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Managing atopic dermatitis

Vet Derm Research

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Controlling Staphylococcus in the veterinary hospital

12-20-2012 19:28:22 PM

With the rapid emergence of methicillin-resistant strains of Stapylococcus pseudintermedius (MRSP), the potential for nosocomial infections should be addressed by every veterinary hospital with a formal, written infection control program. Most of the control measures for MR staphylococci are applicable ... Continue reading →...»

Non-specific effects of immunotherapy in asthmatic cats

10-11-2012 13:14:29 PM

An interesting study pertinent to RESPIT was brought to my attention by my friend Dr. Dean Gebroe of Culver City Animal Hospital. You may have noticed the capsule report in the September 2012 Clinician's Brief entitled "One Allergen to Treat ... Continue reading →...»

Serum allergy test reliability in dogs

08-12-2012 14:33:57 PM

If you are recommending that your client spend several hundred dollars on an allergy test for their dog, it would be nice to have confidence that the test is reliable. It should demonstrate both test-retest reliability (repeatability) and inter-lab reliability ... Continue reading →...»

Serum allergy testing of normal dogs

07-28-2012 17:16:21 PM

Do you wonder about the specificity of allergen-specific IgE tests in dogs (the percentage of dogs not allergic to an allergen that are correctly identified as non-allergic)? Hopefully, you are using clinical criteria to make the diagnosis of canine atopic ... Continue reading →...»

03-24-2012 04:03:24 AM

What can I possibly teach you about that most basic test in veterinary dermatology, the skin scraping? Taking a skin scraping seems like a simple enough technique, yet at least once per month I am able to find a mite ... Continue reading →...»

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Issue: 6

January 2013

Greetings and Happy New Year!

Do you grow tired of ivory-tower recommendations that don't make sense to you or your clients? For years you were advised to rely on antihistamines for canine atopic dermatitis when it was apparent to most of us that they provided a very marginal benefit (since confirmed). Now you are asked to perform allergy testing, although you know that (a) the tests don't agree with one another and (b) there is no real evidence that one testing method is better than the others. (If you doubt me on the first point, try sending in duplicate samples to more than one lab on your next allergy patient!) I take pride in offering my clients a practical, evidence-based approach to managing atopic dermatitis, which I outline in this issue.

2012 was an exciting year for SkinVet, with RESPIT sales more than doubling over 2011. Would you help us grow in the new year by telling some colleagues about RESPIT? They'll save 50% on their first order of RESPIT Injectable placed before February 28, 2013 by using the coupon code below. Based on our experience, we are confident that they will continue to prescribe RESPIT in the future. Our challenge is spreading awareness with less than a seven figure marketing budget.

Please take a moment to forward this newsletter to a several friends and let them know how RESPIT has helped you in your practice of veterinary dermatology!

--Jon Plant, DVM, DACVD

A Practical, 3-Step Approach to Canine Atopic Dermatitis

Step 1: Determine if CAD is the likely diagnosis using a validated checklist available here.

Step 2: Investigate and rule out alternative or concurrent diagnoses based on the clinical findings.

Finding	Rule out	Diagnostic Plan
Dorso-lumbar distribution	Flea allergy dermatitis	Therapeutic trial with Comfortis® or Trifexis®
Ear margin or lateral elbow distribution	Sarcoptes	Superficial skin scrapings Therapeutic trial
Dorsal trunk scale or crust	Cheyletiella	Superficial skin scraping Tape impression Trichogram
Comedones, follicular plugging	Demodicosis	Deep skin scrapings
Epidermal collarettes, pustules, lichenification	Pyoderma, Malassezia dermatitis	Skin surface cytology
Pinnal erythema	Otitis externa	Ear canal cytology
Unusual presentation, poor therapeutic response, late-onset	Cutaneous T-cell lymphoma	Skin biopsy Dermatopathology

Step 3: Intervene early in the course of the disease, with evidence-based medicine.

The long-term plan: Immunotherapy to reduce or eliminate the need for short-term and rescue medications. RESPIT, regionally-specific immunotherapy, is a practical alternative to allergy-test based immunotherapy.
The short-term plan: Atopica® or prednisone, if needed for initial patient comfort or rescue from an allergy flare-up.
Topical therapy: Regular bathing may help remove allergens and aid in the control of pyoderma or Malassezia dermatitis. Topical cortisone sprays can help with spot treatment.

Veterinary Dermatology Research

Background: The third iteration of the Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) is the only tool rigorously validated for canine atopic dermatitis (CAD) lesion scoring. The CADESI-03 requires 248 evaluations, limiting its widespread use.

Hypothesis/Objectives: The goal of the study was to develop and validate a practical method of grading CAD lesions that requires scoring only the frequently affected body regions.

Animals: Fifty-seven privately owned atopic dogs were used in the study.

Methods: The Canine Atopic Dermatitis Lesion Index (CADLI) was evaluated in an open, multicentre reliability study. Validity was assessed with expert opinion (content validity) and comparison of CADLI with existing disease severity measures (construct and criterion validity). Reliability was evaluated by analysing repeated observations of each dog. Convenience was assessed in terms of the time required to complete the scale.