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Canine

Atopic Dermatitis, Canine

Summary

  • An inflammatory, pruritic, chronic, relapsing, and non-contagious disease involving immunoglobulin E (IgE) antibody reactions to various allergens
  • Hypersensitivity occurs to common substances, such as pollens, dust mites, feathers, molds, insects, and other environmental allergens
  • A complex, multifactorial skin disease with a genetic predisposition
  • Clinical signs can be highly variable; otitis externa may be noted
  • Skin lesions may be localized or appear more extensively involving the feet, ears, lip folds, axilla, or inguinal regions
  • Initial signs are often noted between 1 and 3 years of age
  • May occur seasonally, related to environmental factors such as temperature and humidity; these factors also affect severity and duration of clinical signs
  • Severity worsens with age (e.g., symptoms may progress from seasonal to year-round)
  • Estimated prevalence is 3% to 15%
  • Diagnosis is based on a combination of history, clinical signs, physical exam, exclusion of other potential diagnoses, and supportive testing (Intradermal allergen testing or allergen-specific IgE serological testing)
  • Treatment approaches vary for acute versus chronic disease
  • Successful management may be anticipated in the majority of cases; not life-threatening

Causes and Risk Factors

Causes

  • A heritable disease
  • Pollens, such as trees, weeds, and grass
  • Indoor and outdoor mold spores
  • Yeast (Malassezia pachydermatis)
  • Animal dander
  • Dust mites
  • Cytokine dysregulation

Risk Factors

  • Temperate regions with longer allergy seasons, high levels of pollen, and high levels of mold spores
  • Coexisting conditions, such as food allergy or flea allergy dermatitis
  • Psychological factors
  • Anatomical issues (e.g., stenotic ear canals, excessive skin folds)

Signalment

  • Mean age of onset is 1 to 3 years; most show first clinical signs by 3 years of age
  • Predilection noted in the following breeds: Labrador Retriever, Golden Retriever, Soft-Coated Wheaten Terrier, West Highland White Terrier, Jack Russell Terrier, Bulldog, Boston Terrier, Boxer, Pit Bull Terrier, Shar-Pei, Shih Tzu, and Weimaraner
  • No sex predilection

Differential Diagnosis

Diagnosis and Screening

General Points

  • Diagnosis is based on a combination of history, clinical signs, physical exam, exclusion of other potential diagnoses, and supportive testing (Intradermal allergen testing or allergen-specific IgE serological testing)
  • Use of any approach in isolation may lead to misdiagnosis

Signs and History

  • Pruritus, initially without lesions and often symmetrical; typically involves the feet (interdigital), ears, face (lips, chin, muzzle, and periocular areas)
  • Self-induced cutaneous trauma from scratching, itching, and licking leads to hair loss and observable cutaneous signs
  • Progressively worsens over time
  • May initially appear seasonally
  • May present with history of recurring skin or ear infections
  • There may be a familial history
  • Criteria for diagnosis of atopic dermatitis: Chronic disease
    • Diagnostic criteria for atopic dermatitis have sensitivity and specificity of approximately 80% when five criteria are met; similar diseases in differential diagnosis must also be ruled out
      • Age at onset < 3 years
      • Mostly indoor living
      • Corticosteroid-responsive pruritus
      • Chronic or recurrent yeast infections
      • Affected front feet
      • Affected ear pinnae
      • Non-affected ear margins
      • Non-affected dorsolumbar area

  • Criteria for diagnosis of atopic dermatitis: Recent development of clinical signs
    • Diagnostic criteria for atopic dermatitis have sensitivity and specificity of approximately 80% when five criteria are met; similar diseases in differential diagnosis must also be ruled out
      • Age at onset < 3 years
      • Mostly indoor living
      • Pruritus sine materia at onset (pruritus with no lesions)
      • Affected front feet
      • Affected ear pinnae
      • Non-affected ear margins
      • Non-affected dorsolumbar area

Physical Exam

  • Lesions may include:
    • Broken hairs
    • Salivary discoloration/ staining
    • Hyperpigmentation
    • Erythema
    • Crusts
    • Alopecia
    • Papules
    • Lichenification
    • Seborrhea; dry or oily
    • Hyperhidrosis
  • Cutaneous lesions most frequently appear in carpal and tarsal areas, interdigital spaces, ear pinnae, periocular area, muzzle, axillae, groin/genitalia, and abdomen
  • Otitis externa
  • Conjunctivitis
  • Secondary bacterial skin infections
  • Secondary yeast skin infections
  • Acral lick dermatitis
  • Pruritus ani

Laboratory Tests

  • Complete blood count with differential
    • Eosinophilia is rare unless there is a flea infestation

  • Allergen-specific IgE serological tests
    • Presence and quantity of allergen-specific IgE may indicate allergy; should be interpreted in light of clinical findings and when other causes of pruritus have been eliminated
    • May allow identification of appropriate allergens for immunotherapy and allergen avoidance
    • Limited number of allergens can be tested
    • False-positive and false-negative tests are possible
    • Should only be ordered if there is strong clinical evidence for allergy, and after all other possible diagnoses have been ruled out
    • Should not be used as a screening test in animals presenting with pruritus

Other Diagnostic Tests

  • Intradermal allergen testing
    • Involves intradermal injection of small amounts of allergens, with evaluation and measurement of wheal formation
    • May allow identification of appropriate allergens for immunotherapy and allergen avoidance
    • False-positive and false-negative tests are possible
    • Should only be ordered if there is strong clinical evidence for allergy, and after all other possible diagnoses have been ruled out
    • Should not be used as a screening test in animals presenting with pruritus
    • Some anti-allergic drugs should be withdrawn prior to testing:
      • Antihistamines: 10 to 14 days before test
      • Oral glucocorticoids: 4 weeks before test
      • Topical/otic glucocorticoids: 14 days before test
      • Injectable glucocorticoids: 4 to 6 weeks; longer if depot formulations are used
      • Cyclosporine and oclacitinib do not require withdrawal times

  • Skin biopsy for histopathologic analysis
    • May be useful in ruling out other conditions in the differential diagnosis; concurrent skin infections should be treated prior to biopsy
    • Typically, results will not provide a definitive diagnosis of atopic dermatitis; histopathology may support a diagnosis of allergic dermatitis but will not differentiate among allergic etiologies
    • Should not be used as a screening test in animals presenting with pruritus

Prevention

General Points

  • Once causative allergens have been identified through allergy testing (serological and/or intradermal), owners should attempt to avoid or reduce those exposures for their pet
  • Other causes of pruritus should also be avoided or reduced, such as food allergies and flea infestations

Surgical Interventions

  • Dogs with stenotic ear canals or excessive skin folds may benefit from surgical intervention

Treatment

General Points

  • Acute exacerbations or flares
    • Eliminate or reduce exposure to allergenic flare factors, such as food allergens and environmental allergens
    • Treat bacterial or yeast infections
    • Encourage bathing with a non-irritating shampoo
    • Treat with a topical corticosteroid formulation (short-term) or with anti-IL 31 monoclonal antibody therapy to alleviate pruritus
    • Treat severe pruritus with a short course of systemic corticosteroids; also consider for patients with stenotic otitis externa
    • Alternatively, treat severe pruritus with a short course of oclacitinib; however, this is ineffective at reducing inflammation associated with otitis externa and should not be combined with corticosteroids in this setting
    • Oral type 1 antihistamines might offer a small, limited benefit in some dogs, likely with mild disease; should preferably be given before a flare occurs
    • Unlikely to be of benefit for acute flares: essential fatty acids, cyclosporine, topical tacrolimus

  • Chronic disease
    • Eliminate or reduce exposure to allergenic flare factors, such as food allergens and environmental allergens
    • Allergen-specific immunotherapy is a preferred treatment, due to potential for lifelong benefits
    • Treat localized pruritus with topical corticosteroids or tacrolimus
    • Use anti-IL 31 monoclonal antibody therapy, oclacitinib, or cyclosporine for control of non-localized pruritus
    • Systemic corticosteroids are recommended for treatment of chronic disease, particularly non-localized disease, when flare factors have been eliminated, and non-steroidal therapies are ineffective
    • Oral type 1 antihistamines might offer a modest, variable benefit in some dogs; should preferably be given before a flare occurs
    • Restriction-provocation dietary trials (elimination diets) should be performed in any dogs with non-seasonal allergic dermatitis
    • Diet supplementation with essential fatty acids may improve coat quality and gloss
    • Weekly baths in lukewarm water, with nonirritating, antipruritic shampoos may provide relief
    • Dogs with this condition should be treated with flea adulticides, year-round, for prevention of pruritic flares and to avoid development of fleabite hypersensitivity

Medications

  • Acute management of atopic dermatitis
    • Topical corticosteroids
      • Triamcinolone acetonide 0.015% spray, apply to affected areas 1 to 2 times each day until pruritus controlled, OR
      • Hydrocortisone aceponate 0.0584% solution, apply to affected areas 1 to 2 times each day until pruritus controlled; not available in the United States
      • Tailor frequency and duration of application based on severity of clinical signs
      • Avoid long-term use due to adverse effects such as skin thinning (cutaneous atrophy), comedones, and superficial follicular cysts

    • Anti-IL 31 monoclonal antibody therapy
      • Lokivetmab (Cytopoint™) 2 mg/kg SC (minimum dose) every 4 to 8 weeks
      • Available in 4 concentrations; round up to the nearest strength and draw entire vial contents into a syringe to administer as a single injection
      • Can be considered in lieu of corticosteroids to alleviate pruritus
      • Can be used in conjunction with other therapies including corticosteroids, antihistamines, cyclosporine, or oclacitinib
      • Injection site reactions and lethargy are possible side effects; long-term studies are lacking

    • Oclacitinib
      • Oclacitinib (Apoquel ®) 0.4 to 0.6 mg/kg PO (with or without food) twice daily for 14 days, then once daily
      • Approved for the treatment of atopic dermatitis in dogs
      • Not approved for use in dogs less than 12 months of age
      • Level 1 and Level 3 studies have found oclacitinib to be a safe and effective alternative therapy for dogs with atopy; long-term safety and efficacy studies are lacking

    • Oral corticosteroids
      • Prednisone, OR prednisolone, OR methylprednisolone tablets, 0.5 to 1 mg/kg IM or PO daily (0.25 to 0.5 mg/kg PO for methylprednisolone), in one or divided into two doses initially; then taper to 0.3 to 0.5 mg/kg every 48 hours
      • Trimeprazine tartrate with prednisolone (Temaril-P®), One-half tablet for dogs weighing less than 4.5 kg; one tablet for dogs weighing 5 to 9 kg; two tablets for dogs weighing 10 to 18 kg; and three tablets for dogs weighing more than 20 kg. All doses start with every 12 hours, and eventually taper to once daily and once every other day
        • Once clinical signs are controlled, taper to lowest dose and frequency of administration that allows control of signs, good quality of life, and minimal side effects
      • If rapid improvement does not occur within the first few days, or in cases of very severe signs, a longer course may be needed; use lowest dose and frequency of administration that provides control
      • Do not use if concurrent widespread bacterial infections present

    • Antimicrobial therapy
      • Underlying skin or ear infections (bacterial or yeast) should be identified and treated appropriately
      • A combination of skin and/or ear cytology and culture can be used to identify pathogens
      • Use of topical therapies may be sufficient; however, systemic agents may be needed based on severity

  • Chronic management of atopic dermatitis
    • Allergen-specific immunotherapy (ASIT)
      • A preferred treatment, due to potential for lifelong benefits
      • Sublingual and injectable options available
      • Treatment schedule is dependent on manufacturer; procedures and protocols are not standardized
      • May be used in combination with anti-IL 31 monoclonal antibody therapy, oclacitinib, cyclosporine or anti-inflammatory doses of glucocorticoid therapy
      • Frequency of therapy is gradually tapered with clinical response
      • Injections involve 1 mL syringes and fine-gauge needles
      • With instruction, pet owners should be able to give the injections at home
      • Choice of allergens to include depends on results of allergy testing and patient history
      • Response may require 3 months to 1 year for full effect
      • If no improvement occurs after 1 year of therapy, treatment should be stopped
      • If effective, treatment should continue for at least 2 to 3 years. Some patients may experience long-term benefits after treatment is stopped; others may require lifelong maintenance therapy

    • Anti-IL 31 monoclonal antibody therapy
      • Lokivetmab (Cytopoint™) 2 mg/kg SC (minimum dose) every 4 to 8 weeks
        • One study (Level 2) suggested a dose of 1 mg/kg SC every 4 weeks is also effective
      • Available in 4 concentrations; round up to the nearest strength and draw entire vial contents into a syringe to administer as a single injection
      • Can be considered in lieu of corticosteroids to alleviate pruritus
      • Can be used in conjunction with other therapies including corticosteroids, antihistamines, cyclosporine, or oclacitinib
      • Injection site reactions and lethargy are possible side effects; long-term studies are lacking

    • Oclacitinib
      • Oclacitinib (Apoquel ®) 0.4 to 0.6 mg/kg PO (with or without food) twice daily for 14 days, then once daily
      • Approved for the treatment of atopic dermatitis in dogs
      • Not approved for use in dogs less than 12 months of age
      • Can be combined with ASIT therapy
      • Level 1 and Level 3 studies have found oclacitinib to be a safe and effective alternative therapy for dogs with atopy; long-term safety and efficacy studies are lacking

    • Topical corticosteroids
      • Triamcinolone acetonide 0.015% spray, apply to affected areas 2 times each day until pruritus controlled, then taper dose, OR
      • Hydrocortisone aceponate 0.0584% solution, apply to affected areas 1 time each day until pruritus controlled, then taper dose; not available in the United States
      • Tailor frequency and duration of application based on severity of clinical signs
      • Best suited for focal or multifocal lesions and for short durations (< 2 months)
      • Avoid long-term use due to adverse effects such as skin thinning (cutaneous atrophy), comedones, and superficial follicular cysts
      • Contraindicated during pregnancy
      • A randomized, controlled study (Level 1) reported that proactive, long-term treatment with hydrocortisone aceponate 0.0584% spray was efficacious and well-tolerated when applied on 2 consecutive days each week; time to relapse, after remission, was significantly longer than with placebo

    • Tacrolimus topical ointment
      • For treatment of chronic focal or multifocal disease
      • Tacrolimus 0.1% ointment, apply 2 times each day x 1 week, then reduce frequency of application as needed to control signs
      • A calcineurin inhibitor that may be used as an alternative to topical glucocorticoids in dogs with chronic, localized disease; particularly those with visible skin atrophy
      • Mild irritation may occur after application
      • A black box warning from the U.S. Food and Drug Administration suggests a potential risk of neoplasia; clients should be advised to apply product with gloves

    • Systemic corticosteroids
      • For the treatment of chronic disease, particularly non-localized disease and when flare factors have been eliminated
      • Prednisone, OR prednisolone, OR methylprednisolone tablets, 0.5 to 1 mg/kg IM or PO daily (0.25 to 0.5 mg/kg PO for methylprednisolone), in one or divided into two doses initially; then taper to 0.3 to 0.5 mg/kg every 48 hours, OR;
      • Trimeprazine tartrate with prednisolone (Temaril-P®), One-half tablet for dogs weighing less than 4.5 kg; one tablet for dogs weighing 5 to 9 kg; two tablets for dogs weighing 10 to 18 kg; and three tablets for dogs weighing more than 20 kg. All doses start with every 12 hours, and eventually taper to once daily and once every other day
        • Once clinical signs controlled, taper to lowest dose and frequency of administration that allows control of signs, good quality of life, and minimal side effects
      • Adverse effects may include polyuria, polydipsia, polyphagia, urinary tract infections, calcinosis cutis, demodicosis
      • Contraindicated during pregnancy

    • Cyclosporine
      • Approved for the treatment of atopic dermatitis in dogs
      • Cyclosporine (modified) 5 mg/kg PO per day
      • Continue initial dose until adequate reduction in clinical signs; then, reduce dose by increasing dosing intervals (every other day to every third day) or reducing daily dose by half
      • If clinical signs improve 75% or more, increase dosing interval to twice per week or reduce dose to 25% of original dose
      • Initial benefits will not occur for 4 to 8 weeks after treatment initiation; failure to improve at appropriate dose after > 8 weeks of therapy indicates treatment failure
      • Addition of a short course of oral glucocorticoids during the first 1 to 3 weeks of therapy with cyclosporine may result in quicker improvement
      • Minor and temporary adverse effects may include vomiting and diarrhea; monitor for weight loss
      • Gingival hyperplasia and papillomatosis have been reported
      • Opportunistic infections may be more likely
      • Caution if concurrent administration of ketoconazole; reduce cyclosporine dose
      • A topical cyclosporine A formulation has been reported to reduce skin lesion severity and pruritus in dogs, in a randomized, controlled trial

    • Antihistamines
      • There is no conclusive evidence that oral type I antihistamines are effective for treatment of active atopic dermatitis; might offer a modest, variable benefit in some dogs
      • If used, should be given daily as a preventive therapy; should preferably be given before a flare occurs
      • For example, hydroxyzine 2 mg/kg PO or IM every 8 to12 hours
      • Adverse effects may include drowsiness, anorexia, vomiting, and diarrhea; caution with cardiac arrhythmias

    • Other topical formulations
      • Overall, there is insufficient evidence to support use of topical formulations containing essential fatty acids, essential oils, or complex lipid mixtures
      • A randomized, double-blinded, placebo controlled study (Level 1) has reported results suggesting that a topical preparation with polyunsaturated fatty acids and essential oils was effective and safe in treating clinical signs of canine atopic dermatitis

Other Therapies

  • Weekly baths
    • Use lukewarm to cool water and nonirritating, antipruritic shampoos; leave on for 10 to 15 minutes before rinsing
    • May be soothing, remove allergens, and increase skin hydration
    • Antiseborrheic shampoos (for greasy, scaly skin) or antiseptic shampoos (for skin infections) may be considered
    • Bathe from head to tail to avoid traumatic folliculitis (especially in short coated breeds)

  • Diet
    • Restriction-provocation dietary trials (elimination diets) should be performed in any dogs with non-seasonal allergic dermatitis
    • Essential fatty acid (EFA) supplementation (mainly omega-3) or EFA-rich diets can improve coat quality and gloss; may require 2 months of treatment before improvement noted
    • There is no evidence to recommend a specific EFA combination, dosage, ratio, or formulation

Follow-up

General Points

  • Evaluate patients every 2 to 8 weeks after new therapy started, and then every 3 to 12 months, once the condition is adequately controlled

Therapeutic Follow-up

  • When a new therapy is started, evaluate patient every 2 to 8 weeks; monitor cutaneous lesions, degree of pruritus, secondary skin infections, and any adverse drug reactions
  • Once condition is adequately controlled, evaluate patient every 3 to 12 months
  • For patients receiving chronic corticosteroid or cyclosporine treatment, monitor complete blood count, serum chemistry, and urinalysis every 3 to 12 months; with chronic corticosteroids, urine cultures should also be monitored

Prognosis

  • Successful management may be anticipated in the majority of cases; not life-threatening
  • If untreated, pruritus will worsen and clinical signs will present with a longer duration each year; some cases may resolve spontaneously
  • Unremitting pruritus could lead to euthanasia in certain cases

Evidence

Guidelines and Consensus Statements

  • Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res. 2015 Aug 16;11:210. Level B (IND) Article
  • Hensel P, Santoro D, Favrot C, et al. Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification. BMC Vet Res. 2015 Aug 11;11:196. Level B Article
  • Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010;21:233-48. Amendment made June 28, 2011. Level B (IND) Article
  • Olivry T, Saridomichelakis M. Evidence-based guidelines for anti-allergic drug withdrawal times before allergen-specific intradermal and IgE serological tests in dogs. Vet Dermatol. 2013 Apr;2:225-e49. Level B Article

Systematic Reviews/Meta-analyses

  • Olivry T, Bizikova P. A systematic review of randomized controlled trials for prevention or treatment of atopic dermatitis in dogs: 2008-2011 update. Vet Dermatol. 2013;24:97-e26. Level 1 (IND) Abstract

  • Steffan J, Favrot C, Mueller R. A systematic review and meta-analysis of the efficacy and safety of cyclosporine for the treatment of atopic dermatitis in dogs. Vet Dermatol. 2006 Feb;17(1):3-16. Level 2 (IND) Abstract

Randomized, Controlled Trials (RCTs)

  • Lourenco AM, Schmidt V, São Braz B, et al. Efficacy of proactive long-term maintenance therapy of canine atopic dermatitis with 0.0584% hydrocortisone aceponate spray: a double-blind placebo controlled pilot study. Vet Dermatol. 2016 Apr;27(2):88-e25. Epub 2016 Jan 25. Level 1 (IND) Abstract
  • Blaskovic M, Rosenkrantz W, Neuber A, et al. The effect of a spot-on formulation containing polyunsaturated fatty acids and essential oils on dogs with atopic dermatitis. Vet J. 2014 Jan;199:39–43. Level 1 (IND) Abstract
  • Cosgrove SB, Wren JA, Cleaver DM, et al. A blinded, randomized, placebo-controlled trial of the efficacy and safety of the Janus kinase inhibitor oclacitinib (Apoquel®) in client-owned dogs with atopic dermatitis. Vet Dermatol. 2013 Dec;24(6):587-97. Level 1 (IND) Article

  • Van Brussel L, Moyaert H, Escalada M, et al. A masked, randomised clinical trial evaluating the efficacy and safety of lokivetmab compared to saline control in client-owned dogs with allergic dermatitis. Vet Dermatol. 2021 Oct;32(5):477-e131. Level 2 (IND) Article
  • Moyaert H, Van Brussel L, Borowski S, et al. A blinded, randomized clinical trial evaluating the efficacy and safety of lokivetmab compared to ciclosporin in client-owned dogs with atopic dermatitis. Vet Dermatol. 2017 Dec;28(6):593-e145. Epub 2017 Sep 14. Level 2 (IND) Article
  • Michels GM, Walsh KF, Kryda KA, et al. A blinded, randomized, placebo-controlled trial of the safety of lokivetmab (ZTS-00103289), a caninized anti-canine IL-31 monoclonal antibody in client-owned dogs with atopic dermatitis. Vet Dermatol. 2016 Dec;27(6):505-e136. doi: 10.1111/vde.12364. Epub 2016 Sep 19. Level 2 (IND) Abstract
  • Michels GM, Ramsey DS, Walsh KF, et al. A blinded, randomized, placebo-controlled, dose determination trial of lokivetmab (ZTS-00103289), a caninized, anti-canine IL-31 monoclonal antibody in client owned dogs with atopic dermatitis. Vet Dermatol. 2016 Dec;27(6):478-e129. doi: 10.1111/vde.12376. Epub 2016 Sep 19. Level 2 (IND) Abstract
  • Dip R, Carmichael J, Letellier I, et al. Concurrent short-term use of prednisolone with cyclosporine A accelerates pruritus reduction and improvement in clinical scoring in dogs with atopic dermatitis. BMC Vet Res. 2013 Sep 3;9:173. Level 2 (IND) Article
  • Eichenseer M, Johansen C, Mueller RS. Efficacy of dimetinden and hydroxyzine/chlorpheniramine in atopic dogs: a randomised, controlled, double-blinded trial. Vet Rec. 2013 Nov 2;173:423-6. Level 2 Article
  • Puigdemont A, Brazis P, Ordeix L, et al. Efficacy of a new topical cyclosporine A formulation in the treatment of atopic dermatitis in dogs. Vet J. 2013 Aug;197(2):280-5. Level 2 Abstract
  • Cadot P, Hensel P, Bensignor E, et al. Masitinib decreases signs of canine atopic dermatitis: a multicentre, randomized, double-blind, placebo-controlled phase 3 trial. Vet Dermatol. 2011 Dec;22(6):554-64. Level 2 (IND) Abstract
  • Ahlstrom LA, Mason KV, Mills PC. Barazone decreases skin lesions and pruritus and increases quality of life in dogs with atopic dermatitis: a randomized, blinded, placebo-controlled trial. J Vet Pharmacol Ther. 2010 Dec;33(6):573-82. Level 2 (IND) Abstract

Other Studies or Reviews

  • Santoro D, Marsella R, Hernandez J. Investigation on the association between atopic dermatitis and the development of mycosis fungoides in dogs: a retrospective case-control study. Vet Dermatol. 2007 Apr;18(2):101-6. Level 2 Abstract

  • Plumb’s Veterinary Drugs (online database), Tulsa, OK: Brief Media; 2022. Accessed January 11, 2022. Level 3
  • Papich MG. Papich Handbook of Veterinary Drugs, 5th Edition. St Louis, MO: Elsevier; 2021. Level 3
  • Santoro D. Therapies in canine atopic dermatitis: an update. Vet Clin North Am Small Anim Pract. 2019 Jan;49(1):9-26. Level 3
  • Mueller RS. Update on allergen immunotherapy. Vet Clin North Am Small Anim Pract. 2019 Jan;49(1):1-7. Level 3
  • Souza CP, Rosychuk RAW, Contreras ET, et al. A retrospective analysis of the use of lokivetmab in the management of allergic pruritus in a referral population of 135 dogs in the western USA. Vet Dermatol. 2018 Dec;29(6):489-e164. Epub 2018 Aug 23. Level 3
  • Muller MR, Linek M, Lowenstein C, et al. Evaluation of cyclosporine-sparing effects of polyunsaturated fatty acids in the treatment of canine atopic dermatitis. Vet J. 2016 Apr;210:77-81. Level 3 (IND)
  • Saridomichelakis MN, Olivry T. An update on the treatment of canine atopic dermatitis. Vet J. 2016 Jan;207:29-37. Level 3
  • Bizikova P, Pucheu-Haston CM, Eisenchenk MN, et al. Review: Role of genetics and the environment in the pathogenesis of canine atopic dermatitis. Vet Dermatol. 2015 Apr;26(2):95-e26. Epub 2015 Feb 22. Level 3 (IND)
  • Little PR, King VL, Davis KR, et al. A blinded, randomized clinical trial comparing the efficacy and safety of oclacitinib and ciclosporin for the control of atopic dermatitis in client-owned dogs. Vet Dermatol. 2015 Feb;26(1):23-e8. Level 3
  • Favrot C. Diagnostic criteria for canine atopic dermatitis. In: Bonagura JD, Twedt DC, ed.’s. Kirk’s Current Veterinary Therapy. 15th ed. St. Louis: Elsevier Saunders; 2014:403-4. Level 3
  • Olivry T, Prelaud P. Treatment guidelines for canine atopic dermatitis. In: Bonagura JD, Twedt DC, ed.’s. Kirk’s Current Veterinary Therapy. 15th ed. St. Louis: Elsevier Saunders; 2014:405-7. Level 3
  • Hillier A. Cyclosporine use in dermatology. In: Bonagura JD, Twedt DC, ed.’s. Kirk’s Current Veterinary Therapy. 15th ed. St. Louis: Elsevier Saunders; 2014:407-10. Level 3
  • DeBoer DJ. Allergen-specific immunotherapy. In: Bonagura JD, Twedt DC, ed.’s. Kirk’s Current Veterinary Therapy. 15th ed. St. Louis: Elsevier Saunders; 2014:411-14. Level 3
  • Rosenkrantz WS. Topical therapy for pruritus. In: Bonagura JD, Twedt DC, ed.’s. Kirk’s Current Veterinary Therapy. 15th ed. St. Louis: Elsevier Saunders; 2014:419-21. Level 3
  • Jung JY, Nam EH, Park SH, et al. Clinical use of a ceramide-based moisturizer for treating dogs with atopic dermatitis. J Vet Sci. 2013;14(2):199-205. Level 3
  • Ganz EC, Griffin CE, Keys DA, et al. Evaluation of methylprednisolone and triamcinolone for the induction and maintenance treatment of pruritus in allergic cats: a double-blinded, randomized, prospective study. Vet Dermatol. 2012;23:387-e72. Level 3 (IND)
  • Favrot C, Steffan J, Seewald W, et al. A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis. Vet Dermatol. 2010 Feb;21(1):23-31. Level 3 (IND)
  • DeBoer DJ, Hillier A. The ACVD task force on canine atopic dermatitis (XV): fundamental concepts in clinical diagnosis. Veterinary Immunology and Immunopathology. 2001;81:271-6. Level 3
  • DeBoer DJ, Griffin CE. The ACVD task force on canine atopic dermatitis (XXI): antihistamine pharmacotherapy. Veterinary Immunology and Immunopathology. 2001;81:323-9. Level 3

Additional Reading

  • Takahashi J, Kanda S, Imanishi I, et al. Efficacy and safety of 0.0584% hydrocortisone aceponate topical spray and systemic oclacitinib combination therapy in dogs with atopic dermatitis: a randomized, double-blinded, placebo-controlled trial. Vet Dermatol. 2021 Apr;32(2):119-e25. Epub 2020 Nov 13.
  • Timm K, Mueller RS, Nett-Mettler CS. Long-term effects of intralymphatic immunotherapy (ILIT) on canine atopic dermatitis. Vet Dermatol. 2018 Apr;29(2):123-e49. Epub 2018 Jan 12.
  • Klinger CJ, Hobi S, Johansen C, et al. Vitamin D shows in vivo efficacy in a placebo-controlled, double-blinded, randomised clinical trial on canine atopic dermatitis. Vet Rec. 2018 Apr 7;182(14):406. Epub 2018 Feb 1.
  • DeBoer DJ. The future of immunotherapy for canine atopic dermatitis: a review. Vet Dermatol. 2017 Feb;28(1):25-e6. doi: 10.1111/vde.12416.
  • Plant JD, Neradilek MB. Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis. BMC Vet Res. 2017 Jan 5;13(1):4. doi: 10.1186/s12917-016-0917-z.