Puppy Strangles (Juvenile Cellulitis)

The proper term for what many people call puppy strangles is actually juvenile cellulitis or juvenile pyoderma.

Sometimes, the disease can also be referred to as Sterile Granulomatous Dermatitis (SGD) and is related to Lymphadenitis.

The name itself is terrifying, but with prompt veterinary intervention, this immune-mediated disease can be resolved and is not known to recur.

Generally, dogs with this condition remain active and in good health unless side effects of treatment present themselves (1, 2).

Although it's quite rare, puppy owners should be aware of this condition, how it presents itself, and what to do if you notice symptoms of strangles in puppies.

What is Juvenile Cellulitis (Puppy Strangles)?

Juvenile cellulitis is a condition that occurs in many mammals, including dogs, and it refers to a bacterial infection of the skin that causes the skin to swell (3, 4).

This can be painful for the dog, particularly when the skin swells to the point of bursting open, which then allows bacteria to infiltrate the wound and cause serious complications.

The bacteria generally causes swelling of the dog's lymph nodes, which can cause difficulty breathing (hence why some call it “puppy strangles”) and lesions that spread to other areas of the dog's body.

Pictures of what puppy strangles on a dog look like (a) 7-week-old English Cocker Spaniel, (b) 10-week-old Australian Shepherd, (c) 7-week-old Golden Retriever.

Causes of Strangles in Puppies

This is an idiopathic condition, meaning that currently, the underlying cause of strangles in puppies has not been identified.

All we know is that a dog's immune system is targeting the dog's skin cells, but the reasons why this is happening are not yet known to scientists.

There have been some reports of dogs developing juvenile cellulitis, possibly as a reaction to certain drugs (5).

Some scholars proposed a potentially hereditary predisposition to canine juvenile cellulitis, but this hasn't been confirmed yet (6, 7).

The Disease Process of Juvenile Cellulitis in Dogs

Juvenile cellulitis is an uncommon autoimmune disease in dogs, and it's not contagious.

In healthy animals, the immune system fights off foreign substances like bacteria in order to keep the body healthy (8, 9, 10).

It does this by creating antibodies that mark the foreign substances. This mark serves as a target so the white blood cells can identify the foreign substances and destroy them.

With autoimmune diseases in dogs, their autoimmune system malfunctions and mistakenly targets cells that are not foreign to the body as cells that should be attacked. In the case of juvenile cellulitis in dogs, the body identifies skin cells for attack (11, 12).

Juvenile cellulitis is thought to be caused by a temporary hiccup in a dog's immune system.

This is not usually the case in autoimmune disorders, and these are usually lifelong conditions that require lifelong treatment or periodic treatment over the course of a lifetime.

Juvenile cellulitis or “puppy strangles” begins very suddenly with generalized swelling of the dog's muzzle, eyelids, lips, and face overall (13, 14).

The rash will then develop pus-filled bumps that can rupture. When these bumps rupture, they will crust over and create a scab. This scabbing can lead to permanent scarring of the dog's face and muzzle.

It is most common for dogs with puppy strangles to develop the rash on their face, but as the rash progresses without treatment, it may also be seen on a dog's abdomen, thorax, vulva, paws, around the anus, and genitals (15).

Dogs with puppy strangles often develop a large swelling in the neck area as a result of the lymph nodes under the jaw swelling due to this infection.

This area will be tender, and any area affected by the puppy strangle disease may also feel warm to the touch (an indication of infection).

As lymph nodes swell, they can swell to the point of rupture. If this happens, the contents will be released and leave openings and tracts in a dog’s skin that ooze.

Which Dogs Are Most Likely to Develop Puppy Strangles?

As its name suggests, this disease most often presents itself in puppies, particularly those between 3 weeks and 8 months old, and more than one puppy in the litter can be affected by this (16, 17).

There have been cases of juvenile cellulitis in young adult dogs, with the oldest known case being in a four-year-old dog, but that is rare (18, 19).

Some breeds may be more susceptible to this disease: Golden Retrievers, Dachshunds, and Gordon Setters.

Symptoms of Strangles in Puppies

Dogs with juvenile cellulitis may also display other symptoms, including:

• Lethargy
• Appetite loss
• Low energy levels
• Skin that’s warm to the touch
• Fever
• Enlarged lymph nodes
• Redness of the skin
• Fur loss in the affected area
• Swelling of the skin
• Joint pain (seen rarely)
• Limping (seen rarely)

The lesions seen as a result of juvenile cellulitis are more painful for your puppy than they are itchy. Itch is more often seen in dogs with mange or mites.

Diagnosing Puppy Strangles

Because this is a rare disease, most veterinarians will not consider puppy strangles as a primary diagnosis until other potential health problems have been ruled out.

This means taking skin scrapings to check for things like mange, which may have a similar presentation. Your vet may also run fungal cultures to rule out ringworm.

If the more common causes of other canine skin problems have been ruled out, skin cytology can give your vet a better look at the surface skin cells, and a skin biopsy can look at the deeper cells. Both cytology and biopsies can be used to diagnose juvenile cellulitis in puppies and adult dogs.

Treatment of Juvenile Cellulitis

In dogs with juvenile cellulitis, treatment requires a full course of steroids like Prednisone or other immunosuppressant drugs like Ciclosporin to suppress the immune system reaction.

It’s important to monitor your dog while they are on steroids because steroids are known to cause side effects and other conditions.

Very rarely, immunosuppressive drugs like Ciclosporin were observed to cause adverse effects like vomiting, diarrhea, anorexia, involuntary shaking, nephropathy, and bone marrow suppression (20).

It’s also common for puppies to be given antibiotics when they have puppy strangles because secondary infections can occur as a result of inflammation and damage to the skin.

Although antibiotics will clear up any secondary infection, they will not resolve the problem alone because they don’t do anything to mediate the dog's immune response (21).

Prognosis for Juvenile Cellulitis

The prognosis for puppies with juvenile cellulitis is good once steroid treatment has been started.

With the full course of steroid treatment, symptoms should resolve within ten days to two weeks. In very rare cases, symptoms may recur once steroid treatment comes to an end. When this happens, a longer course of steroids will be necessary.

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