Pododermatitis in dogs: sore, red skin between the toes

Overview

Paw inflammation is also called pododermatitis, meaning inflammation in the paw region. The skin between the toes can become irritated for different reasons, so the name alone does not identify the precise cause. Superficial irritation is distinguished from bacterial infection extending into hair follicles and deep skin. Depth affects treatment choice.

In furunculosis, a hair follicle beneath the skin ruptures. Keratin, the material forming hair, enters the tissue and triggers a foreign-body reaction. The resulting painful lumps between the toes are not usually true cysts, meaning fluid-filled cavities. They can occur at one or several sites.

An isolated inflammation caused by a foreign body may resolve once it is removed. Allergic paw inflammation often requires long-term control of signs. The outlook therefore depends on the underlying cause. Most dogs respond well to treatment.

In deep pyoderma, bacterial infection lies within the dermis, below the skin's surface layer. It can also extend into subcutaneous tissue. The proximity of infected areas to skin blood vessels also explains the possibility of serious systemic infection.

Causes

Atopy and food-related hypersensitivity can cause itchy paws. Licking and biting damage the local skin and may trigger deep inflammation. Contact with an irritant can also inflame skin on the underside of a paw. Persistently wet paw hair can perpetuate irritation.

Hair pushed beneath the skin can act as a foreign body that sustains inflammation. A grass awn or splinter can similarly penetrate a paw. Overgrowth of Demodex mites, or demodicosis, can cause deep inflammation between the toes. Bacteria or Malassezia yeast may multiply on damaged skin.

Hormonal diseases, such as an underactive thyroid and Cushing's syndrome, can predispose to secondary bacterial infections. Less commonly, a tumour or deep fungal infection is responsible. Immune-mediated skin diseases can also inflame the paws. Redness alone cannot distinguish these different causes.

Deep infection may involve several organisms. Staphylococcus pseudintermedius is found in more than 90% of canine pyoderma, or bacterial skin infection, cases. Streptococci, Gram-negative bacteria or bacteria growing without oxygen have been found in about 40% of deep bacterial skin infections. This diversity is a reason to identify the cause of deep infection by culture.

Risk factors

Any dog can develop deep interdigital inflammation. Susceptible breeds include Shar Peis, Labrador Retrievers and English Bulldogs. Short, stiff hairs can be driven back into the follicle during movement. In a broad paw, weight may also fall on the haired skin between the pads.

Excess weight increases pressure between the toes. Uneven weight distribution caused by lameness can also strain these areas. A hard or rough surface can injure hair follicles. Moisture and skin maceration make microbial overgrowth easier.

Allergic skin disease and impaired skin barrier function can predispose to repeated bacterial infections.

Typical symptoms

Inflammation between the toes may begin with redness and small bumps. Deeper nodules are often about 1–2 cm in diameter. You may notice the following changes:

• Repeated licking or biting of the paws.
• Red, tender skin between the toes.
• Paw swelling or lumps developing.
• A shiny, reddish-purple nodule.
• Draining openings or ulcers in the skin.
• Lameness in the painful leg.
• Hair turning reddish-brown with licking or yeast overgrowth.

A foreign-body lesion is often isolated and located on a front paw. In bacterial infection, new nodules may appear as previous ones heal. A chronically affected paw may develop thickened skin and hair loss.

Under heavy hair, the true extent of inflammation may be missed until hair is shortened for examination. Some spaces between the toes also have comedones, or blackheads resembling blocked hair follicles. Nearby lymph nodes may also enlarge with the inflammation.

Complications and consequences

Long-standing inflammation can permanently scar the skin between the toes. Calluses and pad-like skin thickening may develop. After healing, the skin may remain hairless and more fragile than before. Deep bacterial infection is also a possible source of infection spreading into the bloodstream.

Free keratin left in the skin can sustain an inflammatory reaction even after the original infection settles. Recurrence may also indicate untreated allergy or demodicosis. Deep lesions may need about 3–6 weeks of treatment to heal. Simply repeating a course does not resolve an ongoing underlying skin disease.

Diagnosis at the vet

The vet also establishes whether skin changes occur elsewhere on the body as well as the paws. Seasonality and your dog's living environment can help identify the cause. Previous treatment response and diet are also discussed. Not every paw problem is bacterial.

Cytology means microscopic examination of a cell sample taken from skin or discharge. The sample is checked for inflammatory cells, bacteria and yeasts. It is examined before antimicrobial treatment begins. Hair sampling or skin scrapings can look for Demodex mites.

Bacterial culture and susceptibility testing are performed on a deep infection to guide medicine choice. A surface swab does not always reach the organism deep in the tissue. Material collected with a needle or a tissue sample may then be needed. Sampling may require pain relief or general anaesthesia.

An unusual or recurring nodule may be investigated by biopsy. An isolated lesion may need surgical exploration to find a foreign body. If allergy is suspected, an elimination diet trial tests a strictly restricted diet. Blood tests, urine testing or X-rays may also be included when needed.

Small numbers of bacteria can be found even on healthy skin. Finding bacteria inside inflammatory cells matters when assessing infection. Culture results are therefore interpreted alongside cytology and skin changes. If healing stalls and bacteria remain within cells, repeat culture can investigate medicine resistance.

A tumour-related paw lesion usually affects only one paw. Cytology and biopsy therefore also look for causes other than an ordinary bacterial infection.

Treatment

The vet prescribes treatment and medicines. Care targets the identified cause. Topical antimicrobial treatment is the first-choice approach for superficial bacterial infection. Deep infection may additionally require an antibiotic acting throughout the body. Culture results guide selection of a suitable medicine.

Washes and topical products chosen by the vet reduce surface microorganisms and remove crusts. An animal-suitable product containing chlorhexidine is one possible option. Yeast overgrowth may need separate antifungal treatment. A foreign body is removed if it is sustaining inflammation.

Pain is treated separately if the paw is tender. Treating an itchy allergy reduces self-inflicted skin damage. However, an allergy medicine does not necessarily treat deep bacterial infection. Inflammation caused by Demodex mites needs treatment targeting the parasite.

A deep infection is re-examined before initial treatment ends, usually at about 3 weeks. If infection remains, reassessment takes place about every 2 weeks. Further treatment depends on skin changes and cytology. Antibiotics are not continued automatically simply because redness remains.

Scar tissue or follicular cysts can be removed by laser in selected cases. Surgery is not the first step for every inflamed paw. Topical care after a procedure can be demanding. Healing also depends on controlling the cause that sustains inflammation.

Treatment of a seriously ill dog may begin before culture results are ready if the risk of deterioration or sepsis is high. Medicine choice is reviewed when laboratory results arrive. Topical treatment of a deep infection starts once the paw can be handled without pain.

After laser treatment of follicular cysts, dressings may need changing every 24–48 hours. Long-term corticosteroid treatment can worsen secondary bacterial infection by weakening the local immune response. The veterinary plan therefore coordinates control of inflammation with treatment of infection.

Prevention

Keep paws and the spaces between the toes clean and dry. Rinse wet or dirty paws when needed and dry them thoroughly. Winter road salt can irritate paw skin, so rinsing after walks helps remove the irritant. Regular paw checks help identify early changes.

Weight management in an overweight dog may reduce pressure between the toes. Softer resting and walking surfaces reduce repeated friction. Suitable boots can protect paws when needed. Long-term topical maintenance care may be required if a cause sustaining recurrence risk cannot be removed.

Avoid causing small skin injuries when managing hair between the toes. Clipping that damages the surface can drive hair fragments into tissue and trigger another foreign-body reaction. Hair shortening on a painful paw is therefore planned at the practice as part of treatment.

Do not apply household bleach undiluted to your dog's inflamed skin. Diluting it at home can cause mixing errors dangerous to the dog or person handling it.

Important for dog owners

Photograph paws from the same angles before rechecks and note which spaces between the toes are affected. Record changes in licking, lameness and discharge, and any relationship to walks or seasons. Tell the vet about every previous medicine and which helped. Bring earlier culture results if available.

Do not squeeze a lump between the toes or dig into skin for a possible foreign body. Ask for clear topical-care instructions and check how to prevent licking. A collar can stop licking when necessary. If pain prevents your dog from tolerating handling, tell the vet treating your dog before trying washes again.

Frequently asked questions

Is inflammation between the toes always furunculosis?

No. Paw inflammation is a pattern of signs with several possible causes, such as allergy, yeast or a foreign body. In furunculosis, a hair follicle ruptures and inflammation extends deeper into the skin. Treatment choice depends on both the cause and depth of inflammation.

Why does the paw inflammation keep coming back?

Allergy, paw structure, keratin left under the skin or Demodex mites can sustain recurrence. The underlying cause therefore needs investigation alongside treatment of bacterial infection. Chronic, recurring disease may need a long-term maintenance plan tailored to investigation results.

Does my dog always need an antibiotic course?

Not always. Superficial bacterial infection can often be treated topically, while deep infection may require an antibiotic acting throughout the body. The need for a medicine and the choice suited to your dog depend on examination, cytology and bacterial culture when necessary.

Can a single painful space between the toes be caused by a splinter?

Yes. A foreign body, such as a grass awn, can cause one inflamed lesion, often on a front paw. It may need to be located and removed surgically. Do not try to dig out a foreign body deep beneath your dog's skin at home.

Can simply drying the paws cure the problem?

Keeping paws dry reduces skin maceration, but deep infection needs veterinary treatment. If allergy, Demodex mites or a foreign body is involved, addressing it is also part of care. Home hygiene supports treatment but does not resolve every cause of paw inflammation.