Puppy strangles | Dr. Justine Lee, DACVECC, DABT, Board-certified Veterinary Specialist
If your Golden retriever puppy was just diagnosed with “puppy strangles,” here’s what you need to know.
This is a rare disease that affects puppies. It’s also known as:
- juvenile cellulitis
- juvenile pyoderma
- lymphadenitis
- juvenile sterile granulomatous dermatitis.
Puppy strangles is usually observed in dogs < 4 months of age, and can result in severe clinical signs such as (keep reading below for a more complete list):
- fever
- lethargy
- not eating well
- enlarged lymph nodes (e.g., under the neck, near the chin)
- acute swelling of the face
- draining lesions from the facial bumps
- a severe dermatitis
- crusty lesions on the face
- painful pustules (e.g., bumps) on the head region.
The exact cause of puppy strangles is unknown, but it is suspected as being due to an abnormal immune system. As certain infectious causes (e.g., ones that can potentially spread to you and other dogs) can result in similar clinical signs, it’s important to seek immediate veterinary attention to identify what the cause is (e.g., via skin scrapes or skin biopsies, etc.) and to treat it promptly. Other ruleouts that your veterinarian will want to make sure aren’t causing similar lesions include:
- demodectic mange (due to Demodex)
- a skin infection (typically secondary to Staphylococcus spp.)
- fungal infections
- rare skin reactions secondary to drugs.
Puppy strangles is more commonly seen in certain purebred dogs, including golden retrievers, dachshunds, and Gordon setters. While it can also be seen in mixed breed dogs, puppy strangles is suspected as being due to a genetic, inherited association. It typically occurs in young puppies – typically between 3 weeks of age and less than 4 months of age – and is rarely seen in adult dogs.
Clinical signs of puppy strangles include:
• Acute severe swelling of the face, muzzle, eyes, lips, etc.
• Pustules (e.g., bumps) found near the muzzle, eyes, chin, jawline, and inside the ear
• Dermatitis around the head, with secondary draining or oozing from the lesions
• Crusts (which appear like scabs) around the head
• Pain
• Lethargy/listlessness
• Fever
• Inappetance/anorexia
• Painful walking due to a secondary arthritis
• Increased lymph nodes around the neck and face
• Secondary ear infections (due to pustules in the ear)
• Hair loss (which can be permanent)
• Scarring (which can be permanent)
So, how do we veterinarians diagnose it? Typically, the diagnosis is based on the history, breed, clinical signs, and the following 3 tests:
• A deep skin scrape to rule out infectious causes (e.g., demodetic mange)
• A skin biopsy
• A skin biopsy culture
A deep skin scrape can be performed in the exam room and doesn’t require sedation. This is the best way to look for the presence of Demodex mites living in the skin. Treatment for mange is typically with an antihelmintic drug called ivermectin. Treatment with corticosteroids (e.g., prednisone) is contraindicated (meaning it is not appropriate treatment) as it can suppress the immune system and make the mange infestation much worse.
A skin biopsy, which typically needs to be performed under sedation, is generally the best way of diagnosing puppy strangles. With this procedure, a small piece of skin is removed. It’s very quick to perform, and generally takes just a few minutes. Performing a skin biopsy is important, as it is key to rapidly identify the disease so prompt treatment can be initiated (or severe pain, scarring, and hair loss can occur). More importantly, if inappropriate treatment is initiated in some cases, it can make infections worse. (See Treatment below). Skin biopsy results with puppy strangles typically reveal granulomas and pyogranulomas, inflammatory changes to the skin, and possible panniculitis.
A small piece of the skin biopsy should also be submitted for culture, to identify if there is a secondary skin infection. This will help guide if the appropriate antibiotics are used for your puppy.
Sometimes, more advanced diagnostics may be necessary, depending if there are secondary signs of disease (such as a very high fever, etc.). These may include:
• A complete blood count to look for evidence of dehydration or anemia or a severe infection (a life-threateningly low white blood cell count or very elevated white blood cell count)
• A chemistry panel to look for electrolyte changes, a low blood sugar (hypoglycemia), increased liver enzymes, elevated kidney values (due to severe dehydration or underlying kidney failure), or other metabolic problems
So how do you treat it?
Unfortunately, puppy strangles needs to be treated with high dose steroids for several weeks, which is not ideal in puppies. Not only does it make it harder to puppy house train your dog (as he or she will be much more thirsty and urine more while on prednisone), but the prednisone can suppress the immune system… that’s why it’s imperative that infectious causes of skin problems – specifically like demodectic mange – be ruled out, or the prednisone can worsen the mite infection significantly!
NOTE: With prednisone, it cannot be stopped or discontinued acutely, and needs to be slowly tapered. Unfortunately, some side effects of prednisone include excessive thirst, excessive hunger, increased urination, increased panting, and immunosuppression.
Treatment may also include antibiotics for a few weeks, if there’s a secondary bacterial infection occurring in the skin. Sometimes an injection (e.g., Covenia) can be used under the skin, as this lasts about 7 days in dogs. It’s important to note that puppy strangles does not respond to just antibiotics ALONE and needs prednisone.
Sometimes, topical therapy such as oatmeal shampoos or topical leave-on steroids may help alleviate some of the clinical signs. Never apply a topical medical without consulting your veterinarian, as some types can potentially worsen the skin problem.
Thanksfully, the outcome for a dog diagnosed with puppy strangles is fair to good, in that most cases respond well to corticosteroids. Relapses rarely occur with proper diagnosis and treatment. However, severe cosmetic complications (e.g., such as scarring, hair loss, etc.) can occur.
The best way to prevent puppy strangles is by making sure that you buy from a reputable breeder. If your dog was diagnosed with puppy strangles, you should notify the breeder immediately as the breeding pair should not be bred again due to the inherited transmission of this problem. Also, puppies with this disease should not be used for breeding; they should be spayed or neutered once at appropriate age to prevent passing this trait on.
References
1. Rhodes KH. Puppy Strangles (Juvenile Cellulitis). In Blackwell’s Five-Minute Veterinary Consult: Canine & Feline. Eds. Tilley LP, Smith FWK. 2007, 4th ed. Blackwell Publishing, Ames, Iowa. pp. 1158-1159.
Thanks for this – I haven’t seen to many of these so they are not on my radar. It’s nice with a refresher. Thanks!
/Soren
I am considering a golden doodle puppy who has come down with this condition. What should I be aware of before Thai g him home? The breeder caught it right away and the puppy is being treated and I won’t be taking him until he is completely well. If this is an auto immune thing, will he be more suceptible to other conditions through his life?
I don’t think anyone has looked at long term effects, but I would be aware that that patient may have inherited other diseases, as there’s a suspected inherited trait.
So do they now have conclusive studies that puppy strangles is genetic? I have read that they are not sure and it “may” have a genetic component. To err on the side of caution I am having my stud neutered as I am dealing with this right now with three out of six puppies from a litter. But as far as I know there was no history of this on either of their parentage
Great question – they suspect it due to the prevalence in certain breeds (e.g., golden retrievers, etc.), but I don’t think it’s conclusive.
Baloo, our 15-week-old goldendoodle has been diagnosed with a “mild” case of juvenile cellulitis. When he was diagnosed, he had pustules that had started oozing/crusting on his muzzle (around nose, chin, and lips) that seem to hurt when touched, as well as swollen lymph nodes in his neck (about the size of golf balls). He has a reduced appetite and less energy than usual. The first vet we saw put him on amoxicillin-clavulanate and said it was probably “just allergies or acne” (he has been on this for 6 days). The second vet we saw diagnosed it as Puppy Strangles and put him on Metronidazole and Clindamycin in addition to the amoxicillin-clavulanate. He has been taking these for about 4 days now. He has now developed a few pustules on his eyelids which have been goopier than usual. When I called to ask about this new development and asked about if he should start steroids since JC is an autoimmune disease, she said that antibiotics should get rid of the problem and I should “just wait” and maybe try to schedule an appointment with a veterinary dermatologist. This concerned me. Is it true that antibiotics alone can cure puppy strangles? Am I just overreacting? I mean he isn’t suffocating, and he still has energy (not his usual amount but still wants to play). It clear that he is in pain as he doesn’t want me touching his face and he is often trying to scratch his face and shake his head (I think this is because of the ear pustules). I just want my puppy to be healthy again. I would appreciate any advice.
They usually need steroids in addition to an antibiotic, so I would schedule a recheck asap wiht your vet for a possible biopsy of the lymph node or an appointment with a dermatologist (as it typically takes several weeks to get in for an appointment). Good luck and keep us posted!
UPDATE: Baloo saw a veterinary dermatologist who diagnosed him with Juvenile Cellulitis (aka Puppy Strangles). He is now on steroids to help get rid of the issue. Even though it has only been a little over a day, I can already see a difference in our baby dog. We are so happy that he is finally on the road to recovery. Thank you for the reassurance and help!
Yeah! Yes, these need to be treated with steroids – so glad he is doing well and that you got a referral! 🙂
I was a foster for a golden retriever rescue group and fostered a 5 week old golden retriever with a severe case of puppy strangles. The vets all said they had never seen a case this bad. He was on antibiotics for 10 days and steroids for almost four months. He is fine now but has some severe scarring on his face, his mouth and his eyes. He now suffers from arthritis and has already needed surgery on one of his elbows. I have since fallen madly in love with This little nugget and became a foster failure and now a mother to 3 golden retrievers.
Awh – thanks for the update – so glad he is now in your home. 🙂 Sounds like he’s in excellent hands! Unfortunately, Golden retrievers seem to be very predisposed to this!
I was wondering. We breed WPG’s and we have a puppy with puppy strangles. What’s the professional opinion on breeding her?
I would not! There is thought that there is an inherited component as it’s so prevalent in certain breeds. Thank you for being such a responsible breeder!
Hi Brooke,
I also breed WPG’s and had a puppy with puppy strangles. Wondering if one of the pairs bred, are related to yours? Feel free to email
I have a pup that is turning one year old on Friday that was diagnosed at 8 months of age after five months of mis-diagnoses ranging from demodectic mange to simple skin infections. He has developed leg deformities and took two rounds of steroids after being diagnosed. The first round was unsuccessful; symptoms returned within seven days. We completed the second round seven days ago. During his second round, he developed rectal prolapse and had a rectal lesion that was sent for biopsy (polypoid tissue with possible lymphatic obstruction). He has become less playful, increasingly tired, and this weekend I had to rush him back to the vet due to bloody stools. The lesion they biopsied on his rectum has grown. He continues to have rectal bleeding, however, his face, lips, tail, and abdomen have not erupted into any additional lesions. There is an old lesion that has started getting larger, but has not opened yet. I am in touch with his specialist and will likely be seeing that veterinarian within the next few days. My question to you (as I have been unable to find any research extending beyond first round of steroids which magically cures most of these pups)…is what happens when a second round of steroids has failed? Are steroids, limb deformities, and rectal prolapses going to be his life? We have changed his diet to Royal Canin hydrolyzed protein two weeks ago after the prolapse hoping once he was off steroids his symptoms will stay resolved. If you have any information I would greatly appreciate it! Thank you!
UGH – I’m so sorry. When in doubt, always self-refer to a board-certified dermatologist to be safe as it sounds like he needed a biopsy of his skin. Just using Bravecto or Nexgard or these oral flea and tick medications routinely can get rid of demodex with 2 doses also. He definitely should have the steroids weaned DOWN as he should NOT be on these life long! There are a lot of side effects long term wise, so while with puppy strangles he needs the steroids initially, we want it weaned after a few months.
Out of curiosity, what kind of dog do you have? My golden retriever puppy had puppy strangles when he was very young and I don’t know exactly when he was born but I guessed he was born the first week or so in April of 2018. I sometimes wonder if any other puppies in his litter had the same issues. I was his foster mom and only know he came from Mexico. He was on steroids for approximately 4 months and unfortunately he has slightly deformed front legs and had surgery on one of his legs when he was around 6 months of age. Aside from his legs and some severe facial scarring he is a happy and thriving dog. I hope your puppy is doing better.
Hi Vanessa, 9ve been doing some research online, and saw your post from last year. I also have a puppy who hasn’t responded to a first round of steroid treatment. As soon as I taper off the dosage with the vet, his strangles comes back.
Were you able to seek / find a cure for your puppy in the end?
I hope your dog has healed and is well.
Jess
I just adopted a 3 year old lab who had puppy strangles. He was given up by his owner because she didn’t like how he looks. His nose is light colored and part of his muzzle looks scarred. What can I do to help it heal? Or is this typical? He’s not in distress. I can’t find any reference to follow up care. Thank you
Nothing re: the color change or scarring.
I just left my 11 week old Golden puppy at the vet. Dr. suspects Puppy Strangles. My pup has lost weight and energy over the past week. He has sniffles, his eyes have had discharge, his nose and mouth are irritated from the excessive salivation. He’s had diarrhea for about 5 days, but I chalked that up to his shots, deworming, and change in puppy food. His hair suddenly started to come out in small clumps. I am really hoping that this condition can cured soon.
Depending on how many vaccines your dog/puppy had, it could also be distemper (hopefully not). Keep us posted and best of luck!
Kim, How is your pup doing? We are dealing with this in our 4 month old Golden
I adopted a mixed 10 week old puppy almost 2 weeks ago. 5 days after adopting him we noticed some swelling in his glands under his jaw and some swelling around his mouth. It was a Saturday so we took him to the ER vet and he was diagnosed with puppy strangles. 😩 He has been on steroids and antibiotics for 6 days now. His swelling in his neck has gone down tremendously. His face swelling has gone down only some but the pustules around his mouth and eyes seem to be increasing and looks worse than he did 6 days ago, or maybe just working their way through the cycle and it’s one of those “it looks worse before it gets better” things. I had my vet do a follow up yesterday and he said he looks like he’s improving based on the pics I’ve been taking everyday. I know he’s improving and he eats and plays well but his poor muzzle looks so painful. Is there anything I can do for his face to help it heal without scarring or at least soothe it? And is it common for the strangles to “look worse” even though it’s improving?
Our puppy got puppy strangles at 8 weeks old. After two rounds of antibiotics and steroids she has fully recovered. Our baby is now 5 months old. I tried to schedule for her to get spayed but was told since she had puppy strangles before she needed to go to a specialty vet. Anyone else ever heard this before? I want to get her spayed but not if it’s going to cause more issues.
Not typically – if she’s off her steroids completely, she should be ok to spay, but when in doubt, you can always consult with a specialist to be safe. 🙂
My 2 months old lab puppy is diagnosed with puppy strangles I am really worried, how much time will it take for him to heal up? I am really worried.
Does puppy strangles result in long-term immune deficiencies? Is it safe to vaccinate a dog after they have had strangles?
Yes, your dog definitely needs to be vaccinated asap as they are more immunosuppressed and may be at risk for other diseases!
Be careful, my puppy’s strangles was CAUSED by the distempter (DAP) vaccine.
No, this does not cause it at all. Your dog’s strangles are NOT from vaccines.
Dr. Justine Lee
Comment I know it is 4 years since, but thank you for your post. It is so hard to find anyone else noticing the connection between vaccines and strangles, and the very likely reality that strangles are an immune system reaction to the vaccines, not an “idiopathic autoimmune disorder” as every single source that I can find states with such confidence. Certain breeds may be more sensitive to different vaccine components, so yes there could be a hereditary factor, but that’s not the same as being a genetic disease.
A pup in my goldendoodle pups litter had strangles diagnosed. My pup only ever had one pustule on his lip and no other noticable symptoms, so didn’t require treatment. Now I’m wanting to be sure this reaction hasn’t affected him in other ways, but it’s hard to find information about untreated strangles.
My puppy’s strangles (juvenile cellulitis) was caused by her Distempter (DAP – ultra duramune DAP to be exact). She had the DHPP vaccine at 7 weeks with no issues. However, within 1 hour of receiving this other vaccination at 15 weeks, she had a severe allergic reaction. First her nose swelled and developed bumps, I gave her a half Benadryl as soon as I noticed the swelling and called the Vet who basically told me he didn’t believe me as her eyes were starting to swell at her tear troughs and her lids. He refused to see her and said we could give her another half Benadryl and another 6 hours later. Over the course of the next hour it worsened until if finally started to get better. The Vet never called to see how she was doing or anything. I called before her next appointment several weeks later and said I didn’t feel like she should get another booster and that her eyes still had pustules and wanted to know if I should at least give her Benadryl and was told no. At her appointment, the Vet seemed bewildered and started turning her lids inside out and squeezing them. Several days later they blew up like frog eyes. I went to a new Vet who thought she had an infection and prescribed antibiotics but she did not improve. The next week her neck blew up like a pelican and I had to take her to the ER Vet who was able to diagnose her pretty quickly with Strangles. My poor puppy endured 5 weeks of hell because these other Vets were so resistant that the vaccine could do this. They kept saying “a vaccine couldn’t do this after this many weeks”. Meanwhile, there’s tons of literature that the distemper certainly can do this an that the juvenile cellulitis can brew for weeks in your poor pups until it becomes and emergency. My poor baby could have died.
Oh, no! I’m so sorry to hear that. That sounds terrible. That sounds like puppy strangles – please know you can always seen an emergency vet if available in your area. I would have the first vet call to report that vaccine immediately. I’m so sorry you and your dog had to go through that. 🙁 Is she better now?
Comment *I’m so sorry to hear that happened, and that you weren’t taken seriously by the vet. I hope your pup (now a full grown dog!) has recovered fully. I haven’t been able to find any sources that make this link, so if you see this and know of any, please let me know. Thank you!
Can you comment on how long steroid treatment usually lasts? My pup was diagnosed with strangles at about 3 months. He’s responded well to steroid treatment, and has been on prednisone for 1 month now. We tried to taper the dose a week or so ago, but his symptoms quickly returned (swelling on face and lethargy) so we went back to the previous dose. He’s now on 5 mg/day. Just curious what to expect in terms of treatment duration. How discouraged should we be that he still needs meds?
Dear Justine-Lee and fellows
I am the very proud trainer of an amazing little 2 Yr old English Springer bitch. She is super bright, so eager and easy to train.
I am considering having a litter from her in the next year or so however the litter of puppies she is from had one puppy who had puppy strangles. Having read of the hereditary element believed to be part of this
disease would it be ill-advised to breed from her?
With thanks in advance for your time taken.
M.
Will my golden retriever that had a mild case of puppy strangles not live as long of a life due to not having as good of an immune system?? will she struggle her whole life with sickness and such even if she gets all of her vaccinations?
Unlikely. But the first few months require high dose steroids with the goal to wean after that!
I have to leave a comment because it was directly after the vaccine that our little fella came down with puppy strangles. I I feel very strongly that there is a correlation. I just wanted to leave my comment. Thank you so much for sharing everybody it’s very helpful. We just got back from the vet and he’s only 9 weeks old. All other littermates totally healthy. Our little Goldendoodle… Luckily we caught it within just a few days and the vet diagnosed it right off. Trying to comfort him as you all probably know it’s extremely sad to see. Again thank you so much for this conversation and this article.
Hi, I’m looking to buy a Springer puppy but it is on steroids for puppy strangles, would you recommend walking away from it or once it’s cleared up and off the steroids will it be ok and live a normal life?
Hi Justine, Before I get into it, I just want to say thank you for this article. It’s so hard to find information on cellulitis and it has been invaluable.
So we have a gorgeous 1yo mini dachs boy Kevin. He’s the light of our days in COVID times. His litter mate/sister Poppy lives next door. Just before Christmas last year Poppy got the strangles. It took a while to diagnose because of everything being shut over the holiday season. It was a pretty late onset (she’s also 1) and has been quite severe with open sores across her body. The poor sweet thing has been in some pain and needed to be hand fed for some time. She’s on the mend now on steroid treatment but it’s been 3 weeks of heartbreaking awfulness.
Poppy has already been neutered, but Kev hasn’t as we have friends who were interested in using him for stud purposes at some stage (he’s awfully handsome). I’m just wondering what your thoughts are. Even though he didn’t have JC his sis did. Would he likely carry the gene (if it us indeed genetic) to pass on? I don’t want any puppy ever going through what Poppy has gone through so it would very much help us to decide to get him snipped or not.
Thanks again
Tim
I am fostering a cocker/poodle who came to me with a serious case of strangles. She has finished her prednisone and antibiotics and is doing very well. She still has some inflammation around her eyes that make them a bit droopy and runny. She is due for her vaccine booster but the stranglea came on after her first vaccine at 6 weeks of age (puppy mill). How safe is it to give booster?
She definitely needs her complete vaccine series, as she’s not protected at all.
Hello Dr. my husband and I foster for an organization in the Coachella Valley. We’ve had our latest foster for 9 months. She is about a year old now and was diagnosed early one but the first foster parents were not diligent due to some serious medical issues in the family right after they adopted her. She was returned to the rescue. Her vet and now her dermatologist have tried everything, different steroids, antibiotics, creams, shampoos all these 9 months, with very little improvement. We are retired and diligent about all treatment. Once we start tapering from the steroid, she back slides. She’s now on Azapriothine combined with prednisone and Primor….very little improvement. Do you have any suggestions? We are reaching out to everyone in the hopes someone will have a new idea. It’s heartbreaking to see her go thru this. She is the sweetest little thing. Thank you, Diane Medley
I’m so sorry – that sucks. I’m glad you are seeing a board-certified dermatologist. When in doubt, steroids longer. I’m assuming all other diseases have been ruled out – it is worth making an appointment with a board-certified veterinary INTERNAL MEDICINE doctor to be safe (DACVIM) to make sure appropriate titers, biopsies, etc. are done and it’s not a weird fungal infection, etc.
Best of luck and keep us posted!
Dr. Lee
Comment *I am a breeder and have one of my pups at 5.5 weeks old that came down with strangled in 2 days. It started with what looked like an ingrown hair bump on his eye lid that he had for maybe 4 days. I warm compresses it and it seemed to get s little better. I took him to the vet however when a second puppy also started to have an ingrown hair looking type lump on his eye lid and they gave me neomycin ointment to put on outside eye lids and continue hot compress. I now have the other male pup with a similar eye bump on his lid but no other pustules on his muzzle and no other symptoms. I had to take the more seriously sick pup to the emergency vets over the weekend two days after seeing our
Regular vet. The ER vets gave me pred and the diagnosis of strangles without doing any tests but he fits every single symptom including severely swollen mandibular lymph nodes
I have let the studs owners know but am I correct in thinking that if I were to keep a female from this litter with the idea that I’d breed her in 2 years after all her genetic screens , OFA, cardiology and ophthalmologist clearances that she potentially could throw a puppy of her own litter that also had strangles? I don’t want to keep a female back if she’s going to have a genetic disposition to this what sounds like an inherent auto immune disease. Even though my females aren’t affected with this strangles and right now it’s currently one male would all the puppies have the potential to pass this on? I’ll be heartbroken if I can’t keep a female back for my program but I also will do the right thing. Is there a genetic screen that can be done for puppy strangles on the parents genes? Is this something I could have found out before the litter was even born had I tested the parents for this specific problem ? It’s not included in UCDavis genetic panels for Labradors but if there’s a test I would start requiring it on all studs I use as well as my females.
Thank you for being such a responsible breeder! I wish I had better advice, but there seems to be a dearth of info about this in the vet world when it comes to genetic testing. I would recommend consulting with a board-certified theriogenologist in your area to see if they may be able to better advise you?
Best of luck and please keep us posted!
Comment *Hi my daughter just got a Daniff about a week ago. He was 6 weeks old when they went and picked him up from the breeder. He is now 7 weeks old and she noticed around the lymph node area being swollen. She contacted a veterinarian where she ended up taking him to for his puppy wellness check and found out he has Puppy Strangles. They put him on a steroid right away and she goes back in 2 weeks for a follow up. He is so precious and full of energy. We all have fallen in love with him.