Atopic Dermatitis Update
Dr. Alice Jeromin, a pharmacist and veterinary dermatologist in private practice in Cleveland, OH, has written an excellent update on the latest for treatment of Atopy (also called Atopic Dermatitis) patients. If you have not already read the basics on Atopy, click here to understand the foundation of the condition.
This month in the trade magazine, DVM360, Dr. Jeromin reminds us there is a defective skin barrier present in atopy. Failure of the normal skin barrier allows allergens contacting the surface of the skin to initiate reactions. This contact reaction is one of the reasons the old name “Allergic Inhalant Dermatitis” is no longer valid. Now, we know why we see instantaneous itchiness in dogs who go outside just long enough to use the bathroom. Contact reactions can be reduced by wiping our pets’ feet, faces and undersides as soon as they are back indoors. A moist washcloth may suffice, but many dermatologists recommend a wipe with antiseptic and antiinflammatory ingredients. In our practice we use Malacetic HC, which contains soothing hydrocortisone. We also recommend them for wiping folds on the face, axillae, tail, anywhere. Dr. Jeromin likes Bayer Preva Medicated Wipes.
Ceramide. If you have an atopic pet, get used to using and hearing the word. Ceramide comes from the Latin cera, meaning “waxy” and amide, referring to a carbon-based compound including oxygen and other organic molecules. Ceramide replacers apply lipids (fats) to the skin, which researchers believe stimulates the skin to again begin creating its own ceramide. It is known that the normal skin barrier cannot be damaged unless ceramides are removed. Appropriate products may also contain phytosphingosine, a precursor to ceramide production.
Frequent bathing with the non-drying shampoo your pet’s doctor recommends removes allergens AND reduces bacterial colonization. It can also moisturize the skin. We now know that dry skin enhances absorption of allergens.
One of the simplest steps can also be very effective: Have your pet wear a cotton T-shirt to help minimize allergen contact with the skin.
As with most allergies, proper (and supplemental) nutrition of the Atopy patient can play an important part. I use GNC’s fish oil product “Ultra Triple Strength Omega 1560 EPA & DHA.” To make it easy to find, just go to the GNC store and ask for catalog number 893322 (or just click on this link). I also use this product to help hyperlipidemia patients. For both conditions (after clearing it with your pet’s doctor) give ½ capsule daily for small dogs and a whole capsule daily for large dogs and small dogs with recalcitrant hyperlipidemia. Dermoscent Essential 6 can supply Omega 3s and 6s, essential fatty acids and other ingredients important to rebuilding a healthy skin barrier. Atopic dermatitis patients in the southeastern US need their supplement year-round. If your pet’s Atopy is seasonal, begin your supplementation at least two months ahead of season.
We have long known that allergy patients with one kind of allergy often suffer flareups of their other allergies simultaneously. Dr. Jeromin hits us with another bombshell. Recent research shows that there is a cross reaction between food allergens and inhalant allergens. She uses the example of grass pollens cross-reacting with grains in food. It is truism to say, “Food allergy can look like anything.” Here it is looking like Atopy!
DR. JEROMIN ON SHAMPOO
Dr. Jeromin reminds us that medicated shampoos require a 15-minute contact period. Click here for medicated shampoo techniques.
Also, she points out, don’t look for it to lather. “It will never happen.” Pet owners can waste shampoo adding more, when more is still not going to cause it to lather.
She also has clients spot-test areas of the body with medicated shampoos to determine whether reactions might occur. Just because a shampoo is designed for use on sensitive skin doesn’t mean some pets won’t react to it.
Dr. Jeromin recommends first cleaning the patient with a hypoallergenic shampoo, followed by the prescription shampoo of the doctor’s choice.
Hyposensitization can be a wonderful tool. It is important to remember that, like any tool, it is not infallible. Allergy patients will always have relapses and breakthroughs, regardless of the type and number of tools in use to control their allergies. She is a big fan of sublingual hyposensitization, having used it in her referral practice for over a year, and notes that its success rate is similar to the injectable form, about 60-75%.
See you next week, Dr. Randolph