Patient 2
A 68-year-old woman was walking her dog when the dog saw a cat running across the street. The dog suddenly leaped toward the cat, causing the owner to fall forward as the animal’s momentum was transferred through the leash. The owner fell awkwardly on her side, leading to an extensive abrasion and contusion of the shoulder (Figure 2). The lesion healed well with conservative management, albeit with moderate postinflammatory hypochromia.
Figure 2. Abrasion and contusion of the shoulder from a fall while dog walking.
Patient 3
A 65-year-old woman was walking her dog and they heard a loud noise. The dog started to run forward—likely, startled. The owner did not fall, but the leash, which was wrapped around her hand, exerted enough force to avulse a 5×3-cm piece of skin from the dorsum of the hand (Figure 3). The painful abrasion and concomitant bruise eventually healed with conservative management but left a noticeable hemosiderin stain.
Figure 3. Skin avulsion of the hand from the dog’s leash.
Patient 4
A 66-year-old man was walking a large Rottweiler when the dog lurched toward another dog that was being walked across the street. The owner, taken by surprise by this sudden motion, fell on the concrete sidewalk and was dragged several feet by the dog. This unexpected and off-balance fall caused multiple injuries, including bruises on the upper arm, a large avulsion of epidermal forearm skin (Figure 4), a gouge in the dermis down to fat, and a large abrasion of the contralateral knee. The patient received a tetanus booster and conservative therapy. The affected area healed with an atrophic hypopigmented scar.
Figure 4. Epidermal avulsion and dermal ulceration from a fall while dog walking.
Patient 5
An 82-year-old woman with known atrial fibrillation who was taking chronic anticoagulation medication was walking her dog. For no apparent reason, the dog sped up the pace. The woman lost her balance and fell face first onto the sidewalk. She did not lose consciousness but did develop a large bruise on the forehead with a tender fluctuant nodule in the center (Figure 5).
Figure 5. Ecchymosis and hematoma suggesting neurologic trauma from a fall while dog walking.
The patient presented the next day, requesting drainage of the forehead hematoma. However, a brief review of systems revealed a persistent severe headache and nausea with vomiting since the prior day. She was immediately transported to the nearest ED where complete neurologic workup revealed a moderate-sized subdural hematoma that was treated by trephination. Recovery was uneventful.
Comment
These 5 cases illustrate the notable skin (and neurologic) trauma that can occur due to a dog-walking accident (Table).11-15
Regrettably, obtaining an accurate national estimate of the annual incidence of cutaneous dog-walking injuries is difficult. Researchers who have described the rise in dog walking–associated bone fractures queried the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System database for its numbers.4 This public database generates incidence estimates of activity- or product-related injuries based on data from a nationally representative sample of approximately 100 hospital EDs.16
We queried the same database for the diagnoses avulsion, abrasion or contusion, and laceration.17 These terms were searched in association with pet supplies, including leashes, and patients 65 years and older. This search yielded fewer than 800 total cases from 2008 to 2017, resulting in unreliable estimates for each year.
The National Electronic Injury Surveillance System database no doubt underestimates the true incidence of dog walking–related skin trauma; the great majority of patients with cutaneous injury, as illustrated here, likely never present to the ED, unlike patients with bone fracture. Moreover, data do not capture cases handled by providers outside the ED and self-treated injuries.
In the absence of accurate estimates of cutaneous morbidity related to dog-walking injury, the case reports here are clearly a cautionary tale. Physicians and older adults need to be cognizant of the hazards of this activity. Providers should discuss with older patients the potential risks of dog walking before recommending or condoning this exercise.
The presence of other comorbidities that could hamper a person’s ability to control a leashed dog warrants special consideration. Older prospective dog owners might consider adopting a small, easily manageable breed. These measures can help protect older adults’ fragile skin (and bones) from avoidable minor to potentially life-threatening trauma.