Episode 34 - Short Noses, Big Problems: Lumps, Chins and Comorbidities in Brachycephalics

Chapter 1 – “Lumps, Not Bugs: Cracking the ‘Sterile’ Case” 03:22 – John welcomes Dr Laura Buckley back for part two on brachycephalic skin disease and tees up two topics: Sterile Granuloma/Pyogranuloma Syndrome (SGPS) and Muzzle Folliculitis/Furunculosis, plus how to manage comorbidities. Laura explains it’s an uncommon, immune‑mediated nodular skin disease of dogs involving histiocytic cells (macrophages). No infectious agent is found and it responds to immunomodulatory therapy. 04:43 – Sue asks which brachy breeds are most affected and typical ages. Laura most often sees Boxers, British Bulldogs, some Mastiffs and (in her clinic) many Staffordshire Bull Terriers. Usual onset is middle‑aged, though younger dogs can be affected. 05:21 – Sue asks what it looks like. Laura: papules, nodules or plaques (mm to several cm), localised or generalised; often on trunk, but head/limbs too. Typically non‑painful and non‑pruritic; may be erythematous, haired or alopecic; sometimes eroded/ulcerated with crusting - the key is a nodular process. 07:20 – Sue asks for key differentials. Laura highlights superficial bacterial folliculitis as the big rule‑out in short‑coated brachys (tufted hairs). Cytology helps: infection shows neutrophils with intracellular cocci (staphylococci); a sterile process shows inflammatory cells without bacteria. 07:49 – Laura notes most SGPS nodules are intact, so fine‑needle aspirates (multiple nodules) are preferred over impression smears. Expect many neutrophils and macrophages; bacteria should be absent. 08:23 – Sue asks about deep fungal disease and other infections. Laura: you can’t reliably exclude on cytology alone—next step is biopsy. Remove a whole nodule if possible so histopathology can section through it and use special stains for atypical organisms (bacteria, deep fungi, parasites, protozoa). This thorough exclusion is critical before immunosuppression. 10:11 – Sue asks how to submit samples. Laura often splits: submit an entire nodule (or half) in formalin for histopathology and keep a second small sample (e.g., 4 mm punch from another lesion) chilled/frozen pending culture. Direct to bacteriology or mycology depending on histopath hints. 11:01 – John asks about treatment and prognosis. Laura finds most dogs do well: disease may wax and wane but responds to therapy; rare spontaneous resolution reported. Start with glucocorticoids (prednisolone). Typical immunosuppressive dose 2–4 mg/kg (sometimes 1–1.5 mg/kg suffices; she often starts at 2 mg/kg). If response is poor or steroid side effects are problematic, add cyclosporine at 5 mg/kg once daily; azathioprine has been used. For localised lesions, topical hydrocortisone aceponate spray can help. 13:24 – Sue asks for a prednisolone protocol. Laura: baseline haematology/biochemistry/urinalysis before starting. Recheck at 2–3 weeks for tolerance and early response; continue same dose another 2–3 weeks to resolution, then taper by ~20% every couple of weeks. Once down to ~0.5 mg/kg, move to alternate‑day dosing. Add cyclosporine if lesions recur on taper to avoid long‑term steroid adverse effects (PU/PD/PP, lethargy/weight gain; long‑term risk: calcinosis cutis). With dual therapy or cytotoxics, schedule regular bloods (after 1 month, then every 2–3 months). Chapter 2 – “Chins Up: Muzzle Mayhem, Managed” 17:05 – John pivots to Muzzle Folliculitis/Furunculosis: what is it and who gets it? Laura: a bacterial follicular disease confined to the muzzle skin, common in coarse/bristly‑coated brachys—British & French Bulldogs, Pugs, Shar‑Pei, Boxers. 18:04 – John asks what drives it. Laura: often linked to allergic skin disease; facial folds create many “mini‑intertrigo” sites. Pruritus → rubbing/trauma to bristly follicles. She suspects a sterile inflammatory start that quickly progresses to secondary bacterial folliculitis. 20:13 – Sue asks if this is the same as acne. Laura: no - acne is a keratinisation disorder (e.g., plugged follicles; classic in cat chins). Muzzle folliculitis/furunculosis is follicular inflammation progressing to follicle rupture (furunculosis) with foreign‑body reaction. Clinically it’s more diffuse over chin/muzzle with erythema, alopecia, papules/pustules, erosions/ulcers/crusts; severe cases show haemorrhagic bullae‑like lesions—“an interdigital cyst on the chin.” 23:24 – John asks about diagnosis and first‑line management. Laura: clinical pattern + cytology to confirm/grade infection. Prioritise topical antiseptics; address primary disease and contributing behaviours (chewing cages/toys, environment). Systemic antibiotics only if deep/severe infection and ideally based on culture. 25:02 – Sue asks preferred topicals. Laura: chlorhexidine‑containing products are mainstay; ethyl lactate also helpful. Choose gentle vehicles (mousses/wipes) for faces; shampoos are good for debris removal ...