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 

- 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

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

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

- can be hard to apply

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

- rapidly absorbed

- potent anti inflamm action

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

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 

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

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

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 

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