Urine scald & skin infections

Question
A 9 y.o. female bunny at a local resuce is e.c. positive, blind, & incontinent.  She is able to groom but has a severe skin infection secondary to the incontinence.  Part of the infection presents like a yeast infection (in folds of skin & on the tail) -- waxy/greasy, whitish buildup.  We have shaved and bathed the area & applied a topical antibiotic (one of the 3-way w/out pain killer). Not culture yet as we only discovered the extent of the problem yesterday.  

After talking to a friend w/cancer who has recently undergone treatment for a mucosal yeast infection, I am wondering if some sort of anti-yeast protocol, either topical or systemic, might help.  Specifically, such drugs as Itraconazole, Miconazole, or Nystatin.  I know Itraconazole has been used in rabbits for other conditions, per FHB, but can find no mention of yeast infection treatments.

I will also talk to our rabbit-savvy vet on Tuesday, but would appreciate your take on this.  I fear we may lose this rabbit soon to her compromised skin.

Thanks in advance.  Kate Hays  

Answer
Dear Kate,

Poor bunny!  She sounds like a mess.  Thank you for taking such good care of her.

If she has a yeast infection, it is--as you say--secondary to the soaking with urine. So the very best way to cure it is to keep the affected areas dry and clean.  The whitish buildup you see may be nothing more than dead skin and maybe some yeast population.  But I, personally, would avoid using any mycostatic drugs--*especially* systemic--on such a compromised bunny.  Because she might groom off ointment or cream, I would advise against using those, either.

The yeast are not the primary problem, and once you get the skin clean and dry, any yeast problem will resolve along with that.

Instead of using mycostatic drugs, simply rinse the areas well with dilute, lukewarm betadine solution (three parts water to one part betadine).  This will not only disinfect, but help keep the skin dry.  DO NOT use hydrogen peroxide.  Although this may help debride necrotic skin, it will burn like crazy if the skin is as raw as you suggest.  Betadine will work much better, and it doesn't sting.

Gentle blowdrying on low will help thoroughly dry the skin, which is key to keeping yeast at bay.  We use baby cornstarch (NOT talcum!  But the bottles are right next to each other in the baby section) to keep the skin dry and smooth, and it helps absorb extra moisture.

Contant vigilance against urine burn are key.  If the problem is being caused by the E. cuniculi, then it *might* help to put her on fenbendazole (Panacur) as per the protocol here:

www.bio.miami.edu/hare/fenbendazole.pdf

Proper bedding will also help keep her dry, if she is not very mobile. The thick fleece bedding at www.palacepet.com is idea.  We have two bunnies who can no longer walk, but they are clean, dry, and free of bedsores because of PalacePet!  We love 'em!

I hope this helps.  Good luck with this bunny, and bless you for taking care of her in her golden years. I am sure she will do well with your tender care.

Dana