Medications for canine allergic dermatitis

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Canine allergic dermatitis is a complex condition that can be influenced by environment, genetics, immune response, skin barrier function, and the cutaneous microbiome of the dog. Because of the complexity of this condition, what do the treatment options and plans look like for these canine patients?

During her lecture Anti-Hero: A Variety of Inflammatory and Antipruritic Medications for Canine Allergic Dermatitis, Brittany Lancellotti, DVM, DACVD, shared a review of therapeutic options available to manage inflammations and pruritus. Throughout the lecture, Lancellotti shared multiple types of medications available to veterinary professionals, through slides and her own version of karaoke [Dermatology Version].

Glucocorticoids

Glucocorticoids (GCs) bind to cytoplasmic glucocorticoid receptors, then translocate to the nucleus where they modulate gene transcription by binding to glucocorticoid response elements. This process upregulates anti-inflammatory proteins and downregulates pro-inflammatory genes. This process causes a few effects within the acute and chronic treatment of both inflammation and pruritus. There are some short-term adverse effects that are common, including behavior changes, diarrhea, panting, polyuria, polydipsia, polyphagia, and more.

Veterinary professionals prescribing these to patients should monitor the patient’s tolerance and reduce to lowest effective dose as well as frequency should be prioritized if GCs are being used in the long-term because of progressive adverse effects. These effects can include cardiovascular workload, immunosuppression, muscle and ligament atrophy, risk of diabetes and pancreatitis, and more. Lancellotti said that these medications are administered to patients by liquid or tablet at 0.5–1.0 mg/kg prednisone/prednisolone equivalent every 24 hours at first. The dose can then be lowered to lowest effective dose and frequency that is maintaining remission of clinical signs in the pet.^2,3 Lancellotti also stated that these medications are not recommended for long term.

For the benefits of GCs, Lancellotti explained that it is rapid acting, effective against edema, can be an inexpensive option for clients, and has that variety of administration options. However, she mentioned some drawbacks for GCs is more frequent changes were observed during monitoring and it interferes with allergy and hormonal testing.

Modified cyclosporine

Cyclosporine inhibitors (Atopica; Elanco) leads to a decrease in activation of T cells, and a decrease in proinflammatory cytokines like interferon-α and is used in canines with atopic dermatitis who weigh at least 4lbs. This then leads to a decrease in pruritus and edema in treatment in chronic allergic dermatitis, not acute. When it comes to this treatment, the most common of the short-term adverse effects are gastrointestinal, with less common long-term risks including gingival hyperplasia, opportunistic fungal infections (which are less common at 5 mg/kg dosing), and papillomas.

This type of medication is administered by liquid or capsule at 5 mg/kg once daily for the first 4-6 weeks to determine if clinical sings improve, then the dosing frequency of administration can be reduced to either every other day or twice daily, and the daily dose itself can be decreased. Lancellotti cautioned attendees that when administering cyclosporine concurrently with medications that can affect the cytochrome p450 enzyme system in the liver, it will in result affect the concentration of cyclosporine circulating.

In conclusion

Right up until the end, Lancellotti engaged the room with her keyboard and voice. Her renditions of 'We Will Block You' and other remixed classics helped the audience understand that just like music in our lives, itchy dogs will be in the clinic. By understanding the different types of treatments, helping these patients get better will just be another song and dance.

References

1. Lancelloti B Anti-Hero: A Variety of Inflammatory and Antipruritic Medications for Canine Allergic Dermatitis. Presented at: WVC; Las Vegas, Nevada. March 2-5, 2025.
2. van den Broek A. Muller & Kirk’s Small Animal Dermatology. William Miller Jr, Craig Griffin, Karen Campbell. Saunders-Elsevier, St Louis; 7th Edition, 2013, 938 p; IBSN: 978-1-4160-0028-0, £113. Veterinary Dermatology. 2013;24(5):559-559. doi:https://doi.org/10.1111/vde.12055
3. Archer TM, Boothe DM, Langston VC, Fellman CL, Lunsford KV, Mackin AJ. Oral cyclosporine treatment in dogs: a review of the literature. J Vet Intern Med. 2014;28(1):1-20. doi:10.1111/jvim.12265