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The diagnostic challenges of canine atopic dermatitis
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Clinicians face a challenge when confronted with a possible case of canine atopic dermatitis; Ana Rostaher reviews the diagnostic options and offers some practical tips.
Ana Rostaher
Vet.Med., Dip. ECVD
Dr. Rostaher graduated from the Slovene veterinary school in 2002 and spent four years working in small animal practice whilst finishing an internship at Vienna’s Veterinary College. She then undertook a dermatology residency in Munich and also completed a research externship on feline hair follicle disorders. She achieved her ECVD Diploma in 2011 and is currently employed at the Vetsuisse Veterinary Faculty as senior clinician. Dr. Rostaher has authored over 100 publications on various aspects of dermatology and was also a committee member of both ESVD and ECVD, having recently served as president of the Slovenian Dermatology Study Group.
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Key points
- The diagnosis of canine atopic dermatitis is problematic, as there is currently no reliable biomarker that can distinguish the disease from other dermatological disorders.
- When faced with a possible atopic dog, the clinician must interpret and consider various aspects, including the patient’s history, characteristic clinical features and exclusion of other differential dermatoses.
- Intradermal testing (IDT) is the preferred diagnostic method among dermatologists to identify canine atopic dermatitis and ascertain the causal allergens.
- Allergen-specific IgE serology offers several advantages over IDT and is often used as an alternative for canine atopic dermatitis diagnosis, but there are also disadvantages, with false positives being a potential risk.
![Diagnostic Options for Canine Atopic Dermatitis Diagnostic Options for Canine Atopic Dermatitis](/sites/default/files/styles/free_dimension/public/images/media/image/vf-312-article-1-figure-3b-eng.jpg?itok=MlqiUKko)
Introduction
Canine atopic dermatitis (CAD) is a common inflammatory skin disease, affecting up to 15% of the global dog population (1). The pathogenesis of the disease is multifactorial, with both skin barrier dysfunction and immunological dysregulation known to have central roles, and both may be influenced by genetic and environmental factors. IgE and non-IgE mediated immunological events are key features in the pathogenesis, with allergens constituting the main triggering factors (2). The most commonly associated laboratory feature in CAD is the allergen-specific serum IgE levels, but (in contrast to humans) elevated total IgE levels do not assist in the diagnosis of CAD. Dogs are reported to have much higher levels of IgE than humans, probably as a result of their more frequent exposure to parasite infestation (3).
There are two major risk factors for atopic dermatitis; breed predisposition (e.g., 50% of West Highland White terriers may be affected) and a familial history of CAD (4). However, since both genetic and environmental factors are involved, the phenotypic manifestation of the disease is highly variable – not only between different breeds, but also among individual dogs of the same breed. Given that CAD is both a complex disease with multiple facets and that other skin conditions may mimic the condition, a definitive clinical diagnosis is considered challenging.
Diagnostic considerations
Because there is currently no reliable biomarker that can distinguish CAD from other dermatological disorders, the diagnosis of CAD remains clinical, and hence the clinician must interpret and consider various aspects, including the patient’s history, characteristic clinical features and exclusion of other differential dermatoses. Figure 1 offers a workflow for the diagnosis of CAD. The first step is to rule out other CAD-mimicking diseases, because although pruritus is the most consistent finding, it is by no means exclusive for CAD, and other differentials should be considered. Ectoparasite infestations or bacterial or yeast infections, secondary to a non-pruritic disorder (e.g., endocrinopathies, sebaceous adenitis), or less frequently neoplastic disease (e.g., cutaneous lymphoma, though more commonly seen in older patients), should be ruled out during the initial workup phase on the basis of the signalment, history or additional targeted tests (Table 1). It is worth noting that one aspect very typical for CAD may be observed at the onset, when pruritus may be alesional or associated with primary skin lesions such as erythema and sometimes papules. With progression over time and additional secondary infections, signs such as pustules, alopecia, excoriations, lichenification, crusting and seborrhea may develop. The face, inner aspect of the pinnae, axillae, abdominal, inguinal and/or perineal areas and distal extremities are typical predilection sites in most dogs with CAD (Figure 2), although the affected body areas may vary with breed 5. [...]
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