درمان های نوین درماتیت آتوپیک سگها
محورهای موضوعی : عوارض درمانگاهی منجر به ایجاد بیماری ها و درمان
جواد خوش نگاه
1
(گروه علوم درمانگاهی، دانشکده دامپزشکی، دانشگاه فردوسی مشهد، مشهد، ایران.)
کلید واژه: آتوپی, درماتیت آتوپیک, درماتیت آلرژیک, سگ, خارش,
چکیده مقاله :
درماتیت آتوپیک یک بیماری پوستی شایعِ خارشدار و التهابی با زمینهی ژنتیکی و دارای تظاهرات باليني خاص است. پژوهش حاضر با هدف ارتقا دانش و یکپارچه سازی روش‌های درمانی دامپزشکان حیوانات خانگی در ایران صورت گرفته است. پژوهش حاضر به صورت مروری (Review) و بر پایه آخرین به روز رسانی دستورالعمل درمان درماتیت آتوپیک سگها (زیر نظر کارگروه بیماریهای آلرژیک حیوانات) و جمع بندی پژوهشهای نگارنده در ده سال گذشته صورت گرفته است. درمان حمله های حاد درماتیت آتوپیک سگها سه بخش دارد؛ 1- شناسایی و حذف علل ایجاد و / یا عوامل آلرژی زای تشدید کننده مانند گرده افشانی گیاهان، جرب گرد و غبار (درماتوفاگوئیدس)، پایودرم و درماتیت مالاسزیایی 2- درمان ضدمیکروبی و ارتقای بهبود بهداشت و سلامت پوست و مو مانند تجویز شستشو با یک شامپوی غیرتحریک کننده و ملایم 3-کاهش شدت خارش و و ضایعات پوستی با داروها مانند درمان کوتاه مدت با گلوکوکورتیکوئیدهای موضعی یا خوراکی یا اُکلاسیتینیب یا اینترفرونهای نوترکیب تزریقی 4- پیشگیری از عود بیماری با ایمنی درمانی توسط آلرژنهای اختصاصی و تجویز پیشگیرانهی گلوکوکورتیکوئیدهای موضعی درمانهایی که تاکنون فاقد کارایی بوده اند: 1- هیچ شاهد قطعی برای اثبات کارایی آنتی هیستامینها در درمان درماتیت آتوپیک فعال در سگها وجود ندارد. 2- تجویز اسیدهای چرب ضروری خوراکی به دلیل طولانی بودن زمان لازم برای هرگونه اثربخشی مؤثر آنها، در درمان التهابهای حاد درماتیت آتوپیک مفید نیست. درمان حملههای حاد درماتیت آتوپیک چندوجهی است و برای دستیابی قطعي يا احتمالي به اثر درماني بهينه، باید مداخلات درمانی ترکیب شوند. لازم است پيش از طراحي يك برنامهي درماني، كيفيت زندگي سگها و صاحبانشان و نيز ترجيح نظر صاحب حيوان، در نظر گرفته شود.
Atopic dermatitis is a common pruritic and inflammatory dermatosis with genetic background and specific clinical manifestations. The present study was carried out with the aim of improving the knowledge and integration of the treatment protocols of veterinarians in Iran. The current research is a review based on the based on the task force for the treatment of canine atopic dermatitis (International Committee of Allergic Diseases of Animals) and a summary of the author's researches in the field of dermatology. The treatment of acute flares of canine atopic dermatitis should involve three parts; 1- To search for and then to eliminate the causes and/or aggravating allergens such as plant pollen allergens, house dust mites (dermatophagoides), pyoderma and/or Malassezia dermatitis. 2- Antimicrobial treatment and improvement of skin and hair health, such as bathing with mild shampoos. 3- To control pruritus and skin lesions with interventions that include topical and oral glucocorticoids, oral Oclacitinib, and injectable recombinant interferons. 4- Immunotherapy using specific allergens and prophylactic administration of topical glucocorticoids are the only interventions that may prevent or delay the recurrence of dermatitis. There is no conclusive evidence to prove the efficacy of: 1- Antihistamines in the treatment of atopic dermatitis in dogs 2- Administration of oral essential fatty acids due to the long time required for any effective effect. The treatment of acute flares of atopic dermatitis is multifaceted, and in order to achieve the optimal therapeutic effect, therapeutic interventions must be combined. Before designing a treatment plan, it is necessary to consider the quality of life of dogs and their owners, as well as the preference of the owner's opinion.
1. Khoshnegah J, Movassaghi AR, Rad M. Survey of dermatological conditions in a population of domestic dogs in Mashhad, northeast of Iran (2007-2011). Vet Res Forum. 2013; 4(2): 99-103.
2. Miller WH, Griffin CE, Campbell K. Muller and Kirk’s Small Animal Dermatology, 7th edition. St Louis, MO: Elsevier Mosby, 2013; 363– 388.
3. Khoshnegah J. Small Animal Internal Medicine, 2th edition. Mashhad, Iran: FUM press, 2018; 170– 189. (In Persian)
4. Reedy LM, Miller WH, Willemse T. Allergic skin diseases of dogs and cats. 2nd edition, Philadelphia, W. B. Saunders, 1997; 25-149.
5. Lund, EM, Armstrong JP, Kirk CA, Kolar LM and Klausner JS. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. J Am Vet Med Assoc, 1999; 214: 1336-1341.
6. Khoshnegah J, Pakzad Shahabi M. Canine atopic/allergic dermatitis in Mashhad (North-East of Iran): clinical observations. Iranian Journal of Veterinary Research, 2009; 10 (4): 352-359.
7. Olivry T, DeBoer DJ, Favrot C, Jackson HA, Mueller RS, Nuttall T, Prélaud P. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010;21(3): 233-48. doi: 10.1111/j.1365-3164.2010.00889.x.
8. Olivry T, Mueller RS: Evidence-based veterinary dermatology: a systematic review of the pharmacotherapy of canine atopic dermatitis. Vet Dermatol 2003;14:121-46.
9. Olivry T, Foster AP, Mueller RS, McEwan NA, Chesney C, Williams HC: Interventions for atopic dermatitis in dogs: a systematic review of randomized controlled trials. Vet Dermatol 2010; 21: 4-22.
10. Rafatpanah Sh, Rad M, Movassaghi AR, Khoshnegah, J. Clinical, bacteriological and histopathological aspects of first-time pyoderma in a population of Iranian domestic dogs: a retrospective study. IJVR 2020; 130-135.
11. Ghiasi Tarzi Z, Eidi S, Khoshnegah J. Clinical and mycological features of dermatophytosis in domestic cats at Ferdowsi University of Mashhad Veterinary Techaing Hospital, IJVST In press. DOI:10.22067/ijvst.2022.75463.1123
12. Beco L, Guaguere E, Lorente Mendez C, Noli C, Nuttall T, Vroom M: Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 2-- antimicrobial choice, treatment regimens and compliance. Vet Rec 2013;172:156-60.
13. Hillier A, Lloyd DH, Weese JS, Blondeau JM, Boothe D, Breitschwerdt E, Guardabassi L, Papich MG, Rankin S, Turnidge JD, Sykes JE: Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol 2014;25:163,75, e42-3.
14. Bensignor E, Pin D, Bourdeau P: A multicentric randomised controlled single blinded study to evaluate the value of a new protocol with a shampoo and a foam to treat canine allergic dermatitis (in French). Prart Méd Chir Anim Comp 2013;48:49-55.
15. Bourdeau P, Bruet V, Gremillet C: Evaluation of phytosphingosine-containing shampoo and microemulsion spray in the clinical control of allergic dermatoses in dogs: preliminary results of a multicentre study (abstract). Vet Dermatol 2007;18:177-8.
16. Nam EH, Park SH, Jung JY, Han SH, Young HY, Chae JS, Hwang CY: Evaluation of the effect of a 0.0584% hydrocortisone aceponate spray on clinical signs and skin barrier function in dogs with atopic dermatitis. J Vet Sci 2012;13:187-91.
17. Gadeyne C, Little P, King VL, Edwards N, Davis K, Stegemann MR: Efficacy of oclacitinib (Apoquel(R)) compared with prednisolone for the control of pruritus and clinical signs associated with allergic dermatitis in client-owned dogs in Australia. Vet Dermatol 2014;25:512,8, e86.
18. Taszkun I: The evaluation of Canine Atopic Dermatitis Extent and Severity Index (CADESI) test in dogs with atopic dermatitis (AD) treated with cyclosporine or prednisone. Pol J Vet Sci 2010;13:681-8.
19. Kovalik M, Taszkun I, Pomorski Z, Kozak M, Pomorska D, Szczepanik M, Wilkolek P, Palenik L, Shaw DJ, van den Broek AH, Thoday KL: Evaluation of a human generic formulation of ciclosporin in the treatment of canine atopic dermatitis with in vitro assessment of the functional capacity of phagocytic cells. Vet Rec 2011;168:537-42.
20. Cosgrove SB, Wren JA, Cleaver DM, Martin DD, Walsh KF, Harfst JA, Follis SL, King VL, Boucher JF, Stegemann MR: Efficacy and safety of oclacitinib for the control of pruritus and associated skin lesions in dogs with canine allergic dermatitis. Vet Dermatol 2013;24:479-e114.
21. Dell DL, Griffin CE, Thompson LA, Griffies JD: Owner assessment of therapeutic interventions for canine atopic dermatitis: a long-term retrospective analysis. Vet Dermatol 2012;23:228-e47.
22. Eichenseer M, Johansen C, Mueller RS: Efficacy of dimetinden and hydroxyzine/chlorpheniramine in atopic dogs: a randomised, controlled, double-blinded trial. Vet Rec 2013;173:423-6.
23. Baeumer W, Stahl J, Sander K, Petersen LJ, Paps J, Stark H, Kietzmann M, Olivry T: Lack of preventing effect of systemically and topically administered histamine H(1) or H(4) receptor antagonists in a dog model of acute atopic dermatitis. Exp Dermatol 2011;20:577-81.
24. Marsella R, Genovese D, Gilmer L, Ahrens K, Gatto H, Navarro C: Investigations on the effects of a topical ceramides-containing emulsion (Allerderm Spot on) on clinical signs and skin barrier function in dogs with atopic dermatitis: a double-blinded randomized controlled study. Intern J Appl Res Vet Med 2013;11:110-6.
25. Lourenço-Martins AM, São-Braz B, Schmidt V, Rème CA, Nuttall TJ: Long-term maintenance therapy of canine atopic dermatitis with a 0.0584% hydrocortisone aceponate spray (Cortavance) used on two consecutive days each week. Veterinary dermatology 2012;23 (Suppl. 1):39 (abstract).
26. Plant JD, Neradelik MB, Polissar NL, Fadok VA, Scott BA: Agreement between allergen-specific IgE assays and ensuing immunotherapy recommendations from four commercial laboratories in the USA. Vet Dermatol 2014;25:15-e6.
27. Dell DL, Griffin CE, Thompson LA, Griffies JD: Owner assessment of therapeutic interventions for canine atopic dermatitis: a long-term retrospective analysis. Vet Dermatol 2012;23:228-e47.
28. Carlotti DN, Gribeauval C, Costargent FA, Ganiayre J, Viaud SE: A retrospective survey of the results of allergen-specific immunotherapy in 205 atopic dogs in Aquitaine, France (1989-2001). Prat Méd Chir Anim Comp 2013;48:41-7.
29. DeBoer D, Verbrugge M, Morris M: Clinical and serological response of dust mite-sensitive dogs with atopic dermatitis to sublingual immunotherapy. Allergo J 2010;19:317 (abstract).
30. DeBoer DJ, Morris M: Multicentre open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis. Vet Dermatol 2012;23 (Suppl. 1):65 (abstract).
31. Hobi S, Mueller RS: Efficacy and safety of rush immunotherapy with alum-precipitated allergens in canine atopic dermatitis. Tierarztl Prax Ausg K Kleintiere Heimtiere 2014;42:167-73.
32. Marsella R, Santoro D, Ahrens K, Thomas AL: Investigation of the effect of probiotic exposure on filaggrin expression in an experimental model of canine atopic dermatitis. Vet Dermatol 2013; 24:260-e57.