Pododermatitis, defined as inflammation of the skin of the paw, is common and has multiple underlying causes. Maximizing successful outcomes requires identifying and correcting the underlying triggers. Regardless of the primary underlying disease, patients commonly develop secondary infections, which significantly contribute to the pruritus and discomfort and can lead to treatment failure when missed. Thus, diagnosing and appropriately treating infections is imperative. After infection and demodicosis have been ruled out, other differentials are linked to whether the nails or footpads are involved. A step-by-step approach to diagnosing the cause of pododermatitis should start with common diseases (e.g., allergies) and progress to less frequent clinical diseases (e.g., autoimmune and metabolic conditions).<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Pododermatitis is common in small animal practice and can be frustrating if not properly diagnosed and treated. A useful way to approach pododermatitis is to think that there is a <\/i>primary underlying disease (e.g., allergy) and often also a secondary infection (e.g., bacteria, yeasts) contributing to the pruritus. In most chronic cases, perpetuating factors (e.g., fibrotic changes, interdigital cysts) prevent resolution of the disease.1<\/sup> (Note that the differentiation between cysts and furuncles is under debate and is beyond the scope of this article.) For outcome success, all factors should be identified and corrected.<\/span><\/p>\n This article presents the differential diagnoses for diseases affecting the feet, footpads, and nails in dogs and cats and provides tips on how to rank the diseases based on specific clinical signs and presence of other clinical signs. The descriptions are presented in order of common (e.g., allergies) to less frequent (e.g., metabolic, autoimmune) clinical conditions. <\/span><\/p>\n The history of patients with pododermatitis is extremely useful. Generally, allergic skin diseases start early in life (1 to 3 years of age) and progressively worsen. Knowing whether the problem occurs seasonally or all year is helpful, as is being aware of other clinical signs (e.g., autoimmune diseases wax and wane, and patients tend to be anorexic and lethargic during flares). <\/span><\/p>\n The combination of signalment, history, and findings on physical examination is used to formulate the list of differential diagnoses and their ranking. During physical examination, determining whether the footpads and\/or nails are affected helps narrow down underlying diseases, as fewer diseases also affect footpads and nails. The type of lesions and their distribution should be noted, as should whether body areas other than the feet are affected. Signs of atopy start with pruritus, and initial lesions may be erythema only. Signs of contact allergy start with a primary papular eruption2<\/sup> (<\/span>FIGURE\u00a01<\/b><\/span>), and if present, other areas of the body may be affected. In dogs with contact allergy, the erythema and pruritus can be severe (<\/span>FIGURE 2<\/b><\/span>) and their history is typically of having failed to respond to multiple antipruritic therapies.<\/span><\/p>\n\n
History and Physical Examination of Pododermatitis<\/h2>\n
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