Veterinary Medicine - November 2008 - (Page PD11)

PRACTICAL THERAPY A conﬁrmed diagnosis may not be immediately possible when a veterinarian is confronted with a pruritic dog or cat, and the list of differential diagnoses can be extensive. Used appropriately, glucocorticoids can alleviate discomfort for patients with the ability to match the dose and duration of treatment to the patient’s needs. As clinicians, we are trained to consider the differential diagnoses and make a diagnosis based on the ﬁndings in the patient’s history, physical examination, and diagnostic tests. While it is important to consider the possibility of scabies, demodicosis, dermatophytosis, neoplasia, and other differential diagnoses, the vast majority of pruritic patients have an allergic or ﬂea-induced dermatitis with a secondary bacterial or yeast infection. Often, treatment of any secondary infections signiﬁcantly reduces the patient’s level of discomfort and pruritus. However, many patients also require additional therapy for the inﬂammation and pruritus associated with the underlying disease. Acute amelioration of clinical signs can be achieved within minutes to hours, depending on the formulation and route of glucocorticoid administration. Dunbar Gram, DVM, DACVD, MRCVS, Animal Allergy and Dermatology Afﬁliated Animal Care, Virginia Beach and Richmond, Va. • Marlene Pariser, DVM, Chesapeake, Va. Regarding intermediate-term use of short-acting glucocorticoids, clients and patients beneﬁt because the dose and route of administration can be changed depending on the patient’s needs. This is particularly useful with atopic patients because the severity of clinical signs can vary daily and weekly. Some common systemic glucocorticoid preparations and their inﬂammatory dosages for dogs are listed in Table 1 (page 12). Patient-speciﬁc dosing is essential, and understanding the diﬀerences in physiologic, antipruritic, anti-inﬂammatory, and immunosuppressive dosages will help the practitioner safely meet the patient’s and client’s needs. As clinicians, we may dismiss the idea of using glucocorticoids as a treatment in patients with a variety of clinical dermatologic signs. Our client education practices have successfully persuaded clients not to overuse this category of drugs. Consequently, we now ﬁnd ourselves educating clients about the beneﬁts of judicious and prudent glucocorticoid use for a variety of dermatoses. Explaining that animals normally produce their own glucocorticoids can help alleviate well-intentioned client aversion to therapy with glucocorticoids. As with most medications, side effects are possible and increase in severity with higher doses and longer courses of therapy. However, glucocorticoids offer a rapid speed of efﬁcacy, a short duration of activity, and an easily adjusted dosage regimen that is desired in the treatment of many dermatoses. Knowing that a one-time therapeutic dose of a glucocorticoid in an otherwise healthy animal can be less than the one-time diagnostic dose in a systemically ill patient (e.g., a high-dose dexamethasone test for hyperadrenocorticism) can be liberating for clinicians who want to safely meet a patient’s and client’s needs. A safe annual glucocorticoid dose can allow clinicians to more comfortably manage patients and educate clients. This dose is actually less than the patient’s own endogenous glucocorticoid production. (See “Guidelines for calculating glucocorticoid use,” page 13.) In veterinary dermatology, glucocorticoids have three main pharmacologic dosage ranges for dogs (Table 1, page 12). Pharmacologic dosages exceed the physiologic requirements and vary according to the desired effect. The physiologic dosage range of glucocorticoids therapy is derived from the normal daily production of endogenous cortisol. People experiencing SPONSORED BY PFIZER ANIMAL HEALTH 11

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Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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