THE ITCHING PET: ALTERNATIVES TO STEROIDS
Excessive licking, chewing, and scratching can make a pet’s life miserable for month after month, even year after year. For rapid relief of itch and inflammation, nothing matches the corticosteroid hormones such as cortisone, hydrocortisone, prednisone, dexamethasone, and others.) There are some animals that seem unable to live with any degree of comfort without these medications. Unfortunately, these hormones have widespread and potentially dangerous actions throughout the body when they are used for inappropriately long periods and it is generally desirable to minimize the use of these hormones when possible to do so. Ideally, corticosteroids are used for a few really tough itch weeks and other forms of itch management are used for “general itch maintenance.”
For more detail on long term corticosteroid use click here
This is, of course, easier to write about than to actually do. When one's pet is scratching and chewing raw spots on his or her skin, practical advice is what is called for. The following list includes assorted non-steroidal methods for relieving itch and reducing the amount of corticosteroid hormones needed.
Histamine, a biological chemical, is the chief mediator of inflammation in humans hence the proliferation of antihistamines available for people both by prescription and "over the counter." Histamine is not the major mediator of inflammation in the dog, thus these medications are not as reliable for dogs as they are for us.
The protocol recommended by this hospital is helpful to approximately 40% of dogs who try it. Four different antihistamines are used, one at a time, at least two weeks each, in hope of finding one that is acceptably effective. While the chance that an individual antihistamine will be helpful is small (about 15%), trying several antihistamines greatly increases the chance of finding one that works.
Antihistamines are not free of side effects; they are notorious for drowsiness in some individuals. Still, this is vastly preferable to the systemic disruption caused by the corticosteroid group.
Our hospital uses the following antihistamines in a typical antihistamine trial (click for more information):
In the cat, antihistamines are substantially more reliable than in dogs so that the chances of a given antihistamine working are usually pretty good. For both cats and dogs, using antihistamines together with a corticosteroid hormone will decrease the amount of corticosteroid hormone needed to control the itching (i.e. less hormone is needed to get the job done if it is given with an antihistamine).
FATTY ACID SUPPLEMENTATION
The discovery of anti-inflammatory properties of evening primrose oils and fish oils in humans has led to similar products on the market for our pets. These products are not analogous to the oil supplements which are recommended as food supplements to make a pet's coat shiny; instead; these are true anti-inflammatory drugs capable of relieving joint pain, cramps, and itchy skin.
The supplement alone is helpful in 10-25% of itchy dogs; we often recommend its use in combination with antihistamines to boost the efficacy of the protocol described above.
Cylcosporine is an immune system modulating drug originally developed for use in organ transplant patients but also useful in other immune-mediated diseases. Since allergy is an immune-mediated condition, cyclosporine was investigated as an alternative to corticosteroids and found effective for most patients. Currently this medication is being marketed only for dogs and one dog in three will develop an upset stomach when starting the drug (though this resolves or is manageable with dose modification).
For more information on Cyclosporine click here.
TOPICALS TO TRY
When using any dip on inflamed skin one should be aware that the use of cool water is considered much more soothing than warm water.
Itchy skin can be the result of skin infection, excess oil accumulation, yeast infection, even parasitic infection. The list goes on. The shampoo products listed above can be used against any itchy skin disease but it should be noted that there are many other shampoo and creme rinse products that can be used against the specific skin diseases listed. If some other type of shampoo product has been prescribed to you for an itchy skin disease, it is important that you use it allowing at least a good 10 minutes of skin contact time before rinsing.
TEN MINUTES OF SKIN CONTACT IS THE MINIMUM REQUIREMENT FOR ANY MEDICATED SHAMPOO. PREMATURE RINSING WILL NOT ALLOW FOR THE THERAPEUTIC BENEFIT TO BE REALIZED.
ALOE VERA GEL - If possible, obtain 100% aloe vera gel from a health food store. Products "containing aloe" are much more available but are generally not as effective and not meant to be licked away by a pet. Aloe vera gel comes from the aloe vera succulent and contains enzymes which break down inflammatory proteins and enhance healing. Pure aloe vera gel is not harmful for pets who want to lick it off.
TOPICAL STEROIDS? - It seems clear that taking steroids orally may be harmful to the body with chronic use but are topical cremes safe for long term use? We now know that topical steroids (cortisone cremes and related products) are absorbed through the skin and into the bloodstream but the hormonal side effects with topical use do seem blunted. For small irritated areas (“hot spots”), topicals can provide excellent relief without the systemic effects of hormones.
RESPECT THE STEROID
Severe itching amounts to a reduction in life quality. It is important not to develop the mindset that corticosteroids should be avoided at all costs. This would not be fair to the itching pet. Steroids are valuable tools in the relief of pain and suffering and have an important place the therapy of the itchy pet. The goal is not to avoid steroid use if possible but to avoid long term dependence on steroids if possible. Despite all of the above management tricks, some pets will still require long term steroid use to achieve any reasonable comfort. There are monitoring protocols in place for such cases. It should also not be forgotten that underlying allergies and recurring skin infections can be addressed specifically and that as these conditions are managed, the itch is also managed.
Steroid hormones have many side effects and, as helpful as they are for allergic skin diseases, it is best to reserve them for only the most itchy episodes.