Dear Dr. John,

Our 7-year-old Labrador Retriever has always been healthy except for  persistent growths on his two front feet. None are more than about one centimeter in diameter. We have been working with a veterinary dermatology specialist for between three and four years. The treatment has been of giving our dog Atopica and Ketoconazole. We asked about removing the cysts but were told that recovery could be difficult and prolonged. One kind of cyst seems to periodically come to a head and then rupture and drain until it comes back again. The other kind of cyst or growth looks like a wart. Could there be two different things going on? A friend suggested that we get a second opinion. What do you think?  L.B.

Dear L.B.,

I do not often second guess a specialist that is board certified but, after such a long period of time with no significant improvement, I think it is reasonable to get another opinion. Given the drugs that have been used and the location of the cysts, it seems that your dog is being treated for a likely allergic condition. That may well be going on. Atopica is safe for long term use. However, it sounds as if there are two different things that you are seeing. A periodic draining cyst that comes to a head and then drains is suggestive, to me, of a draining tract of an infection.

The treatment for this should be antibiotics and may also necessitate surgical intervention which may require being lanced or explored. Growths that look like warts might be papillomas which could be viral in origin. These can also be surgically removed and are merely topical. I do not think that surgery for either is difficult enough that might cause prolonged recovery or problems. Then again, I have not seen the situation.

I would consider getting a second opinion and probably consider surgical removal of the cysts or growths as well as the use of antibiotics, possibly for a longer period of time. Good luck.

Dr. John de Jong is President of the World Veterinary Association. He owns and operates the Boston Mobile Veterinary Clinic and can be reached at 781-899-9994.