Canine atopic dermatitis treatment guidelines updated for first time since 2015: What to know

The International Committee on Allergic Diseases of Animals (ICADA) has published updated recommendations for treating canine atopic dermatitis (cAD), its first major revision since 2015. The guidelines, published September 28, 2026 in Veterinary Dermatology, review evidence through July 2026 and grade the supporting evidence using the Strength of Recommendation Taxonomy (SORT). Grades run from SOR A, based on consistent, good-quality evidence such as systematic reviews, meta-analyses, or 2 or more randomized controlled trials with similar findings, to SOR D, based on expert consensus.

The authors reorganized the guidance around how each therapy works and where it fits in the course of disease, rather than around how quickly it acts. The questions below cover the changes most relevant to daily practice.

What's new in the 2026 canine atopic dermatitis treatment guidelines?

The 2010 and 2015 guidelines grouped treatments into 3 categories: acute flares, chronic lesions, and relapse prevention. The main factor behind those recommendations was how long a drug took to work. According to the 2026 authors, that approach did not reflect how much cAD varies between breeds, individual dogs, and stages of disease. The earlier guidelines did not emphasize long-term proactive maintenance.

The update groups therapies by mechanism of action: skin barrier care, antimicrobial and microbiome-modulating therapy, allergen avoidance and allergen-specific immunotherapy (AIT), and anti-inflammatory or antipruritic drugs. It also describes each drug's spectrum of activity. The authors note that a narrow-spectrum drug can be highly effective for severe pruritus yet have little to no effect on chronic inflammation and otitis.

What do reactive and proactive therapy mean for dogs with atopic dermatitis?

The guidelines divide treatment into 2 phases. Phase 1—reactive therapy—resolves existing pruritus and acute or chronic lesions to bring the dog into clinical remission. Phase 2—proactive therapy—is regular long-term treatment to maintain that remission and reduce flares.

The authors advise continuing reactive treatment at an effective dose until lesions and pruritus have fully resolved, even at the cost of some short-term adverse effects, because adjusting treatment too early raises the risk of a rapid rebound flare. They add that preventing flares of pruritus and inflammation is likely to prevent chronic changes that are harder to manage (SOR D).

Which treatments does ICADA recommend for acute flares of canine atopic dermatitis?

Rapid-acting, broad-spectrum drugs, particularly glucocorticoids, are recommended for reactive treatment. Topical glucocorticoids received an A-level recommendation for flares, chronic lesions, and maintenance. Oral prednisolone, prednisone, or methylprednisolone also received an A-level recommendation for flares, with caution advised for long-term use because adverse effects are common. Long-acting injectable glucocorticoids should be avoided where possible because their dose cannot be tapered, which increases the risk of adverse events.

JAK inhibitors and lokivetmab could be used in pruritic dogs with only acute or mild-to-no skin lesions. Cyclosporine and topical tacrolimus are not recommended for flares because of their slow onset, and antihistamines are not suggested for reactive treatment (SOR B). The authors also advise against prolonged concurrent use of oral glucocorticoids, cyclosporine, and oclacitinib in any combination, citing a theoretical higher risk of immunosuppression that could lead to potentially severe opportunistic infections, as well as neoplasia (SOR D). Suspected secondary bacterial or yeast infections should be confirmed by cytology and treated in either phase, with topical antiseptics as first-line therapy.

How do oclacitinib, ilunocitinib, and atinvicitinib compare for canine atopic dermatitis?

Oclacitinib (Apoquel; Zoetis) received an A-level recommendation for flares and maintenance. The authors describe its activity as likely semi-broad spectrum, so dogs with chronic lesions, particularly otitis and pododermatitis, may benefit from additional or alternative therapy. Pruritus can flare when dosing drops from twice to once daily. A 4-day course of prednisolone at the start of treatment may reduce that rebound.

Ilunocitinib (Zenrelia; Elanco), a pan-JAK inhibitor, also received an A-level recommendation, and its activity is possibly broader than that of oclacitinib or atinvicitinib, so it may be more effective (SOR B). In 1 double-blinded head-to-head trial cited in the guidelines, ilunocitinib lowered pruritus scores significantly more than oclacitinib after day 14 and clinical scores after day 28. The difference persisted through day 112—the end of the study. Safety data beyond 6 months are not available.

In the US, the FDA recommends stopping ilunocitinib before and after vaccination, a step the guidelines note is not required in the European Union, United Kingdom, and other countries. For both oclacitinib and ilunocitinib, the guidelines recommend periodic monitoring of complete blood counts and serum biochemistry in dogs on long-term treatment, although there is no consensus on how often. They also recommend regular monitoring that includes urinalysis, particularly in dogs whose underlying conditions or concurrent treatments make them more susceptible to immunosuppression or other adverse events and, for oclacitinib, in dogs on twice-daily dosing.

Atinvicitinib (Numelvi; MSD/Merck), a JAK1-selective inhibitor, received a C-level recommendation. Its efficacy data come only from published abstracts, and long-term safety data are lacking.

Where does lokivetmab fit in canine atopic dermatitis treatment?

Lokivetmab (Cytopoint; Zoetis), a monoclonal antibody against canine interleukin 31, received an A-level recommendation for flares and maintenance, especially in dogs whose main problem is pruritus. The authors describe its activity as likely narrow spectrum. It reduces itch quickly, but lesions seem to resolve a little more slowly, and dogs with chronic lesions, otitis, or pododermatitis will benefit from additional therapy. Its good short- and long-term safety makes it suitable for combination therapy and for dogs that cannot take other anti-inflammatory drugs (SOR C).

Which therapies keep dogs with atopic dermatitis in remission and prevent flares?

Once signs are fully in remission, a fast onset of action is no longer required, which opens up a wider range of options. The guidelines list skin barrier support, infection control, allergen avoidance, AIT, topical glucocorticoids, cyclosporine, topical tacrolimus, lokivetmab, and JAK inhibitors, chosen according to each dog’s disease pattern and response. Narrow-spectrum drugs such as lokivetmab may be most effective in this phase when more complex inflammation is absent; if that is not enough, broader agents such as JAK inhibitors or cyclosporine can be considered for long-term use.

In 1 small randomized controlled trial, hydrocortisone aceponate spray applied to previously affected areas on 2 consecutive days each week maintained remission for a median of 115 days, compared with 33 days for placebo. The authors prefer nontraditional topical glucocorticoids such as hydrocortisone aceponate for long-term use because of their better safety profile (SOR D). Cyclosporine received an A-level recommendation for maintenance; its benefit normally takes 2 to 4 weeks to appear (up to 6 weeks in some cases), and adding prednisolone for the first 3 weeks sped improvement in 1 study.

Supporting measures include weekly bathing as an adjunct (SOR A) and essential fatty acids, which the authors rate as safe and mildly effective (SOR A) and which, as oral supplements, significantly reduced the doses of prednisolone, cyclosporine, and oclacitinib needed to maintain remission in 3 randomized controlled trials. Year-round flea control is recommended for all dogs with cAD in flea-endemic regions (SOR D).

Is allergen-specific immunotherapy recommended for dogs with atopic dermatitis caused by environmental allergens?

Yes. The summary table recommends AIT for all dogs with cAD caused by environmental allergens, and the text rates it SOR B for proactive therapy. About 50% to 80% of dogs receiving AIT for 6 to 12 months show good improvement or a reduced need for antipruritic drugs, although complete remission occurs in a minority. AIT should usually continue for at least 1 year before response is evaluated.

Intradermal testing and IgE serology can both be used to select allergens, with no clear evidence that outcomes differ, but serology results can vary substantially between laboratories. Several studies found intralymphatic immunotherapy at least as effective as, and potentially more effective than, subcutaneous AIT.

Which food allergy tests and therapies lack evidence in canine atopic dermatitis?

There is no evidence that serologic or intradermal tests for food allergens reliably predict dietary trial results, so the guidelines recommend restriction-provocation diet trials (SOR A), normally 6 to 10 weeks long, for all dogs with nonseasonal cAD. The authors also state that systemic or topical intermittent "pulse" antimicrobial therapy must be avoided, both to avoid increasing antimicrobial pressure and because of a lack of evidence that long-term regular use of topical antiseptics reduces recurrence of infections.

Evidence for oral probiotics remains limited (SOR B). Antihistamines showed limited efficacy in placebo-controlled trials but may be considered for maintenance in mild or seasonal disease or when sedation is desirable. In randomized trials, low-level laser therapy showed no benefit for localized pedal atopic dermatitis, and fluoxetine showed no clinical efficacy (SOR B for both).

How should veterinarians build personalized treatment plans for dogs with atopic dermatitis?

The authors stress that the interventions "are neither universally required, interchangeable nor effective in all cases." Treatment decisions should weigh efficacy, safety, practicality, cost, the quality of life of both dog and owner, and local regulations, including rules on off-label use.

The guidelines were self-funded. All 5 authors disclosed consulting, lecture, or research ties to animal health companies, including manufacturers of drugs discussed in the guidelines.

Reference

Mueller RS, Banovic F, Bensignor E, Santoro D, Nuttall T. Treatment of canine atopic dermatitis: updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). Vet Dermatol. Published online September 28, 2026. doi:10.1111/vde.70128