Pyoderma

By | 2011-06-28

Definition and cause

Broadly defined as a secondary bacterial infection of the skin, pyoderma is one of the most common diseases seen in dogs. It is less common in cats. In most instances the surface of the skin has been compromised and bacteria infections are initiated. Pyodermas are classified as superficial and deep, and arise secondary to allergies and / or in combination with compromised immune function. The most common canine bacterial skin infection is caused by staphylococci. Some pyodermas can be secondary to other diseases such as hypothyroidism and Cushing’s disease.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

The approach to pyodermas is often topical, local, and systemic. The treatment of choice is the use of medicated shampoos and lotions such as chlorhexidine or benzoyl peroxide in combination with systemic antibiotics. Corticosteroids are not recommended due to the potential exacerbation of the infection. The dietary recommendation is a high-quality, hypoallergenic type of diet. Immunotherapy with bacterins such as Staph Lysate has proven to be successful in superficial pyodermas.

Anticipated prognosis

Pyodermas, especially the superficial types, are quite responsive to therapy. However, both superficial and deep pyodermas tend to recur, become chronic, and are often less responsive to medical therapy. This may be due to compromised local and immune system function.

Integrative veterinary therapies

In Western medical terms, the bacterial growth on the skin is the focus of therapy. In IVM therapies, the bacteria is viewed as secondary to the skin’s detoxification process. Bacteria are attracted and replicate in areas that favor their growth. Patients that exude material onto their skin in an attempt to detoxify themselves, with faulty digestion, with defective cutaneous function, or that suffer from altered immunity from a wide variety of causes, are all prone to pyoderma. Parasites, food sensitivities, allergies, endocrinopathies, and a host of other causes such as adverse reactions to drugs, vaccinations, herbs, and some supplements may be involved in chronic recurring pyoderma.

Careful historical and physical evaluation is indicated in all cases, and skin scraping is recommended. In more advanced cases, full laboratory evaluation including CBC, serum chemistries, and thyroid testing are always indicated. Other tests such as further endocrine evaluation, urinalysis, culture and sensitivity, and skin biopsy may be needed. Insufficient treatment duration or client noncompliance is also a common reason for recurrent infections of the skin.

Topical therapy is an important part of any treatment plan. Gentle products that remove exudates are desirable. In more serious cases products that flush the pores and remove debris such as benzoyl peroxide are useful. Antibiotic, antifungal, and antibacterial shampoos should be reserved for cases that do not respond to biological therapy to avoid further intoxification of the cutaneous tissues. In cases requiring systemic antibiotics, it is necessary to treat for at least 3 weeks to get full resolution. Probiotics are recommended in cases undergoing antibiotic therapy because antibiotics can damage the intestinal mucosa and lead to alterations in digestive and immune system function.

Nutrition

General considerations / rationale

While medical therapy is focused externally, therapeutic nutrition adds nutrients, antioxidants, and organ support to help reduce inflammation and enhance detoxification and elimination. In addition, the skin, which is the largest and most visible organ, is often a barometer of internal imbalances, inflammation, and disorders. Therefore, it is especially important in chronic recurrent pyodermas to look past the skin and assess all internal organs for early or overt inflammation or disease. It is therefore recommended that clinicians evaluate the blood both medically and physiologically as a method of assessing glandular health. This information gives clinicians the ability to formulate therapeutic nutritional protocols that address the local lesions as well as underlying organ conditions that may be ultimately responsible for the surface condition (see site, Nutritional Blood Testing).

Appropriate nutrients

Nutritional / gland therapy: Glandular adrenal, thymus, and lymph provide intrinsic nutrients that nourish and help neutralize cellular immune inflammation and degeneration (see Gland Therapy, site, for a more detailed explanation).

Lecithin / phosphatidyl choline: Phosphatidyl choline is a phospholipid that is integral to cellular membranes, particularly those of nerve and brain cells. It helps to move fats into the cells, and it is involved in neurotransmission and acetylcholine, and particularly with cellular integrity. Lecithin, which is part of the cell membranes, is an essential nutrient required by the skin and all of the cells of the body for general health and wellness.

Sterols: Plant-derived sterols such as betasitosterol show antiinflammatory properties which appear to be similar to corticosteriods. A cortisone-like effect without the associated immune-suppressing effects is beneficial in immune-mediated conditions. Bouic (1996) reports on the immune-enhancing and balancing effect of plant sterols, which are also beneficial to animals with immune-mediated disease.

Probiotics: Administration of the proper combination of probiotics has been reported to have a positive impact on the intestines and the digestive process. Probiotics have been shown to improve and aid the digestive process by secreting their own source of enzymes, which is beneficial for immune-compromised animals.

Evening primrose oil (EPO): In diseases of the skin, evening primrose oil has been proven to have both antiinflammatory and antipruritic effects, and is part of a balanced nutritional program that can exert a positive effect on animals with skin disease. Studies suggest that evening primrose oil is beneficial in people with atopic dermatitis and eczema.

Chinese herbal medicine / acupuncture

General considerations / rationale

Practitioners of traditional Chinese medicine consider pyoderma to be caused by Heat and Toxins in the Lung. In general, skin infections are related to either immune deficiency or immune disorders with secondary bacterial infection. There is also often an allergic factor. The Lung controls the Skin, so Heat in the Lung translates to inflammation on the Skin. Toxins refer to the inflammatory mediators seen in dermatitis.

Appropriate Chinese herbs

Angelica (Bai zhi): Inhibits multiple strains of bacteria and is antiinflammatory.

Angelica root (Dang gui): Stimulates the immune system by increasing the phagocytic activity of macrophages. It also inhibits many types of bacteria.

Atractylodes (Cang zhu): Has activity against Staphylococcus auerus and dermatophytes.

Bupleurum (Chai hu): Has antibiotic effects against streptococci.

Cnidium (Chuan xiong): Enhances the immune system. It increases the phagocytic ability of macrophages and increases antibody formation.

Dandelion (Pu gong ying): Has antibiotic activity against a variety of bacteria including Staphylococcus aureus, b-hemolytic streptococci, and Pseudomonas aeruginosa. In addition, it may possess antiinflammatory actions.

Earthworm (Di long): Stimulates the immune system. It has been shown to increase the phagocytic activity of macrophages in mice. It may also shorten the inflammation period, promote fibroblast activity, and enhance the healing rate of the epidermis, thereby promoting the resolution of dermatological lesions.

Honeysuckle (Jin yin hua): Has antibiotic effects against Staphylococcus aureus, E. coli, and Pseudomonas aeruginosa, and is antiinflammatory.

Kochia (Di fu zi): Inhibits some dermatophytes and fungi.

Licorice (Gan cao): Inhibits the growth of Staphylococcus aureus.

Mint (Bo he): Has antiinflammatory effects.

Moutan (Mu dan pi): Inhibits the growth of Staphylococcus aureus, streptococci, and dermatophytes.

Platycodon (Jie geng): Decreases inflammation by increasing the secretion of corticosterone.

Polygonum (He shou wu): Increases hormonal secretion by the thyroid gland. Many animals are hypothyroid and it is necessary to address this imbalance to gain control over the disease process. This herb also enhances immunity. It increases the total white cell count, especially the T-cells. It also increases the phagocytic activity of macrophages and it stimulates the activity of B cells.

Poria (Fu ling): Has inhibitory effects on Staphylococcus aureus.

Rehmannia (Sheng di huang): Has shown antiinflammatory activity in mice.

Schizonepeta (Jing jie): Has been shown to have efficacy against pruritic dermatological conditions.

Scutellaria (Huang qin): Contains biacalin, which has antibiotic activity against many bacteria including Stapylococcus aureus and some dermatophytes. This compound not only acts on its own, but also is synergistic with some penicillins and can help overcome B lactam resistance. Biacalin, along with another component of scutellaria, biacalein, have antiinflammatory effects. Patients with chronic pyoderma may benefit from stimulation of the immune system to help the body fight the pathogens. Scutellaria enhances the cellular immunity and increases production of IL2.

Siegesbeckia (Xi xian cao): Inhibits the growth of Staphylococcus aureus.

Siler (Fang feng): Inhibits bacteria, including Staphylococcus aureus.

Silkworm larva (Jiang can): Inhibits bacteria, including Stapylococcus aureus, E. coli, and Pseudomonas aeruginosa.

Water buffalo horn (Shui niu jiao): Enhances immunity. It increases the total white blood cell count. A second experiment by Wu Xiao Yi showed that this increase in white blood cell count was accompanied by an increase in antibody production.

White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory. It also has antibiotic effects against Staphylococcus aureus, some streptococci, E. coli, Pseudomonas aeruginosa, and some dermatophytes.

Homotoxicology

General considerations / rationale

Simple pyoderma is an Inflammation Phase disorder. Aggravations caused by homeopathic substances can result in pyoderma. The appearance of pustular lesions may represent phase shift toward Inflammation Phase, which is a desirable step toward healing. The clinician must evaluate other signs to determine the most appropriate action in these regressive vicariation cases.

Chronic cases represent Impregnation or Degeneration phase homotoxicoses. So-called Alternative Phase disorders occur when deep, unseen homotoxicoses (neoplasia or precancerous conditions) shift their attempt to excrete toxic materials to the outside. Inhibiting Alternative Phase conditions can suppress needed excretory actions, internalize homotoxins, and lead to rapid progressive vicariation. Caution should be exercised when confronted with elderly pets presenting with recurring, focal, moist, eczema-type lesions. A careful search for other pathological conditions is advised in all such cases.

Appropriate homotoxicology formulas

Belladonna homaccord: Used for focal carbuncles and boils, and larger and more intensely red lesions.

BHI-Infection: Is similar to Echinacea compositum.

BHI-Inflammation: Small pustules, itchy skin, and possible lameness are signs to consider for this remedy. An older formulation contained Staph and Strep nosodes, but the new formulation no longer contains these ingredients, a change that has a negative impact on this product’s efficacy in pyoderma cases. The authors hope that eventually the company will restore the original formula.

BHI-Skin: Used for skin infections, redness, eczema, and blisters.

Cutis compositum: Contains Hepar sulph and Histaminum, both of which indicated in pyodermas.

Echinacea compositum: Used for bacterial infections as a substitute for antibiotics.

Psorinoheel: an excretion Phase and Impregnation Phase remedy that is useful in a wide number of skin issues.

Schwef-Heel: Contains Sulphur, which is useful for minor pustular lesions, dry skin with red color, and malodorous pets.

Tonsilla compositum: Contains Baryta carbonica, Funiculus umbicalis suis, Geranium, Hepar suis, Mercurius solubilis, and Psorinum nosode, all of which have very strong indications for pustular skin diseases. This is often used as an initial autosan-guis, or blood therapy.

Traumeel S: All pustular inflammations benefit from Traumeel due to its antiinflammatory characteristics.

Authors’ suggested protocols

Nutrition

Immune and skin support formulas: 1 tablet for every 25 pounds of body weight BID.

Lymph support formula: One-half tablet for every 25 pounds of body weight BID.

Lecithin / phosphatidyl choline: One-fourth teaspoon for every 25 pounds of body weight BID.

Betathyme: 1 capsule for every 35 pounds of body weight BID. (maximum 2 capsules BID)

Probiotic MPF: One-half capsule for every 25 pounds of body weight with food.

Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.

Chinese herbal medicine / acupuncture

The authors use a combination of ImmunoDerm and DermGuard, which stimulates and modulates the immune system and has antiinflammatory effects and antibacterial function. It helps to control itch. The combination is administered at a dose of 1 capsule of each for every 10 to 20 pounds twice a day.

In addition to the herbs discussed above, these preparations contains bitter orange (Zhi ke), cicada slough (Chan tui), oldenlandia (Bai hua she cao), tokoro (Bi xie), and xanthium fruit (Cang er zi).)

Homotoxicology (Dose: 10 drops PO for 50-pound dog; 5 drops PO small dog or cat)

Therapy depends upon the primary causation. (See also allergy, atopy, food allergy, hypothyroidism, Cushing’s Disease, etc.). In recurring cases autosanguis therapy is worthy of consideration. It is particularly useful to start with Tonsilla compositum and the catalysts Coenzyme compositum and / or Ubichinon compositum. Consider the following in combination with appropriate topical therapy:

Acute pyoderma: Psorinoheel plus Schwef-Heel plus Traumeel S BID PO. Cutis compositum once weekly. Also use Detox Kit BID PO.

Recurrent pyoderma: Psorinoheel plus Schwef-Heel plus BHI-Inflammation or Echinacea compositum plus Traumeel S BID PO. Cutis compositum every two weeks. Also use Deep Detox Formula (below).

Deep detoxification formula: Galium-Heel plus Lymphomyosot plus Thyroidea compositum plus Hepar compositum plus Solidago compositum plus Coenzyme compositum mixed together and taken orally twice weekly for 60 to 120 days.

Product sources

Nutrition

Immune, skin and lymph support formulas: Animal Nutrition Technologies. Alternatives: Immune system and Dermal support — Standard Process; Immuno support — Rx Vitamin for Pets; Derma Strength — Vetri Science; Immugen — Thorne Veterinary Products.

Lecithin / phosphatidyl choline: Designs for Health.

Betathyme: Best for your Pet. Alternative: Moducare — Thorne Veterinary Products.

Probiotic MPF: Progressive Labs, Rx Biotic, Rx Vitamins for Pets.

Oil of evening primrose: Jarrow Formulas.

Chinese herbal medicine

Immunoderm and DermGuard: White Crane Herbs;

Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation