Surgery of Intertriginous Dermatoses

Chapter 54 Surgery of Intertriginous Dermatoses



Jamie R. Bellah


Intertriginous dermatoses are surface pyodermas that are associated with skin folds. Chronic skin apposition results in friction, minor trauma, and poor air circulation along with a moist environment conducive to colonization and infection by bacteria and yeasts.




Key Point


Inflammation and exudates associated with skin fold pyoderma cause pain, pruritus, and malodor. Conservative treatment is only palliative. Resolution of these conditions can be accomplished only by surgery.



ETIOLOGY


Normal skin defense mechanisms are as follows:


• Intact epidermis and stratum corneum

• Sebum that contains antibacterial and antifungal fatty acids

• Skin microflora that may secrete antibiotic-like substances

Skin fold pyoderma is classified as a surface pyoderma. (See Chapter 38 for a complete discussion of pyoderma.)


• Bacteria and yeasts remain on top of the skin.

• Warm, moist environment within recess of the skin fold allows colonization by Staphylococcus intermedius or Malassezia pachydermatis.

• Other infecting organisms include Streptococcus, Escherichia coli, Pseudomonas, Proteus, and Candida.

• Surface bacteria and yeasts act on trapped secretions and sebum, producing breakdown products that are irritating and odoriferous.

• Superficial skin erosions and inflammation result.

• Self-trauma and obesity tend to worsen the condition.

Locations, characteristics, and breeds associated with intertriginous dermatoses include the following.




Facial or Nasal Fold



• Frequently associated with secondary ulcerative keratitis

• Brachycephalic breeds: Pekingese, English bulldog, pug, French bulldog, Boston terrier

• Persian cats


Lip Fold



• Common in dogs with excessive mandibular labial tissue, such as spaniels, Saint Bernard, Irish setter, Newfoundland, golden retriever, and Labrador retriever.

• Redundant lip fold is usually located behind the mandibular canine tooth.

• Can be bilateral.

• Causes severe halitosis.

• May occur after partial mandibulectomy or maxillectomy if a skin fold is created during wound closure.


Body Fold



• Usually affects obese or Chinese shar-pei dogs.

• With shar-pei puppies, body folds become less redundant with growth but persist on the head and face.

• May occur in female dogs or cats along the abdominal midline if mammary glands or body fat creates a skin fold.

• Moist seborrhea predisposes the animal to body fold pyoderma.

• Pendulous cervical skin may result in body fold pyoderma, especially if generalized skin disease exists.

• Folds left after surgery (i.e., total ear canal ablation) or created by surgery may result in residual fold pyoderma.


Vulvar Fold



• Most common in older, obese, spayed female dogs and rarely cats.

• Seen in younger dogs with infantile vulvas.

• Accumulation of urine and vaginal secretions occur.



Key Point


Chronic or relapsing urinary tract infection is commonly secondary to vulvar fold pyoderma and recessed vulva.



Tail Fold (“Screw Tail”)



• Common in English bulldog, pug, Boston terrier, and schipperke breeds.

• Also seen in Manx cats.

• Caused by redundant skin around the tail and the corkscrew conformation of the terminal coccygeal vertebrae.

• A full-thickness ulcer may be present in the skin under the ventrally deviating tail. This can be very painful and uncomfortable for affected dogs.

• Contamination by fecal flora causes fulminating pyoderma.

• Self-trauma and scooting exacerbate the condition.


PREOPERATIVE CONSIDERATIONS



• Conservative treatment, including clipping hair from the skin fold and cleansing with dilute antibacterial solutions, medicated soaps, antiseborrheic shampoos, astringents, and topical and systemic antibiotics, is palliative only.

• Medical treatment may be advisable before surgery in some animals to lessen the amount of wound exudate and to lower bacterial numbers at the time of surgery (see Chapter 38).

• In the presence of severe infection (i.e., tail fold pyoderma), use a perioperative antimicrobial (e.g., cephalosporins) to help prevent a postoperative wound infection.

Related posts:

  1. Feline Infectious Peritonitis (Feline Coronavirus)
  2. Borreliosis (Lyme Disease)
  3. Immune-Mediated Dermatoses
  4. Otitis Media and Otitis Interna

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Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Surgery of Intertriginous Dermatoses

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