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Chronic Pruritus in a Boxer

Shannon Palermo, VMD

Jennifer Kasten, DVM

Emilie Vidémont, Dr Vét, DECVD

Nutrition

|October 2017|Sponsored

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Advertorial sponsored by Hill’s Pet Nutrition Inc.

Izzy, a 3-year-old, 59-lb female boxer, was presented for evaluation of non-seasonal pruritus as one of 20 participants of an in-clinic food trial.1,2 The details of the trial can be found in the discussion section below.

History

Izzy, with a BCS of 2/5, had previously undergone a thorough dermatologic work-up. Parasitic, endocrine, food-related, and other causes of pruritus were ruled out. Despite treatment with subsequent accepted standard therapies for canine atopic dermatitis (CAD) patients, Izzy continued to exhibit a minimum of 5 of Favrot’s3 criteria for diagnosis of CAD.1

HILL’S® PRESCRIPTION DIET® DERM DEFENSE™ WITH HISTAGUARD™ COMPLEX: HOW IT WORKS

Derm Defense is formulated to help support skin recovery and normalize internal response to environmental irritants:

  • Defense against future allergy outbreaks and flares with Histaguard™ Complex, a proprietary blend of bioactives and phytonutrients
  • Continuously normalizes immune response to allergens with natural sources of polyphenols
  • Supports skin rejuvenation with vitamin A, zinc, and essential fatty acids

Diagnosis

Canine Atopic Dermatitis

Discussion

Diagnosis of atopic dermatitis is confirmed via compatible history, clinical signs, and exclusion of other causes of pruritic dermatitis. Confirmation of diagnosis can be time-intensive. Offending environmental allergens can be both seasonal and non-seasonal, making the diagnosis and management of CAD doubly challenging. Dust, pollen, insects, and other environmental allergies frequently contribute to CAD. Treatment may be necessary on an ongoing basis even if the patient is not continuously exposed to the allergy trigger (eg, non-pollen season).

Canine atopic dermatitis is characterized by a cycle of inflammation, pruritus, and excoriation, leading to repeated skin damage, often for a lifetime. The in-clinic food trial2 sought to determine if a food designed to improve skin barrier function and lower inflammation (Hill’s® Prescription Diet® Derm Defense™ Canine dog food, provided free of charge to participants for the duration of the trial) would reduce pruritus and clinical severity in client-owned dogs with CAD. The trial included 11 European countries, and the 20 dogs that met inclusion criteria were exclusively fed 

Derm Defense for 8 weeks. Inclusion criteria included an absence of ectoparasites and skin infections and ≥5 of 8 Favrot’s criteria demonstrated; exclusions included patients on supplements (eg, fatty acids, glucosamine and chondroitin sulfate, antioxidants), with major systemic disease, or with food allergy. 

Treatment

As part of a comprehensive, multimodal approach to CAD (see Multimodal Treatment Options for CAD), Izzy was transitioned to Hill’s Prescription Diet Derm Defense, which she was fed exclusively for 8 weeks. Her owners were advised not to feed any additional supplemental food or treats during this time. Current medications remained unchanged during the course of this trial. 

Multimodal Treatment Options for Atopy

  • Environmental allergen reduction
  • Parasitic control
  • Therapeutic nutrition: Hill’s Prescription Diet Derm Defense Canine*  
  • Topical therapies including medicated shampoo and other topicals
  • Medications such as steroids, antihistamines, oclacitinib, canine atopic dermatitis immunotherapeutic, cyclosporine, allergen-specific immunotherapy

Outcome

At return examination, visible improvement was noted in Izzy’s overall skin condition and haircoat, as well as her level of pruritus, as evidenced by decreased scratching and licking (Figures 1 and 2). Izzy’s owner felt the therapeutic nutrition had improved her quality of life and found it highly effective for managing Izzy’s pruritus long term as part of multimodal atopy management in addition to her previous treatment plan.

Izzy at baseline evaluation.

figure 1 Izzy at baseline evaluation.

Izzy after 8 weeks of feeding Derm Defense™ with no changes in medication.

figure 2 Izzy after 8 weeks of feeding Derm Defense™ with no changes in medication.

Results of the In-Clinic Food Trial

In this in-clinic food trial, after nutrition was added for 8 weeks to the participants’ general treatment plan, the median total dermatologic site score assessed by veterinarians was significantly lower at 4 weeks and at 8 weeks (*p-values, <0.05) when compared to baseline. The participants’ medication plan remained consistent throughout the trial; clinical improvement can be attributed to the multi-modal treatment plan, including the introduction of the new therapeutic food.

Owner assessments of skin condition showed significant improvements in itching and scratching of skin and ears; licking of paws, axillae, and groin; disruption to the family; redness of the skin; and overall skin condition at 4 weeks and at 8 weeks (*p-values, <0.05) when compared with baseline presentation.

Dogs demonstrated marked improvement as reported by both pet owners and veterinarians, although a placebo effect cannot be ruled out. The results of this study support the clinical benefits of feeding specially formulated dermatologic food in addition to standard medical management, as the clinical picture of the dogs has improved without any changes in medical management during the study period.

Role of Fatty Acids in Atopic Dermatitis Management

Omega-6 Fatty Acids

 

  • Maintains the skin barrier and helps control transepidermal water loss
  • Improves coat gloss

 

  • Reduces proinflammatory eicosanoid production in cell membranes in the skin 
  • Decreases pruritus

 

  • Maintains the skin barrier and helps control transepidermal water loss
  • Improves coat gloss

 

  • Reduces proinflammatory eicosanoid production in cell membranes in the skin 
  • Decreases pruritus
Study Notes

Hill’s® Prescription Diet® Derm Defense™ is an integral part of multimodal management of canine atopic dermatitis through its comprehensive package of nutrients to promote skin health and strengthen the skin barrier, break the cycle of inflammation, and support a healthy immune system.4 Derm Defense is Hill’s only clinical nutrition that contains the HistaGuard™ Complex, composed of a blend of antioxidants, egg, and polyphenols including quercetin.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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