You have a lot on your plate. We will direct your attention to some of the most important findings in Veterinary Dermatology from the past year.

Vet Derm Clinical Update:
Terbinafine dosing for Malessezia dermatitis
Terbinafine has been recommended as a cost-effective alternative to ketoconazole or fluconazole for canine Malassezia dermatitis.


Terbinafine concentrations were measured in the serum, sebum and stratum corneum (paw and thorax) of 10 dogs after once daily (30 mg/kg) dosing for 21 days. Samples were taken using a variety of methods and sampled at defined intervals for 35 days. Terbinafine concentrations in each sample were measured with high-pressure liquid chromatography.


Serum concentrations exceeded sebum and stratum corneum concentrations at all time points. The minimum inhibitory concentration (MIC90) of terbinafine for Malessezia pachydermatis has been variably reported as 0.12 ug/mL and 0.25 ug/mL for ears and skin, respectively. However, the mean maximum concentration (Cmax) of all tissue (serum, sebum and stratum corneum) only slightly exceeded the 0.25 ug/mL MIC90 and was never achieved in many individuals. The higher terbinafine MIC90 was not reached in 50% of paw stratum corneum samples and exceeded it at only one time point in another 30%.

This study concluded that 30 mg/kg/day dosing of terbinafine may not reliably achieve the MIC for Malessezia pachydermatis in the sebum and stratum corneum of dogs. A higher dose may be warranted.

Gimmler, JR, et al. Determining canine skin concentrations of terbinafine to guide the treatment of Malassezia dermatitis. (2015) 26:411. 
RESPIT and multi-modal therapy

RESPIT is a great long-term option for managing atopic dermatitis. Immunotherapy is the only treatment that can re-program the immune system to tolerate offending allergens.  A disadvantage of immunotheray is that it has a slow onset.  We recommend that a patient receive RESPIT for 9-12 months to fully assess the efficacy. In the meantime, many patients are going to require some shorter-term relief.  We've had good success starting patients on Apoquel and RESPIT, then stopping the Apoquel periodically to assess the response to RESPIT alone. And, don't forget about the importance of topical therapy to wash away allergens and improve the barrier function of the epidermis!

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Your clients easily grasp the justification for RESPIT: allergy testing is expensive, inexact and (as much as you might wish it wasn't so) doesn't improve the success rate of immunotherapy. With standardized formulations, you can keep RESPIT in stock and prescribe it the same day that you and your client decide to begin immunotherapy. It has been estimated that of those clients that do spend the money to allergy test their dogs, only 50% go on to order immunotherapy prescriptions. 

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