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Overview
Canine acne is a benign self-limiting disease of the chin and lips of young dogs. Short-coated dogs, such as boxers,
Bulldogs and Rottweilers, are at increased risk for acne. The condition starts at puberty around 5 to 8 months of age. Most dogs improve with age and the condition typically resolves after one year of age.
The exact pathogenesis has not been established. Genetics, hormones and trauma have been hypothesized to play a role.
What to Watch For
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Red bumps (papules) and blackheads (comedones) are usually noted on the chin and lips of young dogs. They may become infected and pus can be expressed from these lesions.
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When infection is present itching may develop and the dog may start rubbing his face against carpet and furniture.
Diagnosis
A clinical diagnosis of acne is usually made considering the breed, the age of onset and appearance of the lesions. However, there are other diseases that may look similar to acne that need to be ruled out.
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Demodicosis. This is a non-contagious type of mange, and it is important to do skin scrapings to rule out the possibility of demodicosis. Your veterinarian will scrape an area on the chin until there is some capillary bleeding and then examine the material under a light microscope.
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Ringworm (dermatophytosis). This disease may also start with lesions resembling acne, so a fungal culture may be necessary. Hairs are plucked and submitted for culture, and results are available in 10 to 14 days.
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Puppy
strangles. This is another disease that could start with lesions similar to the those seen with acne. The main difference is that, animals with puppy strangles are depressed and anorexic (poor appetite), while dogs with acne are otherwise healthy.
Treatment
The treatment for acne is typically topical treatment. Some gels are similar to those people use for acne, like benzoyl peroxide. It is important that you use only the products recommended by your veterinarian, as your dog’s skin is thinner and more sensitive than yours. The average product containing benzoyl peroxide for human acne contains 10 percent benzoyl peroxide while the maximum concentration that could be used on a dog is 5 percent.
Some treatments may include:
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Washes containing benzoyl peroxide twice weekly. Only veterinary products should be used. Most shampoos contain 2.5 percent benzoyl peroxide, such as Oxydex® shampoo.
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Some dogs may benefit from topical antibiotics like mupirocin to limit the secondary infection. These products should be used twice daily and gently massaged on the area until completely absorbed.
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Topical steroids may be used to decrease the swelling and the inflammation on the area. Gloves should be used when applying these products.
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In severe cases systemic therapy may be necessary and you will need to administer pills once or twice daily for a prolonged period of time.
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Antibiotic therapy like cephalexin may be necessary for 6 to 8 weeks in chronic cases.
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Retinoids are not usually used in dogs with acne, as the formation and development of canine acne appears to be different from people’s acne.
Home Care
Trauma should be avoided to limit scar formation. You may be required to apply antibacterial lotions or ointments.
Information In-depth
Acne is a disease of young dogs of short-coated breeds. Dobermans,
Bulldogs, Great Danes, Boxers, German Shorthaired Pointers and Rottweilers
appear to be over-represented.
This disease is a localized folliculitis, which is an inflammation of the hair follicle, and furunculosis or rupture of the hair follicle restricted to the chin and lips. Comedones are the first lesions noted on the chin. They result from follicular dilation and plugging with excessive keratin formation. Erythema and alopecia may be present in more advanced cases.
Papules, pustules, firm nodules and fistulous tracts may develop as a consequence of a bacterial infection such as folliculitis and furunculosis. Lesions ulcerate and discharge a purulent exudate. Swelling of the chin is variable but it could be severe in some animals.
Regional lymphadenopathy may be prominent and pain and itchiness may be intense in animals with a secondary skin infection. Cysts may develop in chronic cases.
Clinical Presentation
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Onset of the disease occurs between 5 and 12 months of age. Acne in dogs tends to improve with age. Occasionally, it may persist in adulthood.
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Erythema (redness), crusted papules and furuncles develop on the chin and lips. Hair follicles appear to be plugged (comedones or black head) with keratin.
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With secondary infection, draining tracts may develop and exudate may be present.
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In chronic cases secondary depigmentation may develop.
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Differential diagnoses for this presentation include juvenile onset demodicosis with a secondary bacterial infection, dermatophytosis, contact dermatitis, and early stages of mild juvenile sterile granulomatous dermatitis and lymphadenitis (puppy strangles).
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In contrast with juvenile cellulitis, dogs with acne do not have lymphadenopathy, and lesions are not present on the pinnae. In addition, dogs with acne are not systemically ill.
Causes
Onset of the disease occurs between 5 and 12 months of age. Acne in dogs tends to improve with age. Occasionally, it may persist in adulthood. The exact pathogenesis (development of disease) is unknown, but several theories have been formulated, such as the following:
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Hormones. Hormones, more specifically androgens (male sex hormones), have been hypothesized to play a role. However, this disease does not seem to have a sex predilection and both females and neutered males may be affected. In addition, hormones would not explain why only short-coated breeds tend to develop acne.
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Genetics. Genetics have also hypothesized to play a role to explain why some breeds are at increased risk.
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Trauma. It may lead to hair follicle disruption and release of free keratin in the dermis. Keratin, in turn, could trigger an inflammatory response (foreign body response), and the bacteria present in the hair follicle would cause a deep bacterial infection (furunculosis).
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Bacteria. The role of bacteria appears to be secondary, because at the onset of the disease the lesions are sterile, and antibiotic therapy does not significantly improve the clinical signs.
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Keratinization. Canine acne does not appear to be a disease of keratinization. Excessive sebum production and sebum breakdown to free fatty acids was hypothesized to induce inflammation and comedo formation. However, in one study, where the lipids obtained form the skin of healthy controls and dogs with acne were evaluated, it was found that the lipids obtained from the acne lesions, such as free sterols, fatty acids, and ceramides, are characteristic epidermal lipids and that sebaceous gland contribution is minimal.
Veterinary Care In-depth
Diagnosis In-depth
Diagnosis of chin acne is based on history and clinical signs. Additional tests may include:
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Deep skin scrapings to rule out the possibility of demodicosis. If a deep pyoderma is present, skin scrapings may be falsely negative due to easy bleeding of the lesions with the scraping, and a biopsy may be necessary to rule out demodicosis.
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Fungal culture of hairs
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Cytology exam if pustules or draining tracts are present. This gives information on the presence and type of secondary infection. Pustules can be gently opened with a needle and the content smeared on a glass slide. Swabs should be used to collect the material from draining tracts and rolled onto glass slide. Common findings are degenerated neutrophils, eosinophils (typical finding of furunculosis), macrophages and small number of intracellular bacteria (most commonly cocci).
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Tape preparation from the muzzle to reveal a secondary yeast (Malassezia) infection.
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A biopsy for culture and sensitivity in chronic cases. The area is surgically disinfected and samples are obtained in aseptic conditions to avoid contaminating the culture material.
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Biopsy to reveals follicular dilation and keratosis (comedo) and pyogranulomatous folliculitis and furunculosis. The infiltrate is composed of neutrophils and macrophages and is focused on the hair follicles. Sebaceous glands are large and ducts may be dilated.
Treatment In-depth
In mild cases topical therapy may be sufficient. Topical therapy should be done gently, but avoid aggressive scrubbing of the lesions to limit scar formation.
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Benzoyl peroxide gel (5 percent,
Oxydex® gel,
Pyoben® gel) may be used daily on affected areas. Benzoyl peroxide combines a good antibacterial action against Staphylococcus with a follicular flushing property, which helps in cases of comedones. It could be irritating and some dogs may worsen with this therapy. Prolonged use may also cause excessive drying of the skin and subsequent irritation. Benzoyl peroxide can also be used as a wash at lower concentration (2.5 percent, Oxydex® shampoo). Area should be washed twice weekly with a contact time of 10 minutes.
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Mupirocin (2 percent ointment, Bactoderm®) is also effective against localized bacterial infections, especially against Staphylococcus, and has good penetration in the skin. It is bacteriostatic rather than bactericidal, in that it inhibits the growth of bacteria rather than killing the organisms, although high concentrations may be bactericidal. It should be used once or twice daily. Resistance may develop if mupirocin is used over a prolonged period of time. Mupirocin has little potential of causing systemic toxicity of
sensitisation.
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Topical fusidic acid has also good activity against Staphylococcus and could be useful in dogs with chronic acne. Fusidic acid is lipophilic so it has the ability to penetrate the tissues. It is not available in the United States, but it is readily available in combination with bethametasone in United Kingdom and other countries. Studies of the percutaneous absorption of fusidic acid in canine skin demonstrated that therapeutic levels are obtained in the skin within a few hours after application and can be maintained with a twice daily dosing. Irritation or
sensitisation is extremely rare.
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Topical glucocorticoids like
Synotic® may help to decrease the inflammation and the granulomatous infiltration triggered by the keratin.
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In severe and chronic cases systemic antibiotic therapy is necessary. Antibiotics with activity against Staphylococcus like oxacillin are good empirical choices. In complicated cases a culture and sensitivity may be necessary and broad-spectrum antibiotics such as enrofloxacin, may be more appropriate choices.
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The duration of the systemic antibiotic therapy depends on the severity and depth of the lesions. Chronic cases may require 6 to 8 weeks of antibiotics.
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In cases complicated by secondary yeast infection antifungal therapy may be necessary. Depending on the severity and the number of yeast found on they cytology exam, either topical or systemic therapy can be used. Topical preparations effective against Malassezia include
miconazole
and clortrimazole, which are available as lotions or creams. Topical therapy should be used twice daily for a minimum of two weeks. In severe cases oral
ketoconazole for two weeks may be necessary.
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Retinoids
are not recommended for canine acne, as it is believed not to be a disease of keratinization.
By Dr. Rosanna Marsalla
Edited by: Dr. John Bonagura
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