Monday, February 11, 2008

Furunculosis

Furunculosis in the dog is a painful disease which stymied the veterinary profession for years. Most of the time, the disease affects adult German Shepherds. The treatment of choice, at one time, was massive doses of steroids and antibiotics. The steroids provided a double whammy. First, the steroids caused all the usual side-effects: excessive urination, excessive water consumption, liver failure, gastro-intestinal trauma, etc. Second, in a breed that was already prone to hip dysplasia, the steroids hastened the painful degeneration of these already damaged joints.

Since most dogs with furunculosis had a horrible infection, the next stage in the treatment of this disease was to remove the tail. The theory behind this treatment was that if the skin had access to open air, then bacteria would have a more difficult time setting up an infection. That treatment option very rarely went over well with owners, but a lot of dogs got better, so it was often done as a treatment of last resort.

Next on the list of treatments was cyclosporine. Since this medication, like most of the medications we use in veterinary medicine, came from the human medical field, it was expensive. The cost of cyclosporine has come down dramatically since it was first used and now is a standard of treatment for dogs with furunculosis along with surgery to remove the diseased tissue.

A recent study just came across my desk (Preoperative immunosuppressive therapy and surgery as a treatment for furunculosis; Klein A, et. al; Vet Surg 2006; 35:759-768). In the study they compared two different immunosuppressive therapies along with surgery to determine how effective therapy might be in curing this disease. The authors were able to conclude that surgical therapy combined with pre-surgical medical therapy can be effective in preventing recurrence of furunculosis.

The study does have some limitations. For starters, it was a retrospective study. This means they looked up cases that had been treated without regards to a standard protocol. There also was no control group to compare with the treated groups. These are significant drawbacks, if we were looking for definitive proof. However, since many dogs suffer from this disease and treatment can be frustrating and expensive for the owner (not to mention the dog!) it makes sense to attempt these therapies while we wait for a definitive cure.

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