Topical Glucocorticoids

Triamcinolone acetonide 0.015 %

Topically every 12–24 hours

Indicated for acute flares and localized lesions

Best suited for short-term use (7–14 days); adverse effects include cutaneous atrophy and calcinosis cutis

Hydrocortisone aceponate

Topically every 12–24 hours

Betamethasone valerate

Topically every 12–24 hours

Mometasone furoate

Topically every 12–24 hours

Oral Glucocorticoids

Prednisone/prednisolone

Induction or initial dose: 0.5–1 mg/kg, PO, every 24 hours

target dose after tapering: 0.25–0.5 mg/kg, PO, every 48 hours

Indicated for acute flares

Fast acting

Broad, nonspecific anti-inflammatory response

Many potential adverse effects

Calcineurin Inhibitors

Cyclosporine

Initial dose: 5 mg/kg, PO, every 24 hours; tapered to the lowest dose that controls the disease

Indicated for longterm management

Can take 4–6 weeks to achieve clinical improvement

Not suitable for treatment of acute flares

Most common adverse effects are GI signs

Indicated for localized lesions

Appears to be safe for short-term use

Tacrolimus 0.1 % cream

Topically every 12–24 hours

Prostaglandin E1 Analogs

Misoprostol

5 mcg/kg, PO, every 8 hours

Modest efficacy

Phosphodiesterase inhibitors

Pentoxifylline

10 mg/kg, PO, every 12 hours, or 20 mg/kg, PO, every 8 hours

May be best suited as adjunctive therapy for chronic conditions

Slow onset of action (4–6 weeks)

Not suited for acute flares

Good safety profile

Antihistamines

Fexofenadine

18 mg/kg, PO, every 24 hours

Helpful for mild pruritus

Best as part of combination therapy

Preventive role

Sparing agents for glucocorticoids

Not suitable for acute flares

Hydroxyzine

2 mg/kg, PO, every 12 hours

Hydroxyzine + chlorpheniramine

(20.9 mg + 0.7 mg)/10 kg (divided), PO, every 12 hours

Cetirizine

0.5–1 mg/kg, PO, every 12 hours

Essential Fatty Acids

High-quality fish oil (with EPA and DHA)

300 mg/4.5 kg, PO, every 24 hours

No current evidence of superior efficacy of any particular combination, dosage, ratio, or formulation to improve skin and coat quality and reduce pruritus

Janus Kinase Inhibitors

Oclacitinib maleate

0.4–0.6 mg/kg, PO, every 12 hours for 2 weeks, then every 24 hours

Indicated for acute flares and longterm management

Fast onset of action (within 24 hours) for pruritus control

Most common adverse effects are GI signs

Contraindicated in dogs with serious infections or neoplasia

May increase susceptibility to infections, demodicosis, and neoplastic conditions

Monoclonal Antibodies

Lokivetmab

2 mg/kg, SC, every 2–8 weeks

Indicated for acute flares and longterm management

Fast onset of action (1–3 days) for pruritus control

Most common adverse effects are lethargy and vomiting

Allergen Immunotherapy

Subcutaneous allergen-specific immunotherapy (SCIT)

Various protocols exist; adjust dosage and schedule for each patient

Very specific targeted effect

Slow onset of action (up to 12 months)

Not useful for acute flares

Most common adverse reaction is worsening of pruritus

Oral immunotherapy (SLIT)

Pump dispenser directly onto oral mucosa, between the lip and the gum, every 12 hours

Most common adverse reactions are face rubbing, transient worsening of pruritus, and GI signs