Page 275 - WSAVA2017
P. 275

Anti-inflammatory treatment
Anti-inflammatory therapy should be initiated early to limit the development of chronic inflammation and other perpetuating factors. The correct diagnosis is important since immunosuppressive treatment may exacerbate demodicosis and bacterial infections. Both systemic and topical therapies are often required.
Systemic anti-inflammatory treatment
Glucocorticoids are frequently used to reduce inflammation associated with pododermatitis, although they will cause adverse effects and patients on long- term therapy need regular monitoring of blood pressure and urinalysis. Prednisolone or methyl-prednisolone at 1-2mg/Kg PO every 24 hours are generally used, but dexamethasone at 0.1-0.25 mg/Kg every 24 hours
can be useful in more severe cases. However, the
longer duration of activity makes it less suitable for long term every other day and dogs should be switched
to prednisolone/methyl-prednisolone or twice weekly therapy as soon as possible. Longer term control usually requires 0.4-1mg/Kg prednisolone every 48 hours (or the equivalent).
Ciclosporin at 5-10 mg/Kg every 24 hours is also beneficial. Long term maintenance requires 1.5-4.5 mg/ Kg every 48 hours. Regular urinalysis is advised.
Oclacitinib is licenced for controlling pruritus in dogs with allergic dermatitis. However, the chronic pedal inflammation in dogs with allergic skin disease does not respond as well to oclacitinib as to glucocorticoids or ciclosporin.
Topical anti-inflammatory treatment
Topical treatment is most commonly used with systemic therapy to improve clinical remission, although it can
be used alone in mild cases and to maintain remission. Once or twice day therapy is used initially, tapering the frequency as the inflammation reduces.
Deep pockets of inflammation and scar tissue limit
the efficacy of topical hydrocortisone aceponate. Nevertheless, it is useful for maintenance once the initial inflammation is controlled. More penetrating steroids such as fluocinolone or betamethasone acid are usually required. However, long term use of these products
can lead to local and systemic adverse effects. 0.1% tacrolimus is also beneficial and well tolerated.
Cytotoxic drugs
Where inflammation cannot be fully controlled
and/or there are concerns over adverse effects, glucocorticoids can be combined with cytotoxic drugs such as azathioprine, chlorambucil, mycophenolate or methotrexate. All of these have the potential to cause bone marrow suppression and other side effects so regular haematology and serum biochemistry are mandatory.
End stage disease and surgery
Surgery may be required in cases refractory to medical treatment. Fusion podoplasty has been used but is associated with post-operative pain, wound dehiscence and infections.
Laser podoplasty offers minimal post-operative pain and a much reduced recovery period (patients usually weight bear immediately after the procedure). A CO2 laser is used to remove all the abnormal tissue and to resurface the foot. Lasers cut, ablate and coagulate tissues, resulting in less haemorrhage, pain and wound dehiscence, and destroy any bacteria, reducing the risk of post-operative infection. Treated tissues take 3-4 weeks to granulate and heal. Post-operative treatment in most cases simply requires daily cleaning and topical antimicrobials. Light bandages with daily changes are advisable for the first 7-10 days, but these are not usually necessary once there is a healthy granulation bed. Boots can be used to protect the foot outdoors until fully healed. Recurrence is less likely following laser podoplasty, as hair follicles, follicular cysts and sinus tracts are ablated and replaced with scar tissue.
An Urban Experience
275
                   











































































   273   274   275   276   277