Small Animal Dermatology, 3rd edition

164 DISEASES/DISORDERS

Measure cyclosporine serum level in nonresponders: appropriate levels are

200–400 ng/mL (trough level); levels greater than 1000 ng/mL are toxic/

immunosuppressive

Microemulsion cyclosporine A required (Atopica®); nonmicroemulsion poorly

absorbed

Major disadvantage of cyclosporine is cost

Maintenance therapy required; recurrence rate greater than 35%

Routine monitoring: serum chemistry and CBC every 3–6 months

Adverse effects: gastrointestinal distress (vomiting, diarrhea), gingival hyperpla-

sia, viral papillomas

Ketoconazole (2.5 mg/kg/day) given in conjunction permits 50% reduction in

dosage of cyclosporine for cost savings; decreases clearance of cyclosporine by

inhibition of hepatic cytochrome p450 microsomal enzymes.

 Antibiotics and analgesics may be indicated in some cases: antibiotic choice based

on culture and sensitivity or empirically (initially) on effectiveness against organ-

isms associated with the gastrointestinal tract: clindamycin (11 mg/kg q24h to BID);

metronidazole 10 mg/kg BID; amoxicillin-clavulanate 12.5 mg/kg BID).

 Corticosteroids: immunosuppressive dosages (2 mg/kg q24h to BID initially; tapered

to EOD); significantly less effective than cyclosporine.

 Azathioprine (1–2 mg/kg q24h initially; tapered to EOD or twice weekly).

 Restricted/novel-ingredient diet may yield partial or complete resolution (about 33%

of cases); most dogs do not improve.

 Tacrolimus ointment (0.1%): apply to tissues BID initially; tapered to EOD; may

reduce dosages of or replace systemic therapy for maintenance.

 Mupirocin ointment (2%): apply to tissues q24h to BID until healed.

 Mesenchymal stem cell injections: initial studies report efficacy.

Possible Treatment Complications

 Recurrence.

 Failure to heal.

 Dehiscence of surgical site.

 Tenesmus.

 Fecal incontinence.

 Anal stricture.

 Flatulence.

 The incidence of postoperative complications is directly related to severity of disease.

COMMENTS

Expected Course and Prognosis

 Guarded for complete resolution except in mildly affected patients.

 Treatment is often lifelong.

 Resolution of pain and discharge is primary goal of therapy.

 Client education and understanding of therapy goal required.