These forums have a slew of topics about GI Stasis, dental concerns, post-op care for spay/neuters, but I haven’t seen much for fungal infections. This is not meant to be diagnostic or used as guidelines for treatment without professional consultation. I am not a veterinarian. Wick has completed his treatment successfully, so see below for some information about one case of symptoms, diagnoses, and treatment of a ringworm fungal infection. 

**UPDATE (12/15/17): Second infection confirmed and treatment resumed. See below for dated items which correspond to the 2nd treatment.

**UPDATE (12/20/17): Treatment needs to be revised. See below for dated items!

**UPDATE (04/12/18): Treatment is coming to a close. Finally.

This will not apply to all rabbits, cases, and treatments:

Context: Due to a history of mild illnesses, Wick gets thoroughly examined by his parents every day. At this time, he was going through antibiotic treatment for a tooth infection, which became active after being irritated by a recent molar grinding.

** In between re-occurrences, Wick was still checked for patches, since we know it can come up again easily.

Symptoms: Wick had fur loss on both sides of his mouth, which was not noticeable until the fur was parted. It was minor. It was monitored for a week before visiting the vet, since it was increasing in size and was developing white to off-white crust at its perimeter.

(12/15/17) Small patches appeared of both corners of the mouth, similar to last time. After 2 days, its growth was apparent.

Veterinary Assessment: Upon seeing the crustiness, Wick’s vet pulled a tuff out and put it under a microscope with a bit of solution added. The root was essentially squiggly and windy, rather than straight, which is a sign of a fungal infection working its way through the fur.

(12/15/17) Rabbit syphilis was quickly ruled out since the area focused on the skin around the mouth, not being lesions in the mouth. Wick may be more sensitive to ringworm than normal rabbits.

Diagnosis: Ringworm fungal infection, caused by environmental spores and thrived because young rabbit skin does not have anti-fungal properties to resist the spores. “Ringworm” describes the visual pattern of a bare-skin circle which expands as the infection moves out further and further, searching for a place to thrive. Fur falls out at each expansion and may grow back in once it passes.

Treatment: (Topical: AM & PM; Antibiotic: PM) >> (04/12/18) Treatment was eventually ramped down to once per day (topical), and once per week (antibiotic).

1a) Nolvasan – topical “soap”, typically used to disinfect skin before surgeries. Apply a small amount to wet gauze, rub together to suds up, gently scrub the affected skin areas (focusing on the perimeter, where the fungal infection is located), wash off with another wet gauze, and dry. Applications for each patch should be done with new materials to avoid cross contamination.
1b) (12/15/17) Nolvasan reinstated for 2nd episode of infection.

2a) Silvadine (silver sulfadiazine) – topical cream, typically used to treat burns. After Nolvasan scrub and dry, use Q-tip to apply cream to the perimeter of each affected region. Use a different Q-tip to prevent cross contamination, and never double-dip into the silvadine container.
2b) (12/20/17) Silvadine re-administered to replace clotrimazole (see below)
2c) (04/12/18) Dry skin no longer an issue, so a permanent discontinuation of silvadine.

3a) Itraconazole – Oral antibiotic. Wick was given a conservative dose as a preventative measure, because although the affected area was small, there were two areas (two sides of face), so this was added to the topical treatment to prevent further infection. The antibiotic will promote better fungal resistance in the long-term as well. Side note: Wick LOVED this medication.
3b) (12/20/17) Itraconazole reinstated to help treat the 2nd episode of infection
3c) (4/12/18) Continued, but window in between doses has grown to now only once a week; same dose.

4) Probiotic Powder – Standard supplement to any antibiotic treatment Wick receives to prevent digestive upset. Given twice a day on a piece of wet romaine.
4a) No longer using since antibiotic is not administered very often, and the effectiveness of probiotic powders have generally been questioned.

5a) (12/15/17) Clotrimazole Solution, 1% – Topical treatment which replaces Silvadine, since Wick doesn’t like it. No known bad reactions or side effects reported with this antifungal solution. Apply onto clean area and leave there. It is a clear liquid I can apply with my finger for ease of use, washing afterwards and never double dipping across patches to avoid contamination.
5b)(12/20/17) Clotrimazole discontinued and replaced with Silvadine. The clotrimazole was irritating Wick. This was a personal call of my own after 2 days following the assigned regimen. Wick’s vet confirmed this is the right choice and to continue with the Silvadine.
5c) (4/12/18) Clotrimazole will be the final treatment, since dry skin hasn’t been an issue now.

7) (12/20/17) Oxbow Multi-Vitamin Supplements – Will be purchasing these and trying these to see if they help prevent future infection.

Treatment Notes: 

• Wick would groom the Silvadine off immediately, followed by excessive collar grooming to compensate for feeling uncomfortable. To compensate, we’d give Wick fresh hay and treats to distract him for at least 10min so the cream could treat the infection before being groomed off by him. Eventually, we discontinued the cream and just stuck with the Nolvasan scrub and itraconazole since the infection markedly reduced and visually undetectable (no crust).
• It is very important to look thoroughly at the region to ensure the topical treatments are covering everything. There were times where a crusty area would spread a tiny bit because it was missed at the previous application.
• When the fungal infection was pretty much eliminated, it was important to only apply treatment where it was still affected. To be cautious, I applied it to the entire area still, but realized the skin patch was growing because the treatment and Wick grooming the treatment was causing fur loss instead of the fungal infection now.

• (12/15/17) It seems the spores for this infection cannot be eliminated from the environment since Wick is free roam and there’s no knowing where the spores have spread. Treatment will continue, but I’m encouraged to look for immune system support supplements to potentially help Wick with his sensitivity to this fungal spore.

• (12/20/17) Clotrimazole was irritating Wick, and the crustiness resulting from the fungal infection did not help. Treatment switched to Silvadine because, although Wick excessively groomed himself, it’s better than the clotrimazole, which made him very uncomfortable. Thankfully, I’ve become very skilled at topical applications and Wick has become very compliant— I am able to apply the Silvadine on just the bald spots, plus the perimeter, without having globs which Wick spreads to other fur areas.

• (4/11/18) Shifted back to clotrimazole, and it has not been irritating his skin anymore. This will most likely be the last treatment course.

End of Treatment: Total treatment lasted two weeks. One week following treatment, the majority of Wick’s fur has grown back in healthy.

(12/20/17) Not yet concluded!

(4/12/18) So close!

— Feel free to ask any questions! See below for some videos and images from Wick’s treatment adventures from Round 1:

Wick’s reactions to the topical treatment:
http://www.instagram.com/p/BbCewzDlYRl/?taken-by=wick_theboogeyman
http://www.instagram.com/p/BbEyNVCFgVR/?taken-by=wick_theboogeyman
http://www.instagram.com/p/BbHi4R2lg2C/?taken-by=wick_theboogeyman

Medication and administration:
http://www.instagram.com/p/BbFWAW0lI4E/?taken-by=wick_theboogeyman
http://www.instagram.com/p/BbHhbVYlZTL/?taken-by=wick_theboogeyman

Appearance during the treatment phase:
http://www.instagram.com/p/BbexBmZl-jP/?taken-by=wick_theboogeyman

http://www.instagram.com/p/BbZpII9lrc3/?taken-by=wick_theboogeyman

Appearance after recovery:
http://www.instagram.com/p/BcD8vcth-ao/?taken-by=wick_theboogeyman