Treatment Guidelines for Canine Atopic Dermatitis

Treatment Guidelines for Canine Atopic Dermatitis

Thierry Olivry, Raleigh, North Carolina

Pascal Préaaud, Paris, France

Atopic dermatitis (AD) is a common chronic relapsing pruritic skin disease of dogs. In 2010 the International Task Force on Canine Atopic Dermatitis published guidelines recommending a multifaceted approach to the treatment of dogs with AD (Olivry et al, 2010). Treatment recommendations considered two main factors: whether the patient has an acute flare of disease or the AD is chronic, and whether skin lesions are localized or extensive. Not every intervention is suitable for every patient; neither are drugs equally effective for every dog. Pet owner preferences (based on cost and ease of compliance) and quality of life of each patient must always be considered.

Treatment of Acute Flares of Atopic Dermatitis

Identification and Avoidance of Flare Factors

Allergenic Flares

The clinician must consider whether any known cause of flares is present. Such causes can include flea exposure, ingestion of food allergens, and exposure to environmental allergens such as house dust mites, seasonal pollens, and mold spores. These causes should be eliminated or controlled if identified.

Evaluation of Use of Antimicrobial Therapy

Reemergence of bacterial or yeast infections frequently causes flares of disease and is identified based on clinical signs and cytologic examination. Infections are treated with topical or systemic antimicrobial therapy, or both (see Chapters 100 to 103 and 121 and Web Chapter 44).

Improvement of Skin and Coat Hygiene and Care

Bathing with a Nonirritating Shampoo

A complex-sugar, antiseptic, and lipid-containing shampoo (Allermyl, Virbac) helped reduce pruritus in 25% of dogs treated in one study. Currently there is a lack of evidence for a clinical benefit from other shampoos or conditioners that contain ingredients such as oatmeal, pramoxine, antihistamine, lipids, or glucocorticoids (see Chapter 95).

Reduction of Pruritus and Skin Lesions with Pharmacologic Agents

Pruritus in AD may be improved by short-term use of topical or systemic glucocorticoids.

Short-term Treatment with a Topical Glucocorticoid Formulation

There is evidence for high effectiveness of two medium-potency glucocorticoid sprays for treating acute flares of AD: triamcinolone (Genesis, Virbac) and hydrocortisone aceponate (Cortavance, Virbac). Caution is advised with long-term use because adverse effects, such as skin thinning, are likely to occur (see Chapter 95).

Short Course of Oral Glucocorticoids

Oral glucocorticoids are recommended if severe or extensive clinical signs are present or if there is concurrent stenotic otitis externa. Prednisone, prednisolone, or methylprednisolone can be given at antiinflammatory dosages (see Chapter 94) until clinical remission occurs.

Interventions Likely to Be of Little or No Benefit for Treatment of Acute Atopic Dermatitis

There is no conclusive evidence for the effectiveness of oral type 1 antihistamines for the treatment of active AD in dogs. Essential fatty acids, oral cyclosporine, and topical tacrolimus are also unlikely to be of any benefit for acute flares because their mode of action necessitates several weeks of treatment.

Treatment Options for Chronic Canine Atopic Dermatitis

Identification and Avoidance of Flare Factors

Food allergens may be triggers for AD in dogs; thus restriction-provocation dietary trials (i.e., “elimination diets”) must be performed in all dogs with nonseasonal AD (see Chapter 96). Additionally, because dogs with AD are predisposed to developing fleabite hypersensitivity, all dogs with AD must be treated year-round with flea adulticides (see Chapter 97).

Allergen-Specific Intradermal and/or Immunoglobulin E Serologic Tests

Environmental allergens, such as house dust mites, have been shown to cause flares of AD in dogs hypersensitive to these allergens. Performing intradermal testing or immunoglobulin E serologic testing can help to identify hypersensitivity to environmental allergens. These tests are used for immunotherapy formulation (see Chapter 93) and may be of potential benefit in indicating the need for house dust mite allergen reduction or avoidance, although this is largely unproven.

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Jul 18, 2016 | Posted by admin in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off

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