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====Glucocorticoids====
 
====Glucocorticoids====
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.
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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
 
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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.
Topical treatment directs the steroid to affected skin
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I
and avoids the need for systemic therapy. Topical
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glucocorticoids can be used where inflammation is
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localized to relatively hairless skin, pyotraumatic
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dermatitis (‘hot-spots’) or in the ears and eyes.
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Systemic therapy is necessary with more severe
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or widespread lesions. 0.5-1.0 mg/kg prednisolone
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is given once daily until remission. You can then
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administer the same dose every other day and then
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reduce the dose by 50% every 7-14 days until the
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lowest maintenance dose is established; or,
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gradually wean the alternate day dose off, and
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then establish the lowest every other day
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maintenance dose. The only suitable systemic
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drugs for alternate day dosing are prednisolone
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or methyl-prednisolone, but triamcinolone,
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betamethasone or dexamethasone can be used
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to achieve remission in severe cases. Injectable
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preparations should not be used unless absolutely
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necessary, as it cannot be withdrawn, the dose
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cannot be altered, nor the hypothalamic-pituitaryadrenal
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(HPA) axis allowed to recover.
      
Glucocorticoids will suppress reactions to intradermal
 
Glucocorticoids will suppress reactions to intradermal
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times (Figure 5).
 
times (Figure 5).
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Common acute side-effects
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include polyuria and polydipsia. Other acute sideeffects
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include polyphagia and weight gain
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(which can be managed using a low calorie diet),
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panting and behavioral changes (including
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dullness and, rarely, aggression). The onset of
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iatrogenic hyperadrenocorticism is dose and
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duration dependent, but there is a wide
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variation in tolerance between individuals.
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Immunosuppression and secondary infections
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are quite common with long term treatment.
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Inhibition of cell-mediated immunity can result
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in demodicosis, dermatophytosis and infections
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with intracellular organisms. Immunosuppression
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and alterations in cutaneous barrier function
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commonly result in superficial pyoderma.
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Production of dilute urine is a factor that
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contributes to cystitis.
      
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 dogs<sup>4</sup>. 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 dogs<sup>4</sup>. 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.
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