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Flashcards in Skin therapy 1 Deck (25):
1

4 steps to managing allergic skin disease

1. avoidance
2. medication to control pruritus and erythema
3. immunomodulation
4. control of secondary flare-factors
*combination, tailored to individual*

2

How well can allergens be avoided

1. fleas - possible?
2. food - YES
3. environmental - not really, house dust mites (dead can still be allergenic), epithelia of different species (only if exposure can be limited), pollens (seasonal)

3

What does shampoo therapy do?

- remove allergens from skin
- improve skin/coat hygiene and care
- efficacy rarely documented
- owner compliance important

4

Name 2 types of shampoo

- containing lipids, complex sugars, antiseptics (Allermyl, Virbac)
- oatmeal shampoo

5

Options - medical tx of pruritus

POWERFUL (80% efficacy):
- GCs
- Ciclosporin (Atopica)
- (Tacrolimus: Protopic ointment)
-Oclacitinib

OTHERS (30% efficacy):
- antihistamines
- EFAs
- (chinese herbal medicine)
- (not recommended: progestagens (cats, pentoxifyllin, misoprostol)

- combination of above

6

Adverse effects - GCs

- Immediate: PU/PD, polyphagia, restlessness
- Long-term: HAC, weight gain, CT

7

How useful for topical GCs?

limited use in animals, Cortavance

8

Outline oral GCs

- prednisolone (short-acting)
- anti-inflammatory dose (dog 0.5-1mg/kg/d, cat 1-2mg/kg/d)
- aim for long term control: lowest necessary dose given on alternate days - minimises adrenal suppression)

9

How should you monitor a patient on GCs?

every 6 months perform haem and biochem and urine culture

10

How does ciclosporin work?

- cacineurin-inhibitor
- targets TC response more than GCs although efficacy is comparabe
- slow onset of effect (4 weeks) - not for acute itch

11

Adverse effects - ciclosporin

- transient V+D
- gingival hyperplasia
- hirsutism (increased hair growth)
- lameness
- EXPENSIVE

12

Describe antihistamines

- little EBVM, up to 30%?
- try different types (each for 10-14d)
- chlorpheniramine (only one for cats), clemastine, hydroxyzine
- NL for animals at all

13

What essential fatty acids are used for medical management of pruritus?

- N3 (fish oils) and N6 (plant oils) (eicosanoids)
- interact with arachidonic acid cascade
- more effective for seasonal disease?
- steroid sparing

14

What is oclacitinib (Apoquel)?

- new product for medical management of pruritus
- inhibits JK-1 --> switches off itch but not reddness
- authorised in dogs >12 years
- adverse effects after 14 days

15

Define ASIT

Allergen-specific immunotherapy

16

Describe ASIT

- injection of allergen extract SC at increasing quantities and intervals to patients with AD
- PEOPLE: decreases inflammatory cells, Ig, modulation of TH1/TH2 response
- PREPARATION: aqueous, alum precipitated or glycerinated

17

Efficacy - ASIT for AD

- full efficacy may take up to 9 months
- up to 50% (DOGS), higher in horses, unknown in cats

18

How can individual allergens be identified for ASIT?

- INTRADERMAL TEST: mast cell bound IgE, requires GA
- IgE serology: allergen-specific IgE (most commonly)

19

Define SLIT

= sublingual immunotherapy
- alternative to ASIT
- drops are sprayed under tongue so no injection

20

PROS - ASIT and SLIT

- safe
- potential AEs (anaphylaxis) rare, no long term SEs
- infrequent tx (monthly)
- often more cost effective (esp large breeds)
- preventative not reactive

21

CONS - ASIT and SLIT

- initial higher cost
- risk of anaphylaxis
- full efficacy may take several months
- compliance may drop with long term approach
- flare-factors need controlling during initial tx to allow full assessment of efficacy
- syringes dispensed to owner

22

What are the most common flare-factors in AD?

- fleas
- other concurrent allergens (food, environmental)
- Staph pyoderma
- Malassezia dermatitis

23

What should you say to owner in managing allergic skin disease?

- life-long implications
- no complete cure, overall management
- waxing and waning course of disease

24

What neoplasia can be mistaken for allergic skin disease?

EPITHELIOTROPIC LYMPHOMA

25

Describe epitheliotropic lymphoma

- Ddx allergic skin disease
- affects epidermis
- usually dogs 10+ years (allergy younger)
- exfoliative eryhtroderma (whole skin is red)
- digital pad involvement (unlike allergic skin disease where interdigital skin is affected)
- thus some aspects don't fit exactly with typical hx of allergic skin disease so this should prompt consideration of this condition

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