The multimodal approach to atopic dermatitis in dogs, is an important principle to keep in mind when managing an atopic dog. It underscores the fact that for many atopic dogs there is not just one medication/treatment that is going to be the magic potion to take away their itchiness.
If you find that one medication is not working to completely lower the itchiness, then consider adding on something else...
Therapies to keep in mind:
I can't say enough how important medicated baths are in managing atopic pets. Baths remove pollens/allergens, remove/treat infections, repair the skin barrier and soothes the skin (therefore decreasing pruritus).
Seriously consider immunotherapy. This is one of the best long term management plans for an atopic pet. It gives a chance to change how their immune system reacts to the allergens.
Essential fatty acids (EFAs). EFAs by themselves are not enough to completely reduce pruritus. In combination with other therapies may help with improving the skin barrier and reduce pruritus thru its antiinflammatory effects. Whether you do this topical, oral or in diet --> try it!
Some clients ask about antihistamines. These agents like EFAs by themselves are not strong enough to reduce pruritus. They may help mild atopics. But for moderate to severe atopics, I dont think you will find they will work well (other than maybe sedating the pet). Think about it, it is only working on histamine, and we know there are a bunch of other cytokines that contribute to pruritus. I dont find much harm in using them if the client asks. Therefore, something to consider in conjunction with other therapies.
Some other thoughts when managing an atopic dog….
* Make sure to treat infections on the skin properly --> these contribute to pruritus. Use your antimicrobials! Proper dose/proper length of time.
* We run to Apoquel or Cytopoint, nowadays to relieve pruritus. Yes, these work great, but dont forget Atopica is still another good choice should Apoquel or Cytopoint fail
Share your experiences with managing an atopic pet in general practice.
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