Cutaneous Malassezia dermatitis cases are so frequently complicated by Staphylococcus intermedius that many recommend treating all with a concurrent regimen of antibiotics. I prefer cephalexin 10mg/lb/bid/minimum 21 days. Contra-laterally, many Staph pyodermas are complicated with Malassezia; thus the use of a shampoo and/or conditioner like our 2% acetic/2% boric acid containing MalAcetic products that have been shown to have efficacy on both Malassezia and Staph should be prudent. These cases often present as a pruritic pyoderma and may be misdiagnosed as bacterial hypersensitivity.
The below discussion on VIN is a practical, real life glimpse of a Malassezia/Staph dermatits case in progress and the way numerous experts would approach it.
Subject: bacteria/yeast
Date: Wed, 21 July 1999 09:47 AM EDT
From: BUNMKSVET
Message-id: 19990721094740.09998.00000708@ng-fe1.aol.com
"Joey" is a 3yr old intact male yellow lab with no significant past medical history. He presented for pruritis. He has alopecia and hyyperpigmentation perioccular, ventral neck, axcillia, and flanks. He has a very signficant odor. He also has bilateral otitis externa. The cbc and panel were normal. Skin scrape(x5) for mites was negative. Cytology of the ears revealed cocci(4+) and yeast(3+). The ears were cleaned and flushed under anesthesia. the ears were tx with Otomax.Cytology of the skin scraping revealed yeast(8-10/hpf) and many cocci. He is presently on cephalexin 15 mg/lb bid. I was not suprised to find mixed infections but was suprised at the numbers in the infections. What are the odds of treating the bacterial component and having the yeast part resolve on its own. Nizoral would be big $$$ in this case so I guess that I am asking for a less expensive alternative. We are also using chlorohexadern shampoo eod. Where is allergy in this picture? I planned to tx the bacteria and in 2wks recheck and see what is left.
John Fletcher DVM
Bunkie/Marksville,La
Subject: Re: bacteria/yeast
Date: Wed, 21 July 1999 04:44 PM EDT
From: DRDOG
Message-id: 19990721164448.05675.00001294@ng-ch1.aol.com
John, with this breed and this presentation,I would say that there is a good chance the dog will have atopy and\or food allergies along with what you see. I would keep the dog on the cephalexin and if using chlorhexiderm shampoo,make sure to use the 4% or since you have the yeast,you also might want to try the MalAcetic shampoo and conditioner. Has worked well for yeast dermatitis. I would also do a fT4ED on this animal. Hard to say if the yeast will go away with just treatment for the bacteria,but there's one way to find out.
Steve
Subject: Re: bacteria/yeast
Date: Wed, 21 July 1999 05:03 PM EDT
From: VINwebMsg4
Message-id: 19990721170348.16700.00000733@ng-fw1.aol.com
Subject -- Re:bacteria yeast
From -- Carol Foil (Cfoil@mail.vetmed.lsu.edu)
Date -- 7/21/99 1:51:56 PM
Posted on VIN on the Web
Hi John,
Your lab sounds like a classical allergy dog with secondary otitis externa and yeast and bacterial overgorwth. I just now washed up from seeing a yellow lab that sounds indentical! It is not unusual to find both yeast and Bact in ears and on surface skin cytology. We usually treat these with topical 4% chlorhexiderm (max) and systemic antibiotics and Otomax. Allergy work-up is more important than TT4, especially in such a young dog.
In a lab, I would start with food allergy. These days, in pruritic dogs with spontaneous and inducible pruritus, in Louisiana, you'd better rule out scabies, too. We're using 300 ug/kg weekly SQ in the patient we just saw and Venison and Potato diet. That dog was also very pruritic, so I started him on a 15 day reducing course of pred too.
Good luck,
Carol
Baton Rouge, LA
Subject: Re: bacteria/yeast
Date: Fri, 23 July 1999 08:36 AM EDT
From: Lou E Gee
I find bacteria (Staph) and yeast together often. Staph may alter the lipids on the slin to make them more readily available to the Malassezia. I usually treat the Staph with AB and the lipids with the shampoos. I also prefer the Malacetic shampoo and spray. By the way, ketoconizole has just become generic.
Lou Gotthelf
Animal Hospital of Montgomery
Please send me the email address of (or forward this to) any other vets that you feel might be interested in this or further 'newsletters'.
| Steven Melman VMD DermaPet Animal Dermatology and Behavior Clinics Potomac, MD 20854 |
dermapet@aol.com http://www.dermapet.com 800-755-4738 fax 301-365-0191 |
8909 Iverleigh Court 
Potomac, Maryland 20854
301-983-8387 800-755-4738 Fax 301-365-0191
E-mail dermapet@aol.com