P. 433

C. Sousa1
1None - Retired, None, El Dorado Hills, USA
How I Treat ThePruritic Dog
Candace A. Sousa, DVM
Diplomate (Emeritus) ABVP (Canine and Feline Practice); Diplomate American College of Veterinary Dermatology El Dorado Hills, CA, USA
Pruritus in dogs has many causes - sarcoptic mange,  ea allergy dermatitis, atopic dermatitis, Malassezia colonization, etc. It is a hallmark of allergic skin disease. To ensure maximum success and client satisfaction, treatment approaches for allergic dermatitis in dogs must be individualized and  exible, combine several modes of therapy, and be aimed at both the primary disease and at secondary complications. The goal with each patient is to  nd the right combination of therapies to provide management that is effective, affordable, convenient, and produces as few adverse effects as possible.
Treatment of acute or short-term pruritus
Many allergic skin diseases are acute in onset or short term in duration. These are most commonly the diseases that can be treated, cured or prevented and include sarcoptic mange,  ea allergy dermatitis, contact allergy and food allergy (also known as Cutaneous Adverse Food Reactions [CAFR]). Rapid resolution of pruritus
and control of in ammation and dermatitis are the primary goals of treatment. Evidence-based reviews have shown that glucocorticoids and oclacitinib are the only 2 medications which can provide these two factors for success. [See details of these below] Treatment is usually needed for a few days up to 2 weeks while the underlying pruritic condition is treated and brought under control.
From a strictly evidence-based point of view interventions that have little or no bene t in the acute space include antihistamines, fatty acid supplements and calcineurin inhibitors.
Treating chronic pruritic skin diseases
Atopic dermatitis (AD) is the most common chronic allergic skin disease of the dog. The diagnosis is made by ruling out all other common pruritic conditions. The veterinarian and owner must focus on a management plan consisting of therapies that provide safe, effective, long-term control.
• Identi cation and avoidance of  are factors.
If  eas have been a periodic factor, preventive measures should be instituted. Because infections are so commonly implicated in  ares, consideration should be given to reducing skin colonization with frequent use of antiseptic topical products, such as shampoos, sprays or rinses.
• Improvement of skin and coat hygiene and possibly epidermal barrier function. In addition
to bathing – perhaps with an antiseptic product
if infections have been a problem – therapies
aimed at repairing the epidermal barrier should be considered. Only limited evidence for effectiveness of such measures is available, but it appears that the evidence may be mounting. Dietary approaches may be useful; for example, supplementation with fatty acids or barrier-enhancing micronutrients. Topical approaches with spray-on or spot-on products are the subject of considerable investigation and may also be useful in certain cases.
• Long-term reduction of pruritus and lesions with drugs. Drugs that have proven effective for long-term control of pruritus and lesions of AD include oral or topical glucocorticoids; oclacitinib (Apoquel® – Zoetis); topical or oral ciclosporin A (Atopica® – Eli Lilly); and Cytopoint® (Zoetis).
• Implementation of strategies to prevent recurrence of signs. Allergen-speci c immunotherapy remains a possible long-term treatment for canine AD. It is one treatment that
is aimed at actually reversing an important part of the underlying pathogenesis of the disease, has an excellent safety pro le, and is the only treatment that in some cases can result in a virtual cure of the disease.
Interventions that have insuf cient evidence for use
in controlling chronic allergic skin disease include antihistamines, pentoxifylline, misoprostol, nonsteroidal anti-in ammatory drugs, and leukotriene inhibitors. All of these therapies have received only limited study, and the evidence to date is not convincing that these medications are satisfactory long-term solutions.
Fatty acid nutritional supplements containing omega-3 fatty acids ( sh oil,  ax seed oil) such as eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) may help normalize the cutaneous barrier function, have anti-in ammatory effects, and may act as a steroid- sparing agent or synergistically with antihistamines. It may take from 6 to 12 weeks before they are effective. The recommended dose for anti-pruritic effect is 50 mg/kg/day of combined EPA and DHA. Alternatively, a high fatty acid-containing diet may be tried. Fatty acids
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