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Question:
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"I'm fostering a bulldog who has skin problems, mainly on his feet. The vet suspects a yeast infection. He is now on Keflex and eating a venison-and-potato food. I bathe him with a coal tar/salicylic acid shampoo 3 or 4 times a week, followed by a sulfur dip. Is there anything else I can do?"
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Your situation is both typical and complicated. Bulldogs are prone to skin problems, particularly with their feet and skin folds. Let’s take your case step-by-step:
Yeast infection. Malassezia is the most common type of yeast that causes skin problems in dogs. It especially likes moist areas, such as the ear canals, the feet, the "armpits," and skin folds. Skin infected by Malassezia will often seem greasy and smelly. Vets can sometimes find the organisms by pressing a piece of adhesive tape against the skin, then placing the tape on a slide and staining it, and examining the slide under a microscope for the characteristic peanut-shaped yeast. This method doesn’t always work well with the feet, however, because the yeast can be hidden deep within the cracks of the foot pads rather than on the surface.
The first line of defense against Malassezia is shampoos, rinses, and creams. The coal tar/salicylic shampoo you are using is excellent for removing skin debris and "degreasing" the skin. It also soothes itchiness. The sulfur dip is mildly antibacterial, antifungal, antiparasitic, and anti-itch. A more targeted approach for Malassezia, however, might be to use a shampoo that contains boric acid and acetic acid (such as MalAcetic, made by Dermapet) or miconazole and chlorhexidine (such as MalSeb, made by DVM). You could use boric acid/acetic acid wipes (MalAcetic Wet Wipes, by Dermapet) on the feet between baths.
Moisture contributes to yeast infections, so you want to keep your dog’s feet dry except when you’re bathing him or using the MalAcetic wipes. Use an Elizabethan collar if necessary to keep him from licking his feet.
Persistent Malassezia infections are sometimes treated with an oral antifungal medication, such as ketoconazole or itraconazole. Because these medications can cause side effects and are relatively expensive, you wouldn’t want to use them unless you were sure that Malassezia was the root of the problem.
Keflex. Skin that’s irritated and inflamed from a Malassezia infection often will get a secondary bacterial infection. Keflex is an excellent antibiotic for treating those secondary infections.
Venison-and-potato food. This is a "food trial" to rule out food allergy as an underlying cause of your dog’s skin problems. His symptoms will be evaluated after he has eaten nothing but this diet for 6 weeks. Note that he shouldn’t have treats, table food, or even rawhide during this time, because if they contain substances he’s allergic to, that would throw off the test. See "We’ve been treating our 2-year-old dachshund" for more about food allergies.
Other factors. Inhalant allergies can predispose dogs to skin infections. They can be diagnosed with a blood test or skin testing. Conditions that suppress the immune system, such as hypothyroidism, diabetes, and hyperadrenocorticism (Cushing’s disease), occasionally lead to skin problems.
What to do next. Keep your dog on Keflex for as long as your vet thinks is appropriate. Skin infections often need to be treated with antibiotics for 3 to 6 weeks. Make sure your dog is not licking his feet. Follow the venison-and-potato diet strictly for 6 weeks. Discuss with your vet whether you should switch to one of the anti-yeast shampoos mentioned above. If you do not begin to see significant improvement, you and your vet will need to consider testing for inhaled allergies; biopsying and culturing the skin to look for unusual bacteria, Demodex mites, or other underlying problems; testing for immune problems; or using an oral antifungal medication.
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