Page 273 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 273

WSVA7-0297
DERMATOLOGY
HOW I APPROACH CHRONIC PODODERMATTITIS
T. Nuttall1
1University of Edinburgh, Royal Dick School of Veterinary Studies, Roslin, United Kingdom
HOW I APPROACH CHRONIC PODODERMATITIS
Dr Tim Nuttall
Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Roslin, UK.
tim.nuttall@ed.ac.uk
Introduction
Pododermatitis describes any in ammation of the paw but the most common problem is chronic interdigital furunculosis. Affected dogs have frequent  ares of in ammation and infection. It is very important to manage the underlying causes to reduce or prevent chronic changes. Chronic changes such as hyperplasia or new pad formation make long-term control much harder.
Pododermatitis – a condition with primary, secondary, predisposing and perpetuating causes
Primary factors
These trigger the initial pedal in ammation. The primary cause may be very subtle and easily missed, especially in chronic cases. Primary causes include:
· Atopic dermatitis
· Adverse food reaction
· Contact allergy
· Foreign bodies/contact irritants (e.g. hair, stone, sand, salt etc.)
· Idiopathic sterile granuloma
· Immunomodulatory-responsive pododermatitis
· Footpad hyperkeratosis and other corni cation disorders
· Hypothyrdoidism
· Hyperadrenocorticism
· Demodex
· Hookworm
· Dermatophytosis (Trichophyton)
· Leishmania
Immunomodulatory-responsive pododermatitis is characterised by severe lymphocytic-plasmacytic pedal in ammation and secondary infection. It responds well to immunosuppressive or immunomodulatory treatment, although it is unclear whether it is always a primary problem or it is a chronic change.
Predisposing factors
These increase the risk of developing pododermatitis but less commonly cause disease themselves. Predisposing factors include short hairs (which can cause foreign body reactions and chronic in ammation), increased weight bearing (obesity and large breed dogs) and altered weight bearing (limb deformity, osteoarthritis and cruciate disease).
Perpetuating factors
These prevent resolution, inducing a cycle of in ammation and altered pedal conformation. This is often associated with severe lymphocytic-plasmacytic in ammation. Changes include altered weight bearing (including haired skin), hyperkeratosis and lichenifcation, scarring and chronic in ammation, conjoined pads, new pad formation, deep tissue pockets, ingrown hairs and sinus tracts.
Secondary factors
The altered micro-environment and in ammation predispose to secondary infections with organisms such as Staphylococcus pseudintermedius, Streptococcus, E. coli, Klebsiella, Pseudomonas and Malassezia. There can be multiple infections at different depths, especially in chronic cases.
Diagnostic approach
A detailed history and examination is needed to determine the likely primary, predisposing and perpetuating causes in each case. Both the dorsal and palmer/planter foot surfaces should be inspected, with the interdigital spaces carefully opened out.
An Urban Experience
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