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Histologic changes are non-specific but include acanthosis, a mixed mononuclear perivascular dermatitis, sebaceous gland metaplasia and secondary superficial pyoderma<sup>1</sup>.
Histologic changes are non-specific but include acanthosis, a mixed mononuclear perivascular dermatitis, sebaceous gland metaplasia and secondary superficial pyoderma<sup>1</sup>.
== Treatment ==
==Treatment==
===Flare factors===
====Ectoparasites====
Fleas and Neotrombicula frequently complicate
Fleas and Neotrombicula frequently complicate
AD. Atopic dogs can also contract Sarcoptes.
AD. Atopic dogs can also contract Sarcoptes.
pyoderma, however, can benefit from long term
pyoderma, however, can benefit from long term
pulse antibiotic therapy.
pulse antibiotic therapy.
Stress
====Stress====
Stress can exacerbate human inflammatory dermatoses,
Stress can exacerbate human inflammatory dermatoses,
and this may be true in animals. There is
and this may be true in animals. There is
anecdotal evidence that behavioral therapy and
anecdotal evidence that behavioral therapy and
pheromones can help.
pheromones can help.
Environmental effects
====Environmental effects====
Excesses of temperature and humidity, irritant
Excesses of temperature and humidity, irritant
surfaces or cleaning solutions etc. can all worsen
surfaces or cleaning solutions etc. can all worsen
skin diseases. Observant owners will often report
skin diseases. Observant owners will often report
associations.
associations.
Improving skin barrier function
Diet and the skin
===Improving skin barrier function===
====Diet and the skin====
Many atopic animals non-specifically improve
Many atopic animals non-specifically improve
following food trials, probably because high quality,
following food trials, probably because high quality,
Support diets significantly ameliorated clinical
Support diets significantly ameliorated clinical
signs in atopic dogs.
signs in atopic dogs.
Topical therapy
====Topical therapy====
Topical therapy has a number of benefits although
Topical therapy has a number of benefits although
it is time-consuming. Physical removal of allergens
it is time-consuming. Physical removal of allergens
prepared to try different products and/or alternate
prepared to try different products and/or alternate
between antimicrobial and emollient shampoos.
between antimicrobial and emollient shampoos.
Essential fatty acids (EFA)
====Essential fatty acids (EFA)====
Numerous clinical trials and studies have evaluated
Numerous clinical trials and studies have evaluated
EFAs particularly the n-3 EFA eicosapentenoic acid
EFAs particularly the n-3 EFA eicosapentenoic acid
much of this is due to anti-inflammatory activity
much of this is due to anti-inflammatory activity
or cutaneous barrier improvements is unclear (4).
or cutaneous barrier improvements is unclear (4).
Allergen specific therapy
===Allergen specific therapy===
Allergen specific therapy will only be appropriate
Allergen specific therapy will only be appropriate
in animals with identified sensitivities. The aim of
in animals with identified sensitivities. The aim of
allergen testing is to identify allergens for avoidance
allergen testing is to identify allergens for avoidance
and immunotherapy, not to confirm the diagnosis.
and immunotherapy, not to confirm the diagnosis.
Allergen avoidance
====Allergen avoidance====
Allergen avoidance measures can result in a significant
Allergen avoidance measures can result in a significant
reduction in exposure to house dust mite (5).
reduction in exposure to house dust mite (5).
significant improvement is controversial, although
significant improvement is controversial, although
one uncontrolled study demonstrated that allergen
one uncontrolled study demonstrated that allergen
avoidance was beneficial in canine AD (6). Allergen specific immunotherapy (ASIT)
avoidance was beneficial in canine AD (6).
====Allergen specific immunotherapy (ASIT)====
ASIT involves the administration of gradually
ASIT involves the administration of gradually
increasing amounts of allergen by subcutaneous
increasing amounts of allergen by subcutaneous
too high although mild reactions can sometimes be
too high although mild reactions can sometimes be
managed with antihistamines.
managed with antihistamines.
Anti-inflammatory therapy
===Anti-inflammatory therapy===
Anti-inflammatory therapy is used as required
Anti-inflammatory therapy is used as required
to control residual pruritus and inflammation.
to control residual pruritus and inflammation.
and/or potency of drugs can be reduced if other
and/or potency of drugs can be reduced if other
treatments are successful in the long term.
treatments are successful in the long term.
Cyclosporine
====Cyclosporine====
Cyclosporine suppresses T-cells, which have been
Cyclosporine suppresses T-cells, which have been
implicated in the pathogenesis of canine AD.
implicated in the pathogenesis of canine AD.
pros and cons for each individual case should
pros and cons for each individual case should
be discussed with the owner.
be discussed with the owner.
====Phytopica™====
Phytopica™
Phytopica™, a compound derived from Rehmannia
Phytopica™, a compound derived from Rehmannia
glutinosa, Paeonia lactiflora and Glycyrrhiza
glutinosa, Paeonia lactiflora and Glycyrrhiza
safety profile than has been reported for other
safety profile than has been reported for other
anti-inflammatory therapies (16).
anti-inflammatory therapies (16).
Glucocorticoids
====Glucocorticoids====
Corticosteroids, synthesized in the adrenal cortex,
Corticosteroids, synthesized in the adrenal cortex,
have glucocorticoid (anti-inflammatory and
have glucocorticoid (anti-inflammatory and
clinical signs if cyclosporine has to be withdrawn
clinical signs if cyclosporine has to be withdrawn
because of routine vaccination.
because of routine vaccination.
Hydrocortisone aceponate
====Hydrocortisone aceponate====
Hydrocortisone aceponate is a novel topical
Hydrocortisone aceponate is a novel topical
diester glucocorticoid for the treatment of pruritus
diester glucocorticoid for the treatment of pruritus
other day therapy. Twice weekly administration,
other day therapy. Twice weekly administration,
however, resulted in a relapse in most dogs.
however, resulted in a relapse in most dogs.
Antihistamines
====Antihistamines====
A large review of clinical trials (16) concluded
A large review of clinical trials (16) concluded
that there is no more than fair evidence of
that there is no more than fair evidence of
are more common and include gastrointestinal
are more common and include gastrointestinal
tract upsets and cardiac arrhythmias.
tract upsets and cardiac arrhythmias.
==Prognosis==
==Prognosis==