Management of Atopic Dermatitis

It is important to note that atopic dermatitis is an incurable disease and clients must be informed of this at the outset so that they don’t have unrealistic expectations. Treatment is therefore lifelong and based on management rather than cure. This makes it especially important that other potential skin problems have been ruled out, or controlled, prior to starting therapy. The treatment of atopic dermatitis may involve the following modalities: allergen avoidance, allergen-specific immunotherapy, glucocorticoids, cyclosporine, antihistamines, essential fatty acids, Chinese herbs, topical therapy, and control of secondary skin and ear infections. In a typical case, up to three of the above treatments may be needed at the same time, especially if an attempt is made to avoid, or minimise the use of, glucocorticoids. Very severe cases may require four or five treatments, all given concurrently. The clinician’s job is to find the right combination of treatments that control the clinical signs without inducing severe adverse effects, all at an appropriate cost for the owner.

The dog will only be perceived to have got better by the owner if long term maintenance treatment is prescribed that provides continuous control, rather than intermittent “stop-start” therapy prescribed at multiple visits. However, the treatment options for atopic dermatitis are not universally effective and if a case is not responding, it is necessary to try other options until adequate control is achieved. Common causes of a poor outcome are misdiagnosis, failure to control secondary infections before assessing the efficacy of anti-pruritic drugs, and instituting immunotherapy on the basis of a serum based allergy test without undertaking a full diagnostic and therapeutic evaluation of the case. Flare-ups in a previously well-controlled case should be carefully evaluated because they may be due to another skin disease rather than worsening of the atopic dermatitis.

Treatment options

Allergen avoidance would be the ideal method of controlling atopic dermatitis but, in reality, it is difficult to achieve. Attempts to control dust mite populations or avoid pollens rarely have significant effects.

Allergen-specific immunotherapy can only be undertaken if the dog has previously had an allergy test. Immunotherapy is beneficial in 50 – 75% of cases but it takes 2 - 9 months to take effect. During the early stages, it is often necessary to use concurrent symptomatic therapy to control the clinical signs. The risk of adverse effects is very low and serious complications such as anaphylaxis are extremely rare. [...]