Marsella Rosanna
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida Gainesville, FL, USA,
Vet Med (Auckl). 2012 Aug 29;3:85-91. doi: 10.2147/VMRR.S28488. eCollection 2012.
Remarkable progress has been made in recent years concerning our understanding of the pathogenesis of canine atopic dermatitis (AD). As our understanding improves, the therapeutic approach evolves. Of utmost importance is the documentation of skin barrier impairment in canine AD: ceramides deficiency leads to increased permeability and increased allergen penetration and sensitization. It is currently unknown whether this dysfunction is primary and genetically inherited or secondary to inflammation but it is accepted that skin barrier deficiency plays an important role in either starting or minimally exacerbating canine AD. Thus, the therapeutic approach has changed from focusing on the control of the inflammation to a combined approach that includes therapies aimed at skin barrier repair. The issue of skin barrier repair has been addressed both with oral administration of essential fatty acids and the topical application of products containing a combination of ceramides and fatty acids. These strategies are most helpful as adjunctive treatments and would be best used in young patients that have not developed chronic skin changes. Importantly, treatment for canine AD is multimodal and tailored to the individual patient, the age, and the duration of the disease. Client education plays an important role in explaining the importance of a long-term approach to minimize flare-ups and, in this context, topical therapy to correct skin barrier can be of great benefit. This is an area still in infancy and much work is needed to identify the best formulation. In human medicine, long-term use of moisturizers can have a profound effect on skin barrier and gene expression of proteins involved in skin barrier. This effect is variable depending on the formulation used. It is reasonable to speculate that the same may be true in dogs; thus, it is very important to identify the correct ingredients and formulation to use.
近年来，我们对犬特应性皮炎（AD）发病机制的理解取得了显著进展。随着我们理解的加深，治疗方法也在不断演变。犬AD皮肤屏障受损的记录至关重要：神经酰胺缺乏会导致通透性增加以及变应原渗透和致敏增加。目前尚不清楚这种功能障碍是原发性的且由基因遗传，还是继发于炎症，但人们公认皮肤屏障缺陷在犬AD的起始或至少在加重方面起着重要作用。因此，治疗方法已从专注于控制炎症转变为一种综合方法，包括旨在修复皮肤屏障的疗法。皮肤屏障修复问题已通过口服必需脂肪酸以及局部应用含有神经酰胺和脂肪酸组合的产品来解决。这些策略作为辅助治疗非常有帮助，并且最适合用于尚未出现慢性皮肤变化的年轻患者。重要的是，犬AD的治疗是多模式的，并且是根据个体患者、年龄和疾病持续时间量身定制的。客户教育在解释长期治疗以尽量减少病情发作的重要性方面起着重要作用，在这种情况下，局部治疗以纠正皮肤屏障可能会有很大益处。这是一个仍处于起步阶段的领域，需要做大量工作来确定最佳配方。在人类医学中，长期使用保湿剂可对皮肤屏障以及参与皮肤屏障的蛋白质的基因表达产生深远影响。这种效果因所用配方而异。合理推测狗可能也是如此；因此，确定正确的成分和使用配方非常重要。
