Atopic dermatitis is an allergic skin disease affecting both dogs and cats. The exact cause or development of atopic dermatitis is not fully understood but it is currently thought that affected animals are genetically predisposed and as a result, they have an exaggerated immune response and defective skin barrier. A poor skin barrier allows easy penetration of bacteria/yeast (naturally residing on the skin) and environmental allergens (such as pollens and mites) and consequently, these “foreign invaders” exacerbate the detrimental cycle of skin inflammation and feeling itchy. Certain breeds are more likely to develop atopic dermatitis than others such as, in dogs, West Highland White Terriers, French Bulldogs and Labradors.

As previously mentioned, atopic dogs and cats have inflamed and itchy skin; to protect the skin and make affected animals feel less itchy, anti-itch treatment should be started. In general, there are six different anti-itch treatment options available, all with various pros and cons. There is no one option that suits all dogs and cats, so it is the responsibility of the dermatologist to choose the most suitable. Examples of factors influencing the decision include:

• If itching and/or the affected skin (including the ears) is localised or widespread
• How quickly it takes for the treatment to have an effect
• What treatment has been tried before and what has worked well
• How the skin looks and if a secondary infection is present
• Route of administration
• Cost and owner preference.

Below summarises the six anti-itch treatment options available – if you have any further questions, please speak to your dermatologist.

Option 1 – Topical steroid: Cortavance (Licensed for use on the skin of the body only)

What is it and how does it work?

Anti-inflammatory that inhibits the process of inflammation in the skin only, i.e. minimal systemic effects.

How is it given?

A solution that is either:

• Sprayed onto the skin
• Applied into the ear

Speed of action

Quite rapid with obvious improvement after 1-2 weeks

Cost

1 bottle costs approximately £70 and once broached, can be used for 6 months

Side effects

Short-term: none reported
Long-term: thinning of the skin, alopecia, ulceration

Option 2 – Oral steroids: Prednisolone/methylprednisolone/ dexamethasone

What is it and how does it work?

Anti-inflammatory that inhibits the process of inflammation.

How is it given?

Tablets or liquid are given daily to start with, then tapered

Speed of action

Rapid: 4 hours

Cost

Cheap, for example, tablets for a medium-sized dog for 1 month would cost approximately £20

Side effects

Short-term: increased drinking and urination, increased appetite, and weight gain
Long-term: muscle wastage, urinary tract infections, induced hormone disease (Cushing’s)

Option 3 – Atopica/Cyclavance/Sporimmune

What is it and how does it work?

Another anti-inflammatory that inhibits the different cell types involved in allergy.

How is it given?

Capsules or liquid are given daily to start with, then tapered

Speed of action

Slow: 4-6 weeks

Cost

Most expensive, for example, capsules for a medium-sized dog for 1 month would cost approximately £275

Side effects

Short-term: vomiting/diarrhoea can occur
Long-term: thickening of the gum, increased hair growth, a risk of secondary skin infections

Option 4 – Apoquel (Licensed for dogs only)

What is it and how does it work?

Blocks the neural pathway which causes the itching sensation.

How is it given?

Tablets are given twice daily for 2 weeks, then once daily

Speed of action

Rapid: within 24 hours

Cost

Expensive, for example, tablets for a medium-sized dog for 1 month would cost approximately £85

Side effects

Short- and long-term: urinary tract infections/cystitis, vomiting/diarrhoea, skin abnormalities including masses

Option 5 – Cytopoint (Licensed for dogs only)

What is it and how does it work?

It’s a synthetic antibody that neutralises a specific cell type involved in allergy.

How is it given?

4 weeks to start with, then potentially every 5-6 weeks

Speed of action

Rapid: 24 hours

Cost

Expensive, for example, an injection for a medium-sized dog for 1 month would cost approximately £100

Side effects

None reported so far (new medication)

Option 6 – Allergen-specific immunotherapy

What is it and how does it work?

It’s a solution containing a tiny amount of selected allergens; the intention of this treatment is to desensitise the immune system to the allergens in the solution so that when they are encountered in day-to-day life, no allergic reaction occurs.

How is it given?

Injections are given every few weeks to start with, then every month

Speed of action

Very slow: 9-12 months

Cost

Initially expensive, for example, a vial for 1 year would cost in the region of £250-300

Side effects

Very rare but a few side effects are reported to transiently occur after the injection is given: itchiness, sleepiness, vomiting/diarrhoea.