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158 Principles of Therapy of Dermatologic Diseases 1399

sulfate. Antimicrobial agents help remove purulent glucocorticoids, cyclosporine, oclacitinib maleate,
VetBooks.ir discharge and treat bacterial and fungal infections; they essential fatty acids, pentoxifylline, and a combination of
a tetracycline and niacinamide. Systemic glucocorticoid
include chlorhexidine, ethylenediaminetetraacetic acid‐
tromethamine (Tris‐EDTA), monosaccharides, para-
inflammatory and immunosuppressive, depending on
chlorometaxylenol (PCMX), and organic acids. therapy is somewhat arbitrarily divided into anti‐
The appropriate use and indications for the various ear the dosage used to treat the disease.
cleansing agents will be discussed in more detail in There are many indications for the anti–inflammatory
Chapter 167. effects of glucocorticoids including treatment of pruritic
dermatoses such as allergic skin diseases and otitis.
Indications for the immunosuppressive effects of gluco-
Systemic Therapy corticoids include many autoimmune skin disorders such
as the pemphigus complex and various sterile inflamma-
tory dermatoses. Commonly used systemic gluco-
Systemic therapy is commonly implemented to treat var- corticoids include methylprednisolone, prednisone or
ious dermatoses; however, it requires much knowledge prednisolone, dexamethasone, and triamcinolone aceto-
of the patient’s medical history, drug pharmacokinetics nide. The glucocorticoid potency must be chosen based
and pharmacodynamics, potential side‐effects, toxicity on the disease being treated, its severity, and the patient’s
monitoring guidelines, and potential drug interactions. overall health. It has been shown that only 21% of orally
The veterinarian needs to be familiar with the disease administered prednisone was present in the blood of
being treated and be aware of all treatment options and cats when compared to prednisolone, suggesting poor
decide on the most appropriate therapeutic intervention prednisone absorption or inadequate conversion into
in order to achieve the best clinical efficacy with the least prednisolone in the liver. Therefore, prednisolone should
possible toxicity.
be used in cats instead of prednisone due to potential
lack of response to prednisone. Injectable glucocorti-
coids should be avoided for treatment of chronic skin and
Categories and Indications of Topical ear diseases because this route of administration does
and Systemic Therapy not offer any therapeutic benefits over oral administra-
tion and is associated with more severe hypothalamic‐
Some of the major categories used in veterinary dermatol- pituitary‐adrenal axis side‐effects.
ogy include anti–inflammatory, antipruritic, immunosup- Cyclosporine is a calcineurin inhibitor that is used as
pressive, antibacterial and antifungal agents, antiparasitics an anti–inflammatory or immunosuppressive medica-
and medications to treat hormonal disorders. tion according to the condition being treated and the
dose used. It is labeled for the treatment of atopic derma-
titis in dogs and cats. Other indications include perianal
Anti–inflammatory Agents
fistulae in dogs, sebaceous adenitis, autoimmune dis-
Topical anti–inflammatory agents include glucocorticoids eases such as the pemphigus complex (particularly in
and essential fatty acids. Topical glucocorticoids may be a cats), and various sterile and inflammatory skin disor-
useful adjunct to systemic therapy in the treatment of both ders. For most treated conditions, cyclosporine may take
allergic and autoimmune skin disease. They are often used 4–6 weeks to be effective.
in pruritic and/or inflammatory skin and otic conditions. Oclacitinib maleate, a novel immunomodulatory drug,
Common topical glucocorticoids include betamethasone, is a selective Janus kinase (JAK) inhibitor, preferentially
hydrocortisone, isoflupredone acetate, fluocinolone, JAK‐1, labeled for the control of pruritus and inflamma-
mometasone furoate monohydrate, and triamcinolone ace- tion associated with canine allergic skin diseases, includ-
tonide. These products are available in the form of oint- ing atopic dermatitis, in dogs at least 12 months of age. It
ments, creams, lotions, gels, wipes, shampoos, rinses, and has a rapid mode of action in most patients, reducing
sprays. Many of the available products are otic preparations pruritus within 24 hours.
containing antimicrobials that are also used extra‐label on Essential fatty acids are nutritional supplements with
the skin. Topical essential fatty acids may be used as adjunc- anti–inflammatory properties. They may be used con-
tive therapy to treat inflammatory dermatoses including currently with other medications to treat pruritic and/or
atopic dermatitis and sebaceous adenitis, as well as keratini- inflammatory dermatoses such as atopic dermatitis,
zation disorders. They are available in formulations such as sebaceous adenitis, and symmetric onychodystrophy, as
spot‐on, sprays, shampoos, rinses, and mousses. well as keratinization disorders. They may also help
Systemic products with anti–inflammatory and/or improve the skin barrier and hair coat quality and
antipruritic and immunosuppressive effects include ameliorate dry and scaly skin. Omega‐3 formulations