Overview of canine atopic dermatitis Flashcards
Define canine atopic dermatitis
Genetically predisposed inflammatory & pruritic allergic skin disease with characteristic clinical features, associated with IgE antibodies most commonly to environmental allergens
Which allergens might cause CAD?
Allergens include house dust mites, pollens and mould spores in the environment and food allergens fed to the dog
10-30% of cases have NO detectable allergen-specific IgE for environmental allergens, this is termed…?
Atopic like dermatitis
Describe the 4 main features in the pathogenesis of CAD
- Cutaneous inflammation and pruritis
- Defective skin barrier function
- Microbial colonisation
- Other flare factors
Which hypersensitivities are involved in CAD?
Type 1 = Immediate reactions
Type 4 = delayed reactions
Describe type 1 hypersensitivity reactions
- IgE bound to mast cells
- Allergen bound by IgE causes mast cell degranulation
- Products of mast cell degranulation cause tissue inflammation and pruritis
Describe type 4 hypersensitivity reactions
- TH2 bias
- Allergen peptides presented to T-cells by langerhans cells
- Induce clonal expansion
- T-cells produce pro-inflammatory cytokines which cause tissue inflammation and pruritis
- T-cells produce cytokines that direct B-cells to produce IgE
What are the presenting signs of CAD?
Most common clinical signs are pruritus, recurrent pyoderma, recurrent otitis, seborrhoea, alopecia and occasionally urticaria
Describe the defective barrier seen in CAD
- Leaky skin – water gets out – microbes and allergens can penetrate more easily
- Increased transepidermal water loss (TEWL)
- Wide intercellular spaces between corneocytes
- Disorganised & fragmented lipid matrix
- Decreased levels of certain proteins and lipids in some breeds
Dogs with cAD show increased carriage of which bacteria?
Staphylococcus spp
How does microbial colonisation affect CAD
- Increased binding sites (due to inflammation)
- Reduced lipids and other proteins (barrier function)
- Damage to skin surface (self trauma)
- Dysbiosis: changed patterns of bacterial colonisation on the skin - imbalance
What are Atopic flares?
VERY common to see secondary staphylococcal pyoderma and otitis and Malassezia dermatitis in cases of CAD
Bacteria and yeast induce further inflammation and pruritus that is often not alleviated by specific anti-pruritics (e.g., lokivetmab or oclacitinib)
Describe the ‘vicious cycle’ of CAD
Inflammation -> Skin thickening -> increased antigen penetration and presentation -> reduced barrier -> secondary infection ->
What are the common causes of flares in CAD?
- Bacteria and yeast 2˚ infection
- Increase in allergen through seasonal changes or changes in environment
- Fleas, scabies or other ectoparasite infestation
- Reduction of therapy by owner / vet
Clinical diagnosis of CAD is based on which factors?
Compatible history
Clinical signs
Exclusion of differential diagnoses
There are no pathognomonic signs!