LRC News Room
Canine Juvenile Cellulitis
By Dr Julie Oghigian, DVM - Monday July 17, 2017.

Canine Juvenile Cellulitis/Pyoderma (“Puppy Strangles”)

There aren’t many things that are cuter (or more filled with promise) than a litter of healthy, well-bred puppies. However, sometimes things can happen that can make them less than attractive… or things can happen which threaten these little lives that we’ve spent so many hours (and dollars!) planning, whelping, and caring for.

Puppy Strangles is one of these things. It is a disease of unknown cause that is usually called Juvenile Cellulitis or Juvenile Pyoderma in the veterinary community. While not commonly seen, it does seem to be more common in breeds such as Labrador Retrievers, Golden Retrievers, pointers, setters, beagles, and dachshunds. It is often suspected that immune system dysfunction is the initial cause, as it may be seen following vaccination or with other concurrent illness.  Juvenile Cellulitis is a disease that most commonly affects young puppies from 3 wks of age up through 4-6 months of age. It typically starts off as facial or eyelid swelling, progressing to skin irritation around the chin, lips, and muzzle. This progresses rapidly to crusts, hair loss, and inflammation/cellulitis and affects not only the muzzle region but also eyelids and often ears (otitis) and ear flap (pinnae) margins. Some puppies will have blister-like lesions or pustules, with clear yellow to thick white discharge, appear within the first 24-48 hrs. Occasionally, similar lesions are seen around the anus, vulva, and prepuce. If severely affected, puppies will become lethargic and depressed, often refusing to eat. They may also have a higher than normal body temperature.

Skin lesions can be confused for ringworm, demodectic mange, distemper lesions, or an allergic reaction, but can actually be quite painful for affected puppies. These puppies don’t usually present with itching or scratching as a clinical sign. In more advanced cases, area lymph nodes can become severely inflamed and enlarged, even becoming abscessed if infection sets in - usually this involves the submandibular lymph nodes (under the jaw), though prescapular, inguinal, popliteal or other peripheral lymph nodes may also become enlarged. These lymph nodes can become so enlarged that they can actually interfere with normal breathing or swallowing, which is how the disease came to be referred to as “puppy strangles.” Inflamed lymph nodes may even form tracts through the surrounding tissue that drain out of the skin surface. Occasionally, affected puppies will develop joint pain resulting from suppurative (systemic inflammatory) arthritis.

Diagnosis of Juvenile Cellulitis can be difficult and is often made based on clinical signs alone. Cultures and special stains used to diagnose infectious agents are often negative, though secondary infections can occur. Cytology (swab or “squash prep”) or biopsies of skin, ears, and lymph nodes usually show severe pyogranulomatous or granulomatous inflammation, with or without secondary bacterial infection. Treatment of puppies with strangles requires quick and aggressive, sometimes long-term treatment with immunosuppressive doses of corticosteroids (usually prednisone) and often bactericidal antibiotics to prevent the disease from worsening. If left untreated, death can occur. Juvenile Cellulitis progresses rapidly and can become extremely severe. This is why rapid initiation of appropriate treatment is extremely important. This may also help reduce scar formation related to skin lesions, which can also be quite extensive. Warm water soaks and mild topical astringents can be used twice daily to soften and remove crusts from affected skin. Steroid treatment usually continues for 1-4 weeks before tapering the dose down over the remaining few weeks. If tapered down or discontinued too soon, it is common for the puppy to relapse. More recently, griseofulvin, an antifungal medication that has been found to control the immune response , has also been reported to effectively treat puppy strangles, sometimes allowing for steroids to be tapered and discontinued sooner.

While prognosis is usually good in these cases when treated, especially if a good response is noted within the first 5 days of treatment, it is not uncommon for skin scarring to occur in more severe cases. Typically, the earlier treatment is started in the course of the disease, the better the prognosis and lesser the residual scarring. Vaccination is usually delayed until affected puppies are recovered, which may predispose these puppies to serious diseases unless exposure is prevented. More than a few successful dogs in the show ring and in performance venues today have recovered from Juvenile Cellulitis as puppies. With careful monitoring, outstanding veterinary care and good husbandry and medical management at home, a case of Juvenile Cellulitis does not have to end the successful career of a promising puppy. Enjoy those adorable puppies in the whelping box and never stop dreaming about your next champion.