Bulldog Recurring Interdigital Cysts and Surgery

Dear Dr. Kraemer

We have been struggling with interdigital cysts on our bully’s front paws. He is getting them underneath his paws and it seems the whole pad of the paw sometimes gets inflamed.

He is currently on atopica to manage his allergies and just came off a long course of prednisone. We decided to take him off the steroids due to the side effects.

bulldog inflamed interdigital cysts question

We do Epsom salt and hibitane soaks twice a day.

Lately, the cysts are flaring up and both his feet are inflamed. It’s probably worse since he moved off the prednisone. We don’t know what to do anymore, as we have had quite a few surgically removed, and they keep coming back a few weeks or days later.

I’ve read in previous articles that you recommend medicating them instead of surgery.

My question is, would the cyst go away by using medication only, as it seems it’s okay for a day or two but keeps flaring up again?

Any advice would be appreciated.
Regards
Lezanne

1 Answers
Dr. Roy Kraemer Staff answered 5 months ago

Answer for Bulldog Recurring Interdigital Cysts and Surgery

Dear Lezanne

I know only too well how challenging interdigital cysts can be. All your concerns are valid and on point.

Recurring Interdigital Cysts: VETERINARIAN CHALLENGE

This condition is more common in bulldogs than in other breeds, and the anatomical complexities make it a unique challenge for veterinarians.

 

Bulldog Interdigital Cysts: SURGICAL DELIMA AND CAUTION

I am sorry to hear about the repeated surgical removals your bulldog has undergone. In some cases, surgery may not be the most suitable approach.

The “surgical procedures” commonly offered by the local vets for interdigital cysts may inadvertently cause additional trauma and increase the risk of infection.

It’s essential to follow the principle of “do no harm” and be cautious about invasive interventions.

blistered Interdigital cyst

Probing and surgeries labeled as “removal” are usually intended for external foreign bodies like foxtails or thorns. Unfortunately, a significant number of veterinarians lack comprehensive knowledge about the origin and biomechanics of interdigital cysts. This includes understanding the optimal timing for surgery, procedural intricacies, associated risks, and postoperative care, not to mention the heightened risk of anesthesia.

 

Recurring Interdigital Cysts MOST COMMON CAUSE:

Interdigital cysts in bulldogs are often related to their unique anatomy, including

  • skinfold (moist dermatitis)
  • thorny hair
  • ingrown hair
  • traumatic implantation
  • webbing

bulldog webbing leading to interdigital cyst

Bulldog Recurring Interdigital Cysts OTHER COMMON FACTORS:

Other factors can either be the origin or, more commonly, exacerbate the problem. Examples are:

  • Allergies: bulldogs have a high propensity for allergies
  • Overweight
  • Skin mites
  • Secondary infection
  • Stress & Anxiety
    • chronic disease
    • separation
    • boarding
  • Incompetent immune system 
    • due to immune suppression drugs (prednisone/steroids)
    • breed genetics
    • chronic disease
    • parasite infestation
    • poor diet
    • chronic stress
    • autoimmune
    • Cushing’s syndrome
  • Orthopedic conditions 

Bulldog Recurring Interdigital Cysts: BEST SURGERY

The only surgical option I recommend for those nonresponsive to medical care is fusion podoplasty, which is a last-resort salvage reconstructive procedure.

 

Recurring Interdigital Cysts FUSION PODOPLASTY

Fusion podoplasty is a complex surgical procedure that demands the skills of a proficient veterinarian with a history of successful outcomes.

It is a highly technical process that necessitates specialized expertise. The surgical objective is to:

  1. Direct the affected skin, web, pad, underlying tissue, and potentially even part of the bone between the toes.
  2. The remaining healthy toe bones and digital pads are then sutured together, creating a fused pad structure.

The aftercare is labor intensive and requires multiple visits to the surgeon’s office for bandage replacement and possible splinting.

 

Bulldog Recurring Interdigital Cysts: MULTIMODAL THERAPY

For the majority of cases, a multimodal therapeutic approach is ideal, and that is what I would advise.

The focus is on prevention, often long-term management, and treatment.

Here’s a summary of key preventive and therapeutic elements:

  • WEIGHT CONTROL: Maintain an optimal body
  • STRESS CONTROL: Create a calm environment
  • GOOD HYGINE: Ensure good paw hygiene.
  • ALLERGY CONTROL: Manage Allergies
  • ITCH CONTROL: prevent biting, licking, and itching of the area
  • PARASITE CONTROL: such as Demodex mites
  • SKINFOLD CONTROL: Manage Skinfold Moist Dermatitis
  • PAIN CONTROL: Manage pain effectively.
  • ORTHOPEDIC MANAGEMENT: Consider the impact of orthopedic conditions on your bulldog’s weight bearing and alignment.

Given the potential for lifelong prevention and care, your goal and aim are to minimize the use of prescription drugs and focus on their careful and wise use.

Your goal is to strike a balance, using medication when necessary while prioritizing safety.

 

Recurring Interdigital Cysts: 3-Tire TIRE TREATMENT

For simplicity, I will outline three tiers of bulldog interdigital cyst prevention and care:

BULLDOG INTERDIGITAL TREATMENT TIRE 1:

  • Non-Prescription
  • At-home
  • High safety
  • Can be used for the life of the pet
  • Low cost
  • Easy to implement

v4b-bulldog-skin-fold-rinse-handout

Bully Antiseptic Topical Therapeutic for Cyst Hygiene:

  • SOACK: Soaking the foot with Apson salt and bully antiseptic rinse
  • WIPE & LOTION & SPRAY: Wiping the toe’s damp skinfolds and webs with
    • wipe with bully antiseptic wipes
    • apply bully skinfold antiseptic lotion
    • Spray with a bully antiseptic spray

Bulldog Interdigital Cyst Bundle

Bully Interdigital Cyst Therapeutic Supplement

  • SKIN & COAT:
    • V4B Bully Dermal Care tab
  • SKIN-IMMUNE-JOINTS:
    • V4B Bully Fish Oil EFA
  • STRESS & ANXIETY CONTROL
    • V4B Bully Hemp Calm & Relax
    • V4B Bully StressLess
  • ORTHOPEDIC CONDITIONS
    • Bully Total Joint Advance Care
    • Bully Hemp Mobility
  • PAIN CONTROL
    • Bully Comfort and AcheLess

Interdigital Cyst Bundle - Ultimate

Interdigital Cyst Weight Control

Lean body weight may require weight loss with a prescription diet, activity, and exercise

Interdigital Cyst Allergy Control

Food allergy: Hypoallergenic prescription diet (6–8 weeks trial)

 

BULLDOG INTERDIGITAL TREATMENT TIRE 2:

  • Relatively safe
  • Implemented by the medical team
  • Cost can vary

Allergy and Itch Control RX For Bulldog Interdigital Cysts

  1. Atopic Dermatitis:
    1. Cytopoint injection
    2. Immunotherapy
  2. Itch Control:
    1. Apoquel
    2. Cyclosporin (Atopica)
    3. Antihistamins

Pain and Anti-Inflammetories For Bulldog Interdigital Cysts

  • Anti-Inflammatory:
    • Stem cell therapy
    • laser therapy
    • PRP

bulldog interdigital cysts before stem cell therapy

bulldog interdigital cysts after stem cell therapy

  • Pain Control:
    • Analgesics
    • NSAIDs

BULLDOG INTERDIGITAL TREATMENT TIRE 2:

  • Prescription
  • Medication that can cause harm
  • Cost varies
  • Surgery as a last resort

Prescription Drugs For Bulldog Interdigital Cysts

  • Itch and Inflammation Control:
    • Cortisone (prednisone, triamcinolone, methylprednisolone, dexamethasone, etc)

Cortisones are usually effective for inflammation, pain, and itch control, and might be required especialy during intense flare-ups

  • Antibiotics: Topical and systemic (rarely required, with preference for topicals over systemic)
  • Antifungal: Topical and systemic
  • Mite Treatment: Prophylactically start flea prevention that is also effective against demodex mites

BULLDOG INTERDIGITAL DRUG  TREATMENT CAUTION

CAUTION CORTISONE

Cortisone medication comes with varying degrees of potency and half-life duration.

For safety, I prefer the least potent and short-acting ones. I also try to taper them to the minimum required.

Long-term use of cortisone requires monitoring and periodic blood and urine tests.  

CAUTION ANTIBIOTICS

Overuse of antibiotics can lead to bacterial multidrug resistance (MRSP).

CAUTION GUT MICROBIOME AND DYSBIOSIS 

Whenever cortisone or antibiotics are administered for an extended period, I suggest incorporating probiotic therapeutic supplements to mitigate their effects on your bulldog’s gut microbiome.

Probiotics therapeutic supplement for bulldog pancreatitis

In conclusion,

  1. Eliminate any other potential medical problems, many of which I’ve already outlined, that could worsen and prolong the intensity of the cyst.
  2. Keep in mind that managing interdigital cysts might be a lifelong commitment, exhibiting cyclical and seasonal patterns with occasional acute flare-ups that could necessitate prescription medications.
  3. Enhance treatment and care by incorporating therapeutic topical supplements.
  4. Adopt a comprehensive approach to minimize costs and reduce reliance on potentially harmful medications.
  5. Lastly, consider surgery as a final option and ensure it is performed by a seasoned, expert surgeon.

For more comprehensive information covering bulldog interdigital cysts, visit my prevent & treat article HERE

Best of luck

Dr. Kraemer

Vet4Bulldog

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