Changes

In most cases, anti-inflammatory drugs are required in addition to topical treatments and allergen-specific therapy to control residual pruritus and inflammation. The dose and treatment regime should be adapted according to how successful other treatments are, the response to treatment and the presence of allergen in the environment (for example, pollen is present in the summer but not the winter). The aim should be to use the minimum dose that gives effective control of pruritus.

In most cases, anti-inflammatory drugs are required in addition to topical treatments and allergen-specific therapy to control residual pruritus and inflammation. The dose and treatment regime should be adapted according to how successful other treatments are, the response to treatment and the presence of allergen in the environment (for example, pollen is present in the summer but not the winter). The aim should be to use the minimum dose that gives effective control of pruritus.

Cyclosporine is an immunosuppressive drug that acts by suppressing T-cells, as well as mast cells and eosinophils. The doses used in atopy are immuno-modulating, and suppression of these cells impairs antigen presentation, IgE production and the development of inflammatory lesions.⁴. Studies have suggested that cyclosporine is at least as effective as prednisolone for controllin atopic dermatitis⁴, but is better tolerated than the corticosteroid. The most likely side effects are transient anorexia and vomiting, but this can be avoided by administering cyclosporine with food. Uncommonly, hirsutism, alopecia, ginvival hyperplasia, diarrhoea, tremors or erythema of the ears may be seen, but these effects are dose-dependent and reversible⁴. Immunosuppresion is a potential concern, and so patients should be observed closely for opportunistic infections or infestations. Cyclosporine may also affect the efficacy of vaccination, and so some vets choose to treat with corticosteroids around this time instead. The drug minimally affects intradermal and serological allergy testing⁴.

Glucocorticoids the most commonly used anti-inflammatory drugs in veterinary dermatology. Although they are are cheap and efficaceous, they are associated with many undesirable side effects. They should therefore be used with caution in atopic dermatitis. Drugs such as prednisolone or methyl-prednisolone can be used in the initial stages of treatment to break the itch-scratch cycle while animals begin to respond to other forms of control. They may also be used to manage seasonal atopy for a few months of the year. Short courses that gradually taper off can be implemented in flare-ups, or corticosteroids can be used as a very last resort in pets non-responsive to other forms of treatment. Topical steroids may be used where inflammation is localised to small areas of relatively hairless skin, or to control pyotraumatic dermatitis. In most cases, lesions are more widespread and so systemic administration is necessary. A dose should be established that induces remission, and this should be gradually tapered to the minimal effective dose, for example alternate day treatment. "Depot" injections of corticosteroids do not permit this flexibility in dosing, and should not be used. Glucocorticoids will suppress reactions to intradermal allergen tests and allergen-specific serology. However, the drugs are not thought to hamper the efficacy of vaccines.

Glucocorticoids the most commonly used anti-inflammatory drugs in veterinary dermatology. Although they are are cheap and efficaceous, they are associated with many undesirable side effects. They should therefore be used with caution in atopic dermatitis. Drugs such as prednisolone or methyl-prednisolone can be used in the initial stages of treatment to break the itch-scratch cycle while animals begin to respond to other forms of control. They may also be used to manage seasonal atopy for a few months of the year. Short courses that gradually taper off can be implemented in flare-ups, or corticosteroids can be used as a very last resort in pets non-responsive to other forms of treatment. Topical steroids may be used where inflammation is localised to small areas of relatively hairless skin, or to control pyotraumatic dermatitis. In most cases, lesions are more widespread and so systemic administration is necessary. A dose should be established that induces remission, and this should be gradually tapered to the minimal effective dose, for example alternate day treatment. "Depot" injections of corticosteroids do not permit this flexibility in dosing, and should not be used. Glucocorticoids will suppress reactions to intradermal allergen tests and allergen-specific serology. However, the drugs are not thought to hamper the efficacy of vaccines.

Cyclosporine is an immunosuppressive drug that acts by suppressing T-cells, as well as mast cells and eosinophils. The doses used in atopy are immuno-modulating, and suppression of these cells impairs antigen presentation, IgE production and the development of inflammatory lesions³. Studies have suggested that cyclosporine is at least as effective as prednisolone for controllin atopic dermatitis³, but is better tolerated than the corticosteroid. The most likely side effects are transient anorexia and vomiting, but this can be avoided by administering cyclosporine with food. Uncommonly, hirsutism, alopecia, ginvival hyperplasia, diarrhoea, tremors or erythema of the ears may be seen, but these effects are dose-dependent and reversible³. Immunosuppresion is a potential concern, and so patients should be observed closely for opportunistic infections or infestations. Cyclosporine may also affect the efficacy of vaccination, and so some vets choose to treat with corticosteroids around this time instead. The drug minimally affects intradermal and serological allergy testing⁴.

Phytopica is a product containing a selection of Chinese herbs, which has been shown to be an efficaceous, safe and palatable treatment for atopic dermatitis in dogs⁴. However, only a 20-50% improvement in signs is achieved, and so Phytopica is best used in combination with other control strategies and anti-inflammatory drugs.

Phytopica is a product containing a selection of Chinese herbs, which has been shown to be an efficaceous, safe and palatable treatment for atopic dermatitis in dogs³. However, only a 20-50% improvement in signs is achieved, and so Phytopica is best used in combination with other control strategies and anti-inflammatory drugs.

Hydrocortisone aceponate is a topical glucocorticoid that relieves pruritus. The topical administration and the fact that hydrocotisone aceponate is metabolised in the dermis means that many of the traditional side-effects of glucocorticoid therapy are avoided⁴. The product is potent, and rapidly exerts its effects following application. The formulation of the product makes it easy to apply, even to haired skin, and most animals only require every-other-day treatment. Adverse effects are rare, and only one dog has been reported to suffer a contact reaction.

Hydrocortisone aceponate is a topical glucocorticoid that relieves pruritus. The topical administration and the fact that hydrocotisone aceponate is metabolised in the dermis means that many of the traditional side-effects of glucocorticoid therapy are avoided^{1, 3, 4}. The product is potent, and rapidly exerts its effects following application. The formulation of the product makes it easy to apply, even to haired skin, and most animals only require every-other-day treatment. Adverse effects are rare, and only one dog has been reported to suffer a contact reaction.

Antihistamines have some efficacy in the face of atopic dermatitis, and may have synergistic activity with essential fatty acids and glucocorticoids⁴.

Antihistamines have some efficacy in the face of atopic dermatitis, and may have synergistic activity with essential fatty acids and glucocorticoids^{3, 4}.

==Prognosis==

==Prognosis==