Table 2 2015 updated guidelines of acute and chronic atopic dermatitis treatment [51]

Identification and avoidance of flare factors

Elimination of allergenic flare factors (fleas, food and environmental);

Evaluation of the use of antimicrobial therapy if clinical signs of infection with bacteria or yeast are present on the skin or in the ears.

Dietary restriction-provocation trials in dogs with nonseason signs;

Implementation of an effective flea control regimen;

Performance of allergen-specific intradermal and/or IgE serological tests to identify possible environmental allergen flare factors;

Implementation of house dust mice or other allergen control measures;

Evaluation of the use of antimicrobial therapy (terbinafine or itraconazole once a day [SID] for two consecutive days each week for 3 weeks to treat flares provoked or exacerbated by Malassezia skin infections).

Improvement in skin and coat hygiene and care

Bathing with a non-irritating shampoo containing lipids, complex sugars and antiseptics or phytosphingosine, raspberry oil and lipids.

Bathing at least once weekly with a non-irritating shampoo or an antiseborrheic/ antimicrobial shampoo and dietary supplementation with essential fatty acids.

Reduction of pruritus and skin lesions

Topical glucocorticoids sprays for localized lesions;

Oral glucocorticoids (prednisolone, prednisone or methylprednisolone given at 0.5 to 1.0 mg/kg per day SID or two times a day [BID]) or oral oclacitinib (0.4 to 0.6 mg/kg BID for up to 14 days) for widespread or severe lesions.

Topical glucocorticoids sprays for localized lesions;

Oral glucocorticoids (prednisolone, prednisone or methylprednisolone given at 0.5 mg/kg SID or BID), oral cyclosporine (5 mg/kg SID until satisfactory control of clinical signs), oclacitinib (0.4 to 0.6 mg/kg BID for 14 days and then SID) or injectable interferons (recombinant canine interferon-gamma given subcutaneously [SC] at 5.000–10.000 units/kg three times weekly for four weeks and then once weekly) for widespread or severe lesions.

These drugs should not be combined together in the long term to reduce the risk of immunosuppression.