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Atopic Dermatitis Treatment - Coggle Diagram
Atopic Dermatitis Treatment
antihistamines
trial with different options
hydroxazine
diphenhydramine
amitriptilyne
doxepin
chlorpheniramine
citerizine
never use alone
not always effective
efficacy 10-20%
1-2w
must treat coexisting problems first
or effects will confound
avoidance
treatment of coexisting problems
essential fatty acids (EFAs)
modest effect
mode of action
infhibit competes with arachidonic acids
less inflammatory prostagladins and leukotrenes produced
synergistic effects with antihistamines
may be able ot reduce corticosteroid dosage by 30%
immunotherapy
efficacy
may take 3-4mo
60-70%
need 1y to determine
stop therapy if no improvement after 1y
rare side effects
worsening CSs
local edma/pruritus
anaphylaxis (extra rare)
requires intradermal IgE-specific on dermal mast cells
glucocorticosteroids
highly effective
side effects
best for seasonal/cyclic AD
start daily, then reduce dose
use
oral
short-acting
discontinuing is much easier
short half-life
:forbidden: injectable
lowest possible dose
monitor!
examples
prednisone
prednisolone
methyprednisolone
immune modulatory drugs
options
oclacitinob (Apoquel)
dosage
maintenance dose
pruritis increases during maintenance schedule
0.4-0.6mg/kg posid
initial treatment
0..4-0.6mg/kg pobid :dog:
best effects in 1st 2w
1mg/kg pobid :cat:
monitoring
monthly CBC
CBC + chem + UA every 3-6mo
side effects
common
vomiting
diarrhea
UTI
pyoderma
uncommon
lethargy
anorexia
decreased leukocytes
aggression
cancer found in :man:
anti-IL-32 monocolonal (Cytopoint)
:forbidden: :cat:
:dog:
mode of action
neutralizes IL-31
interrupts pruritis
effect in 1-3d
lasts 30-60d
sq admin by vet
85% efficacy
cyclosporine A 5mg/kg q24h
may take 4w for effecs
costly
combine with ketoconazole/fluconazole to halve cyclo dose
works as well as glucocorticosteroids
side effects
vomtiing
diarrhea
gingival hyperplasia
hypertrichosis
viral papillomatosis
lymphadenopathy (rare)