Episode 33 - Bulldogs, Pugs and Plenty of Folds; A Deep Dive into Brachy Skin (Laura Buckley)

Chapter 1 – Intertrigo: Prevention, Work-Up, and When (Not) to Use Antibiotics

(00:11) John introduces the podcast episode and the hosts.

(02:39) John welcomes Dr Laura Buckley (Senior Lecturer, Veterinary Dermatology, University of Liverpool) and asks what “brachycephalic” means and which breeds it covers. Laura explains shortened muzzles and broad, domed heads; the most extreme include French and British Bulldogs, Pugs and Boston Terriers, with Cavaliers, Chihuahuas and Dogue de Bordeaux also affected.

(04:00) Sue notes their huge popularity in UK primary care. Laura adds that around 40% of her clinic can be French Bulldogs, with brachycephalics a very large overall share.

(04:33) Sue asks which skin problems are most common. Laura explains that atopic dermatitis and otitis (externa/media) lead, with interdigital furunculosis also frequent. Cavaliers often show primary secretory otitis media. Skin-fold dermatitis (intertrigo) and muzzle furunculosis are common, and lesions can form over bony prominences where itchy dogs rub.

(06:15) Sue asks what intertrigo is and why brachys get it. Laura explains shortened muzzles leave redundant skin that folds around eyes and muzzle, creating humid, low-airflow pockets that accumulate keratinous/sebaceous debris. Microbial overgrowth follows; bristly coats plus rubbing traumatises follicles and escalates inflammation.

(08:06) Sue asks about prevention. Laura suggests daily fold hygiene from the start: clean away debris; consider antiseptic wipes (e.g., chlorhexidine) once or twice daily, and increase during flare-prone periods.

(09:15) Sue highlights how early routines improve compliance and handling; Laura agrees it gives a “head start,” especially as atopy often appears within the first three years.

(10:08) John asks how early disease presents and how to work it up. Laura explains earliest signs are diffuse erythema in the fold, then partial/complete alopecia, erosion/ulceration, crusting; severe untreated cases may progress to folliculitis and even deep pyoderma.

(11:48) Sue asks about cytology. Laura explains it’s pivotal: expect keratinous debris with cocci (staphylococci) or Malassezia in overgrowth; neutrophils with intracellular bacteria indicate infection and guide therapy.

(12:57) John asks if systemic antibiotics are ever needed. Laura explains they’re rarely indicated: most cases respond to topical antiseptics/antimicrobials plus strong anti-inflammatory control. Consider systemic antibiotics only for genuine deep, painful, draining pyoderma, immunosuppression, poor feasibility for topicals, or proven topical failure - always post culture & susceptibility.

(15:47) John asks how she controls inflammation. Laura uses topical glucocorticoids (often in combination products). For severe inflammation, short anti-inflammatory courses of prednisolone (~0.5–1 mg/kg for a few days before tapering) can calm tissue so topicals can work.

(16:48) Sue asks about long-term routines and when to consider surgery. Laura advises daily fold cleaning (once–twice daily) and twice-weekly topical anti-inflammatories (e.g., hydrocortisone aceponate or mometasone) with minimal systemic absorption; discuss surgery if medical care is impractical, or if maintenance fails with frequent relapses or recurrent infections.

Chapter 2 – Viral Pigmented Plaques (VPP)

(19:33) John moves to VPP and asks which brachy breeds are affected. Laura most often sees Pugs, plus Boston Terriers, Chihuahuas and French Bulldogs.

(20:25) Sue asks what they look like. Laura describes numerous, heavily pigmented, slightly raised plaques that may begin flatter and become scaly, verruciform and hyperkeratotic over time.

(22:00) Sue asks how to differentiate melanoma. Laura says biopsy/histopathology is the diagnostic choice; FNAs from plaques are often low-cellularity keratinocytes, whereas melanoma cytology differs.

(23:43) John asks if plaques regress. Laura explains most persist or increase, likely due to a virus-specific, genetically influenced immunodeficiency in otherwise healthy, often young dogs. For treatment, Laura notes most are cosmetic, but very rarely plaques can transform to SCC, so monitoring matters. Limited numbers can be removed surgically or with laser; for numerous lesions consider systemic/medical options (e.g., azithromycin, interferon, retinoids, vitamin A, topical imiquimod) with variable success.

(25:35) Sue summarises a primary-care approach: monitor unless numerous, pruritic, function-limiting or rapidly changing. Laura agrees; schedule regular reviews.

Chapter 3 – Seasonal Flank Alopecia (SFA)

(26:30) Sue introduces SFA and asks what it is and why it happens. Laura explains it’s a localised cyclic follicular dysplasia linked to photoperiod and melatonin; predisposed breeds include Boxers, Affenpinschers, British Bulldogs, Staffies and Chihuahuas.

(29:40) John asks about geography. Laura notes seasonality is more marked away from the equator where day-length swings are greater. Sue recalls light-box data suggesting equal photoperiod may prevent SFA; both agree the pattern fits a light/melatonin mechanism.

(30:18) Sue contrasts the clinical picture with endocrine alopecia. Laura explains SFA shows sharply demarcated, bilateral flank patches (± hyperpigmentation). Endocrinopathies tend to be diffuse, affect coat quality and other sites (e.g., tail).

(32:27) Sue asks differentials and work-up. Laura highlights hypothyroidism and Cushing’s; use signalment and systemic signs, then haematology/biochemistry ± T4/TSH and targeted endocrine tests as indicated.

(33:03) Sue asks about monitoring. Laura expects regrowth in spring within 1–4 months as day length rises, though a minority become permanently alopecic.

(35:45) John asks about treatment. Laura reassures it’s cosmetic once endocrinopathies are excluded; many owners opt to observe. For those wanting intervention, oral melatonin and increased light exposure are reasonable.

(37:30) John thanks Laura and invites her for episode 2!