The Skin Flint Podcast

(00:00:00) John introduces a new episode on Feline Orofacial Pain Syndrome (FOPS) — a baffling condition where cats can flip from calm to frantic self-injury around the mouth and face in seconds.

 

Chapter 1: Not Toothache — Neuropathic Pain With Teeth

 

(00:03:21) Clare Rusbridge introduces herself as a veterinary neurologist focused on neuropathic pain. She first recognised FOPS working alongside dentist Norman Johnston, then developed a rare multi-disciplinary collaboration with internist Danièle Gunn‑Moore and behaviourist Sarah Heath — a clue to how complex FOPS can be.

 

(00:05:05) What it looks like: the defining feature is mutilation — cats injuring themselves trying to get at the tongue/oral mucosa (and sometimes face). Clare’s headline: don’t call simple dental pain “FOPS”. Dental disease hurts, but in “normal” pain, self-trauma should stop once it becomes painful. In FOPS, the cat may keep going, causing extreme damage.

 

(00:07:51) Clare uses a neuropathic itch analogy: ordinary itch tends to stop once it hurts; neuropathic syndromes can drive continued self-trauma despite escalating injury.

 

(00:09:03) What it isn’t: Clare cautions against over-attributing dramatic grooming/rubbing to neurology — many cats shared online as “neurological” actually have facial pruritus/dermatitis. FOPS often looks unilateral (one-sided facial targeting), though that’s harder to see if the cat is focused on its tongue.

 

(00:10:07) Classic signalment: a Burmese (or related) kitten around five months, often during teething (commonly canine eruption). Owners may find a “bloodbath” with frantic tongue trauma. Some Burmese breeders bandage paws during teething to reduce injury.

 

(00:11:29) The life-course pattern: kitten episodes may resolve once teething ends, then recur later with periodontal disease. Adult episodes are often triggered rather than continuous.

 

(00:14:57) Why it behaves like this: Clare points to trigeminal nerve pain as the leading candidate (teeth/buccal mucosa), with glossopharyngeal also plausible given tongue focus. Adult signs may be triggered within minutes after eating, drinking or grooming, echoing trigeminal neuralgia in humans where mouth movement can trigger paroxysms of pain.

 

Chapter 2: Diagnosis With a Fine Tooth Comb

 

(00:17:39) Breed/genetics: a five-month Burmese kitten is highly suspicious; Clare says she hasn’t seen the teething presentation outside Burmese/very closely related breeds (for example Siamese crosses). Genetic work suggested a likely inherited component and a strong candidate region/gene involved in neural processing, but no funded clinical test exists.

 

(00:20:10) In older cats it’s harder: Clare insists on two anchors — there must be mutilation, and it should be disproportionate to the visible dental disease (often “just a bit of gingivitis” by everyday feline standards). Dental disease remains the most common trigger.

Dentistry is central: proper evaluation usually needs sedation/GA and ideally dental radiographs to identify lesions that are easily missed on casual inspection (Clare describes cats sent to neurology as “no dental lesions” who later prove to have pathology).

 

(00:22:40) A caution for clinicians: FOPS can be worsened by suboptimal dentistry or iatrogenic irritation near trigeminal nerve roots. Clare often advises referral to a colleague with strong dentistry skills/equipment, both for patient welfare and to reduce the risk of treatment-triggered deterioration.

 

(00:24:30) When dentistry is required, she recommends appropriate nerve blocks and careful peri-dental analgesia to reduce pain wind-up.

 

(00:25:15) Neurological exam (keep it simple): focus on trigeminal sensation and compare left vs right. Clare suggests gently stimulating inside each nostril, tickling whiskers to see facial twitch, and checking medial/lateral canthal reflexes. Remember the blink/whisker/ear movement includes a motor component via the facial nerve, which is worth assessing too.

 

(00:26:40) Don’t miss other head pain: Clare highlights ocular/retrobulbar disease as an important differential and recalls a rare, very painful post-lens-trauma tumour that once presented like FOPS (she can’t remember its name).

 

Chapter 3: Stop the Mutilation, Then Treat the Triggers

 

(00:28:40) Clare splits management into three parts: acute control, chronic management, and behaviour/environment.

 

(00:29:52) Acute priorities: prevent further injury (often a buster collar) — but “collar for life” is framed as unacceptable welfare. Then move quickly to neuropathic pain control; NSAIDs/opioids may help a little but are rarely enough alone.

 

(00:31:04) Common options in practice: pregabalin (noting availability of a licensed cat product for anxiety) and gabapentin. Clare notes trigeminal pain can respond differently, and some cases need alternatives.

 

(00:32:10) Anti-epileptic drugs in FOPS: Clare describes historical acute response to a benzodiazepine during a “seizure vs pain” debate, and subsequent benefit from phenobarbital. She frames this as pain modulation rather than “treating seizures”, notes modern caution around diazepam in cats, and points out injectable phenobarbital (where available) can be very effective.

 

(00:36:00) Duration/weaning: in teething kittens, medicate through the teething window (around four weeks) then wean, especially with phenobarbital (not stopped abruptly). Warn owners about later recurrence with periodontal disease.

 

(00:37:11) Dental-triggered episodes: treat dental disease properly and continue analgesia longer than “routine”. Clare notes dental pain in normal cats can persist about a week post-procedure; FOPS-prone cats may need longer coverage plus neuropathic pain medication.

 

(00:39:32) Behaviour and environment: around 1 in 5 cases had a stress-related trigger. Common themes include multi-cat households, new cats, catteries/cat shows, builders, and environmental disruption. Clare highlights the “five pillars” approach and even unusual triggers such as strong smells (perfume/air fresheners).

 

(00:43:52) Prognosis: generally good if triggers are identified and owners accept dental investigation/management. Poorer prognosis includes refusal/inability to investigate dental triggers under sedation, or inability to medicate.

 

(00:46:05) Hard-to-treat cases: Clare mentions off-licence use of Solensia (frunevetmab) in a difficult-to-medicate cat, stressing careful risk–benefit discussion and informed consent.

 

(00:50:23) John thanks Clare for clear, primary-care-friendly guidance and points listeners to the follow-up resources she’s provided for the show notes.

 the show notes.

 

Links:

 

https://neurovet.co.uk/neuropathic-pain-syndrome/

 

https://journals.sagepub.com/doi/10.1177/1098612X241246518 Case 3

 

https://www.youtube.com/playlist?list=PLsBrqYVMr5vOBgQSAVDNKJaKfvP7gxnPd

Bow Ties and Blink Reflexes: Periocular Perils on SkinFlint

 

In this month's episode, Sue & John invite a well known vet with his eye on pet eyes - David Williams.

(00:00) John opens SkinFlint. Today’s focus is the periocular region — small real estate, big consequences — from itchy eyelids and rogue hairs to lumps and lesions that can threaten vision.

 

Chapter 1: The Eyelid Is the Windshield Wiper

 

(03:54) David Williams joins: associate lecturer in veterinary ophthalmology at Cambridge, teaching students and travelling between practices to manage eye cases. He’s been operating that morning on a severe corneal ulcer — a reminder that “eyelid problems” often matter because of what they do to the cornea.

 

(06:10) Mucocutaneous junction basics. David frames the eyelids as protective, moving structures that maintain the ocular surface. The lid margin is more than skin: it includes meibomian gland openings that support tear film stability.

 

(07:21) Tear film (briefly, promise). David describes modern tear film understanding as a mixed mucin and aqueous layer with a lipid surface. The eyelid spreads it over the cornea; tears behave as a non Newtonian fluid, becoming “runnier” as the lid moves, which helps smooth distribution during blinking.

 

(09:08) Rubbing: skin itch vs eye pain. Sue highlights the GP dilemma: is the dog rubbing because periocular skin is pruritic (allergy) or because the eye is painful? David describes the vicious cycle (irritation → rubbing → more inflammation) and stresses looking at both eyelids and the globe. Stopping self trauma (sometimes a collar) can be part of breaking the loop.

 

(11:01) Red eye triage and eyelid eversion. David’s practical tip: clinicians don’t evert eyelids enough. If both palpebral conjunctiva (inside the lid) and bulbar conjunctiva (on the globe) are inflamed, conjunctivitis is more likely. If the globe looks red but the inner lid does not, widen your differential (including uveitis and glaucoma). Don’t guess from the outside.

 

(11:45) The lash trio explained.

 

Trichiasis: normal hairs rub the cornea due to lid conformation.

Distichiasis: extra lashes from the meibomian gland orifices at the lid margin.

Ectopic cilia: a lash emerges through conjunctiva and points at the cornea — often very irritating.

 

David suggests checking for allergy clues elsewhere (paws, general pattern) if you suspect pruritus is the driver.

 

(13:33) Distichiasis: common, not always guilty. Many dogs have distichiae in both eyes without ulcers. Lashes may delay healing rather than cause the initial lesion. Plucking, freezing or electrolysis can lead to regrowth (sometimes shorter and more abrasive). If treatment is truly needed, David prefers approaches that remove the lash follicle within the eyelid to reduce recurrence.

 

(16:45) Older Cockers and “saggy lash syndrome”. David describes age related lid changes in Cocker Spaniels where long lashes start rubbing persistently. He flags the importance of a Schirmer tear test, as dry eye commonly co exists and must be addressed alongside lid conformation.

 

(18:15) Two quick diagnostics. A topical local anaesthetic drop can be used diagnostically (briefly) to see if discomfort reduces, but repeated use is unsafe for the corneal epithelium. David also reminds listeners to check the third eyelid: lymphoid follicles on its inner surface can keep an eye irritated and are only found by everting it.

 

Chapter 2: Lumps, Bumps and the Cat Exception Clause

 

(22:56) Eyelid masses: chalazion or tumour? David frames the common dilemma as meibomian gland inflammation versus neoplasia, though many cases end up managed surgically either way. In dogs, most eyelid tumours are benign (often meibomian adenomas/epitheliomas) and are usually suitable for wedge resection. His bias: remove earlier rather than later (smaller surgery, lower anaesthetic risk than waiting).

 

(24:38) When heat helps. If you suspect a meibomian gland abscess or granulomatous lesion, David suggests warm compresses applied regularly (as hot as comfortably tolerated) to encourage drainage and reduce the lump.

 

(26:20) Cats: higher suspicion. David contrasts this with cats, where eyelid tumours are more likely malignant (including squamous cell carcinoma) and may look ulcerated or invasive. He mentions photodynamic therapy as a tissue sparing option in delicate areas like eyelids.

 

(27:40) A feline oddity to remember. A dark, round medial canthus mass in a Persian cat may be an apocrine hidrocystoma (benign), and similar lesions can appear at other mucocutaneous sites.

 

(29:03) Melanomas. Behaviour varies by species and site. David is generally more concerned in cats than dogs and flags mucocutaneous junction melanomas as potentially more aggressive — excise when feasible.

 

Chapter 3: VKH — The One You Don’t Sit On

 

(30:45) Sue brings up VKH (Vogt Koyanagi Harada) syndrome, a true derm ophthalm crossover where delay can cost vision. David describes it as autoimmune disease against melanocyte associated antigens, classically seen in Akitas (but not exclusively).

 

(31:49) Clues and consequences. Skin signs may include periocular poliosis and vitiligo (white hairs/depigmentation) around the eyes and lips. The urgent issue is ocular: chorioretinal inflammation that can progress to retinal detachment and blindness.

 

(33:38) Treat early, treat hard. David cautions against slow escalation. Steroids alone for weeks may waste time, especially because azathioprine takes time to reach effect. If the posterior segment looks inflamed, he favours starting azathioprine early alongside steroids.

 

(35:06) Sue agrees: start decisively, get ophthalmology input, and monitor closely with baseline and follow up bloods due to bone marrow suppression risk (especially noted in Akitas).

 

(35:51) They land on the headline: periocular cases reward teamwork — dermatology and ophthalmology together can prevent wrong turns and speed up patient comfort.

 

(38:33) Closing banter: David’s bow tie collection and his case sharing on social media get a final mention.   Insagram @bow_teye

Episode Overview
Join us as we venture into the stables to explore urticaria in horses - those mysterious swellings that appear seemingly out of nowhere and may disappear just as suddenly. Expert guest Dr. Valerie Fadok shares her extensive experience as both a veterinary dermatologist and immunologist to help us understand what causes these puzzling conditions, how to differentiate them from other lumps, and when to investigate further rather than automatically reaching for steroids.

Featured Guest
Dr. Valerie Fadok - A dual specialist bringing unique expertise as both a veterinary dermatologist and immunologist. With experience across three veterinary schools, private practice, and as a field specialist with Zoetis, Val brings a wealth of practical knowledge from working with veterinarians and horse owners around the world.

Episode Breakdown
Introduction to Urticaria in Horses
Val discusses how horses are the most commonly affected species with urticaria among the animals veterinarians treat, and how this condition can drive both horses and their owners to distraction. The disease presents unique challenges, with sudden onset cases that sometimes resolve on their own, and chronic cases where horses experience repeated outbreaks over time.

Clinical Presentation and Diagnosis
What Urticaria Looks Like:

Val emphasizes the importance of palpation—urticarial lesions tend to be soft compared to nodular diseases like eosinophilic granulomas

Individual lesions wax and wane, even if the horse has hives every day

Lesions can take fascinating shapes: round, linear, or ring-like configurations (serpiginous patterns)

Not all horses with urticaria are particularly itchy

Papular Urticaria:

Papular (miliary) lesions are commonly associated with insect bites

Val shares examples of horses moving from northern US states to Florida developing papular urticaria in their first year due to high insect pressure from mosquitoes and Culicoides

These cases often resolve after the first year

Sue confirms similar patterns in the UK with Culicoides

Immunological vs Non-Immunological Reactions
The Role of Mast Cells:

Urticaria involves mast cells in the skin

Immunological urticaria occurs when allergens bind to IgE on mast cells, triggering the reaction

Non-immunological causes involve "twitchy" mast cells that react to physical triggers

Physical Urticaria:

Pressure urticaria and dermatographism—where a handprint appears on the horse's flank after touching

Cold-induced urticaria

Heat-induced urticaria

Exercise-induced urticaria

Some horses have both immunological and physical components, making diagnosis particularly challenging

History is Key:

Observant owners can provide crucial information (e.g., "hives appeared after training session" or "outline of saddle appeared after removal")

Owner observations are often the best way to differentiate between causes

Acute vs Chronic Urticaria
Acute Urticaria Management:

Most acute urticaria in horses is drug-related (antibiotics, pain medications) or from blood transfusions

Val's approach: Don't do an intense workup immediately

Treat with antihistamines (Val prefers hydroxyzine) for a few months to let mast cells settle

If it recurs after stopping medication, then investigate further

Sue agrees: not chronic unless present for 8+ weeks or recurring annually

When to Investigate:

Sue and Val agree: 8-12 weeks or recurrent episodes warrant deeper investigation

Both emphasize the value of owners who keep detailed calendars noting when hives appear

50% of urticaria in people remains idiopathic—same often true for horses

Competition horses present particular challenges due to medication restrictions

Investigation and Testing
Seasonal Cases:

For seasonal urticaria, Val recommends intradermal or serum allergy testing

Horses with urticaria respond well to allergen immunotherapy compared to other species

Most horse owners are comfortable giving injections

Non-Seasonal Cases:

Consider dietary factors and whether feed changes throughout the year

Horse owners are surprisingly open to food trials

Val has only proven a handful of food-related urticaria cases (alfalfa and grains)

Diet trials are difficult in horses, though owners are willing

Environmental Allergens:

House dust mites and storage mites are the most commonly identified allergens across all species

Molds are important triggers, especially in humid environments

Val notes regional differences: Florida has unusual pollens and insects, Texas is drier with mainly pollens, Pacific Northwest sees more mold allergies

Sue observes autumn cases in UK when horses start wearing rugs, potentially related to house dust mites, temperature, dampness, or molds

Allergen-Specific Immunotherapy
Val's Approach:

Uses traditional step-up procedure for injection immunotherapy

Consults pollen charts (from Greer allergy company, pollen.com, Google searches)

Selects major allergens relevant to the horse's region and history

Doesn't include everything that tests positive—focuses on major allergens that fit the history

Builds up from 2-3 injections per week to maintenance (once weekly to once monthly, depending on the horse)

Customization is Key:

Frequency depends on individual horse response

Traveling horses present challenges (Val shares experience with a Budweiser Clydesdale that traveled nationwide)

For traveling horses, select major allergens common across regions (cedar trees, ragweed, common grasses)

Seasonal Management:

Val prefers to wait until the season is over before starting immunotherapy

Aims for at least 6 months of treatment before the next allergy season

Backs off frequency during off-season (e.g., monthly injections)

Increases frequency during active season (weekly if needed)

Never stops completely during off-season to avoid starting over

Sometimes "less is more"—half a milliliter every two weeks may work better than full dose every four weeks

Success with Horses:

Horses respond particularly well to immunotherapy compared to other species

Dedicated horse owners are excellent at fine-tuning treatment based on their horse's patterns

Flexibility is key: can adjust dose and frequency as needed

Treatment Options
Antihistamines:

Val's preference: hydroxyzine (though colleague Stephen White prefers doxepin)

First-line treatment when possible

Corticosteroids:

Most US equine vets prefer dexamethasone (less expensive)

Val prefers prednisolone (learned from equine mentor at Texas A&M)

Alternate-day prednisolone is useful approach

Long-term dexamethasone is concerning—if needed, aim for every 3-4 days

For competition horses, medication restrictions are a major consideration

Off-Label Options:

Apoquel has helped some difficult cases when antihistamines and steroids aren't sufficient

Very expensive and off-license (requires justification)

Not on horse competition drug registers (as of recording)

Can be useful short-term, such as before shows

Not a long-term solution

Long-Term Outlook
Realistic Expectations:

Flares will likely be part of life even with successful immunotherapy

Stress can trigger urticarial eruptions (similar to people)

Hope is to avoid year-round medication, but some horses require continuous treatment for comfort

Some owners relocate horses from high-allergen areas (e.g., Florida/Southeast) to northern states

Education Needs:

Val sees room for growth in equine veterinary use of immunotherapy

Cautions against testing too early (not after just one outbreak)

Healthy animals can make IgE without it being clinically relevant

Need for education on proper use of testing and setting realistic expectations

Horse Owner Compliance
Both Val and Sue emphasize how remarkably compliant and dedicated horse owners are:

Horse owners will food trial willingly

Will shampoo horses twice weekly in freezing weather

Keep detailed records and calendars

Are observant about patterns and triggers

Are open to considering food allergies

Follow through consistently with immunotherapy protocols

The bond between pleasure horse owners and their horses makes treatment particularly rewarding

Key Takeaways

Palpation matters - Soft lesions that wax and wane suggest urticaria over other nodular diseases

Don't over-investigate acute cases - Wait 8-12 weeks or for recurrence before extensive workup

History is everything - Detailed owner observations are invaluable for diagnosis

Horses respond well to immunotherapy - Better success rates than many other species

Flexibility in treatment - Adjust immunotherapy frequency and dose based on individual response

50% remain idiopathic - Many cases resolve without identifying the cause

Horse owners are exceptional - Compliance and dedication make management possible

In this month's episode, Sue John and Paul invite exotics guru Madonna Livingstone onto the podcast to discuss general and skin issues in ferrets.

 

Overview of ferrets as pets:

   - Ferrets have been domesticated for over 3,000 years, evolving from the European polecat.

   - They are highly social and prefer to be kept in groups of at least two.

   - Ferrets have high protein and fat dietary requirements, and need a lot of space and environmental enrichment.

 

Common Skin Conditions in Ferrets:

   - Ectoparasites:

     - Fleas (usually dog and cat fleas) are the most common ectoparasite, causing pruritus and alopecia.

     - Ear mites are very common in ferrets, often asymptomatic.

     - Sarcoptic mange can affect the feet, causing severe pruritus and scabs.

   - Allergies:

     - Skin allergies are rare in ferrets, but environmental contact dermatitis can occur.

     - Food allergies are very uncommon.

   - Hormonal Imbalances:

     - Hyperadrenocorticism (adrenal gland disease) is less common than hyperestrogenism in female ferrets.

     - Hyperestrogenism can lead to alopecia, bone marrow suppression, and even death if untreated.

 

Treatment Approaches:

   - Ectoparasites: Use of selamectin, fipronil, or moxidectin is recommended.

   - Allergies: Antihistamines, steroids, and omega-3/6 fatty acids can be used.

   - Hormonal Imbalances:

     - Hyperestrogenism is often managed with deslorelin implants or HCG injections.

     - Hyperadrenocorticism may require surgical adrenalectomy or deslorelin implants.

 

Insights and Takeaways

- Ferrets are unique and fascinating pets, with specific care and medical needs.

- Skin conditions in ferrets can present similarly to dogs and cats, but there are some key differences in diagnosis and treatment.

- Ectoparasites, especially fleas and ear mites, are very common and should be the first consideration when a ferret presents with skin disease.

- Hormonal imbalances, particularly hyperestrogenism in females, are an important cause of skin problems in ferrets and require prompt recognition and management.

- Veterinarians should be familiar with ferret-specific care and be prepared to handle ferret skin cases, as they may be uncommon but can be challenging.

 

Conclusions and Decisions

- Ferrets are becoming increasingly popular pets, and veterinarians should be equipped to provide appropriate care for their skin conditions.

- Developing a good understanding of ferret biology, common skin diseases, and treatment approaches can help build confidence in managing these cases.

- Consulting resources like the BSAVA Exotic Animal Formulary and seeking advice from experienced exotic animal veterinarians can be invaluable when caring for ferrets with skin problems.

- Promoting proper husbandry and preventive care, such as regular ectoparasite control and monitoring for hormonal imbalances, can help minimize skin issues in ferrets.

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 but impractical on muzzles. Educate owners to avoid mechanical trauma. Benzoyl peroxide was useful historically but isn’t currently available in the UK. Topical clindamycin/fusidic acid can work, but antiseptics usually outperform; always control inflammation alongside antimicrobials.

Chapter 3 – More than a twofold problem: Comorbidities Without Chaos

29:52 – Sue asks about juggling comorbidities (e.g., SGPS plus history of demodicosis). Laura: set expectations with owners; if on isoxazoline preventatives, relapse of demodex during immunosuppression is unlikely but monitor closely. Risk is higher during combination immunosuppression (e.g., pred + cyclosporine) and lower on single‑agent maintenance.

32:15 – Sue asks about surveillance. Laura: in addition to haematology/biochemistry and urine checks, perform periodic hair plucks/skin scrapes to rule out demodex whenever new alopecic lesions appear or during ongoing therapy. Any follicular disease (including muzzle furunculosis) warrants demodex checks.

33:18 – Closing remarks. Sue and John thank Laura; they note the focus on common, real‑world brachy problems (intertrigo, muzzle folliculitis, seasonal flank alopecia, SGPS) and the importance of pragmatic, owner‑friendly routines.