Select Therapeutic Agents for Atopic Dermatitis
Select Therapeutic Agents for Atopic Dermatitis
Active Ingredient | Dosage | Key Points |
|---|---|---|
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 |
Adapted from Sandra Koch. What is new in the diagnosis and management of canine atopic dermatitis. Today’s Veterinary Practice. May/June 2015: 95–102. | ||