feline cyclosporine 2009.ppt - itchnot.com1 petslivinglonger.com keith a hnilica dvm, ms,...
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PetsLivingLonger.com
Keith A Hnilica DVM, MS, MBADiplomate ACVD
[email protected](865) 405-4203
Evaluating Feline Pruritus
What's the problem?Cats are not small dogs…Differentials for feline pruritusDifferentials for feline pruritus.A dermatologists approach…
CookbookMethodical
Managing Feline Pruritus
Cats only eat what THEY want.Cats are in touch with the inner barbarianbarbarian.Cats don't like pills.Cats don't like elixirs.Cats don't like water.Cat's remember!
Evaluating Feline Pruritus
Distinct Clinical Syndromes?Miliary DermatitisAllergic Alopecia - PruritusAllergic Alopecia PruritusEosinophilic Granuloma Complex"Head and Neck Pruritus"
All have similar etiologiesSimilar diagnostic strategySimilar therapeutics
Miliary Dermatitis Allergic Alopecia
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Eosinophilic Granuloma Complex Eosinophilic Dermatoses
Eosinophilic Dermatoses Evaluating Feline PruritusFleas
Fleas Fleas
Food allergyAtopyContact DermatitisPyodermaMalasseziaMites
Demodex gatoiOtodectesCheyletiellaNotoedres
Insect HypersensitivityMosquitoesMoth, CockroachFlies
MalasseziaDermatophytosisDrug ReactionParaneoplasticPemphigusMycosis FungoidesPsychogenicHerpes VirusFeLV/FIVPapilloma virus
Cat Dermatitis: Easy or NOT
1. Eliminate fleasCapstar qod for 30 days
2. Ring worm
3 Eliminate mites3. Eliminate mitesRevolutionLime sulfur
4. Food trial
5. Cyclosporine
Hnilica itchnot.com
Dr. Depo approach
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Evaluating Feline Pruritus
5 days post Depomedrol
When Steroids Go Bad - CatsDiabetesCorticoid-associated Congestive Heart Failure in 29 Cats. Smith SA, et al.
271 cats with CHF
29 with steroid administration in previous 90 days (11%)
VIN searchapx >30 cats with CHF after steroid administration
Allergy Testing
http://www.cvm.ncsu.edu/docs/dermat_allergyclinic.htm
Managing Feline PruritusGo with the odds
FleasFleasFleasDemodexDemodexInsects/MitesFood
Eosinophilic Dermatoses Evaluating Feline Pruritus
Ciba AH Novartis
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http://www.cymedica.com
Cat Dermatitis: Easy or NOT
1. Eliminate fleasCapstar qod for 30 days
2. Ring worm
3 Eliminate mites3. Eliminate mitesRevolutionLime sulfur
4. Food trial
5. Cyclosporine
Hnilica itchnot.com Hnilica 2007
Hnilica 2007
Cyclosporine and Dermatology
MacrolactamsCyclosporine, tacrolimus, pimecrolimusDerived fromDerived from
Tolypocladium inflatum – cyclosporineStreptomyces tsukubaenis - tacrolimus
1979 improved psoriasisDecreased lymphocytes infiltrates
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Allergic Inflammation
Atopica is a registered trademark of Novartis Animal Health US, Inc.
Novartis AH AtopicaR 2003
Atopicap
Vaccine X
T-cells
inhibits cytokines
Langerhans cells
IgE receptor
tissue migration
Antigen processing
Mast Cells
histamine release
Keratinocytes
IL-8 receptorsMacrolactam immunomodulators for topical treatment of inflammatory skin diseases. Bornhovd E et al. JAAD 2001.
CyclosporineTacrolimus
Atopica in Cats
Currently off Label5-10mg/kg (7mg/kg/day)Useful for many diseasesUseful for many diseasesFewer side effects+/- faster response
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Atopica in Cats
Toxo risk“Super absorbers”Titers not useful – negative more riskyTiters not useful negative more riskyKeep inside to limited exposure
Felv/FIV negativeOther infectionsSafer than steroids
Idiopathic Pruritus - Cyclosporine
Idiopathic Pruritus
Dr. A. Vercelli, ItalyNovartis Proceedings, 5th World Congress of Veterinary Dermatology
b d86% improvement by day 3097% improvement by day 60100% improvement by day 90
Eosinophilic Dermatoses
Eosinophilic Granuloma Idiopathic Pruritus - Cyclosporine
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Eosinophilic DermatosesFeline Idiopathic Ulcerative Dermatosis
Eosinophilic Granuloma
Dr. A. Vercelli, ItalyNovartis Proceedings, 5th World Congress of Veterinary Dermatology
b d78% improvement by day 3097% improvement by day 60100% improvement by day 90
Stomatitis
D. Mawby
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MacrolactamsAllergic DermatitisDiscoid LupusPemphigusBullous pemphigoid
VasculitisUrticariaRheumatoid arthritisSweet’s syndrome
Poison Ivy
AIHAColitisBullous pemphigoid
Systemic LupusSebaceous AdenitisGranulomatous
dermatosesPsoriasisActinic dermatitisDermatomyositis
Sweet s syndromePanniculitisErythema multiformeHypereosinophilic
syndromeEosinophilic granulomasSclerodermaSenile pruritus
ColitisOrgan Transplants
Androgenic alopeciaVitiligoIchthyosisMycosis fungoides
Evaluating Feline PruritusFleas
Fleas Fleas
Food allergyAtopyContact DermatitisPyodermaMalasseziaMites
Demodex gatoiOtodectesCheyletiellaNotoedres
Insect HypersensitivityMosquitoesMoth, CockroachFlies
MalasseziaDermatophytosisDrug ReactionParaneoplasticPemphigusMycosis FungoidesPsychogenicHerpes VirusFeLV/FIVPapilloma virus
Managing Feline Pruritus Eosinophilic Dermatoses
Persian Facial Dermatitis
Idiopathic Facial DermatitisFacial DermatitisPersian SeborrheaPersian Seborrhea
Is it a new disease or a fixed reaction pattern?
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Persian Facial Dermatitis
What is it?Characteristic symptoms
Young adultsgFaceSeborrheaInflammationPruritus after skin changesOtitisLymphadenopathy
Persian Facial Dermatitis
C. Foil
Persian Facial Dermatitis
Primary or SecondaryGenetics – reaction pattern or keratinization defectFeLV, FIV, Herpes virusDermatophytosisPyodermaMalasseziaDemodexAllergies
Food
Persian Facial Dermatitis
HistopathologyInflammatory dermatitis
Neutrophils, eosinophils, mast cellsNeutrophils, eosinophils, mast cellsInterfaceSpongiosis
Persian Facial Dermatitis
How do you treat it?Treat any identifiable diseaseTopical antiseborrheicsTopical antiseborrheics
Degreasing shampooBenzoyl peroxideSulfur/salicylic acid
Systemic antimicrobialsAntibioticsItraconazole
If idiopathic?
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Allergic Inflammation
Atopica is a registered trademark of Novartis Animal Health US, Inc.
Novartis AH AtopicaR 2003
CyclosporineTacrolimus
Atopica in Cats
Currently off Label5-10mg/kg (7mg/kg/day)Useful for many diseasesUseful for many diseasesFewer side effects+/- faster response
Atopica in Cats
Toxo risk“Super absorbers”Titers not useful – negative more riskyTiters not useful negative more riskyKeep inside to limited exposure
Felv/FIV negativeOther infectionsSafer than steroids
Hnilica 2007
Generics?? (7 Derms say . . . )Lose 10-50% efficacyLose control of dispensed productNot FDA veterinary approvedOnly cheaper through outside pharmaciesNot wise practice management
PetsLivingLonger.com
Keith A Hnilica DVM, MS, MBADiplomate ACVD
[email protected](865) 405-4203