Preventing Relapses in Canine Atopic Dermatitis: A Practical Long-Term Management Plan

Managing an acute flare of canine atopic dermatitis (CAD) is only half the battle. The real measure of success is keeping the patient comfortable long after the skin lesions have resolved. 

Many dogs respond well to treatment initially but return weeks or months later with recurrent pruritus, otitis, or skin infections. These repeated flare-ups not only affect the dog's quality of life but also frustrate owners and increase the need for long-term medication. The key to reducing relapses lies in adopting a proactive, multimodal management strategy that addresses the disease beyond symptom control¹. 

Think Beyond Anti-Itch Medication 

Modern therapies such as oclacitinib, lokivetmab, and ciclosporin have revolutionised the management of CAD by effectively reducing pruritus and inflammation. However, these medications work best when they are part of a comprehensive treatment plan rather than the sole intervention¹. 

Persistent allergen exposure, skin barrier dysfunction, microbial imbalance, nutritional deficiencies, or secondary infections can continue to drive inflammation even when itching appears controlled. 

Instead of asking, "What should I prescribe next?", consider asking: 

"What underlying factor is preventing this patient from achieving long-term stability?" 

This shift in perspective often leads to more sustainable disease control. 

Strengthen the Skin Barrier 

Every flare damages the skin barrier, making it easier for allergens, irritants and microorganisms to penetrate the skin and trigger further inflammation^1,2. 

Supporting barrier repair should therefore become a routine part of every management plan. 

Practical strategies include: 

• Regular bathing with therapeutic shampoos to remove allergens and reduce microbial load. 

• Using moisturising rinses or leave-on emollients to improve skin hydration. 

• Applying barrier-support topical products where appropriate. 

• Maintaining routine ear hygiene in dogs prone to recurrent otitis. 

Consistent barrier care helps reduce allergen penetration and supports restoration of the skin's natural defence mechanisms. 

Identify and Treat Secondary Infections Early 

One of the most common reasons for relapse is undiagnosed bacterial pyoderma or Malassezia overgrowth. 

Clinical signs often worsen before obvious lesions become apparent. Routine skin and ear cytology allows veterinarians to identify microbial overgrowth early and institute targeted therapy before a full flare develops¹. 

Early intervention can often prevent unnecessary escalation of systemic anti-inflammatory medication. 

Nutrition Is Part of the Treatment Plan 

Nutrition is no longer viewed as simply supportive care—it is increasingly recognised as an important component of disease management. 

Dogs receiving diets enriched with omega-3 fatty acids (EPA and DHA), antioxidants and polyphenols have demonstrated significant reductions in skin lesion severity and owner-reported pruritus when compared with standard diets³. These nutrients help regulate inflammatory responses while supporting skin barrier repair. 

Emerging evidence also suggests that chronic inflammation associated with CAD may impair the absorption and utilisation of important micronutrients, including iron, zinc and certain vitamins, even when dietary intake is adequate⁴. 

This inflammation-associated "mucosal block" may contribute to persistent immune activation and delayed skin recovery. Optimising nutritional support may therefore complement pharmacological therapy and improve long-term disease control⁴. 

Consider Allergen-Specific Immunotherapy Early 

Unlike medications that primarily suppress clinical signs, allergen-specific immunotherapy (ASIT) targets the underlying allergic response and remains the only treatment capable of modifying the natural course of the disease¹. 

Although clinical improvement may take several months, appropriately selected dogs can experience reduced flare frequency, decreased medication requirements and improved long-term disease stability. 

Discussing ASIT early with owners helps establish realistic expectations and may improve long-term treatment success. 

Partner with Owners for Better Outcomes 

Long-term success depends as much on owner compliance as it does on the treatment protocol itself. 

Owners should understand that CAD is a lifelong condition requiring ongoing management rather than intermittent treatment during flare-ups. 

Simple measures can significantly improve compliance: 

• Explain the purpose of each therapy. 

• Demonstrate proper bathing and ear-cleaning techniques. 

• Encourage owners to recognise the earliest signs of relapse. 

• Reinforce year-round parasite control. 

• Schedule regular follow-up visits instead of waiting for clinical deterioration. 

When owners become active participants in disease management, treatment outcomes often improve considerably. 

Monitor Patients Before Problems Escalate 

Routine rechecks allow veterinarians to detect subtle changes before they become major clinical problems. 

During follow-up visits, consider: 

• Assessing lesion severity using CADESI where appropriate. 

• Reviewing owner-assessed pruritus scores. 

• Performing cytology if pruritus has increased. 

• Evaluating nutritional management. 

• Reviewing medication response and adverse effects. 

• Adjusting the treatment plan according to disease activity. 

Proactive monitoring enables earlier intervention and reduces the likelihood of severe flare-ups. 

A Practical Relapse Prevention Checklist 

For every dog with chronic CAD: 

✔ Maintain year-round flea and parasite control. 

✔ Support the skin barrier with regular topical therapy. 

✔ Perform skin and ear cytology whenever pruritus worsens. 

✔ Optimise nutrition with evidence-based skin-support diets. 

✔ Consider allergen-specific immunotherapy for suitable patients. 

✔ Schedule routine dermatology rechecks every few months. 

✔ Educate owners to identify and report early signs of relapse. 

The Clinical Take-Home 

Preventing relapses in canine atopic dermatitis requires more than prescribing effective anti-pruritic medication. Successful long-term management depends on combining pharmacological therapy with skin barrier support, early detection of secondary infections, nutritional optimisation, owner education and regular clinical monitoring. By proactively addressing the factors that sustain inflammation rather than simply reacting to flare-ups, veterinarians can reduce relapse frequency, minimise medication dependence and provide dogs with more consistent, long-term disease control. 

References (Vancouver) 

1. Outerbridge CA, Jordan TJM. Current knowledge on canine atopic dermatitis: Pathogenesis and treatment. Adv Small Anim Care. 2021;2:101-115. doi:10.1016/j.yasa.2021.07.004. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9204668/ 

2. Santoro D, Saridomichelakis M, Eisenschenk M, Tamamoto‐Mochizuki C, Hensel P, Pucheu‐Haston C, International Committee on Allergic Diseases of Animals (ICADA), Banovic F, Bensignor E, DeBoer D, Griffin G. Update on the skin barrier, cutaneous microbiome and host defence peptides in canine atopic dermatitis. Veterinary Dermatology. 2024 Feb;35(1):5-14. https://doi.org/10.1111/vde.13215?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle 

3. de Santiago I, Puigdemont A, Brazis P, et al. A diet enriched with omega-3 fatty acids, antioxidants and polyphenols improves clinical signs in dogs with atopic dermatitis: A randomized, double-blind, placebo-controlled clinical trial. BMC Vet Res. 2021;17:354. doi:10.1186/s12917-021-03072-6. https://doi.org/10.1186/s12917-021-03063-w

4. Frizzo-Ramos C, Doulidis PG, Burgener IA, Horvath Ungerböck C, Einspieler V, Weiser U, Panakova L, Roth-Walter F. Lymph food to improve canine atopic dermatitis: A randomized, double-blinded, controlled trial in dogs with standard-care treatment. Front Vet Sci. 2025;12:1657869. doi:10.3389/fvets.2025.1657869. Available from: https://www.frontiersin.org/articles/10.3389/fvets.2025.1657869/full