Demodicosis most common underlying cause of persistent pododermatitis
There is nothing more frustrating than treating a dog with bacterial pododermatitis.
You can use antibiotics, foot soaks in antibacterial soaps, and sometimes a small dose of steroid, and this infection keeps lingering!
The most common underlying cause of a persistent pododermatitis is demodicosis. In some patients, only the feet will be involved. In some cases, just one foot is effected.
If skin scrapings are not performed or the mite is missed and the dog is treated with antibiotics and steroids, the feet improve. Unfortunately the steroid leads to more immunosuppression, and the patient's feet flare up worse than on the original presentation.
If the mite is missed again on scrapings, more of the same medications are dispensed typically. The patient enters a cycle of improvement, yet worsens over time. Another common mistake is to check the patient's feet for yeast and dispense appropriate anti-yeast medications yet when demodex is present, the yeast is a secondary problem. In essence, diagnosing the mite is essential to clearing up any secondary bacterial or fungal infection.
Long-term antibiotics Treatment of pododemodicosis can be difficult because of the accompanying infection.
The patient should be discouraged from getting its paws wet between dips, which makes these dips difficult to use in patients that go outside. If the owner is performing weekly dips, they should be cautioned not to use the medication on dogs if they are pregnant, diabetic, on antihypertensives, cardiac medications or antidepressants.
Once the mites have been eradicated, we suggest that the patient have four more weekly dips as insurance. Along with the dip and benzoyl peroxide shampoos, antibiotics need to be prescribed for the entire treatment regimen. Do not prescribe steroids, not even a small amount! In some patients a "small" dose of steroids is enough to perpetuate immunosuppression that the demodex mite is causing anyway. Ivermectin at 200-800ug/kg/day orally is another treatment for demodex of the feet. It is not FDA-approved for use in the dog for demodex and should not be used in herding breeds, herding breed mixes, white German Shepherds or in elderly patients. The patient should be heartworm negative before starting therapy.