These cases are treated similarly as the others, but you may include so-called pulse therapy, which actually is a misnomer.
You may offer antibiotics for long-term treatment by administering antibiotics several days of the week on and the remaining
days of the week off. I also recommend using staphage lysate at 0.5cc subcutaneously twice weekly.
We could nickname this one the itch that won't go away! This condition is indeed very difficult to manage and equally frustrating.
I will not go deep into the immunologic dysfunction of this condition, but it's worth repeating the fact that atopic dogs
have a higher carriage of cocci with stronger adherence factors to epidermal corneocytes. This leads, in part, to recurrent
pyoderma as previously described. They also are pruritic, so self-trauma potentiates pyoderma. These dogs start to manifest
symptoms of pruritus less than 3 years of age (as early as 3-4 months) and can be affected seasonally or non-seasonally. Facial
or pedal involvement is very common, as well as axillary pruritus, perianal pruritus, otic disease and groin involvement.
Some candies prove toxic for dogs
The main issue with atopic dermatitis is itch. Owners complain that this symptom is their biggest concern. Here is our job
to help relieve the dog's pruritus and make everyone happy. I don't believe in long-term corticosteroid administration but
the reality is, many cases respond only to this type of therapy. In mild to moderate cases, I strong advise antihistamine
therapy accompanied by fatty acids given orally. The fatty acids should be comprised of omega-6 and omega-3 fatty acids in
a 5:1 ratio, respectively. This type of therapy should be given for at least three to four weeks to evaluate effectiveness.
I prefer diphenhydramine or hydroxyzine for antihistamine therapy. It is clear that the newer generation antihistamines, such
as loraditine or cetirizine, are ineffective for the management of pruritus.
Topical therapy also can be prescribed with or without the antihistamine/fatty acid treatment and can include oatmeal shampoo
with or without a topical anesthetic, witch hazel sprays, epidermal lipid-replacement therapy and corticosteroid-containing
sprays. Recently, a new topical, low-potency corticosteroid spray has been introduced and appears to be very effective.
Concerns about iatrogenic Cushing's disease (at the site of repeated spraying) warrants close monitoring patients. Comedones
(cream-colored or black), thinning skin and bruising are all warnings that corticosteroid therapy must cease. If oral corticosteroid
therapy is administered for long-term therapy, I advise performing a urinalysis and aerobic culture (do not rely on the lab
for culture, ask for it initially). About 20 percent of cases will have occult urinary tract infection.
Recently, modified cyclosporine has been approved for use in the dog. It has been available for many years for treatment of
human diseases, so veterinary patients have benefited from this drug since 1995. This drug is an immunosuppressant, therefore
careful patient selection and monitoring are in order when prescribing this drug. The drug suppresses non-stimulated T-cells,
so its use in human patients extends to immune-mediated diseases, as well as the prevention of transplantation rejection.
Feline patients have been prescribed this drug for the prevention of kidney transplant rejection as well. The dosage is 5mg/kg/day
for atopic dermatitis and should be given on an empty stomach. It can take one to two weeks to take effect. The most common
side effect is nausea and vomiting which, if mild to moderate, can be treated with famotidine one hour prior to administration.
Given with a full stomach can diminish absorption, so it is advised to administer cyclosporine one hour prior or two hours
after a meal. This drug can be used for short to intermediate lengths of time. The long-term effects (greater than three years)
has not been evaluated. It might be advisable in some cases to monitor kidney and liver functions, as well as cyclosporine
plasma levels due to the unusual occurrence of toxicity at that dosage.