Treatment of Feline Plasma Cell Pododermatitis Using a CO₂ Laser: A Case Report

Introduction

Feline plasma cell pododermatitis (PCP), also known as “pillow foot,” is an uncommon inflammatory condition characterized by plasmacytic infiltration of the paw pads. Affected cats typically present with soft, swollen, and sometimes ulcerated pads, which may be painful or lead to lameness. While medical therapy—particularly doxycycline or immunomodulatory drugs—is often effective, some cases require surgical intervention when lesions are refractory, ulcerated, or functionally debilitating.

CO₂ laser surgery has emerged as a valuable option for managing chronic or non-responsive cases. Its ability to precisely ablate diseased tissue while providing excellent hemostasis makes it useful for delicate structures such as paw pads. This article reviews the use of CO₂ laser therapy for PCP and presents a case report seen at the Dermvet Skin & Ear Clinic demonstrating its practical application and clinical outcome.

Understanding Plasma Cell Pododermatitis

Etiology and Pathogenesis
The exact cause of PCP remains unclear, but it is suspected to involve:
– Immune dysregulation (possible immune-complex deposition)
– Chronic antigenic stimulation
– Association with FIV in some cats
– Idiopathic inflammatory processes

Histologically, the paw pads show dense infiltration of plasma cells, often with Mott cells, and varying degrees of dermal edema.

Clinical Signs
Common findings include:
– Markedly swollen, soft, “cushiony” paw pads
– Ulcerations or fissures
– Lameness or discomfort
– Purplish discoloration
– Occasionally systemic signs (fever, lethargy)

Traditional Treatment Options

Medical Management
Most cats improve with:
– Doxycycline (anti-inflammatory and immunomodulatory effects)
– Prednisolone in immune-mediated cases
– Cyclosporine for refractory disease

These therapies may require weeks to months of treatment and are not always successful.

Surgical Management
Surgery is considered when:
– Pads are ulcerated and non-healing
– Medical therapy fails
– The cat experiences persistent pain or lameness

CO₂ laser surgery provides advantages over scalpel excision, including reduced bleeding, decreased postoperative swelling, and faster recovery.

CO₂ Laser Treatment: Mechanism and Advantages
CO₂ lasers emit infrared light at 10,600 nm, which is highly absorbed by water in soft tissues. This allows for:
– Precise tissue ablation
– Excellent hemostasis, minimizing intraoperative bleeding
– Reduced postoperative pain and inflammation due to sealed nerve endings
– Sterilization of the tissue surface, lowering risk of infection
– Minimal thermal damage when used appropriately

These benefits make CO₂ lasers particularly well-suited for delicate structures such as digital pads.

 

Case Report – Belle, 3yo DSH 

History

Symptoms appeared at 6 months of age and were confined to the feet. Digital and metacarpal/metatarsal pads were dry and cracking initially and then the metatarsal and metacarpal pads became quite swollen and developed open wounds on the pads, which were then sutured on three separate occasions. The digital pads were never affected by ulceration.  Belle’s sister is also affected to a lesser degree with the same condition.
The condition did appear to respond to depot steroid injections, giving remission of up to 4 months after an injection, but concerned about the long-term risks of steroids, cyclosporin (Atopica liquid) was tried, but it was found very difficult to get this treatment down her orally and was given up on after 4 weeks 4 weeks. Her sister hadn’t responded to Doxycycline and it was almost impossible to get doxycycline tablets down her. Diagnosis of Plasma Cell Pododermatitis had been  confirmed by histopathology, and recent bloods had shown no renal issues and only mildly elevated glucose (stress)   and she was FeLV/FIV negative.  She had had 3 separate surgeries over time to suture split/ulcerated pads.

Physical examination on initial referral revealed:

–  Metatarsal and metacarpal pads were shiny with white striae and mild scale- digital pass unaffected. 
–  Metatarsal and Metacarpal pad tissue feels flabby.
–  One of the pads still has 2mm scab where it had previously opened up
–  No other systemic abnormalities

In view of the difficulty of tableting doxycyline and the reluctance of Belle to take cyclosporin, it was decided to try oral dexamethasone solution twice weekly, which can be fine-tuned much better compared to depot steroid injections.  She did reasonably well on this therapy for over a year.  Although the pads were still a bit flabby and dry on the surface, repeated ulceration and slitting of the pads appeared to be under control.  After several months the treatment was stopped, but the condition started to relapse within a few months, so treatment with twice-weekly oral dexamethasone solution was restarted.   Unfortunately, after another few months of good control, one of the metatarsal pads ulcerated, prolapsing the diseased pad tissue outwards (see photo).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It was decided to try pad excision with the Vetscalpel CO2 laser. Pad excision can be curative, but is difficult to do by traditional sharp steel methods and involves a lot of haemmorhage during the procedure, which can affect post- op healing.

Surgical Procedure
Belle was anesthetized and positioned in lateral recumbency. After aseptic preparation of the paw, the  Vetscalpel CO₂ laser was used to excise prolapsed pad tissue and some  “normal” pad using Superpulse 25W setting  and then the remaining abnormal pad tissue was ablated using the wide ceramic tip on a 20W Continuous setting. The resulting wound was sutured with subcutaneous 1.5metric vicryl rapide and then surface sutured with simple interrupted 2 metric prolene. There was virtually no bleeding through the whole of the procedure. As you can see from the photo, there was only a couple of mm of pad tissue present either side of the suture line.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postoperative Care

Belle was sent home with the foot lightly bandaged and on a short course of antibiotics, She remained on twice-weekly dexamethasone to keep the other pads in remission, and her activity was restricted to indoors until the suture removal that was done 2.5 weeks later (slightly longer than normal, due to the dexamethasone slowing down wound healing).
– Strict bandage changes and limited activity for 10–14 days

Outcome

At 2.5 weeks post-surgery, the sutures were removed and the pad appeared a normal sise again, having “regenerated.”   Belle was walking well on the foot.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discussion
This case demonstrates that CO₂ laser ablation is a practical and effective option for managing feline PCP when medical therapy is insufficient. Benefits observed included:
– Rapid improvement in comfort
– High-quality tissue healing
– Good preservation of pad structure.

The published literature suggests that pad excision can be curative for this condition:-

1. Dias Pereira P, et al. Feline plasma cell pododermatitis: a study of 8 cases. (2003) — Case series; surgical excision produced long-term remission in the cats treated surgically.

Summary: In this study of eight cases, clinical follow-up for over 1 year showed total remission of lesions after glucocorticoid therapy in four cases and total surgical excision in two cases.

2. Brosseau G. Feline plasma cell pododermatitis. Can Vet J. 2022;63(5):545–548. — Clinical review stating surgical excision is an option and reporting surgical cases with good outcomes.

Summary: This recent clinical review discusses management options and notes that surgical removal of large ulcerated masses/pads can be required, with favourable outcomes documented.

3. Banović F. Feline immune-mediated skin disorders: Part 2. (2025) — Review stating “surgical excision of affected footpads is usually curative” (reserved for medically refractory cases).

Summary: Authoritative review of feline immune skin disease that explicitly says pad excision is usually curative and is reserved for cases that do not respond to medical therapy.

4. Guaguère E. FC-23 Feline plasma cell pododermatitis: a retrospective … (conference/abstract 2004) — Large case series / retrospective reporting surgical excision with no relapse for 1–5 years in surgically treated cats.

Summary: Abstract/retrospective material describing ~24 cats treated by surgical excision with no relapse over 1–5 years (useful clinical evidence though not a full peer-reviewed article).

5. Taylor JE, et al. Plasma cell pododermatitis with chronic footpad hemorrhage. JAVMA. 1990;197(3):375–378. — Early case report describing surgical management among other treatments and clinical outcomes.

Summary: Classic case report(s) describing presentation and treatments; surgical removal of severely affected tissue was used in some cases and helped resolve clinical signs.

6. (Clinical resource) Royal Canin Academy — Feline Pododermatitis (clinical overview). — Clinical guidance: medical therapy is first-line; surgery (excision) is described as indicated for severe/ulcerated lesions and reported curative in many cases.

Summary: Veterinary clinical review that summarizes evidence and guidance — useful for practical guidance though not primary peer-reviewed research.