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Itchy pets form 20 – 30% of most vets’ caseloads, about half of those will be Atopic Dermatitis. 1,2
Pet owners can often have unrealistic expectations with these difficult to manage cases and may wax and wane with their compliance and quality of life can become a real issue as pets suffer with the cascade of itch, self-trauma and chronic symptoms.
Atopy is a genetic condition characterised by a predisposition to hypersensitivity reactions following exposure to environmental allergens such as pollens, grasses, dust mite and moulds. Some individuals will have this inherited immune dysregulation and of course there are breeds that are more genetically predisposed – Westies, Golden Retrievers, Boxers….
The reaction is a delayed Type-IV cell mediated hypersensitivity, and patients will be alesional at onset, usually around 1-3 years. It can be seasonal but not always, affecting areas where there is skin friction such as axillae, inguinal, carpal and tarsal areas or mucocutaneous junctions such as around mouth and eyes, pinnal and peri-anal regions. Steroid responsiveness is another hallmark.
Diagnosis is by exclusion, with many causes of itchy pets presenting alike. Ruling out parasitic, bacterial, fungal causes, with diagnostics and treatments, as well as performing a dietary elimination trial to eliminate food reactions. This leaves you with rare neoplastic conditions and endocrinopathies, but Atopic Dermatitis in the vast majority. Immune issues rarely being textbook, can have multiple processes happening at once!
Intra-dermal skin and serum antibody tests can pinpoint allergens for immunotherapy purposes but are not specific screening tests. In fact, there are no biomarkers; to say it is complex is an understatement. But being lifelong, it’s essential to tease out all the possible causative factors.
The task of trying to avoid triggering allergens can often be impossible, so management then becomes symptomatic. Inflammation of the skin, sometimes otitis and/or anal gland disease causes erythema and pruritis. This leads to self-trauma, secondary infections, and if untreated, lichenification and hyperpigmentation down the track.
Protocols, unambiguous communication and education with owners is key. Managing expectations, regular check-ups and minimising flareups becomes the balancing act you perform – cost, compliance, side effects, patient welfare. Here is where keeping below that itch threshold using a multimodal treatment plan is crucial.
Atopic Dermatitis has two components to treat.
Abnormal Immune response. Medical treatments like Glucocorticoids, Immune-Modulating Cytokine inhibitors and Monoclonal Antibody therapies are mainstay to down regulate the immune response. Atopic dermatitis is a condition where clinical signs need to be managed judiciously as side effects of treatment can be another main concern of owners along with cost.
Defective Skin Barrier function. Epithelial cells in atopic patients lack the normal tight lipid junctions that form a waterproof barrier in the skin, like a brick wall where the mortar is the lipid. This allows the antigenic allergens entrance into, and water loss through the epidermis, resulting in dry itchy “leaky skin.”
Another mode of management, nutritional therapy, can physically benefit the defensive skin structure to help minimise antigenic presentation to the local immunity. Dietary formulations enriched with essential fatty acids support reduction of inflammation and improve ceremide function help strengthen the compromised barrier. Additional nutritional support for the atopic patient can come in the form of: Amino acids for cell repair and regeneration; Specific vitamins and minerals involved in keratinisation, fatty acid metabolism and reduction of oxidation; Selected nutrients supporting fibroblast migration to support wound repair. Where compliance can be difficult, supporting
patient health with something given without fail or issue, their food, is a modality beneficial for all.
References
1 *Hill PB, Lo A, Eden CAN, et al. Survey of the prevalence, diagnosis and treatment of dermatological conditions in small animals in general practice. Vet Rec 2006; 158:533-539.
2 *Banfield internal data, 2020
