If your dog spends autumn chewing a bald patch onto his flank, the treatment playbook just changed. The International Committee on Allergic Diseases of Animals published updated canine atopic dermatitis guidelines on September 28, the first major revision since 2015.
The old version sorted drugs by how fast they worked. The new one sorts them by mechanism: skin barrier care, infection and microbiome treatment, allergen avoidance and immunotherapy, and anti-itch drugs. Speed alone, the authors argue, never captured how differently the disease behaves across breeds.
The bigger shift is the two-phase plan. Reactive therapy clears the flare at an effective dose until the skin and the scratching settle, even at the cost of short-term side effects, because cutting the dose early invites a rebound. Proactive therapy then continues at a lower level to hold remission and prevent the thickened, darkened skin that gets harder to treat.
Topical steroids earned the top evidence grade for flares, chronic lesions and maintenance, as did oral prednisolone for flares, with a warning about long-term use. Oclacitinib and the newer ilunocitinib also earned top grades, and one trial found ilunocitinib lowered itch scores more after two weeks. Lokivetmab remains strong for itch-dominant dogs.
Two cheap items got top grades as support: a weekly bath and essential fatty acids, which in three trials reduced the steroid and cyclosporine doses dogs needed. Allergy shots are recommended for environmental cases, with a year before judging.
What this means for your dog: ask for a maintenance plan, not just a flare prescription. Bathe weekly. Do not stop the drug the week the scratching stops.
For the seasonal version, see why the scratching starts in fall, and if your dog takes Apoquel, read the rise in Apoquel overdoses. The guideline summary is at dvm360.