Superficial Pyoderma Research Articles

Superficial Granulomatous Pyoderma of the Vulva in a Patient Receiving Maintenance Rituximab (MabThera) for Lymphoma

Vulval ulceration can be caused by a wide variety of etiological factors including bacterial and viral infections, granulomatous disorders, and malignancy. Superficial granulomatous pyoderma (SGP) is a variant of pyoderma gangrenosum. It is characterized by localized ulcerative lesions that may be precipitated by surgery. We report a case of vulval SPG in an immunocompromised patient. A 51-year-old woman presented with a 6-week history of severe vulval pain, bleeding, and rapidly progressing ulceration. She had a previous history of relapsed follicular non-Hodgkin lymphoma and was currently receiving regular MabThera (Welwyn Garden City, Hertfordshire, UK). Examination revealed deep ulceration involving the entire vulva and extending into the vagina with areas of necrosis. Histological examination showed ulceration with sparse granulomas and eosinophils. The clinical and histological findings confirmed a diagnosis of SGP. Vulval ulceration in an immunocompromised patient has a broad differential diagnosis. The possibility of a granulomatous condition such as SGP must always be considered.

Dose assessment of 2% chlorhexidine acetate for canine superficial pyoderma

The dose of 2% chlorhexidine acetate (2CA; Nolvasan(®) Surgical Scrub; Fort Dodge Animal Health, Fort Dodge, IA, USA) for canine superficial pyoderma was evaluated. The first trial compared three doses (group 1, 57 mL/m(2) body surface area; group 2, 29 mL/m(2) body surface area; and group 3, 19 mL/m(2) body surface area) in a randomized, double-blind, controlled fashion. Twenty-seven dogs with superficial pyoderma were treated with 2CA at the allocated doses every 2 days for 1 week. The owners and investigators subjectively evaluated the dogs, and investigators scored skin lesions, including erythema, papules/pustules, alopecia and scales, on a 0-4 scale. There were no significant differences in response between the treatment groups. The second trial established a practical dose-measuring method for 2CA. Sixty-eight owners were asked to apply 2CA on their palm in an amount corresponding to a Japanese ¥500 coin, 26.5 mm in diameter. This yielded an average dose of 0.90±0.40 mL. Mathematically, the doses used in groups 1, 2 and 3 can be represented as one coin per approximately one-, two- and three-hand-sized lesions, respectively. The results therefore suggest that owners instructed to apply one coin of the product per two-hand-sized areas of superficial pyoderma would use the range of doses evaluated in this trial.

Estimation of the clinical and economic consequences of non-compliance with antimicrobial treatment of canine skin infections

The goal of this study was to estimate the health and economic consequences of non-compliance with oral antimicrobial treatment in dogs with superficial pyoderma, wounds or abscesses in the US. A mathematical model (Markov model) which simulated treatment with long-term injectable cefovecin versus oral amoxicillin/clavulanic acid was developed and accounted for the effect of non-compliance on clinical outcomes and mean total treatment costs per patient. Efficacy parameters considered in the model were derived from clinical studies. Treatment failure due to oral antimicrobial treatment non-compliance was approximated from published data at 13.6%. US cost data for 2009 were derived from public sources. When non-compliance was considered as a cause of treatment failure with oral medication, the long-term injectable antibiotic was more effective than oral comparator (162 versus 158 days without clinical signs). Mean total treatment costs were lower with cefovecin (USD 376.74) versus amoxicillin/clavulanic acid (USD 382.34) in dogs of 25 kg; and cefovecin remained cost-saving up to a body weight of 31 kg. In large dogs, cefovecin was more costly; however, total therapy costs were less than 6% greater than with amoxicillin/clavulanic acid. Accordingly the higher drug and administration costs of the long-term injectable antibiotic were totally or substantially offset when non-compliance was considered as reason for treatment failure with oral medication. The model also allowed for the estimation of the impact of various non-compliance scenarios.

Identification and Antimicrobial Drug Susceptibility of Clinical Staphylococcus spp. Isolates from Canine Superficial Pyoderma at a Primary Veterinary Hospital

Staphylococcus spp. was isolated from 20 dogs with superficial pyoderma at a primary veterinary hospital. Among the 20 isolates, 19 Staphylococcal strains were identified as S. pseudintermedius and one as S. schleiferi. The 20 isolates had three (15%) positive for mecA gene. Typing of Staphylococcal cassette chromosome mec (SCCmec) revealed all carried type V SCCmec. The mecA-positive S. pseudintermedius showed resistance to a variety of antimicrobial agents other than β-lactams indicating multiple-drug resistant phenotype. Our results strongly suggest primary veterinary hospital clinicians should consider the possibility of mecA-positive S. pseudintermedius as an etiologic agent of canine pyoderma.

Canine pyoderma Part 2: Diagnosis

UK Vet Vol 15 No 9 November 2010 53 INTRODUCTION The diagnosis is based on compatible history, clinical signs, cytology and, where necessary, bacterial culture and antibiotic susceptibility testing. In some cases dermato-histopathology will be needed to investigate an underlying predisposing condition. In these cases it is recommended to take biopsies once the obvious surface to superficial pyoderma has been treated, as this will increase the chance of yielding representative samples.

Efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma

The clinical efficacy of a surgical scrub containing 2% chlorhexidine acetate (2CA; Nolvasan® Surgical Scrub; Fort Dodge Animal Health, USA) was evaluated for the topical management of canine superficial pyoderma. The first study was a randomized, double-blind, controlled trial. The control was a shampoo containing 4% chlorhexidine gluconate (4CG; Skin Clinic Shampoo; CHD MEDICS, Goyang, Korea). Ten dogs with symmetrical lesions of canine superficial pyoderma were allocated to receive either 2CA or the control shampoo applied to either side of the body twice weekly for 1 week. Both the owners and the investigators subjectively scored skin lesions including pruritus, erythema, crusted papules and scales on a scale of 0-3. The 2CA and 4CG resulted in almost the same degree of improvement of skin lesions, and there were no significant differences between the two groups. The second study was an open trial of 2CA monotherapy in eight dogs with cefalexin-resistant Staphylococcus intermedius group-associated superficial pyoderma. The 2CA monotherapy was applied every 2 days for 2 weeks. Five dogs improved with 2CA monotherapy, one partially improved and two did not. No adverse reactions were seen in either trial. This suggests that a 2CA surgical scrub could be a useful and safe topical adjunct therapy for dogs with superficial pyoderma involving cefalexin-resistant Staphylococcus intermedius group.

In vitro susceptibility testing of meticillin‐resistant and meticillin‐susceptible staphylococci to mupirocin and novobiocin

Antimicrobials effective against meticillin-resistant staphylococci are limited. Mupirocin is a topical antimicrobial used to treat bacterial skin infections. Novobiocin is an oral antimicrobial approved for treatment of staphylococcal upper respiratory infections in dogs. This study reports the in vitro activity of mupirocin and novobiocin on meticillin-susceptible (MSS) and resistant staphylococci (MRS) from healthy dogs and dogs with superficial pyoderma. Staphylococci were isolated from skin swabs at four sites on healthy dogs and from lesions on dogs with superficial pyoderma. Staphylococci were identified by morphology and by catalase and coagulase testing. Speciation and susceptibility testing were performed by the Dade Microscan (W. Sacramento, CA, USA). Meticillin resistance was confirmed by an oxacillin screen plate. Novobiocin and mupirocin susceptibilities were tested by disc diffusion. Staphylococci were cultured from 61 healthy dogs (17 MRS and 44 MSS) and 30 dogs with pyoderma (15 MRS and 15 MSS), with higher proportions of MRS isolates in dogs with pyoderma (P=0.038; χ(2) test). For mupirocin, 79.5% (35 of 44) MSS and 82.3% (14 of 17) MRS isolates from healthy dogs, and 100% (15 of 15) MSS and 86.6% (13 of 15) MRS isolates from dogs with pyoderma were susceptible (MSS, P=0.094; MRS, P=1.0; Fisher's exact test). For novobiocin, 95.4% (42 of 44) MSS and 52.9% (nine of 17) MRS isolates from healthy dogs and 93.3% (14 of 15) MSS and 80% (12 of 15) MRS isolates from dogs with pyoderma were susceptible (MSS, P=1.0; MRS, P=0.148; Fisher's exact test).

Comparison of two formulations of chlorhexidine for treating canine superficial pyoderma

CANINE superficial pyoderma is a common skin disease in dogs ([Scott and others 2001][1]). It is mainly treated with systemic antimicrobials, particularly oral cefalexin ([Lloyd and others 1996][2]). However, the emergence of multiresistant mecA -positive Staphylococcus intermedius was reported by [

Identification of a novel Staphylococcus pseudintermedius exfoliative toxin gene and its prevalence in isolates from canines with pyoderma and healthy dogs

Staphylococcal exfoliative toxins are involved in some cutaneous infections in mammals by targeting desmoglein 1 (Dsg1), a desmosomal cell-cell adhesion molecule. Recently, an exfoliative toxin gene (exi) was identified in Staphylococcus pseudintermedius isolated from canine pyoderma. The aim of this study was to identify novel exfoliative toxin genes in S. pseudintermedius. Here, we describe a novel orf in the genome of S. pseudintermedius isolated from canine impetigo, whose deduced amino acid sequence was homologous to that of the SHETB exfoliative toxin from Staphylococcus hyicus (70.4%). The ORF recombinant protein caused skin exfoliation and abolished cell surface staining of Dsg1 in canine skin. Moreover, the ORF protein degraded the recombinant extracellular domains of canine Dsg1, but not Dsg3, in vitro. PCR analysis revealed that the orf was present in 23.2% (23/99) of S. pseudintermedius isolates from dogs with superficial pyoderma exhibiting various clinical phenotypes, while the occurrence in S. pseudintermedius isolates from healthy dogs was 6.1% (3/49). In summary, this newly found orf in S. pseudintermedius encodes a novel exfoliative toxin, which targets a cell-cell adhesion molecule in canine epidermis and might be involved in a broad spectrum of canine pyoderma.

Superficial Granulomatous Pyoderma: A Case in an 11-Year-Old Girl and Review of the Literature

Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.

Evaluation of the Clinical Efficacy of Pradofloxacin Tablets for the Treatment of Canine Pyoderma

A third-generation fluoroquinolone, pradofloxacin (PRA), is currently being developed to treat bacterial infections in dogs. The purpose of this study was to assess the clinical efficacy in 20 dogs affected with superficial and deep pyoderma. An initial aerobic skin culture was performed in dogs with superficial pyoderma; aerobic/anaerobic tissue culture was performed in dogs with deep pyoderma; and skin cytology and biopsies were obtained from all dogs. Pradofloxacin (approximately 3 mg/kg per os [PO]) was administered daily to all dogs. Clinical efficacy was recorded at 4 weeks for dogs with superficial pyoderma and at 3 and 6 weeks for dogs with deep pyoderma. At a mean dosage of 3.7 mg/kg PO once daily, PRA treatment resulted in an excellent to good clinical response within 3 to 6 weeks for all 20 dogs with superficial and deep pyoderma.

Successful treatment of superficial pyoderma gangrenosum associated with hidradenitis suppurativa with adalimumab

Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are chronic inflammatory dermatoses that can be a challenge to treat. A role for TNF-alpha in their pathogenesis has been postulated in the literature. A therapeutic benefit of infliximab has been reported in recalcitrant cases of both conditions. To date, there is less evidence about the use of adalimumab for these conditions. We report a patient with severe superficial PG on a background of HS, which responded to adalumimab therapy after failure of infliximab therapy.

Mortality in red squirrels (Sciurus vulgaris) associated with exudative dermatitis

Red squirrels (Sciurus vulgaris) found dead or dying on the Isle of Wight and the island of Jersey were suffering from exudative, ulcerative dermatitis and superficial staphylococcal pyoderma. The principal...

Investigation of the clinical efficacy of 0.2% topical stannous fluoride for the treatment of canine superficial pyoderma: a prospective, randomized, double-blinded, placebo-controlled trial

Stannous fluoride (SF) is an antibacterial compound that has been successfully used to treat gingivitis in people and dogs, and cutaneous bacterial infections in horses. The purpose of this prospective, double-blinded, placebo-controlled clinical trial was to investigate the efficacy of 0.2% SF spray (BacDerm; Emerald 3 Enterprises Inc., Camdenton, MO, USA) for the treatment of canine superficial pyoderma. Twenty-six privately owned dogs with bacterial skin infections diagnosed on clinical signs, cytology and aerobic culture were enrolled. Dogs were randomly assigned to vehicle only or active ingredient treatment groups. The product was applied topically to affected areas once daily for 28 days, with assessments at days 0, 14, 28 and 42. Clinical and cytological evaluations were performed by the same investigators at each visit. Owners scored the improvement of hair coat, odour, pruritus and overall improvement at each recheck. Linear mixed models showed significant effects of treatment (P < 0.0001) and time (P = 0.0037) for investigator's scores, and a significant time effect for owners' haircoat (P = 0.0077) and odour (P = 0.0170) improvement scores. Dogs in both placebo and SF groups showed some improvement over time, and the investigator's scores on days 0 and 28 were not significantly different between groups for both (t-test P > 0.05). Spearman's rho correlation coefficients revealed a significant negative correlation between investigator's scores and all categories of owners' assessment scores in dogs of both groups. Although some dogs improved on SF, this study does not support the use of 0.2% SF as sole therapy for canine superficial pyoderma.

Development of an enzyme‐linked immunosorbent assay for detection of circulating IgG autoantibodies against canine desmoglein 3 in dogs with pemphigus

Pemphigus, a group of autoimmune blistering dermatoses recognized in humans and dogs, is divided into three subgroups: pemphigus vulgaris (PV), pemphigus foliaceus (PF) and paraneoplastic pemphigus (PNP). Previously, we have demonstrated that circulating anti-desmoglein 3 (Dsg3) IgG in dogs with PV and PNP disrupts Dsg3-mediated keratinocyte cell-cell adhesion. The aim of this study was to develop an enzyme-linked immunosorbent assay (ELISA) for the detection of circulating IgG against canine Dsg3 in dogs with pemphigus. A secreted form of recombinant protein representing the entire extracellular domain of canine Dsg3 (cDsg3) was produced by baculovirus expression and used as the coated antigen in the ELISA. The titre of anti-cDsg3 ELISA was significantly higher in canine PV (n = 14) than that in healthy dogs (n = 44) (P < 0.05). Of the canine PV and PNP sera, 11/14 (79%) canine PV sera and the canine PNP serum were positive in the anti-cDsg3 ELISA. On the other hand, 14/37 (38%) sera from canine PF and 9/18 (50%) sera from canine autoimmune subepidermal bullous dermatoses were positive in the ELISA. Circulating IgG against cDsg3 was not recognized in dogs with superficial pyoderma (n = 5), atopic dermatitis (n = 8), or in healthy dogs (n = 44). Moreover, IgG immunoreactivity against cDsg3 in all 21 sera was completely absorbed by preincubation with cDsg3. These findings altogether suggest that the anti-cDsg3 ELISA can be used as a rapid screening test for the detection of circulating anti-Dsg3 IgG autoantibodies in canine pemphigus.

Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso

Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4% of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.

Topical therapy in veterinary dermatology: Part 2

The first part of this mini-series described the different forms of application of topical therapy available to the veterinary practitioner. This second part will discuss the different ingredients and their uses for different dermatological conditions. CUTANEOUS INFECTIONS A large number of antibacterial substances are available as sole therapy for mild cases of superficial pyoderma (Figs. 1 and 2) or as adjunctive treatment in more severe cases and cases of deep pyoderma. Creams can be useful for spot treatment of small areas, e.g. in fold pyoderma (Fig. 3) or chin acne, while, for more widespread problems, shampoos, conditioners and sprays are more useful. As many allergic patients suffer from secondary bacterial or yeast infections, which act as flare factors, microbial control is often a vital part of the management in these individuals.

Superficial granulomatous pyoderma treated preoperatively with infliximab

We report a case of superficial granulomatous pyoderma (SGP) treated successfully with infliximab. A 71-year-old woman developed erythema, erosions and cribriform scarring in the right periorbital area following enucleation of the right eye. Histology showed three-layered granulomas typical of SGP. The patient's disease was unusual in that it failed to respond to a wide variety of immunosuppressants and this condition is rarely reported to affect the face. Eventually she was treated successfully with infliximab, enabling her to undergo extensive surgery despite the fact that her disease was pathergic in onset.

Psoriasis vulgaris als Trigger eines superfiziellen multilokulären Pyoderma gangraenosum?

We report on a 60-year-old man with psoriasis vulgaris who had developed disseminated ulcerations of different sizes over the complete integument over a period of 3 months. The initial examination revealed approximately 150 clearly defined ulcerations, which were mostly reported to be painless. The histopathology report of a biopsy taken from the border area of an ulceration showed a nonspecific inflammation with a predominantly neutrophilic infiltrate. In the synopsis of all results, after excluding relevant differential diagnoses, we diagnosed a superficial multilocular pyoderma gangrenosum that had possibly developed in the areas of the preexisting psoriasis vulgaris. Reports of superficial multilocular pyoderma gangrenosum, a variation of pyoderma gangrenosum, are extremely rare. This condition is characterised by multiple superficial, chronically persistent ulcerations. These ulcerations are often described as indolent and usually develop from a pustule in the area of a preexisting condition or trauma. Up to now, psoriasis vulgaris has seldom been described as a trigger for pyoderma gangrenosum. The treatment is very difficult and is based on local and/or systemic immunosuppression. In this patient's case, considerable improvement was attained with a topical polyhexanide gel in combination with moist wound therapy, with no systemic immunosuppression. Our case report underscores that physicians should keep in mind the rare variation of superficial multilocular pyoderma gangrenosum in the differential diagnosis of multiple disseminated, painless ulcerations over the complete integument in patients with psoriasis vulgaris.

Multifocal papular deep bacterial pyoderma in a Boxer dog caused by Pseudomonas aeruginosa

A young adult Boxer dog was presented with a papular dermatitis on the dorsal back and ventral neck that had developed while it was being treated with cyclosporine and cephalexin for atopic dermatitis and secondary superficial staphylococcal pyoderma, respectively. Histopathology demonstrated nodular to diffuse pyogranulomatous dermatitis with focal furunculosis. Numerous bacterial rods, free in the tissue and engulfed by neutrophils and macrophages, could be demonstrated on stained samples (haematoxylin-eosin; Giemsa). Bacterial culture from an aseptically collected skin biopsy punch sample yielded a pure growth of Pseudomonas aeruginosa, sensitive to a variety of antimicrobials. Successful treatment was accomplished following discontinuation of cyclosporine and an extended course of enrofloxacin. There has not been a recurrence of the pseudomonal pyoderma during the subsequent 2 years.