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weeks; the improvement in pruritus was higher with the daily treatment.
Severe claw fold infections may require longer treatment or higher doses, however, and otitis externa cases may not respond adequately.
WSV18-0187
FASAVA/HILLS FELINE MEDICINE
INITIAL CONSIDERATIONS BEFORE CHASING REMISSION IN DIABETIC CATS
C. Mooney1
1University College Dublin, Small Animal Clinical Studies, Dublin 4, Ireland
INITIAL CONSIDERATIONS BEFORE CHASING REMISSION IN DIABETIC CATS
Carmel T Mooney MVB MPhil PhD DipECVIM-CA MRCVS
Small Animal Clinical Studies, School of Veterinary Medicine, UCD, Belfield, Dublin 4, Ireland
carmel.mooney@ucd.ie
Diabetes mellitus is a common endocrine disease of cats that is probably increasing in prevalence. There is strong evidence that the majority of cats suffer a disorder similar to human type 2 diabetes mellitus. This is characterised by both insulin resistance and impaired insulin secretion. In cats, as in humans, remission is a possibility particularly if those factors contributing to insulin resistance (such as obesity) and impaired insulin secretion (such as glucose toxicity) are effectively addressed.
Remission rates vary in different studies from 0 to
100 % but none are directly comparable. In practice, remission rates of between 30 and 50 % are probably more realistic. From a review of the literature it appears that dietary therapy (using a low carbohydrate high protein diet) and the intensity of monitoring strategies (particularly those that attempt to tightly control blood glucose concentrations) are extremely important
in achieving remission1. The type of insulin used
may also play a role but this appears to be of lesser importance. Many owners would prefer to know
the likelihood of remission before choosing a given treatment protocol with an intense monitoring strategy. Unfortunately it is difficult to predict which cats will
go into remission and which will not but generally if remission is to occur it will do so in 3-4 months. Not surprisingly remission is more likely in cats that are less severely hyperglcycaemic at diagnosis. Additionally, remission is more likely in cats intensively treated
soon after (< 6 months) first diagnosis, in cats recently treated with glucocorticoids, in older cats and in those without signs of peripheral neuropathy2. Gender, weight (including obesity), presence of diabetic ketoacidosis, renal disease or hyperthyroidism, and frequency
of hypoglycaemia are not predictors of remission. Approximately 25 – 30 % of cats in remission will relapse and most have evidence of impaired glucose tolerance or inappropriately high glucose concentrations3. Repeat
There are no veterinary products licensed for the treatment of Malassezia dermatitis in cats. Systemic therapy is the treatment of choice. Itraconazole
is preferred to ketoconazole because it is better tolerated in cats. Fluconazole has also been used to treat Malassezia dermatitis in cats and may be a more affordable treatment option.
Prophylaxis for chronic/relapsing Malassezia dermatitis
• Regular shampoo therapy (weekly or biweekly)
• Pulse oral itraconazole or terbinafine: two consecutive days each week
• Monitor for hepatotoxicity with CBC and biochemistry every 6 months
Immunotherapy for Malassezia dermatitis
A commercial Malassezia extract is licensed and available (Greer Laboratories®). A good response
to subcutaneous immunotherapy administered for a minimum of 10 months was reported in nine of 16 cases (56%) of Malassezia hypersensitivity confirmed by intradermal allergy testing with both a reduction in use of anti-inflammatory and antifungal medication as well as a reduction in pruritus scores by >50%. No adverse effects were reported (Aberg 2017)
REFERENCES AND FURTHER READING
Aberg L, Varjonen K, Ahman S. Results of allergen specific immunotherapy in atopic dogs with Malassezia hypersensitivity: a retrospective study of 16 cases. Vet Dermatology. 2017 28: 633-636
Bond R et al Factors associated with elevated cutaneous Malassezia pachydermatis populations in dogs with pruritic skin disease J. Sm. An. Pract. 1996 37: 103-107
Chen T, Hill PB. Review: The biology of Malassezia organisms and their ability to induce immune responses and skin disease. Vet Dermatology. 2005 16: 4-26
Glatz M, Buchner M, Von Bartenwerffer W et al. Malassezia spp – specific IgE level as a marker for severity of atopic dermatitis in adults. Acta Derm Venereol 2015 95: 191-196
Harada K, Sait M, Sugita T, Tsuboi R. Malassezia species and their associated skin disease. J of Dermatology. 2015 42: 250 – 257
Negre A, Bensignor E and Guillot J Evidence-based veterinary dermatology: a systematic review of interventions for Malassezia dermatitis in dogs. Vet Dermatology. 2009 20(1): 1-12.
Oldenhoff WE, Frank GR, DeBoer DJ. Comparison of the results of intradermal test reactivity and serum allergen-specific IgE measurements for Malassezia
pachydermatis in atopic dogs. Vet Dermatology. 2014 25: 507-511
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