In the first article in this series on atopic dermatitis, Anita Patel explained what the condition is and how it is diagnosed. In this article she explains how atopic dermatitis can be managed in affected dogs and cats. This photo shows redness and hair loss on an atopic dog’s foot due to excessive licking – dogs will exhibit itchiness by licking, rubbing or chewing at the itch as well as by scratching it
Can I cure atopic dermatitis? In one word “No”, but you can manage the condition successfully. Atopic dermatitis in dogs and cats can be compared to asthma in people. Asthma can’t be cured but it can be managed; and just like asthma the management of atopic dermatitis is life-long. It is therefore important to put in place measures that are going to have the least side-effects for your pet in the long term that will provide him/her a good quality of life and that are the most cost effective and affordable for you.
How can I manage the condition? You need to take a multi-step approach to managing atopic dermatitis. These steps include:
Treatment and prevention of infections
Medications to stop the itch
Treatment that modulates the immune system
Nutritional supplements
Topical treatments
Unfortunately some treatments work some of the time but not all the time and so you may need to switch treatments periodically. Some treatments may result in undesirable side effects and so may need modification.
Management options: 1) Treatment and prevention of infections:
Any bacterial (mostly staphylococcal) and/or yeast (Malassezia) infections should be treated at the outset. Antibiotics for bacterial infections need to be administered for 7 – 14 days beyond clinical cure and the duration of treatment is generally determined by the depth of the pyoderma.
Your vet may prescribe a shampoo for your dog
For yeast infections a shampoo containing either 2% chlorhexidine/2% miconazole or one containing 3% chlorhexidine have shown good efficacy and will suffice; however, if the infection is severe your vet may opt to prescribe antifungal tablets. Because there is a tendency for infections to recur it is best to bath your pet once or twice a week on a regular basis, which will keep the microbial load on the skin low and thus help reduce the frequency of infections.
2) Stopping the itch:
Glucocorticoids (steroids) will stop the itch in most cases, but need to be used with caution, especially if used for a long time. In the short term they can increase water intake, increase urination and appetite. Some owners and pets find these side effects distressing. In the long term they can affect almost any organ in the body, therefore, even when well tolerated, they should be used with caution and your pet should be monitored regularly. Topical steroid containing sprays and ointments may be useful for targeted areas but with long term use thinning of the skin, infections and systemic side effects can occur.
Medication may be prescribed by your vet for your atopic pet to stop itchiness or damp-down their over-reacting immune system
Cyclosporin is used to damp-down (modulate) an over-reacting immune system in an atopic pet. One starts with a high dose and then tapers it down to alternate day, or better still twice a week, treatment. The most common side effects with ciclosporin are vomiting and diarrhoea. In some dogs, gingival hyperplasia and papillomas may also occur.
Oclacitinib is another immunomodulating drug which specifically targets the pathway that results in an itch. It is effective and can stop itching rapidly. This is the newest drug on the market and the reported side effects are vomiting and diarrhoea in a small number of cases. It can be used both short term and long term; however, given that this drug has now been on the open market for only a few months (at the time of writing this) it should be used with caution as side effects with prolonged use are not known.
Antihistamines; the response to this group is variable and they are often used in combination with steroids in order to reduce the steroid dose.
3) Immune Modulation:
4) Nutritional support:
5) Topical treatments:
Atopic dermatitis is a lifelong condition that requires life-long management; and often more than one type of treatment will be required. So, when your vet chooses a treatment, it should be efficacious, suitable for your pet with the least side effects, easy for you to administer and affordable. Most of all it/they should improve your pet’s (and your) quality of life.
About Anita Patel
Anita is a Recognised Specialist in Veterinary Dermatology and runs a busy dermatology referral service from 4 clinics in London and the South East of England and lectures both in the UK and abroad. She has over 20 years experience in the subject, with the last 12 years dedicated to small animal dermatology. Before devoting herself full time to veterinary dermatology, Anita had her own 2 clinic, busy small animal practice in Surrey where she was a general practitioner as well as perusing her interest in dermatology.
The Veterinary Expert| Pet Health
The veterinary expert provides information about important conditions of dogs and cats such as arthrits, hip dysplasia, cruciate disease, diabetes, epilepsy and fits.