DERMATOLOGY
Figure 5: Atopic lip fold dermatitis with cheilitis
and secondary Staphylococcus spp infection
Figure 6: Perioral and facial demodicosis
in a dog.
Treatment
Lip Fold Intertrigo
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Daily use of topical antiseptic and drying agents
should be initiated.
- 2% acetic acid, 2% boric acid, and antimicrobial-based wipes and solutions are appropriate for
maintenance therapy.
Acid- and alcohol-based topical medications are not
recommended for erosive or ulcerative lesions.
- If erosions, ulcers, crusts, nodules, or depigmentation are present, systemic antimicrobial
therapy is indicated (see
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Bacterial Infection & Mucocutaneous Pyoderma).
Figure 7: Mucous membrane pemphigoid
in a dog
or 1%–2% ketoconazole may be used q24–48h until resolved, then maintained 1–2 times weekly.
Focal, dry presentations should be treated with daily applications of ointments with 1% clotrimazole, 1%– 2% miconazole, 1% terbinafine, 4% thiabendazole, or nystatin.
Shampoos with 1%–2% ketoconazole, 2% miconazole,
2%–4% chlorhexidine, or 2.5% benzoyl peroxide may be
used 2–3 times weekly.
Adjunct systemic therapy for generalized or severe multifocal presentations should be initiated:
- Ketoconazole at 5–10 mg/kg PO q24h
- Itraconazole at 5–10 mg/kg PO q24h
- Fluconazole at 10 mg/kg PO q24h
- Terbinafine at 30 mg/kg PO q24h
Cheiloplasty is curative in patients that have lip fold
intertrigo (with no other underlying cause) and are refractory to maintenance therapy.
Dermatophytosis
Bacterial Infection & Mucocutaneous Pyoderma
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Immune-Mediated Conditions*
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Topical therapy is recommended in all cases.
Systemic antimicrobial therapy is recommended
for erosive or ulcerative, crusting, and depigmentation presentations.
If cocci are found on cytology, appropriate empirical choices include:
- Clindamycin at 11 mg/kg PO q12–24h
- Cephalexin at 22–30 mg/kg PO q12h
- Cefpodoxime at 5–10 mg/kg PO q24h
- Cefovecin at 8 mg/kg SC q14d up to 2–3 times
- Amoxicillin–clavulanate at 13.75 mg/kg PO
q12h
Solutions and wipes containing 2% acetic acid, 2%
boric acid, or 2%–4% chlorhexidine may be used
daily and maintained q3–7d after resolution.
Avoid acid or alcohol-containing products if erosions are present.
Shampoos containing 2.5% benzoyl peroxide or
2%–4% chlorhexidine may be used 2–3 times
weekly.
For mixed infections and ulcerative lesions, silver
sulfadiazine cream should be considered.
Mupirocin ointment is most appro