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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 28580
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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There. my two year old GSDxlab had a lip infection

Customer Question

hi there. my two year old GSDxlab had a nasty lip infection and our vet gave us a five day course of antibiotics. The infection subsided and then came back with a vengeance. then the vet said he was really unwell and his glands were swollen (his behaviour also changed and he became defensive/ aggressive to non-family members) and the vert prescribed two very strong antibiotics (two large pink pills and one small white morning and night) for 10 days and this did completely clear the infection. The last dose was on christmas eve (24) but I now fear that the infection is returning again. Can I send you a picture and ask your advice please? Thanks
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, please do. You can use the paperclip icon in the toolbar above your message box (if that icon is visible) or you can use an external app such as I can be more accurate for you if I can see what you're seeing.

Customer: replied 1 year ago.

thanks. This is him with a 'normal' lip:

https:[email protected]/23585717035/

and then with the infection a couple of weeks ago:

and then now, today:

thank you!!

Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you! This is most indicative of mucocutaneous pyoderma which is a bacterial infection of mucocutaneous junctions (such as where the mucous membranes of the oral cavity meet the skin). It's uncommon in dogs; German shepherds and their crosses are possibly predisposed, indicating possible association with the ulcerative syndromes of German shepherds (mucocutaneous pyoderma, perianal fistula, metatarsal ulceration). Lesions are characterized by some combination of mucocutaneous swelling (quite apparent in Bandha), erythema (reddening/quite apparent), and crusting, often bilateral and sometimes symmetrical. Affected areas may be painful or pruritic (itchy), and self-traumatized; they may become exudative, eroded, ulcerated, fissured, and depigmented. The margins of the lips, especially at the commissures, are most frequently affected.

Treatment is as follows:

1) For mild to moderate lesions, affected areas should be clipped and cleaned with shampoo that contains chlorhexidne.

2) Topical prescription mupirocin ointment or cream should be applied every 12-24 hours for 1 week, then every 3-7 days for maintenance therapy, as needed.

3) For severe lesions, in addition to topical therapy, appropriate systemic antibiotics should be administered for 3 weeks.

4) The prognosis is good if an underlying primary disease (allergy, endocrinopathy) can be identified and controlled but lifelong maintenance therapy is often needed. If regularly applied, topical antibiotics may maintain remission.

Feel free to share our conversation with Bandha's vet. The top differentials are superficial pyoderma, lip fold pyoderma, autoimmune skin disorders (unlikely if it has responded nicely to only antibiotics), demodicosis (the Demodex mange mite), dermatophytosis (fungal infection), Malassezia (yeast) dermatitis, candidiasis, and epithliotropic lymphoma (not a consideration because it has responded to antibiotics). Please continue our conversation if you wish.

Customer: replied 1 year ago.
Thank you so much! This is really helpful. I have one last question. It is holiday here in the uk. How urgently should I get him to a vet (I am worried because last time his behaviour became very worrying)? Should I take him to an emergency vet or wait until Monday? Thank you very much
Expert:  Dr. Michael Salkin replied 1 year ago.

If he'll let you do so, applying an over the counter topical antibacterial ointment or cream such as one containing fusidic acid or neomycin should be helpful. I don't want your getting bit, however. He'll ingest some of the product but that should be of little consequence. This isn't an emergency situation other than it can abruptly worsen prompting a more protracted therapy.

You're quite welcome. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.

Dr. Michael Salkin and other Dog Specialists are ready to help you
Customer: replied 1 year ago.

hi again. I already rated and thank you so much - the advice was excellent - but I just wanted to check - is the ointment (fusidic acid/ neomycin) a vetinary one or could a human one be used? Thanks again so much - and Happy New Year!!

Expert:  Dr. Michael Salkin replied 1 year ago.

Those products can be found at your local druggist and are used in both veterinary and human patients. Thank you for your kind accept. I appreciate it.

I can't set a follow up in this venue and so would appreciate your returning to our conversation with an update at your convenience.

Customer: replied 1 year ago.
Hi there. Thank you so much for your useful help last time! My dog went on to have a four week course of antibiotics which -again - took care of the infection but now, ten days later - the infection is back.
I've done some research and I am wondering if this might be pemphigus vulgaris? I know you suggested an autoimmune condition might be at the root.
If this is the case, what is the treatment/ prognosis?
Thank you so very much
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, please, I would like to see a photo(s). You can upload photos by using the paperclip icon in the toolbar above your message box (if you can see the icon) or you can use an external app such as Pemphigus folicaceus, perhaps, but let me take a look...pemphigus doesn't respond to antibiotics alone; glucocorticoids such as prednisone are most always necessary.

Customer: replied 1 year ago.
Hi. Thanks. This is his normal lip: https:[email protected]/23585717035/ and this was the penultimate time it flared up
and this is the last time
I am unable to upload today's photo for some reason but it is becoming red and inflamed again.
If we do need steroids, can it be cured? I am really worried. I know that German shepherds are more prone to pemphigus vulgaris but I would prefer it to be folicaceous as it would appear this is easier to treat.
What do you think? And what prognosis/ treatment? Thank you so much
Expert:  Dr. Michael Salkin replied 1 year ago.

I can't see the second and third posted photos because they aren't specified as you specified the first one. The provided link only brings me to the home page of flickr. Please try again.

Customer: replied 1 year ago.
https:[email protected]/23980727072/
And https:[email protected]/23477197102/
Hope it works this time... And, sorry
Previous questions still apply!! Thank you so much
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you! There's no evidence of pemphigus in those photos. The anatomy of the lip (a large lip flap) predisposes to a skin (lip) fold pyoderma also called lipfold intertrigo. Bacterial and/or Malassezia (yeast) overgrowth is extremely common in these folds and actic acid treatment once to twice daily can be beneficial. Dogs with very deep folds often can't be cleaned well enough. These dogs often need treatments with oral antibiotics and/or oral antifungal products to keep the dermatitis under control. Cheiloplasty (lip reduction) is curative and should be considered in Bandha. Please continue our conversation if you wish.

Customer: replied 1 year ago.
Hi again. Following on from repeated lip fold infections a few months back, my dog now has this in his groin area. The photo is an indication, but I'd say he has around 12 lesions. I'm pretty worried: https:[email protected]/28004123055/
Expert:  Dr. Michael Salkin replied 1 year ago.

Julia, those are epidermal collarettes which start as pustules (which I can also see in the photos) and most often represent a superficial spreading pyoderma (a Staph infection, usually) which is best addressed with a systemic antibiotic in the cephalosporin class such as cephalexin for a minimum of 3-4 weeks and 1 week past clinical signs. Shampooing twice weekly in a shampoo containing either chlorhexidine or benzoyl peroxide should hasten resolution of the infection.

Please open up a new question for a new problem lest my moderator become upset with me, rip off my left leg, and beat me to death with it. You need only to type "for Dr. Michael Salkin, only" as the first few words of your new question so my colleagues will know to defer to me.