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143.e2 Callus/Pressure Sore

Callus/Pressure Sore
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BASIC INFORMATION
Etiology and Pathophysiology • Specific tests to rule out hypothyroidism
should be performed in cases with other
Definition • Callus: chronic friction or trauma results in consistent clinical signs.
• Callus: alopecic, thickened plaque of skin skin thickening and folding. Entrapment of
overlying a pressure point hairs and hair follicle rupture (furunculosis) TREATMENT
• Pressure sore: skin erosion or ulceration over lead to inflammation and secondary infec-
a bony prominence tion, causing callus pyoderma. Treatment Overview
• Pressure sore: prolonged recumbency leads • Callus: reduce friction by providing soft
Synonyms to skin pressure necrosis, ulceration, and bedding and using commercially available
• Callus: pressure point granuloma secondary infection. The following grading protective wraps. Callus pyoderma must be
• Pressure sore: decubital ulcer scale is used for pressure sores in people: recognized and treated with topical therapies
○ Grade I: affected area reddened or discol- and often with systemic antibiotics.
Epidemiology ored, softer than surrounding skin • Pressure sore: frequent nursing care, consist-
SPECIES, AGE, SEX ○ Grade II: blister or open wound forms, ing of wound care and position manage-
Any animal can develop a callus; the lesions exposing subcutaneous adipose tissue ment, is required. Treatment of underlying
often worsen with age. Older animals are ○ Grade III: wound deepens, edges under- debilitating disease is important for wound
predisposed to pressure sores due to age-related mined, can involve underlying connective resolution.
skin degeneration and concurrent debilitating tissue
disease. ○ Grade IV: severe wound involving underly- Acute General Treatment
ing muscle, bone, and joint • Callus: application of urea-containing
GENETICS, BREED PREDISPOSITION ointment provides hydration and soften-
Large- and giant-breed dogs, particularly DIAGNOSIS ing of keratin accumulation. Warm water
those with short coats, are prone to callus soaks or compresses with antiseptic (e.g.,
formation. Diagnostic Overview chlorhexidine) are needed if callus pyoderma
Diagnosis of calluses and pressure sores is based is present. Topical antibiotic ointment (e.g.,
RISK FACTORS on history, clinical appearance, and location. over-the-counter bacitracin or prescription
• Housing on rough or hard surfaces Differential diagnoses are for lesions in unusual 2% mupirocin) may be sufficient for super-
without padded bedding is a risk factor for locations, of unexpected severity, or of sudden ficial infection. Systemic antibiotic therapy
calluses. onset. based on culture and sensitivity is indicated
• Disorders of keratinization, either primary for areas of furunculosis.
or secondary to underlying disease (e.g., Differential Diagnosis ○ Surgical laser ablation of furunculosis
hypothyroidism), can promote rapid/severe • Callus has been reported effective for reducing
callus formation. ○ Acral lick granuloma recurrence of callus pyoderma.
• Pressure sores are a concern in debilitated ○ Actinic keratosis • Pressure sore: gentle disinfection (chlorhexi-
animals due to prolonged recumbency and ○ Skin neoplasm dine diluted to 0.05%) and application of
immune compromise. ○ Calcinosis circumscripta a wound ointment to provide a barrier
• Pressure sore against microorganisms should be used for
CONTAGION AND ZOONOSIS ○ Wound basic wound management. A variety of com-
Infectious organisms in callus pyoderma or ○ Ulcerating skin disease (vasculitis, infec- mercial wound dressings could be considered
infected pressure sores can pose a contagion tious, drug eruption, immune-mediated, in severe cases. Systemic antibiotic therapy is
risk to other hospitalized animals. neoplasm) indicated for severe wounds. Soft bedding,
padding around bony areas, frequent bedding
ASSOCIATED DISORDERS Initial Database changes, and frequent body position changes
• Callus: callus pyoderma and furunculosis • Physical examination, including thorough should be instituted in any recumbent large-
• Pressure sore: osteomyelitis or septic arthritis skin examination, is often sufficient for initial breed dog.
diagnosis. ○ Surgical debridement and primary closure
Clinical Presentation • Impression and/or aspiration cytology is may be necessary and should be performed
HISTORY, CHIEF COMPLAINT used to detect callus pyoderma or secondary by a surgeon experienced with wound
• Callus: most calluses are asymptomatic; when infection of pressure sores. management.
they are infected, the owner may notice
licking, chewing, or inflammation. Advanced or Confirmatory Testing Chronic Treatment
• Pressure sore: wound, often related to • Aerobic bacterial culture for callus pyoderma • Regular soaking, disinfection, and application
inability to rise and pressure sores if systemic antibiotic of topical softening agents at least once per
therapy is necessary. Culture of material week can slow the progression of calluses
PHYSICAL EXAM FINDINGS aspirated from furuncles or thickened tissue and reduce episodes of pyoderma. A variety
• Calluses are clinically distinctive, thickened, should be performed rather than surface swab of veterinary skin care products are available
folded plaques of hairless skin over pressure to isolate causal organism instead of surface for calluses.
points, typically on elbows, hocks, lateral flora. • Addition of a low-potency or low-
digits, or sternum. They can occur on other • Histopathology is indicated for lesions in concentration corticosteroid cream (1%
bony prominences subjected to chronic unusual locations or of unexpected severity. hydrocortisone, 0.1% triamcinolone) applied
trauma or friction. • Radiography is indicated to detect osteo- a few times per week can reduce skin
• Pressure sores are open wounds over bony myelitis associated with severe pressure thickness and minimize inflammation due
prominences. sores. to furunculosis.

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