Fungal Dermatitis Treatment

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Hello.

I’ve gone to the vet multiple times for my bunny’s fur loss around the mouth and odd scabbing/crusting. First we tried sulfadiazine but she had a bad reaction. Then, oral chloramphenicol for 21 days but no cure. Finally, we tried ANTIMAX ointment which is nystatin-neomycin sulfate-thiostrephon-triamcinolone acetonine ointment. The vet prescribed this for a week, and it worked! He said to do it for another week to make sure it doesn’t come back, so I did. But a week after stopping the ointment, the yellow crusty skin and red scabs are appearing again. I had asked him before if her area where she lives needed to be treated, or if fur around her mouth needed to be clipped since it’s a fungal infection. He said no, just the ointment. I have a vet appointment for tomorrow, and he is most likely going to do penicillin shots because we have exhausted all our other options. But I wonder, does she need the shots or was he wrong in saying her living space doesn’t need to be treated, and that could be what’s causing it to come back?

TLDR: For fungal dermatitis, is just ointment satisfactory or does the bunny’s living space need to be treated, or does their surrounding fur need to be clipped?

Thank you! I am very worried.
 

John Wick

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Was there any discussion of running a test for syphilis? While syphilis mainly shows symptoms around the face and genitalia, there's an increase in cases that only show face symptoms.

My rabbit is one who only showed symptoms at the mouth. Coincidentally, we discovered it after treating some persistent ringworm around his mouth (which traveled characteristically to his neck/shoulder, so we know it was ringworm at one point). Several months later, the crustiness and fur loss was still happening, but I noticed that even when I didn't treat daily, it wouldn't spread as much as it would initially, so I discussed with my vet how these most recent episodes seemed different from past episodes and we did a test for syphilis... ding ding! He had it.

.... PenG is one of the main treatments for syphilis actually. I'm sure there's different types and the course may be different for it, but that's just a fact that may be useful to know.

Syphilis aside, there is some wisdom in cleaning her environment. In some ways though, that can be a lost-cause. I've been told that fungal spores can live on practically any surface for long periods of time, so trying to exterminate it all would be a daring feat -- that being said, it probably wouldn't hurt. Also, most rabbits can combat ringworm on their own; however, those who cannot tend to have an underlying condition that's suppressing or stressing their system (ex. My rabbit had syphilis and was younger in general at the time, so his system couldn't fight ringworm back). It may be worthwhile to do some blood work which can provide indirect evidence for/against syphilis, but also see what else may be happening.
 
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Thank you very much for your reply!

I had mentioned to the vet that there is a form of syphilis that only presents around the mouth, but he said that’s very rare. I didn’t want to push him because I already have a lot to say!

If it were syphilis, do you think that the ointment would help as much as it did, even if the ointment was prescribed for fungal issues?

Either way, it sounds like regardless of treating her living area or not, and regardless of whether it’s fungal or something like syphilis or ringworm, she will probably need penicillin shots since the scabbing come back when stopping the ointment?
 

John Wick

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As I alluded to, the ringworm and syphilis blended together for my rabbit, so I'm unsure. I will say that the syphilis seem to come and go on it's own and the topical treatment did treat the scabbing and help it heal. Scabs are still scabs, so anything that can help them heal, regardless if started by syphilis or a fungal infection, will show improvement.

Penicillin was brought up as a treatment for the syphilis exclusively -- we never discussed it with the fungal infection. For the fungal infection, I would wash the skin and surrounding fur perimeter with a wet qtip, then use a qtip with a little nolvasan soap on it, rinse with another qtip, and then dry. After drying, a qtip of silver sulfadiazine. My rabbit did not have an adverse reaction to it, but he didn't like it, so we did the scrub still but put clotrimazole on it afterwards. Also added oral itraconazole ... then there came the realization that that combo was too drying so I'd alternate the silver sulfadiazine and clotrimazole day to day. Then came a combination of laziness on my part and observation to realize what I was seeing didn't match what I had seen when I started treating him. That started the syphilis track and penicillin.


And clarifying I believe ringworm is a fungal infection!
 

JBun

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Syphilis has to be treated with pen g procaine/benzathine injections. Topical products or any other antibiotics, may initially clear up outward signs of the disease, but it will still be present in the rabbit and will reemerge at a later time.

It's not a different form of syphilis that shows up around the mouth. It's the same type, it can just be unpredictable on where it might show up. If your rabbit has this, it needs to be treated with injectable pen g.
http://www.medirabbit.com/EN/Skin_diseases/Bacterial/Syph_gen.html
http://www.medirabbit.com/EN/Skin_diseases/Bacterial/Syphilis.htm
 
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