CO₂ laser use in interdigital pododermatitis

By Dr. Claudia Kreil Ouschan (FELLcheck.at)
Translated from German – Download the Original PDF (In German)

INTRODUCTION

Pododermatitis is inflammation of the skin between toes. It is common in dogs and has various causes that always need to be investigated (Nuttall, 2019, Fig.1). Like otitis externa, there are primary, predisposing, secondary, and perpetuating factors. It is often a multifactor disease. The diagnostic schedule consists of signalment, anamnesis, and general and special dermatological examinations with targeted diagnostics. All factors must be identified and treated to get 100% control of the disease.

In some cases, a surgical approach is required. The surgical techniques include surgical cyst removal, partial or total fusion podoplasty, and surgery using a carbon dioxide (CO₂) laser. Using a CO₂ laser is good for removing cysts as well as locating and removing scar tissue, inflamed and clogged hair follicles, and excess tissue. Subsequent wound healing occurs via secondary wound healing. The advantages of the laser include less bleeding, less swelling, less pain, less infection, and faster healing.

In a study by Duclos et al (2008) the application of CO₂ laser surgery showed a cure in 25 out of 28 dogs. This result corresponds to personal experiences with the Aesculight laser.

CASE REPORT

ALIA, an 8-year-old female spayed Labrador retriever was presented with recurrent interdigital pododermatitis.

History: The dog came from a breeder, has been with the owner since puppyhood, and had recurrent interdigital eczema. The dog had been pre-treated with cortisone therapy and was given a self-prepared diet of horse meat and potatoes.

Based on the previous report, the clinical and dermatological examination, the following diagnosis was made: interdigital podofolliculitis with secondary bacterial colonization, formation of comedones and pseudo-balls with roots in hair follicles, and thus a foreign body reaction on the patient’s own hair (Fig. 2).

Treatment: Alia received antibiotics according to the antibiogram (enrofloxacin 5 mg/kg PO SID), ciclosporin (5 mg/kg PO SID), foot baths with chlorhexidine, and an elimination diet with ANALLERGENIC (Royal Canin). This treatment showed a general clinical improvement, however, the fistula formation remained unchanged. For this reason, CO₂ laser surgery was performed under anesthesia (butomidor, propofol, intubation, and isoflurane inhalation). Pseudo-balls were removed with the aid of the Aesculight CO₂ laser (model AE-2010) and the blocked fistula tracts were then removed using 6-10 Watts in the continuous wave mode. The pathohistological examination revealed an ulcerative pododermatitis with a comedo formation and furunculosis.

After the laser surgery, the bitch received bandages with L-Mesitrane Soft wound gel for 14 days, which were changed every one to two days. Thereafter, the paw was bathed daily with chlorhexidine and protected with paw shoes or socks. The healing was complete within four weeks (Fig. 3).

There was no recurrence within the year. A food intolerance was confirmed using the gold standard elimination diet and subsequent provocation.

CONCLUSION

Pododermatitis is a disease with many facets. The correct treatment of the infection, as well as the analysis and correction of the underlying disease, are essential for lasting treatment success. CO₂ laser surgery offers a sensible and painless alternative to podoplasty.

About The Author

Dr. Claudia Kreil Ouschan practices veterinary dermatology at FELLcheck in Grafenstein, Austria. Learn more about her at fellcheck.at.

References

1. Duclos DD, Hargis AM, Hanley PW: Pathogenesis of canine interdigital palmar and plantar comedones and follicular cysts, and their response to laser surgery. Vet Dermatol 2008, 19, 3, 134-141
2. Kreil-Ouschan C: Pododermatitis in dogs – roadmap to causes, diagnostics and treatment options. News4Vets 2021/1
3. Nuttall T: Chronic pododermatitis and interdigital furunculosis in dogs, Companion Animal 2019, Vol. 24/4