Cutaneous Malassezia dermatitis cases are so frequently complicated by Staphylococcus intermedius that many recommend treating them 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 a popular internet server is a practical, real life glimpse of a Malassezia/Staph dermatits case in progress and the way numerous experts would approach it. (It has been edited to protect identities and for teaching purposes).
The Case: A 3yr old intact male yellow lab with no significant past medical history presented for pruritus. PE revealed alopecia and pericocular hyperpigmentation of the ventral neck, axillia and groin. He has a very significant odor and a bilateral otitis externa. 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. Ear tx included Otomax. Cytology of the skin scraping revealed yeast(8-10/hpf) and many cocci. He is presently on cephalexin 15 mg/lb bid. What are the odds of treating the bacterial component and having the yeast 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 a chlorohexadine 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
From: Steve Young aka, DRDOG@aol.com writes: 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
From: Dr. Melman: This case sounds like classical allergy dog with secondary otitis externa, yeast and bacterial 'pyoderma'. It is not unusual to find both yeast and Bact in ears and on surface skin cytology. Allergy work-up is the key, especially in such a young dog. In a lab, I would start with food allergy using IVD and also use ivermectin at scabicidal doses. I would use cepahlexin (10 mg/# bid) and prednisone (at anti-inflamm doses for just 12 days) as well as MalAcetic Shampoo eod and MalAcetic conditioner QD.
From Lou Gotthelf, Montgomery, Alabama: I find bacteria (Staph) and yeast together often. Staph may alter the lipids on the skin 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.
Lou
An update: Dr John Fletcher(3 weeks later) The dog is doing much better. Odor gone, no pruritus, skin negative for yeast 3wks post treatment. He was basically negative on allergy test. He is now on duck/potato. He was swapped from chlorohexiderm to MalAcetic shampoo.
John Fletcher
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| Steven Melman VMD DermaPet Animal Dermatology and Behavior Clinics Potomac, MD 20854 |
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