Summer 2008 derm discourse3

D E R M A T O L O G Y C L I N I C F O R A N I M A L S L A S V E G A S Phone: (702) 821-1002 Fax: (702) 821-1007 Phone: (702) 434 - 1002 Fax: (702) 434 - 1058 V i s i t u s o n t h e W e b a t w w w . d e r m v e t v e g a s . c o m The Pros and Cons of Cyclosporin in the Treatment of Atopy One of the most frequent questions we re- toxicity, but the most common side affect ceive from referring veterinarians and cli- that we see is gastrointestinal upset, espe- ents at our office is “what do you think of cially vomiting. The drug has maximum cyclosporin, and does it work for the treat- ment of atopy?” We have been using cyc- losporin for the treatment of refractory may decrease the incidence of vomiting. e atopic cases since 1996. Like all of our Less common side affects which are re- s therapeutic options for atopy, it has both ported and which we have seen include (wart-like) growths on the skin. The start- u Cyclosporin is a fat-soluble cyclic polypep- ing dose is 5 mg/kg orally daily. If im- o tide derived from the fungus Tolypocla- provement in clinical signs is seen, the dose c dium inflatum gams. It was originally de- may be decreased to every other day us- s veloped for the prevention of organ trans- age or less. Although reported, we do not m available and approved for veterinary use zole, other drugs reported to decrease the r under the brand name Atopica (Novartis metabolism of cyclosporin (and thereby e Animal Health). The human counterpart increase its blood levels) include itracona- drug is Neoral or the generic product Gen- zole, fluoroquinolone antibiotics, calcium ally expect to see a favorable response When deciding on appropriate therapy for within the first two weeks, although some an atopic patient there are many factors patients are reported to require four to six which should be considered. The severity of weeks to respond. It has a relatively low the disease, the duration (short-term sea- sonal vs. year round) and the tal toxoplasmosis and atypi- age of the patient are some cal mycobacteriosis in cats gether, so that a steroid-of the important variables. treated with cyclosporin. Ad- suppressive therapy such as this drug in patients judged cyclosporin may predispose too old in which to perform patients to development of intradermal allergy testing, lergens off the coat and so neoplasia due to suppression or which do not respond to reduce percutaneous absorp- tion), antipruritic sprays or term therapy with cyc- conditioners, antihistamines losporin remains the most ex- pensive medical option for tory pruritus. Our concern is quate in controlling pruritus. phy is to consider cyclosporin treated with cyclosporin life-In those cases, the remaining to be a temporary therapy in long when, in fact, they had treatment options are sys- most patients. We like the food hypersensitivity, scabies, temic corticosteroids, allergen fact that this is one of the few cheyletiella, dermatophytosis, specific losporin. Steroids offer the pruritus with- fastest and least expensive out interfering relief but obviously have the with results of most long-term side affects, i n t r a d e r m a l gen-specific immunotherapy We often will is the safest long-term option use cyclosporin but often requires several during the cor- months before improvement t i c o s t e r o i d is seen. This approach has a w i t h d r a w a l greater upfront cost because time prior to this test. In addition, we can harmful choice. In appropri- apy is less costly. Cyclosporin duction phase of immuno- is less toxic than steroids, but therapy until the positive af- there are reports of cases of fects of desensitization are ment of atopy in both the systemic infections such as fa- 1. E. Guaguere, et al. Cyclosporin A: a new drug in the field of canine dermatology. Veterinary Der-matology 2004; 15: 61-74. 2. D. Robson, et al. Cyclosporin: applications in small animal dermatology. Veterinary Dermatology 2003; 14: 1-9. 3. T. Olivry, et al. Cyclosporin decreases skin lesions and pruritus in dogs with atopic dermatitis: a blinded randomized prednisolone-controlled trial. Veterinary Dermatology 2002; 13: 77-87.


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Curriculum Vitae ANAVAJ SAKUNTABHAI M.D.(Thailand), M.D.(Newcastle, UK), D. Phil. (Oxon) Present address Present position Honorary Assistant Professor Qualifications Degree/Certification Graduation Institute The Wellcome Trust Centre for Human Genetics Professional experience since graduation Position Duration Institute Laboratoire d

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