Dealing with Chronic Dog Skin Lesions. A Reader's Question and Detailed Treatment Suggestions

by Jessica Lapsley
(Omaha, Nebraska, USA)

Reader Question: Chronic Dog Skin Infection

My dog Taz has had this since November 3rd 2024. It started on his back about the size of a quarter. He had gotten out of the yard for a couple of minutes (he's a wonderer not a runner). I cleaned it with water and dawn soap as it just looked like a booboo. Then about a week later it started to look infected so we gave him a bath cleaned it again. While in the bath hair started to fall out and it because about the size of a half dollar so I stared putting triple antibiotic ointment on it and cleaning it every day. Then a few days later we noticed that he started to get another spot on his neck and his chin. He also developed an eye infection.

So I took him up to the mobile vet clinic. They gave him antibiotic pills 3 weeks worth an antibiotic shot and pain pills 3 weeks worth. He finish all of that then the spot on his back started to scab over so we thought that it was healing. Then about a week later he stopped eating his head sunk in he barely moved he smelled like death he lost weight he could barely walk so I took him back in to the vet this time I took him to our normal vet because we thought we might have to put him down.

The vet told us that he was stumped. He said it could be cancer he's probably sepsis. He said it looked like Taz had checked out. He's dehydrated severely, he needed the scab off to see it better and that he want to keep Taz over night put him under so he could get the scab off without hurting him do a biopsy to see if it's cancer do blood work and if that doesn't tell us anything then send him to dermatology. I vetoed against that because I didn't want to put my dog under that looked like he was already dying because I was scared he wouldn't wake back up. So instead we started new antibiotic. He doesn't look like death anymore but it's still not healing. Eyes are still infected he drools horribly he stumbles and falls when he walks.

Our Response

Hi Jessica,
From the images and detailed account of Taz’s condition, this appears to be a multifaceted and advanced issue requiring a thorough analysis. Let’s address it step by step, focusing on both the visible symptoms and his systemic health

Observations

• Lesions: The wounds on Taz’s back and neck are large, scabbed, and inflamed with significant hair loss. The initial small wound’s progression to multiple lesions suggests an escalating underlying issue rather than a simple injury.


• Systemic Symptoms: Symptoms like drooling, stumbling, lethargy, weight loss, and the odor of infection indicate that his body is struggling to manage the condition, potentially leading to systemic effects such as sepsis or organ dysfunction.


• Eye Infection: Persistent infection in the eyes suggests either a secondary issue linked to his overall immune system suppression or a chronic localized problem.


• Timeline: The failure to respond adequately to multiple courses of antibiotics raises concern for resistant bacteria, fungal involvement, or immune-related
  disease.

Comprehensive Analysis

1. Primary Skin Condition:
   
   • Most likely, this started as deep pyoderma—a bacterial infection affecting the deeper layers of the skin.
   
   
   • Considering the persistence and expansion of lesions, secondary causes like a fungal infection (e.g., blastomycosis) or immune-mediated disease (pemphigus or discoid lupus erythematosus) must be ruled out.
   
   
   • Skin cancer (e.g., mast cell tumor or squamous cell carcinoma) remains a possibility, especially given the slow progression and resistance to treatment.
   
   
   
   


2. Systemic Health: Dehydration, lethargy, and weight loss point to systemic inflammation or infection. Sepsis remains a serious concern given the advanced state of the condition.


3. Treatment Resistance: Antibiotic resistance is a likely issue here, emphasizing the need for culture and sensitivity testing to guide treatment. If fungal infection is involved, antibiotics alone would be ineffective.

Recommended Course of Action

Immediate Care at Home

• Hydration Support: Ensure Taz stays hydrated. If he won’t drink water, offer diluted unflavored Pedialyte or broth to restore electrolytes. Severe dehydration may require subcutaneous fluids from the vet.


• Wound Care:
  • Use a diluted antiseptic solution (chlorhexidine 0.05%) to clean the lesions once daily.
  
  
  • Avoid soap-based cleansers like Dawn, which can further irritate and dry the skin.
  
  
  • Apply a veterinary-recommended antimicrobial ointment (e.g., silver sulfadiazine cream) for localized protection.
• Encourage Nutrition: Offer easily digestible, calorie-dense meals, such as boiled chicken and rice, or add pet-specific calorie supplements. Appetite stimulants might be needed if he continues to refuse food.

Diagnostics

• Bloodwork: Comprehensive blood tests are essential to assess for infection markers, organ function, and systemic inflammation.


• Wound Culture and Sensitivity Testing: Collect samples from the lesions to identify specific bacteria or fungi and determine effective medications.


• Biopsy: While anesthesia poses risks, a biopsy is critical to confirm or rule out cancer, autoimmune diseases, or fungal infections. Discuss alternatives with your vet, such as local sedation with minimal impact on Taz’s overall health.

Treatment Adjustments

• Targeted Antibiotics: If resistance is confirmed, switch to an appropriate antibiotic based on culture results.


• Antifungal Therapy: If fungal infection is suspected (e.g., blastomycosis or aspergillosis), start systemic antifungal medication such as itraconazole.


• Anti-Inflammatory and Immune Therapy: If autoimmune disease is confirmed, steroids or immunosuppressants may be necessary, but only under careful supervision.


• Eye Care: Continue using prescribed antibiotic drops (e.g., gentamicin), but consult the vet if no improvement is noted, as additional medications might be required.

Specialist Referral

If Taz stabilizes but shows no significant improvement, referral to a veterinary dermatologist or internist is highly recommended for advanced diagnostics and a tailored treatment plan.

Long-Term Considerations

If this is an immune-mediated condition, Taz may need long-term management with periodic checkups. For bacterial or fungal infections, ensuring the full treatment course is completed—even if he shows improvement—is crucial to prevent recurrence. Monitor his overall demeanor, appetite, and hydration closely—any sudden decline warrants immediate veterinary attention.
Jessica, I know this has been an overwhelming journey for you and Taz. You’re doing an incredible job staying vigilant and proactive about his care. While the situation is serious, these next steps can help identify the root cause and guide his recovery. To be clear I am not a Veterinarian so please only use this response to inform decisions you are making with your Veterinarian. Keep us updated, and don’t hesitate to reach out if you have any questions. You and Taz are in my thoughts!

Jeff
Editor and Publisher
Dog Health Guide