Skin Fold Dermatitis

LAST UPDATED 20 December 2022

This article is written by Pet Circle veterinarian, Dr Nicole du Plessis BVSc (Hons)

Over the years, dogs have been selectively bred for certain physical characteristics. This has given rise to thousands of recognised dog breeds of different sizes, coats, temperaments and shapes. This can also mean that certain breeds are predisposed to different health conditions.

We are all familiar with the gorgeous 'rolly' dogs and the loveable 'squishy' faced dogs. Those adorable faces come with skin folds, which makes these breeds more prone to skin fold dermatitis or skin fold pyoderma.

So, what is a pyoderma? Prepare for the 'ick' factor, it means 'pus' in the skin. When talking about pyodermas in dogs, it is often from a bacterial infection but there can be other causes.

Contents

What causes skin fold dermatitis?

Which breeds are prone to skin fold dermatitis?

What are the symptoms of skin fold dermatitis?

How to diagnose skin fold dermatitis?

What are the treatments for skin fold dermatitis?

What is the best diet for skin fold dermatitis?

Causes of skin fold dermatitis

Skin fold pyoderma in a Bulldog. Image source: Royal Veterinary College

Skin fold dermatitis has a few different names; it is also known as skin fold pyoderma or intertrigo. It is an infection of the surface layer of the skin. ¹. Skin folds are created by excess skin, which is a characteristic of many popular breeds. However, there are health implications for these adorable 'rolly' dogs.

There is surface bacteria on our dog's skin, which are usually harmless to normal, healthy skin. However, skin folds have reduced airflow and increased friction, which provides a warm and moist environment for bacteria to grow. Skin folds are often located in areas where increased moisture through tears, saliva or urine exacerbates the problem.

This overgrowth of bacteria causes inflammation and the surface of the skin to breakdown, allowing infection to travel deeper into the skin. The most common bacterial organism found in skin pyodermas are Staphylococcus pseudintermedius, and occasionally Staphylococcus aureus². In some cases, Proteus spp, Pseudomonas spp, and Escherichia coli are also found in pyodermas.²

DID YOU KNOW? Selecting a responsible registered breeder is important for animal welfare. Look for a breeder who acknowledges the health problem within the breed and selects individuals less likely to pass on any heritable conditions. For more tips of choosing a breeder, see our article: How to find a good breeder?

Which breeds are prone to skin fold dermatitis?

Brachycephalic breeds with shortened noses will have facial folds to a certain degree. Pugs, Bulldogs and Perkinese tend to have more exaggerated skin folds. The close apposition to the eye means tearing can add further moisture to the skin folds.³

Some of the brachycephalic breeds like Boston terriers, Bulldogs and Pugs have 'corkscrew' or 'ingrown' tails. This conformation creates a deep skin fold underneath the tail.³

Spaniel breeds, Setters and Saint Bernards have large lower lip folds which predispose them to lip-fold pyoderma.³

Breeds prone to skin fold dermatitis:

Breeds prone to lip fold pyoderma:

Saint Bernard

Cocker Spaniel

Springer Spaniel

The Cavalier King Charles Spaniel

DID YOU KNOW? A study of 900 000 dogs in the UK found that, in general, brachycephalic breeds were more prone to developing facial fold dermatitis.⁵ The worst affected breeds being English Bulldogs, French Bulldogs and Pugs.⁵

Although skin fold dermatitis is relatively common in these breeds, it is important to note that not all dogs will develop skin issues. Many other factors can contribute to whether an individual will have skin issues.

Other contributing factors include:

Overweight or obese - this creates more tissue around folds, which can make moisture, friction and collection of tears, urine or even faeces much worse.
Allergies - some dogs will have underlying allergies, this can affect the skin barrier and trauma can occur from rubbing or scratching.
Endocrine influences - certain endocrine disorders can contribute to skin problems or make the skin more susceptible to infection, such as Cushing's Disease or Hyperadrenocorticism.
Mammary development- if an entire female dog or ex-breeding dog has significant mammary folds, this can also be a troublesome area. To read more, see our article Everything you need to know about desexing your pet.

What are the symptoms of skin fold dermatitis?

There are often visible signs that your dog has skin fold dermatitis. It can develop in any part of the dog's body where skin is in close apposition. Facial folds, neck folds, tail folds, recessed vulvas or 'hooded' vulvas and mammary folds are the most common areas.

Symptoms of skin fold dermatitis or skin fold pyoderma:

Redness
Hair-loss
Discharge or pus
Odour
Pain
Brown 'staining'

It is important not to ignore any changes to the appearance of your dog's skin. Infections can travel deeper into the tissue and can make the treatment more difficult and prolonged.

DID YOU KNOW? Out of 28 European countries, Australia is the 8th highest user of antibiotics.⁴ Not all of your dog's skin problems require antibiotics. Your veterinarian will be able to advise the best treatment for your dog.

How to diagnose skin fold dermatitis?

Skin fold dermatitis or skin fold pyodermas will often have a distinct appearance; however, diagnosis is not always simple. With all skin problems, a thorough history is needed as there can be a number of contributing factors, such as parasites, conformation, concurrent infection and allergies.

To diagnose skin fold dermatitis or skin fold pyoderma, your veterinarian may perform the following:

Physical examination
Swab to examine discharge
Sticky-tape preparation
Deep skin scrape
Culture and sensitivity
Biopsy

Swabs, sticky-tape preparations and skin scrapes provide valuable diagnostic information to help guide your veterinarian in selecting the best treatment for your dog. In the age of antimicrobial resistance, a profile of which antibiotic is best to treat severe infections or those not responding to current therapy. In rarer cases where other disease is suspected (eg. immune-mediated disease, skin cancers), skin biopsies may be recommended.

How to treat skin fold dermatitis?

Treatment of skin fold dermatitis or skin fold pyoderma can be frustrating. In most cases, the skin folds are part of the dog's conformation. Therefore, treatment works towards addressing allergies or parasites that could be contributing to inflammation of the skin, clearing any bacterial and/or yeast infection and keeping the skin folds clean and dry.

In severe cases where there are excessive skin folds present, your veterinarian may recommend surgery to remove some of the excess skin. This can make maintenance of the skin folds more manageable for owners. If your dog is overweight, this can also make pre-existing skin folds worse and a weight-loss plan is recommended. To read more about weight-loss in dogs, see our article Tips to Help Your Dog Lose Weight.

The folds should be cleaned regularly with an antiseptic solution to help keep surface bacteria under control. Chlorhexadine (+ Miconazole) is one of the most regularly used treatments. Chlorhexadine works on surface pyodermas by disrupting the bacterial cell memrane, killing the bacteria. It is gentle on the skin and is not inactivated by dirt or pus. Chlorhexadine is easily accessible and relatively cheap. Malaseb Shampoo is a medicated shampoo which contains both Chlorhexadine and Miconazole (an antifungal treatment). Keep in mind that Malaseb is irritant to to the eyes and should not be ingested.

Zodiac Pet Eye Wipes 150 Packs

Absorb Plus Antibacterial Pet Wipes - Aloe Vera

Malaseb Medicated Shampoo

What is the best diet for managing skin fold dermatitis?

There are so many diets available for a range of issues. So, how do you know which diet would be the best for your dog with skin folds? Any factors that could cause additional inflammation to the skin should be addressed first. Hydrolysed protein diets are often used in suspected cases of food allergies. Environmental allergies or atopy, nutrition is used to help support the skin barrier.

Key ingredients to support skin health:

B-group vitamins: these help the outer layer of the skin by increasing ceramides, an important component of the 'skin barrier.'
Omega 3 fatty acids: DHA and EPA to reduce inflammation caused by skin irritation and help restore normal barrier function.
Omega 6: an example of this fatty acid is linoleic acid. It is also included in many skin support diets for it's vital role in many bodily functions, including skin and coat health.
Vitamin C & E: antioxidants included in skin support diets to help fight free-radicals and support healthy skin.