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Managing Atopic dermatitis
N/A
11
Veterinary Medicine
Graduate
03/24/2015

Additional Veterinary Medicine Flashcards

 


 

Cards

Term
Approach to management of Atopic dermatitis
Definition

There are various approaches as Acute and Chronic 

1. control flare factors

2. improve skin barrier function

3. allergen avoidance and allergen specific immunotherapy (ASIT)

4. Anti-inflamm treatment

5. will require lifelong therapy 

Term
1. Control Flare factors
Definition

- infections- ID and treat pyoderma and Malassezia infections 

- parasites- regular flea control 

- stress- 

- environment 

- some diet studies have shown improvement

- Allermyl shampoo or spot on- reduce pruritis- inhibit colonisation by pathogens, Vitamin E/linoleic acid ( antioxidant and antifinflamm, barrier function)

- Dermoscent essential 6- spot on

Term
2. allergen avoidance
Definition

hard to limit

- reduce exposure to house dust mites 

- environmental flea sprays

- allergen specific immunotherapy- admin of gradually increasing amounts of allergens- trial for 12 months

- ciclosporin ( atopica)- highly effective, may take 2-3 weeks( full respsonse may take 4-6 weeks). maintenance once in remission- reduce gradually, every other day to twice weekly. combo therapy can reduce frequency

Term
Ciclosporin adverse effects
Definition

well tolerated by most dogs

transient vomiting- give with food, use gut protectants

no evidence of an association with neoplasia

- might see increased shedding of hair +/- transient alopecia

- and vaccination- inhibits t helper cell function and b cell activation

Term
Topical Glucocorticoids
Definition

- can be hard to apply

- local and systemic adverse effects- iatrogenic hyperadrenocorticism, skin atrophy and ulceration, comedomes, infection and demodicosis

Term
Topical diester glucocorticoids
Definition

- rapidly absorbed

- potent anti inflamm action

- metabolised in dermis- very little active drug reaches the circulation.minimal systemic adverse effects. 

Term
Safer use of glucocorticoids
Definition

daily to remission

- switch to every other day

- decrease to lowest maintenance dose

- seasonal treatment

- Methyl-prednisolone less mineralcorticoid activity

- cats generally need 2X dog dose- might respsond better to dexamethasone 

Term
Oclacitinib ( apoquel)
Definition

evidence for reduction of pruritis for dogs with atopic dermatitis. 

- potent BS immunomodulating agent

- long term safety is not known yet

- treat underlying infections first

- gastrointestinal upsets are the most common Ad E. 

- samples of haem and biochem recommended- 1 mo, 3, then every 6 mo. 

AVOID IN IMMUNOSUPRESSED DOGS

Term
Antihistamines
Definition

variable response

- adjunct with EFAs and glucocorticoids

- might get sedation, GI upsets, Cardiac arrythmias

- fair evidence of medium efficacy for clemastine, chlorpheniramine, hydroxyzine, and oxatomide

Term
2010 AD guidelines for Acute flares
Definition

1. Non irritating baths (allermyl) and topical glucocorticoids ( HCA/Cortavence, 1% Triamcinolone/Genesis)

2. ID and remove causes of flare

3. oral glucocorticoids and antimicrobial therapy when needed 

Term
2010 AD guidelines for chronic AD
Definition

1. ID and avoid flare factors

2. Bath with non irrit. shampoo

3. supplement with EFAs

4. use anti-inflamm ( topical and oral glucocorticoids, oral ciclosporin and topical tacrlimus

5. offer allergen-specific immunotherapy to try to prevent recurrence 

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