Skin Fold Dermatitis

Patty Khuly

Summary

Skin fold dermatitis is a dermatologic condition specific to dogs and cats whose conformation allows for infection-prone folds in the skin (“wrinkles”). These abnormal conformations are most common in breeds with pronounced facial, tail and vulvar folds, in particular, though any deep skin fold anywhere in the body can yield skin fold dermatitis.

This condition occurs when skin folds are deep, causing abnormal rubbing and retaining moisture in an area that’s both warm and not well-aerated. These conditions are ideal for the overgrowth of normal skin inhabitants like yeast and bacteria. The resulting skin inflammation, called dermatitis, typically leads to a skin infection, called pyoderma. Chronic pyoderma is typical in cases of skin fold pyoderma.

Though not a genetic disease, per se, conformations that yield deep skin folds are selected for in certain breeds. In pets already predisposed to skin fold dermatitis, obesity will exacerbate the condition. Underlying skin disease (such as allergic skin disease) will also aggravate the condition, often severely.

Symptoms and Identification

Skin fold dermatitis is easily identified as typically hairless (alopecic), reddened and malodorous skin fold interiors. In the case of deep facial folds (typical to brachycephalic dogs and cats), facial staining with the porphyrin pigments found in tears will make these folds look even more pronounced.

Tail fold dermatitis (typical to dogs with corkscrew tails), when especially severe, can lead to deep fistulas that can even enter the body cavity and lead to deadly systemic infections. These deep tail folds are typically identified by probing the tail base with a cotton-tipped swab to determine its depth.

Vulvar tail fold dermatitis is an equally insidious and often overlooked condition common to breeds that suffer deeply recessed vulvas. Urinary tract infection as the result of ascending bacterial infections is a common sequela to this form of skin fold pyoderma.

Affected Breeds

All brachycephalic (short-nosed) breeds that are predisposed to facial folds are similarly predisposed to skin fold dermatitis of this area (Bulldogs, Pugs, Shih-tzus, etc). “Wrinkly” dogs like Shar-peis and Bloodhounds are also affected. Likewise, dogs with corkscrew tails (English Bulldogs, for example) and any breed that propagates a deeply recessed vulvar conformation.

Treatment

Treatment for all versions of skin fold dermatitis is undertaken through assiduous cleaning of the affected areas and frequent use of topical or systemic antimicrobials to manage the resulting pyodermas.

Surgical intervention in moderate to severely affected animals is strongly recommended. Removing the abnormal skin folds in these cases will in many cases yield a complete cure.

Treating any underlying skin disease and achieving weight loss will many times reduce the severity or even eliminate skin fold dermatitis.

Veterinary Cost

The cost of chronic drug and topical treatment runs an average of $30 to $50 every month for those who must continuously clean and medicate the affected areas. Surgical intervention, because it often requires the expertise of a board-certified veterinary surgeon for best results, is an undeniably expensive proposition. Nonetheless, this approach is strongly recommended for pets who would otherwise suffer a lifetime with a surgically curable disease.

Surgical treatment of folds can range from $500 to $2,500, depending on the size and sensitivity of the location of the area in question.

Prevention

Preventing skin infections with careful cleaning will reduce the worst symptoms. Weight management and concurrent skin disease management is crucial as well. Breeding away from extreme conformations, however, is the only way to prevent more pets from suffering this completely preventable disease of abnormal conformation.



References

Sasaki A, Shimizu A, Kawano J, et al. Characteristics of Staphylococcus intermedius isolates from diseased and healthy dogs. J Vet Med Sci. 2005;67:103–106.

Mason IS, Mason KV, Lloyd DH. A review of the biology of canine skin with respect to the commensals Staphylococcus intermedius, Demodex canis and Malassezia pachydermatis. Vet Dermatol. 1996;7:119–132.