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Today's VeTerinary PracTice | January/February 2016 | tvpjournal.com 72 DERMATOLOGY DETAILS Peer Reviewed • a diet trial must be performed for up to 3 months, although some animals experience relief much sooner. • diet trials should never be performed with "pet store brand" diets, as these diets often contain trace amounts of important allergens not listed on the label. 10 The most frequently asked question—"Which diet is the best to use?"—is the one that generates the most controversy. no convincing evidence exists regarding whether a home-cooked or commercially prepared diet is better for a given patient. regardless of the diet chosen, compliance is paramount and strict adherence to the prescribed food is necessary. DILEMMA 4. What's best for treating canine generalized demodicosis? Pitfalls & Challenges Treatment options for canine demodicosis have been limited by lack of available products for treatment and potential adverse effects: • Amitraz is still a viable treatment option, although frequent dipping presents formidable compliance problems. • oral ivermectin (0.4–0.6 mg/kg Q 24 H) is preferred by many, but adverse reactions (typically neurologic signs) can occur. • Milbemycin (1–2 mg/kg Po Q 24 H) is very effective and has recently reappeared on the U.s. market, but daily use makes it rather costly. • Topical once-weekly moxidectin + imidacloprid has met with variable success in the U. s. • off-label use of doramectin (0.6 mg/kg sc once weekly) is sometimes considered, but may also produce adverse effects similar to those caused by ivermectin. it is important for clients to understand that, regardless of the regimen selected, treatment must continue for a very long time—until repeated skin scrapings are negative—and, if treatment stops prematurely, the disease will surely return. Clinical Pearls This dilemma appears to be resolving, however, with the recent buzz about use of the isoxazoline compounds (afoxolaner and furalaner) as off-label treatments for canine generalized demodicosis. There is only one published study of such use, 11 but dermatologists are anecdotally reporting tremendous success with these drugs—even at the usual label-indicated, fea-and-tick prevention doses (Figure 3). More studies are sure to follow, and we may be on our way to an easy method for long-term control of this serious dermatosis. DILEMMA 5. How should I treat feline eosinophilic granuloma complex? Feline eosinophilic granuloma complex is a clinical syndrome that classically manifests as eosinophilic ulceration, eosinophilic plaque, or collagenolytic granuloma (Figure 4, page 75). This syndrome should not be viewed as a specifc diagnosis but rather as a reaction pattern in feline skin that may be induced by many different defnable underlying causes, such as parasites, infection, or allergy. However, it is clear that feline eosinophilic granuloma complex can exist as an idiopathic condition on its own, without a FIGURE 3. Severe pododermatitis due to Demodex canis infestation in a dog before treatment (A). Two months after 2 monthly oral doses of afoxolaner, the dog showed marked improvement (B), which should continue with additional treatment. A B