Treatment

Dental Care

  • Professional cleaning.
  • Periodontal surgery.
  • The ultimate goal of periodontal therapy is to control plaque and prevent attachment loss; a willing pet and a client who can provide home care are important considerations in creating a treatment plan.

Diet

  • Dry food or hard, biscuit-type foods are preferable to soft, sticky foods.
  • Dental diets, such as Hill’s Prescription Diet t/d—specifically indicated to control plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface) in dogs and cats.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Antibiotics—clindamycin and amoxicillin/clavulanic acid are approved for periodontal disease
  • Tetracycline

Follow-Up Care

Patient Monitoring

  • The degree of periodontal disease determines recall interval; some pets are checked monthly, while others can be evaluated every 3–6 months.

Preventions and Avoidance

  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Your pet’s veterinarian will discuss home care and available products and will provide instructions for their use.

Possible Complications

  • Loss of teeth; loss of bone structure in lower jaw (mandible), leading to shortened lower jaw; tongue protruding from mouth.
  • Generalized infection in the body.
  • Possible heart, liver and/or kidney disease.

Expected Course and Prognosis

  • The response of the individual pet and the expected course and prognosis are highly variable.
  • Early diagnosis and appropriate treatment can minimize the destructive effects of this disease.

Key Points

  • Periodontal disease is the most common infectious disease in dogs and cats.
  • Periodontal disease can lead to infection in other areas of the body and may cause heart, liver, and or kidney disease.
  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Our staff will discuss home care and available products and will provide instructions for their use.

Mouth Ulcers

Ulcers on the Mouth – An Overview

  • “Oral ulceration” is the term for “ulcers of the mouth”; ulcers are lesions on the moist tissues, characterized by the loss of the top layer(s) of tissue, usually associated with inflammation
  • Ulcers may occur as individual lesions or multiple lesions in the tissues of the mouth
  • Ulcers of the mouth (oral ulceration) frequently accompanies inflammation of the mouth; inflammation of the mouth is classified by location as follows:
  • Inflammation of the gums or gingiva—gingivitis
  • Inflammation of the tissues that support the teeth—periodontitis
  • Inflammation of the tongue—glossitis
  • Inflammation of the bone and bone marrow of the jaws—ostomyelitis
  • Inflammation of the lining of the mouth—stomatitis
  • “Chronic” is defined as being long-term or prolonged
  • “Paradental” refers to adjacent, beside, or alongside (“para”) the teeth (dental)
  • Chronic ulcerative paradental stomatitis is also known as “CUPS”
  • “Lymphocytic plasmacytic stomatitis” is seen in cats; it also is known as LPS—it is inflammation of the lining of the mouth, characterized by the presence of lymphocytes and plasma cells; lymphocytes are a type of white-blood cell that are formed in lymphatic tissues throughout the body; lymphocytes are involved in the immune process; plasma cells or plasmacytes are a specialized type of white-blood cell; plasma cells are lymphocytes that have been altered to produce immunoglobulin, an immune protein or antibody necessary for fighting disease

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Inflammation of the lining of the mouth, characterized by ulcers (known as “canine ulcerative stomatitis” and also known as “chronic ulcerative paradental stomatitis” [CUPS])—Maltese, Cavalier King Charles spaniels, cocker spaniels, Bouvier des Flandres
  • Inflammation/infection of the bone for unknown reason (known as “idiopathic osteomyelitis”)—cocker spaniels may have increased likelihood of developing idiopathic osteomyelitis as compared to other dog breeds; complication associated with CUPS
  • Inflammation of the lining of the mouth, characterized by the presence of lymphocytes and plasma cells in cats (known as “feline stomatitis complex” or “lymphocytic plasmacytic stomatitis”)—the Somali and Abyssinian may have a tendency to develop feline stomatitis

Mean Age and Range

  • Any age

Signs/Observed Changes in the Pet

  • Bad breath (known as “halitosis”)
  • Inflammation of the gums (known as “gingivitis”)
  • Inflammation of the throat or pharynx (known as “pharyngitis”)
  • Inflammation of the lining of the cheek (known as “buccitis”) with ulcers (known as “buccal mucosal ulceration”)
  • Excessive salivation (known as “hypersalivation” or “ptyalism”) with thick, ropey saliva
  • Pain
  • Lack of appetite (known as “anorexia”)
  • Ulcers of the lining of the mouth (known as “mucosal ulceration”)—ulcers that occur on surfaces of the moist lining of the mouth that oppose the teeth (known as “kissing ulcers”) common in ulcerative stomatitis
  • Plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva)—with or without tartar or calculus (mineralized plaque on the tooth surface)
  • Exposed, dead (necrotic) bone—with inflammation of the bone of the tooth socket (known as “alveolar osteitis”) and inflammation/infection of the bone for unknown reason (known as “idiopathic osteomyelitis”); conditions of unknown cause are called “idiopathic”
  • Behavior changes secondary to pain or sensitivity in the mouth
  • Scar formation on lateral margins of tongue—with CUPS

Causes

Metabolic

  • Diabetes mellitus (“sugar diabetes”)
  • Inadequate production of parathyroid hormone by the parathyroid glands (known as “hypoparathyroidism”)
  • Inadequate production of thyroid hormone (known as “hypothyroidism”)
  • Kidney disease/failure—excess levels of urea and other nitrogenous waste products in the blood (known as “uremia” or “azotemia”)

Nutritional

  • Protein-calorie malnutrition
  • Riboflavin deficiency; riboflavin is part of the vitamin B complex

Cancer or Tumors

  • Dog—malignant melanoma; squamous cell carcinoma; fibrosarcoma; benign epulis (the epulides [plural of epulis] are masses located on the gums; they are the most common benign tumor of the mouth)
  • Cat—squamous cell carcinoma; fibrosarcoma; malignant melanoma

Immune-Mediated

  • Autoimmune diseases (such as pemphigus vulgaris, bullous pemphigoid, systemic lupus erythematosus, discoid lupus erythematosus)
  • Drug-induced—ulcerative disorder of the skin and moist tissues of the mouth (such as “toxic epidermal necrolysis” or “erythema multiforme”)
  • Immune-mediated inflammation of the blood vessels (known as “immune-mediated vasculitis”)

Infectious

  • Retrovirus—cats; feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV)
  • Calicivirus—cat
  • Herpesvirus—cat
  • Leptospirosis—dog
  • Inflammation/infection of the tissues surrounding and supporting the teeth (known as “periodontal disease”)—dog and cat

Traumatic

  • Foreign body—bone or wood fragments
  • Electric-cord shock
  • Any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth (known as “malocclusion”)
  • “Gum-chewer’s disease”—chronic chewing of the moist tissues lining the cheek

Chemical/Toxic

  • Ingestion of caustic chemicals
  • Thallium

Idiopathic (Unknown Cause)

  • Eosinophilic granuloma (a mass or nodular lesion containing a type of white-blood cell, called an eosinophil)—cats, Siberian huskies, Samoyeds
  • Feline stomatitis complex—cats
  • Canine ulcerative stomatitis—dogs; allergic reaction to plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva)
  • Inflammation/infection of the bone for unknown reason (idiopathic osteomyelitis)—dogs

Treatment

Health Care

  • Supportive therapy—soft diet; fluids; hospitalization in severe cases
  • Pain management—topical pain relievers (known as “analgesics”), medications to cover the ulcers
  • Canine ulcerative stomatitis—continuous, meticulous home care to prevent plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) accumulation; dental cleaning initially and frequently; periodontal therapy; extraction of diseased teeth
  • Underlying metabolic or other disease—treat underlying illness

Diet

  • Soft diet
  • Nutritional support—via feeding tube

Surgery

  • Select extractions (partial mouth, teeth in the back of the mouth, or full mouth)—may be indicated for long-term (chronic) conditions of unknown cause (idiopathic), such as canine ulcerative stomatitis and feline stomatitis complex, to remove the source of reaction (plaque [the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva] and teeth)
  • Removal of entire tooth structure—important in extraction treatment for feline stomatitis complex
  • Removal of dead (necrotic) bone or bone that has lost blood supply (known as “avascular bone”) indicated for inflammation/infection of the bone for unknown reason (idiopathic osteomyelitis)

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Antibiotics—treat primary and secondary bacterial infections—clindamycin; amoxicillin-clavulanate; tetracycline
  • Broad-spectrum antibiotics—indicated for inflammation/infection of the bone for unknown reason (idiopathic osteomyelitis)
  • Anti-inflammatory/immunosuppressive drugs—used to decrease inflammation and to decrease the immune response; the comfort of the pet must be weighed against potential long-term side effects of steroid usage—prednisone
  • Agents to protect the surface of the lining of the mouth (known as “mucosal protectants”) for chemical insults—sucralfate; cimetidine
  • Pain relievers (known as “analgesics”) following extraction or teeth—carprofen; hydrocodone; tramadol
  • Topical treatment (that is, treatment applied directly to the tissues of the mouth)—chlorhexidine solution or gel (antibacterial); zinc gluconate/ascorbic acid; stabilized chlorine dioxide for bad breath (halitosis)

Follow-Up Care

Patient Monitoring

  • Frequent examinations of the mouth to monitor for improvement or recurrence of ulcers

Preventions and Avoidance

  • Meticulous home care to prevent accumulation of plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva)

Expected Course and Prognosis

  • Prognosis is guarded, response to therapy depends on underlying cause, and prolonged treatment and/or further extractions may be necessary
  • Inflammation may take 4–6 weeks to subside after extractions due to plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) build-up on sutures and the tongue
  • Feline stomatitis complex—following extractions of the premolar and molar teeth or extractions of all teeth: 60% significant improvement, 25% some improvement, and 15% no improvement has been reported

Key Points

  • Inflammation may take 4–6 weeks to subside after extractions; ulceration in some pets may not improve following extractions
  • Prognosis is guarded, response to therapy depends on underlying cause, and prolonged treatment and/or further extractions may be necessary
  • Any level of home care (brushing or topical antimicrobials) that can be provided is encouraged in pets with canine ulcerative stomatitis or feline stomatitis complex; however, these pets may have very sensitive and painful mouths so owner should be cautious when using home care

Mouth Tumors

Tumors in the Mouth – An Overview

  • “Oral” refers to the mouth; “oral masses” are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Golden retrievers, German shorthaired pointers, Weimaraners, Saint Bernards, and cocker spaniels are more prone to tumors of the mouth than other breeds; dachshunds and beagles are less prone to tumors of the mouth than other breeds; boxers are more prone to have enlargement of the gums (known as “gingival hyperplasia”) than other breeds
  • Malignant melanoma—the most common cancer of the mouth in the dog; cocker spaniels, German shepherd dogs, chow chows, and dogs with heavily pigmented linings of the mouth (known as “mucous membranes”) are more likely to develop malignant melanoma than other dogs
  • Squamous cell carcinoma—the second most common cancer of the mouth in the dog; large-breed dogs are more likely to develop squamous cell carcinoma than other dogs

Mean Age and Range

  • Older pets are affected most often
  • Fibromatous epulis—the epulides (plural of epulis) are masses located on the gums; they are the most common benign tumor of the mouth; fibromatous epulis age range is 1–17 years; mean age is 7.5 years
  • Papillary squamous cell carcinoma—a rapidly growing cancer of young dogs (less than 1 year of age)
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogsOsteosarcoma—middle-aged medium- to large-breed dogs
  • Plasmacytoma—older dogs
  • Squamous cell carcinoma in the cat—type of cancer in the mouth; age range is 3–21 years; mean age is 12.5 years
  • Fibrosarcoma in the cat—the second most common cancer of the mouth; age range is 1–21 years; mean age is 10.3 years

Predominant Sex

  • Malignant melanoma—the most common cancer of the mouth in the dog; males more frequently affected than females
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogs
  • Osteosarcoma—females more commonly affected than males

Signs/Observed Changes in the Pet

  • May have no signs
  • May include bad breath (known as “halitosis”), tooth displacement, malocclusion (any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth), bleeding in the mouth, and drooling
  • Weight loss
  • Lack of appetite (known as “anorexia”)
  • Reluctance to chew or can only eat soft food; chews only on one side of the mouth
  • Inability to open or close mouth
  • Abnormal facial appearance
  • Tooth loss

Causes

  • Unknown for most oral masses
  • Papilloma virus—papilloma, a benign tumor

Risk Factors

  • Squamous cell carcinoma of the tonsils occurs ten times more commonly in dogs from urban settings than in rural dogs
  • Squamous cell carcinoma—more common in white dogs in one study
  • Any long-term (chronic) irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [known as “periodontal disease”] or second-hand smoke) increases the risk of tumor development in the mouth
  • Feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) may play a role in squamous cell carcinoma development in cats
  • Some researchers showed that cats that wore flea collars had 5 times the risk of developing squamous cell carcinoma of the mouth than cats that did not wear flea collars
  • Second-hand smoke may be associated with squamous cell carcinoma in cats
  • Dogs and puppies that have an inability to develop a normal immune response (known as “immunosuppression”) are affected more commonly with papillomas (benign tumors) than dogs with normal immune responses

Treatment

Health Care

  • Depends on the tumor type
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (known as “metastasis”) at time of presentation to the pet’s veterinarian
  • In advanced cancer, combined therapy (surgery, chemotherapy, and radiation) may provide the best care
  • Pain control
  • Supportive care

Diet

  • Nutritional support is essential with any treatment
  • Gruel or liquefied diet may be necessary following surgery of the mouth
  • Tube feeding may be necessary

Surgery

  • Fibromatous epulis—surgical removal is the treatment of choice; freezing (known as “cryotherapy”); and radiation treatment also give long-term success
  • Peripheral odontogenic fibromas (ossifying epulis)—treat the same as fibromatous epulis
  • Acanthomatous ameloblastoma—surgical removal is usually curative; radiation also has been used successfully; the combination of surgery and radiation may be most effective (requiring less aggressive surgery), but if radiation is not readily available, surgery may be the only option; multiple injections of bleomycin at the tumor site have been effective in a small number of reported cases
  • Malignant melanoma—if surgery is chosen for therapy, it should be aggressive; typically involving surgical removal of the lower jaw or mandible (known as “mandibulectomy”) or the upper jaw or maxilla (known as “maxillectomy”)
  • Squamous cell carcinoma—may be removed surgically with wide margins or may be treated with radiation therapy in the dog, especially; surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy) with a 2-cm clean surgical margin is the goal; dogs tolerate surgical removal of 40% to 60% of the tongue (known as “partial glossotomy”); surgery, radiation, and chemotherapy (mitoxantrone) may be the best options for tumors larger than 2 cm or those with incomplete surgical removal
  • Fibrosarcoma—usually requires surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)
  • Radiation therapy should be considered in pets where complete removal of the tumor is not possible or the location of the tumor makes surgical removal impossible

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Chemotherapy may be indicated for some forms of cancer in the mouth; chemotherapeutic drugs may include mitoxantrone, bleomycin, or cisplatin
  • DNA-based vaccine for malignant melanoma may be used in certain cases after surgical treatment of the tumor in the mouth

Follow-Up Care

Patient Monitoring

  • Depends on type of tumor and the presence or absence of spread of cancer (metastasis)

Preventions and Avoidance

  • Remove or treat any source of irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [periodontal disease] or second-hand smoke)

Possible Complications

  • Surgical removal of part of the tongue may result in loss of blood supply to the remaining tongue, with death of tongue tissue
  • Postoperative complications of surgical removal of the lower jaw or mandible (mandibulectomy) include splitting open or bursting along the incision line (known as “wound dehiscence”), difficulty grasping food, tongue hanging out of the mouth, and excessive drooling
  • Surgical removal of the lower jaw or mandible (mandibulectomy) can be performed in cats, but mandibulectomy results in greater complications (such as tongue swelling) than in dogs
  • Within the first few weeks of low-dose radiation therapy, diarrhea, nausea, vomiting, and hair loss may occur (regrowth of hair is usually white); high-dose radiation therapy has these complications as well as superficial loss of tissue on the surface of the lining of the mouth, frequently with inflammation (known as “oral ulceration”) and/or death of tissues in the mouth (known as “oral necrosis”), cataracts (opacities in the normally clear lens), and radiation-induced tumors (mainly in young dogs that underwent radiation therapy)
  • Chemotherapy complications vary depending on the drug used

Expected Course and Prognosis

  • Early diagnosis and treatment offers the best chance for a successful outcome
  • Dogs with inadequate tumor-free surgical margins were 2.5 times more likely to die of the tumor than those with complete surgical removal of the tumor (as demonstrated by microscopic evaluation of tumor margins); some surgical patients need feeding tubes to facilitate nutritional supplementation during the treatment period
  • Dogs with tumors located behind the first premolar tooth had three times greater risk of dying from the disease than those with tumors located in front of the first premolar tooth
  • Malignant melanoma—prognosis improves if the tumor is small and located in the front part of the lower jaw or mandible; treatment of malignant melanoma involves surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)—median survival times average 8 months; combination of surgery, radiation, and chemotherapy (low-dose cisplatin) yielded a median survival of 14 months in one study; pigmentation does not affect the prognosis; this cancer of the mouth is relatively resistant to radiation therapy—one study showed a median survival time of 14 months after radiation only; the problem with melanoma is not local disease management, but spread of the cancer to other body tissues (metastasis)
  • Squamous cell carcinoma in dogs—better long-term prognosis than malignant melanoma or fibrosarcoma in the dog; the prognosis is better if the cancer is located toward the front of the mouth than if it is located toward the back of the mouth in dogs; radiation therapy alone delivers a median survival rate of 15–17 months; in dogs, prognosis for survival following treatment for squamous cell carcinoma of the tongue is poor
  • Squamous cell carcinoma in cats—mean survival time of 2 months; chemotherapy and/or radiation therapy can be used to control the cancer, but not to cure it (known as “palliative treatment”)
  • Fibrosarcoma—surgical removal of the cancer, with at least 2-cm margins, usually results in a 12-month median survival rate; surgical excision in combination with radiation therapy and chemotherapy offers the best prognosis; radiation or chemotherapy alone offered a poorer median survival rate than surgery alone; fibrosarcomas involving the roof of the mouth (palate) carry the poorest prognosis because of the inability to remove them adequately with surgery; radiation therapy can be useful following surgical removal of the mass
  • Osteosarcoma—wide surgical removal is ideal; recurrence can occur and the tumor can spread to other locations in the body (metastasis); radiation therapy can be used following surgery or can be used alone to control the cancer, without curing it (palliative treatment)

Key Points

  • Oral masses are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (metastasis)
  • Nutritional support is essential with any treatment