MY dog Fido is an eight-year-old
Labrador cross Springer Spaniel.
She first showed signs of atopic
dermatitis when she was 15 months
old and has been on treatment ever
since.
Although I wish for Fido’s sake
she wasn’t atopic, living with her
and medicating her has given me an
insight as a vet into the condition that
I otherwise wouldn’t have had. This
enables me to empathise with owners,
understanding that nothing
is more distressing and
frustrating then living with a
persistently pruritic dog.
My experience with Fido
has improved the way I work
up cases and because I’ve
personally tried practically all
the available treatments, I can advise
owners more comprehensively of the
options available to them.
Distressing and difficult
Living with an atopic dog can be
extremely distressing; it is so difficult
to see your pet in
such discomfort
and in some cases
cause real damage
to their skin
from scratching
and nibbling.
Fido’s clinical
signs started
out fairly mild
with her itching
and scratching
around her face.
As her condition
progressed, her
clinical signs
worsened; she
became restless
and was chewing
at her feet until
she nearly bled. Fido was obviously
very uncomfortable and it became clear
that we needed to find an appropriate
management strategy to make her
itch-free.
Diagnosing atopic dermatitis can be
a difficult process, not helped by the
fact that clinical presentation can vary
quite markedly between individuals,
as shown by some of the other case
studies detailed here.
Good compliance can also be really difficult to achieve when performing
diet trials and other diagnostic
processes and many dogs experience
episodes of are-ups which seem to
have no clear underlying cause. This
can make the process of identifying the
allergen(s) responsible full of hurdles
and frustrations, for the owner and for
the vet.
How I worked Fido up wasn’t
exactly textbook, but following my
experience with her, I would always stress the importance of following
a clear diagnostic pathway. Fido had
responded very well to steroids but,
unsurprisingly, once treatment was
stopped the pruritus would return.
Initially my diagnostic work-up was
relatively short, with coat brushings
and tape strips, from which
I was able to
rule out surface
parasites and
Malessezia. I ran
a general health
profile including
t4, which was
unremarkable.
I didn’t do skin
scrapes as I felt
with no obvious
lesions, demodex
and sarcoptes
were unlikely. I
have subsequently
seen a dog on
treatment for
atopy which was actually suffering from demodicosis, so
I now try to never skip this step.
Logically it would have made
sense to do a food trial at this point;
however, I rationalised that she was
more likely to be allergic to something
in her environment than food, so I
concentrated on trying to identify what
the allergen might be.
Care with medication
I wanted to run allergy blood tests at
this point but couldn’t stop her steroids
without her becoming puritic again,
so it was at this stage I started her on
ciclosporin.
I needed a medication which
would keep her comfortable without
interfering with the blood test.
The allergy blood tests showed a
strong positive result for house dust
mites and storage mites, so there were
a few management controls that I was able to introduce to help minimise her
exposure whilst her immunotherapy
was prepared.
At this stage, I did a six-week food
trial in case a food allergy was a
component of her condition; however,
I felt there was no obvious difference
in her during the trial and there was no are-up in her symptoms when we re-
challenged her with the original diet.
The situation today
Atopic dermatitis is such a big topic
that it can be daunting for us vets,
let alone for owners. One of the
hardest points to get across to owners
is that atopic dermatitis is a lifelong
condition that requires lifelong and
often multimodal treatment.
In Fido’s case, alongside her
immunotherapy
and ciclosporin,
she also receives
anti-histamines,
medicated shampoos
and spot-on
treatments to keep
her comfortable.
At present Fido is
itch-free 95% of the
time, with any are-ups treated with a
short course of steroids.
People always comment on her shiny
coat and she has a good quality of life
which I believe has been achieved by
not assuming that one solution is going
to act as a “cure all”.
Sadly, however good your
communication is, there will always be
non-compliance amongst owners who
stop their dog’s medication once they
are itch-free, causing a recurrence of their clinical signs.
Finances also
play a massive role
in what diagnostics
you can perform
and what treatment
can be afforded. It
is vital, however, to communicate to
owners the benefits
of these treatments
and the value of
having an itch-free pet. With lots
of treatment options available, the world of atopic dermatitis is always a
rewarding challenge!
For more information and
educational resources about diagnosing
and treating atopic dermatitis, visit
http://dog.atopica.co.uk.
