The dermatologist came to find me the other day for a consult on one of her patients. George is an 8-month-old, male English Bulldog. He had been diagnosed with yeast intertrigo (skin fold dermatitis).
The owner would need to wipe his nasal folds once daily with an antifungal wipe to treat the infection. When the dermatologist told the owner this, she started crying. She knew that he was suffering, but there was just no way that George would let her do this. Could I help?
I went to see George. He was a friendly dog, but when I went to reach for his head to pet him, he backed away. It was clear from his body language that he wanted to approach me, but he was afraid that I would touch his face. His owner said that he was really a wonderful dog in every other way and had not shown any aggression when she went to medicate him.
George was already conditioned to believe that if someone touched his facial folds, it would hurt. When his owner would approach him with a wipe, he would run away and hide. Trying to apply something to his face or tail was like trying to put lipstick on a greased pig. It just wouldn’t happen. After talking to the owner and evaluating George, we got him set up with a plan that included desensitization and counterconditioning. This is where the puppy is exposed to something that scares him, in very small increments, while he does something pleasurable.
What if George had learned as a puppy that having his nasal folds or tail fold cleaned was not painful, but was instead fun? Then, the owner would be able to treat his disease today, eliminating his pain and suffering as well as preventing the disease’s progression, further improving his quality of life.
If your puppy has a short face or a corkscrew tail he probably has had intertrigo at some point in his life. Intertrigo is the medical term for skin fold dermatitis (an infection of the skin folds). It affects brachycephalic (short faced) dogs like the English Bulldog and Pug, wrinkled dogs like the Sharpei, and dogs with tightly curled tails like the Boston Terrier, all of which are predisposed to this condition because of their anatomy.
Bacteria and yeast live on your pup’s skin. This is normal. Healthy skin acts as a nice barrier for infection, keeping the bacteria from going any farther than the surface. Both bacteria and yeast like to live in warm, moist environments. When the skin folds over, it creates a perfect place for the bugs to set up camp, causing infection. The skin fold traps normal skin secretions due to poor ventilation. Then, the sides of the fold rub against each other, causing microtrauma to the skin surface and breaking that ever important barrier. To add insult to injury, the tail fold may contain fecal material if the tail hangs over the anus.
Affected areas are usually smelly and discolored with icky brown discharge. The infection causes dogs to be itchy and painful. They often rub, lick, chew, scratch or bite the affected areas. For dogs like English Bulldogs, who can’t reach back to their tails, they may whine or cry for help from the owner.
Treating intertrigo, involves clipping away any extra fur and cleaning the area. Then, your pup will be sent home with one or more of the following: topical corticosteroids, topical antifungals, and drying agents. Your dog may also need oral antibiotics, oral corticosteroids (prednisone), or oral antifungals.
These types of infections can start in puppyhood. Dogs with chronic infections can have other predisposing factors, such as food allergy and inhaled allergies, so if your pup’s infection isn’t clearing with proper treatment, ask your veterinarian about other contributing diagnoses. Some dogs will need surgery to open up the skin fold to see true resolution of the infection.
Recurrent infections can be lessened or prevented with proper cleaning with a gentle cleanser intended for dogs. Be careful of baby wipes and other products which may change the pH of the skin or dry the skin too much, helping bacteria to thrive.
If you have a pup with this type of conformation, it is best for you to teach him to have the skin folds cleaned starting in puppyhood. You will need really great treats and a wipe with a veterinarian-recommended cleaner for your dog. Your pup can start in any position — sit, lie down or stand. For instructions on how to teach your pup to stand, see last week’s blog. No matter what position you choose to start with, set the interaction up by asking your dog to get into that position. In other words, don’t surprise her when she is resting with a wet cotton ball in her face. Condition her to react to a specific phrase, such as "clean up," by using that phrase before you start each repetition.
For this exercise, it is best to have soft food, such as canned food or low fat peanut butter, but you can use treats that have been broken up into very tiny pieces (less than ¼ inch). If you are using smearable food, you will need something to smear it on. Plates, bowls, and food toys work well for this purpose. If you are using small treats, you can just toss them on the floor; just don’t practice this exercise on your expensive area rug.
Start by placing the plate down on the ground or tossing the treats on the floor. Then, say "clean up," and wipe the skin area gently. You should be starting with very light pressure. Your goal is not to clean out the skin fold in one swish of your wipe. The goal is to teach your dog to like skin fold cleaning. Make sure to wipe only as long as your dog is eating. If she stops eating — even if there is food left on the plate — stop touching her.
The purpose of this exercise is to pair the goodness of the food with the negative feeling of being touched in an area that is sensitive or painful. In order for two things to be paired, they should occur together or in very close proximity. Ideally, the touching would stop just before the food is gone. When the food is gone, start the exercise over from the beginning. Some pups will give you a worried look or try to get away during this exercise. In cases like this, it is best to slow down or increase the value of the food that you are using. It would also be helpful to shorten your training sessions. If your dog is already showing aggression or strong avoidance behavior, it is better to talk to your veterinarian about the next step before you continue this exercise.
Dr. Lisa Radosta