Canine Atopic Dermatitis Lesion Index Research Articles

Clinical effects of combined Lactobacillus paracasei and kestose on canine atopic dermatitis.

Probiotics and prebiotics are viable bacteria with beneficial effects on the host and components that selectively act on the beneficial commensal bacteria, respectively. The combined use of probiotics and prebiotics is termed synbiotics. Probiotic intake improves dysbiosis in the intestinal microbiota and can positively affect canine atopic dermatitis (CAD). However, clinical studies on improvements in CAD using synbiotics remain limited. In this study, 15 dogs with CAD who received prednisolone, a synthetic glucocorticoid (GC) used in the treatment of CAD, for more than 90 days were continuously treated with Lactobacillus paracasei M-1 from fermented food as a probiotic, and trisaccharide kestose as a prebiotic, for 90 days to determine their synbiotic effects on CAD. The CAD symptoms were evaluated using the canine atopic dermatitis lesion index (CADLI) and pruritus visual analog scores (PVAS) at 30, 60 and 90 days after synbiotic administration. The total prednisolone use for 90 days pre- and post-administration was also evaluated. Synbiotic administration significantly reduced the CADLI (pre: median, 28.0 [22.0-32.0]; 30 days: median, 20.0 [20.0-28.0]; 60 days: median, 20.0 [10.0-21.0]; 90 days: median, 12.0 [10.0-19.0]) and PVAS (pre: median, 6.0 [5.0-7.0]; 30 days: median, 3.0 [3.0-3.5]; 60 days: median, 3.0 [3.0-3.5]; 90 days: median, 2.0 [2.0-3.5]) scores, and reduced the total prednisone use over 90 days (pre: 112.0 [25-450] mg; post: 80.0 [18.-300.0] mg; p⟨0.001) in the 15 dogs. Thus, the synbiotic activity of L. paracasei M-1 and trisaccharide kestose can improve CAD.

A randomised, double-blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs.

Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed. To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT). Fifty privately owned dogs with AD. In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point. There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen. Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the score of a recognised scoring system?

PICO question
 In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the Canine Atopic Dermatitis Lesion Index score (or some other recognised scoring system)?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 One randomised controlled trial and one before and after study were critically appraised
 Strength of evidence
 Weak
 Outcomes reported
 One randomised controlled trial studied the effects of lokivetmab and oclacitinib and found that both drugs were similar in reducing the Canine Atopic Dermatitis Lesion Index (CADESI-03) score.
 An additional study was evaluated but had non-standardised data as it was a before-and-after study on use of lokivetmab. The paper noted that dogs’ response to oclacitinib can be used to predict how well these dogs respond to lokivetmab. This study also reported a reduction in Pruritus Visual Analog Scale (PVAS) score between before and after lokivetmab administration
 Conclusion
 In view of the strength of evidence and outcomes from the studies, there is insufficient quality of evidence to answer the PICO question and so further comparative study is required
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Weekly topical therapy based on plant extracts combined with lokivetmab in canine atopic dermatitis.

Lokivetmab is an effective treatment for atopic dermatitis (AD) in dogs. The aim of this prospective study was to determine if topical products containing plant extracts could enhance the clinical efficacy of lokivetmab. Thirty atopic dogs were included. Dogs were allocated randomly to be treated either with a single injection of lokivetmab (mean dose 1.34 mg/kg; Group A) or to a single injection (mean dose 1.28 mg/kg) coupled with a weekly topical treatment using a shampoo and a spot-on specifically designed to improve skin barrier defect (Group B). Clinical parameters evaluated included pruritus (pruritus Visual Analog Scale) and skin lesions (Canine Atopic Dermatitis Lesion Index, CADLI); cosmetic evaluation, and owner and investigator global assessment of efficacy (OGATE) also were carried out. Dogs were re-examined after 10, 17 and 31 days, and until a clinical relapse occurred. An improvement was noted for all dogs, with scores being significantly better in dogs in Group B than in those in Group A; after 10 days for cosmetic evaluation, 17 days for pruritus (P = 0.039) and OGATE, and 31 days for CADLI (P = 0.043). A longer-lasting remission was noted in Group B compared to Group A; dogs receiving the combined treatment showed an extended time to flare compared to dogs treated with lokivetmab alone (P = 0.012). This study suggests that combining lokivetmab with topical therapies designed to repair the skin barrier potentially have value in the treatment of AD in dogs.

Successful nutritional control of scratching and clinical signs associated with adverse food reaction: A randomized controlled COSCAD'18 adherent clinical trial in dogs in the United States.

BackgroundAdverse reactions to food are a common dermatological condition in dogs, requiring nutritional intervention using a novel or hydrolysate protein‐based food.ObjectiveTo evaluate a therapeutic food containing egg and phytonutrients in dogs with food allergies using an activity monitor and core outcome set for canine atopic dermatitis (COSCAD'18) guidelines and in a controlled double‐masked, multicenter, prospective clinical trial.AnimalsAdult dogs with a history of adverse food reaction as diagnosed by a food elimination trial were recruited from general practices.MethodsAfter a 21‐day baseline period, dogs were randomized to test or positive control (hydrolyzed protein) food for 21 days. Owner (pruritus visual analog score [PVAS], coat quality, food acceptance, and satisfaction) and veterinarian (canine atopic dermatitis lesion index [CADLI], physical examination) assessments were completed on days 0, 21, and 42. Dogs wore a collar‐mounted activity monitor to record scratching and shaking behavior throughout the study. Statistical analysis included within‐group comparison to baseline and between‐group comparison at study end using a significance threshold of alpha = 0.05.ResultsAt the end of the treatment period, all results were similar between groups for CADLI, PVAS, owner satisfaction, activity, and questionnaire data. Scores for hair dullness, brittleness, amount of dandruff, feces quality, and food acceptance were positive and not statistically different between groups.Conclusions and Clinical ImportanceThe therapeutic test food was well‐accepted and efficacious in managing signs of adverse reactions to food compared to baseline as well as compared to the positive control food.

Successful nutritional control of scratching and clinical signs associated with adverse food reaction: A randomized controlled COSCAD'18 adherent clinical trial in dogs in the United Kingdom.

BackgroundAdverse reactions to food are a common dermatological condition in dogs, requiring nutritional intervention using novel or hydrolysate protein‐based foods.ObjectiveTo evaluate a therapeutic food containing egg and phytonutrients in dogs with food allergies using an activity monitor and core outcome set for canine atopic dermatitis (COSCAD'18) in a controlled double‐masked, multicenter, prospective clinical trial.AnimalsAdult dogs with a history of adverse food reaction as diagnosed by a food elimination trial were recruited from general practices.MethodsAfter a 21‐day baseline period, dogs were randomized to test or positive control (hydrolyzed protein) food for 21 days. Owner (pruritus visual analog score [PVAS], coat quality, food acceptance, and satisfaction) and veterinarian (canine atopic dermatitis lesion index [CADLI], physical examination) assessments were completed on days 0, 21, and 42. Dogs wore a collar‐mounted activity monitor to record sleep, scratching, and shaking behavior throughout the study. Statistical analysis included within‐group comparison to baseline and between‐group comparison at study end using a significance threshold of alpha = 0.05.ResultsAt the end of the treatment period, all results were similar between groups for CADLI, PVAS, owner satisfaction, activity, and questionnaire data. Scores for hair dullness, brittleness, amount of dandruff, feces quality, and food acceptance were positive and were not statistically different between groups.Conclusions and Clinical ImportanceThe therapeutic test food was well‐accepted and efficacious in managing signs of adverse reactions to food compared to baseline as well as compared to the positive control food.

Evaluation of skin erythema severity by dermatoscopy in dogs with atopic dermatitis.

To estimate the extent and severity of atopic dermatitis (AD)-related skin lesions, clinical trials enrolling dogs with AD often use categorical scales such as the Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) and Canine Atopic Dermatitis Lesion Index (CADLI). Despite recent progress in the standardization of these AD-grading scales, the evaluation of the severity of skin lesions (including erythema) remains subjective. To validate an optical set-up with a smartphone and a dermatoscope for the objective estimation of skin erythema severity in atopic dogs. Forty-three dogs with AD. An erythema index (EI) was calculated from calibrated skin images and compared to the dermatologist's erythema severity estimate using the erythema grading scale used in the CADESI-04, as well as an ad hoc Visual Analog Scale (VAS) with a continuous palette of red shades. We found a strong correlation based on the Spearman rank correlation coefficient between all erythema valuations: CADESI-04 and VAS: 0.93 [95% CI: (0.85, 0.96)]; CADESI-04 and EI: 0.85 (0.72, 0.92); VAS and EI: 0.82 (0.67, 0.91). There was a good agreement between the objective EI and CADESI-04-based estimates because 71% of samples were classified in the same erythema severity category. When comparing the EI and the VAS, the standard deviation of misestimates was 12% (maximum 100%). The proposed optical set-up has the potential to make erythema severity estimation objective, thus leading to more reliable AD severity scales for the use in experimental canine AD models or in clinical trials enrolling atopic dogs.

Effects of a homeopathic medication on clinical signs of canine atopic dermatitis

A commercially available medication containing homeopathic ingredients showed first signs of success in atopic dermatitis in dogs. The aim of this case series was to evaluate the effect of the preparation in a larger number of dogs with atopic dermatitis. Ten atopic dogs received the oral homoeopathic combination preparation daily for 3 weeks according to the manufacturer's specifications. The diagnosis of atopic dermatitis was made previously by medical history, clinical examination and exclusion of differential diagnoses. Skin infections with bacteria and yeasts were excluded by clinical examination and cytological evaluation of impression smears. In food-allergic dogs, an elimination diet was fed at least 2 months prior and during the entire study period. Patients with suspected or confirmed flea allergy received flea control for at least 1 month prior to and during the study. The clinical signs were evaluated before and after therapy using a validated Pruritus Visual Analogue Acale (PVAS) and the Canine Atopic Dermatitis Lesion Index (CADLI). The coat quality was assessed by the owners. Possible adverse effects were recorded at the recheck. There were no significant changes in the lesion score (Wilcoxon test, p = 1.0), pruritus score (paired t test, p = 0.34) and coat quality (paired t test, p = 0.34) over the duration of treatment. Only one patient showed a slight improvement in itching and coat quality. No side effects were observed. In this case series, the tested homoeopathic preparation did not show a positive effect on the clinical signs of canine atopic dermatitis.

Development and validation of a graphic 2D investigator's global assessment instrument for grading the overall severity of atopic dermatitis in dogs.

Clinical trials enrolling dogs with atopic dermatitis (AD) use validated instruments that aggregate the extent and severity of selected skin lesions; none of these provides a global assessment of the severity of all lesions. To validate an Investigator Global Assessment (IGA) instrument to globally evaluate the severity of skin lesions in dogs with AD. Forty dogs with AD. A 2D graphic IGA (2D-IGA) instrument was created to subjectively score, with a single dot, the overall extent and severity of all canine AD lesions. This tool was tested for its validity (content, construct and criterion), reliability (inter- and intraobserver) and sensitivity to change. The content of the 2D-IGA was first validated by a supportive vote by the International Committee of Allergic Diseases of Animals (ICADA) membership. Its construct was verified by positive correlations between the 2D-IGA scores and those of the Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) and the Canine Atopic Dermatitis Lesion Index (CADLI) (Spearman's rank-order correlation, P<0.0001). The positive correlation (P<0.0001) between an Owner Global Assessment of Disease Severity (OGADS) and the 2D-IGA indirectly satisfied its criterion. Scores graded by the same investigator hours apart and those between investigators were positively correlated (P<0.0001), thereby validating this scale's intra- and interobserver reliabilities. Finally, the changes in 2D-IGA values during treatment were correlated positively with scores of an Owner Global Assessment of Treatment Efficacy (OGATE; P<0.0001), thus showing its sensitivity to change. This novel 2D-IGA is a simple static graphic instrument that could be useful for clinical trials testing the efficacy of interventions for canine AD.

Antibody levels to Malassezia pachydermatis and Staphylococcus pseudintermedius in atopic dogs and their relationship with lesion scores.

Elevated immunoglobulin E (IgE) levels to Malassezia or Staphylococcus species in human atopic dermatitis are related to the skin severity index; a similar association has not been reported in atopic dogs. To investigate serum levels of allergen-specific IgE, total specific IgG and IgG subclasses (IgG1 and IgG2) for M.pachydermatis and S.pseudintermedius, and to correlate them with the severity of dermatitis in dogs. Serum samples were collected from dogs categorized by age and disease status. Groups 1 and 2: <3-year-old healthy (n=9) and atopic dogs (n=9), respectively; and groups 3 and 4: ≥3-year-old healthy (n=11) and atopic dogs (n=14), respectively. Antibody levels were measured by ELISA. The Canine Atopic Dermatitis Lesion Index (CADLI) was analyzed in relation to antibody levels. Specific IgE and total IgG against M.pachydermatis and S.pseudintermedius were significantly increased in atopic dogs of all ages. Although differences between atopic and healthy dogs, with regard to specific IgG1 and IgG2 levels to each microbe, varied in significance within age groups. No significant relationships were found between the CADLI and any specific immunoglobulin levels for both microbe types. In dog skin, microbes may act as allergens triggering inflammatory responses via IgE- and IgG-dependent pathway(s). The affinity of the IgG subclass produced may vary according to antigen type. Specific IgE levels may be related to clinical disease in dogs and not to skin lesion severity.

Multidose intramuscular allogeneic adipose stem cells decrease the severity of canine atopic dermatitis: A pilot study.

Aim:The aim of this pilot study was to evaluate the therapeutic and safety performance of an intramuscular treatment protocol of multidose of allogeneic adipose stem cells (ASCs) isolated, characterized, and expanded ex vivo from a healthy canine donor.Materials and Methods:Twelve dogs diagnosed with canine atopic dermatitis (CAD) were intramuscularly treated with 0.5×106 of cryopreserved ASCs from a healthy immunized young canine Ehrlichia canis free donor weekly for 6 weeks. Treatment efficacy was evaluated by the pruritus index and the CAD Lesion Index (CADLI) test. Safety and adverse effects were determined by injection site reaction, weight, blood chemistry, liver function, and whole blood count.Results:Canine ASCs obtained from a donor met the minimum qualities required for this type of cells and showed viability of 90% after thawing. The efficacy of the CADLI score and the pruritus index in 12 dogs with atopic dermatitis was statistically significant efficacy. No adverse reactions were observed at the intramuscular application site, or in relation to animal weight, blood cell populations, or liver and renal function.Conclusion:These results suggest that intramuscular administration of cryopreserved ASCs to dogs with atopic dermatitis is a promising cellular therapeutic product for the relief of the symptoms of this disease; however, the duration of the effects obtained with this dose and with other doses should be evaluated, as well as possible immune reactions. As far as we know, this is the first report of the use of multiple intramuscular doses cryopreserved ASCs to treat atopic dermatitis.

Alterations in circulating concentrations of IL‐17, IL‐31 and total IgE in dogs with atopic dermatitis

The pathogenesis of canine atopic dermatitis (AD) is complex. Dysregulation of the cutaneous immune system is considered an important regulator of the allergic response. Exploration of association of interleukin-17 (IL-17), IL-31, IgE and leukogram attributes with canine AD could provide novel insights into its immunopathology. To investigate possible associations of IL-17, IL-3, IgE and leukogram attributes of canine AD. 17 dogs diagnosed with AD and six healthy dogs. Circulating concentrations of IL-17, IL-31 and total IgE from sera samples were determined using commercial canine-specific quantitative immunoassay kits. Complete blood cell counts were analysed by an automated haematology analyser. Statistical differences between the two groups were determined using an unpaired t-test. The degree of relationship between the IL-17, IL-31, IgE, total leukocyte count (TLC) values and clinical signs scores (Canine Atopic Dermatitis Lesion Index and pruritus Visual Analog Scale pVAS) was determined by Pearson's r correlation statistic. Dogs with AD had significantly (P<0.0001) higher circulating concentrations of IL-17, IL-31 and total IgE compared with healthy dogs. Dogs with AD also had significantly higher TLC (P<0.0002), absolute neutrophils (P<0.0001) and absolute eosinophils (P<0.0001) counts, and percentage of neutrophils (P<0.03) and eosinophils (P<0.0001) compared with healthy controls. A significant positive correlation (r2 =0.396; P<0.007) between the pVAS and IL-31 was observed in dogs with AD. Marked elevation in circulating IL-17, IL-31 and total IgE along with the abnormalities in leukogram may be associated with canine AD and could be possible targets in the therapeutic management of canine AD.

Efficacy of hydrolyzed soy dog food and homemade food with original protein in the control of food-induced atopic dermatitis in dogs

ABSTRACT: Trophoallergens are specific components of food or its ingredients, able to precipitate the atopic eczema at 19.6% to 30% of the dogs with atopic dermatitis (AD). This study evaluated the efficacy of hydrolyzed soy dog food and homemade food with unusual protein in the control of chronic pruritus in dogs with AD. For this, twenty-eight dogs with AD were selected. AD diagnosis was based on Favrot’s criteria. The animals were separated in two groups; one group consumed hydrolyzed soy dog food while the other group consumed homemade food with protein sources and original carbohydrates. They were evaluated every two weeks by the Rybnicek and CADLI scale over 60 days. Animals in the group that consumed hydrolyzed soy dog food presented a reduced score of pruritus (Rybnicek scale) on days +15, +30, +45 and +60 (P&lt;0.01) compared to day 0. While the dogs in the homemade food group have not presented a significant difference (P&gt;0.05) in 60 days of treatment. When evaluated by the Canine Atopic Dermatitis Lesion Index (CADLI), dogs treated with soy hydrolyzed dog food had a partial improvement on days +45 (P&lt;0.05) and +60 (P&lt;0.01) compared to day 0, while the dogs in the second group did not show improvements (P&gt;0.05) in 60 days of treatment. In conclusion, soy hydrolyzed dog food has proved effective to partially control clinical signs of food-induced atopic dermatitis; however, it is not effective for the complete control of the disease.

A pilot study of the effect of pullulan-conjugated Der f 2 allergen-specific immunotherapy on canine atopic dermatitis.

Dermatophagoides farinae is a major and common environmental house dust mite involved in canine atopic dermatitis (CAD). A formulation of recombinant protein Der f 2 is available in Japan for immunotherapy in dogs. To evaluate the efficacy of a recombinant allergen based on Der f 2-pullulan for the treatment of cAD. Dogs (n = 15) with atopic dermatitis were administered Der f 2 conjugated with pullulan (-P). Two dogs were eliminated because of death unrelated to the treatment during the study. The remaining 13 cases were included in the analysis. Clinical signs were evaluated with the Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus levels were evaluated from 0 to 10 with a pruritus Visual Analog Scale (PVAS). The mean ± standard deviation (SD) of CADLI [before allergen-specific immunotherapy (pre-ASIT) 21.9 ± 9.7; 60 days post-ASIT 9.8 ± 8.4 and 120 days post-ASIT 9.7 ± 8.2] and the mean ± SD of PVAS [pre-ASIT 7.2 ± 1.2; post-ASIT (60 days) 2.6 ± 2.2 and post-ASIT (120 days) 3.1 ± 2.5] significantly decreased after treatment (Dunnett's test, P < 0.05). Furthermore, the total doses of oral glucocorticoids in the two months pre-ASIT significantly decreased in comparison with two months post-ASIT (123 ± 72.6 mg vs. 70.0 ± 84.3 mg; Dunnett's test, P < 0.05). The results indicate the effectiveness of Der f 2-P recombinant protein in the treatment of dogs with CAD and testing positive to D. farinae.

A double-blinded, randomized, controlled, crossover evaluation of a zinc methionine supplement as an adjunctive treatment for canine atopic dermatitis.

Zinc is important for skin health and proper immune system function. A zinc methionine, essential fatty acids (EFA) and biotin product (Zn supplement) was compared to an EFA and biotin product (control) in canine atopic dermatitis (CAD). Twenty seven client-owned dogs with chronic CAD receiving ciclosporin or glucocorticoids. A 24 week, randomized, double-blinded, controlled study with crossover at week 12 and 4 week period of allergy medication reduction at weeks 8 and 20. Evaluations included Canine Atopic Dermatitis Lesion Index (CADLI), pruritus Visual Analog Scale (VAS) and cytology sampling. In dogs receiving the zinc supplement and ciclosporin for eight weeks, 44% (n = 7) had significantly decreased CADLI from 11.9 to 6.0 (P = 0.0002) with no significant change in pruritus VAS (P = 1.0). In dogs receiving the zinc supplement and glucocorticoids for eight weeks, 55% (n = 6) had significantly decreased CADLI from 10.9 to 5.0 (P = 0.0043) and pruritus VAS from 7.4 to 3.2 (P = 0.0166). For dogs receiving either steroids or ciclosporin there was a reduction in use of such medications, for at least four weeks, in 63% of dogs receiving the zinc supplement and 37% of dogs receiving the control. This difference was not significant (P = 0.1027). Seventy eight percent of dogs were diagnosed and treated for superficial skin infections during the study. This study supports a potential benefit of adjunctive zinc methionine supplementation in CAD. Dogs receiving glucocorticoids may be more likely to benefit. Further studies are needed to substantiate these initial results.

Validation of the Canine Atopic Dermatitis Extent and Severity Index (CADESI)‐4, a simplified severity scale for assessing skin lesions of atopic dermatitis in dogs

Severity scales are used to grade skin lesions in clinical trials for treatment of dogs with atopic dermatitis (AD). At this time, only two scales have been validated, namely the Canine Atopic Dermatitis Extent and Severity Index (CADESI)-3 and the Canine Atopic Dermatitis Lesion Index (CADLI). However, the high number of assessed sites makes the CADESI-3 impractical. The aim of this study was to develop and validate a fourth version of the CADESI that is simpler and quicker to administer. Body sites, lesions and severity grades were revised by members of the International Committee on Allergic Diseases of Animals (ICADA). The newly designed CADESI-4 was tested for its validity (i.e. content, construct and criterion), reliability (i.e. inter- and intra-observer reliability and internal consistency), responsiveness (i.e. sensitivity to change) and time to administer. Disease severity benchmarks were chosen using receiver operating characteristic methodology. The CADESI-4 was simplified in comparison to its previous version to comprise 20 body sites typically affected in atopic dogs. Three lesions (erythema, lichenification and alopecia/excoriation) were scored from 0 to 3 at each site. The CADESI-4 had satisfactory validity, reliability and sensitivity to change. On average, the time to administer a CADESI-4 was one-third that of a CADESI-3. Proposed benchmarks for mild, moderate and severe AD skin lesions are 10, 35 and 60, respectively. The CADESI-4 is simpler to use and quicker to administer than its previous version. The ICADA recommends the CADESI-4 instead of the CADESI-3 to score skin lesions of AD in dogs enrolled in clinical trials.

Development and validation of the Canine Atopic Dermatitis Lesion Index, a scale for the rapid scoring of lesion severity in canine atopic dermatitis

The third iteration of the Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) is the only tool rigorously validated for canine atopic dermatitis (CAD) lesion scoring. The CADESI-03 requires 248 evaluations, limiting its widespread use. The goal of the study was to develop and validate a practical method of grading CAD lesions that requires scoring only the frequently affected body regions. Fifty-seven privately owned atopic dogs were used in the study. The Canine Atopic Dermatitis Lesion Index (CADLI) was evaluated in an open, multicentre reliability study. Validity was assessed with expert opinion (content validity) and comparison of CADLI with existing disease severity measures (construct and criterion validity). Reliability was evaluated by analysing repeated observations of each dog. Convenience was assessed in terms of the time required to complete the scale. The CADLI scores correlated with overall assessment scores (r = 0.60, P < 0.001, linear mixed model) and pruritus severity scores (r = 0.53, P < 0.001, linear mixed model), establishing construct validity. The CADLI was strongly correlated with CADESI-03 (r = 0.84, P < 0.001, linear mixed model), establishing criterion validity. The CADLI values obtained by two observers correlated very strongly (r = 0.91, P < 0.001), as did the repeat values for the same observer (r = 0.98, P < 0.001). The mean time to complete the CADLI was less than that required for CADESI-03 (1.9 and 12.6 min, respectively), a highly significant difference (P < 0.001). The CADLI was found to be an effective measure of CAD lesion severity, strongly correlating with CADESI-03. The convenience of CADLI makes it suitable for use in both clinical research and practice.