Lip Fold Dermatitis in Dogs (Lip Fold Pyoderma)

Lip fold dermatitis (lip fold pyoderma) is an infection in the deep folds of skin on a dog's lower lip, usually near the lower canine teeth. Saliva, food and warmth get trapped in the fold, and bacteria and yeast overgrow, causing red, moist skin and a strong smell that many owners mistake for bad breath.^1,2,3 It's most common in spaniels, Saint Bernards and other breeds with heavy, droopy lips.^1,4 Most cases improve with daily cleaning and drying of the folds and medicated topical products from your vet; dogs that keep relapsing may need minor surgery to remove the fold.^3,4

Is It Bad Breath or a Lip Fold Infection?

Infected lip folds can produce an odor that seems to come from the mouth but doesn't.⁶ Veterinary dentistry references note that bad breath can come from skin disease around the mouth, not just from the teeth.⁵ To check, gently lift your dog's lower lip near the canine tooth and look into the fold. If the skin is red, wet, greasy or smelly, the fold is a likely source. Dental disease and lip fold infection often happen together, because plaque on the nearby teeth adds bacteria to the fold.⁵ See bad breath in dogs and periodontal disease.

Signs

• A strong, unpleasant smell from the face or lips^1,2
• Red, swollen, moist or raw skin inside the lower lip fold^2,7
• Brown staining or discharge in the fold
• Pawing at the face, rubbing the muzzle on furniture or the floor, or not wanting the face touched⁷

Breeds at Risk

Any dog with a deep lower lip fold can get it. Breeds most often mentioned include Cocker Spaniels, English Springer Spaniels and other spaniels, Saint Bernards, Basset Hounds, Bloodhounds, English Bulldogs and Irish Setters.^1,2,5,4,7

Causes and Contributing Factors

• Moisture and friction: the folds press together and trap warmth, saliva, food and tears, with little airflow.^3,8
• Microbes: the main bacterium is Staphylococcus pseudintermedius, and Malassezia yeast is common, alone or with bacteria.^4,7
• Contributing problems: excess weight, allergies, dental disease, hypothyroidism, Cushing's disease and mites (demodicosis).^3,7

Lip fold pyoderma isn't contagious to people or other dogs in the usual sense, because the bacteria involved normally live on dog skin. See staph infections in dogs.

Diagnosis

• Cytology: your vet presses tape or a swab onto the fold and looks at it under a microscope for bacteria, yeast and inflammatory cells.^3,7
• Culture: done if the infection keeps coming back or oral antibiotics are being considered.^3,8
• Ruling out other causes: such as allergies, mites and immune-mediated disease of the lips; a biopsy is rarely needed.³

Treatment

• Cleaning is the core of treatment. Clean the folds once or twice a day and dry them thoroughly. In new cases, this is often needed twice daily for about two weeks.^1,2,3
• Medicated wipes, gels or shampoos prescribed by your vet, often containing chlorhexidine with an antifungal such as miconazole or ketoconazole, or benzoyl peroxide.^3,4
• Topical antibiotic or anti-inflammatory creams for a short time, if your vet recommends them.^3,4
• Oral antibiotics only when needed: veterinary dermatologists reserve them for severe or deep infections, ideally after a culture. Some general practice sources describe longer oral courses, so follow your own vet's plan.^3,8
• Clipping: keep long hair around the fold short. Don't clip short-coated dogs, because stubble can irritate the fold.⁴
• Use vet-recommended products: human baby wipes may not suit a dog's skin.⁷

Lip Fold Surgery (Cheiloplasty)

When cleaning and medication don't keep the fold healthy, or the infection keeps returning, a vet can surgically remove or reduce the fold. Veterinary dermatologists describe it as the most effective treatment, and without it the problem tends to become chronic.^4,5,3 It's often done at the same time as a dental cleaning. Ask your vet whether your dog is a good candidate.

Daily Prevention

• Wipe the lip folds after meals and drinks, then dry them completely. As VCA notes, keeping the area dry and clean is the most important step.^8,1
• Use stainless steel bowls and wash them between meals.⁷
• Keep your dog at a healthy weight, which makes folds shallower.^2,4
• Manage allergies and dental disease, and brush your dog's teeth.^3,7
• Ask your vet about a maintenance routine with medicated wipes a few times a week if your dog is prone to flare-ups.³

Other skin folds can have the same problem: facial folds in Bulldogs and Pugs, tail folds in screw-tailed breeds, and vulvar folds in some females.^3,4 See skin infections in dogs and how to brush your dog's teeth.

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