Superficial spreading pyoderma is characterised by large, spreading and coalescing epidermal collarettes, erythema and exfoliation (Fig 5). If family members or people in close contact with the patient are immunosuppressed, the veterinarian should be aggressive in assessing the risk for zoonosis and contagion, culture the patient to identify MRS, discuss isolating the patient from at-risk people, and so on. TSST-1 and the staphylococcal enterotoxins are also known as pyrogenic toxin superantigens. Bullous pyoderma gangrenosum is also a superficial variant that affects the upper limbs and face more than the lower extremities. Although Staphylococcus pseudintermedius is the most prevalent bacterium recovered from canine pyoderma, other staphylococcal species have been isolated, including S. schleiferi, S. aureus, and S. lugdunensis. Differentials include demodicosis, dermatophytosis, scabies, and autoimmune skin diseases. Consequently, if the underlying cause is not identified and corrected, pyoderma will recur. Most cases of pyoderma are caused by bacterial infections. Inducible resistance to clindamycin should be excluded by performing a D-zone disk-diffusion test. In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). Deep pyoderma can be seen with any underlying trigger or acquired immunodeficiency, and it is commonly associated with demodicosis. Bullous impetigo is caused by S. aureus. pyoderma gangrenosum A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. These toxins have unique potent effects on immune cells and other biologic effects as well, ultimately inhibiting host immune response. Any individuals with open staphylococcal infections are high-risk potential carriers and transmitters of infection. The frequency of isolation of group A Streptococcus makes such therapy a reasonable approach in most patients who have a significant degree of involvement. As these macules expand, superficial keratin layers lift and peel peripherally, resulting in expansive epidermal collarettes. SITES OF COLONIZATION IN NEONATES (AND SITES OF INFECTION), METASTATIC SKIN INFECTIONS ASSOCIATED WITH BACTEREMIA (OFTEN S. aureus ACUTE INFECTIONS ENDOCARDITIS), STAPHYLOCOCCAL TOXIN-ASSOCIATED SYNDROMES. Premature discontinuation of therapy, inability to completely control the primary disease, and the use of fluoroquinilone antibiotics will likely perpetuate the resistant infection. In superficial pyoderma, hair is clipped from the surrounding area, but disinfection is not attempted. Classification of disease is based on the depth of bacterial infection, which is associated with characteristic lesions and recognized clinical presentations. Attempts to eradicate MRSA have generally been unsuccessful. Recently, two additional staphylococci have been isolated from cases of recurrent pyodermas, namely Staphylococcus schleiferi subsp schleiferi and Staphylococcus schleiferi subsp coagulans, both of which are frequently methicillin-resistant staphylococci. S. aureus in pyodermas or STIs can invade the bloodstream, producing bacteremia, metastatic infection such as osteomyelitis, and acute infective endocarditis. However, it is currently unavailable in the United States.15 Systemic antibiotics may be required in extensive cases. Chin pyoderma manifests as nonpainful and nonpruritic comedones, papules, pustules, and bullae, or as ulcerative draining tracts with serosanguineous discharge on the chin or muzzle. 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