New international guidelines on atopic dermatitis in dogs: the first major update since 2015 splits treatment into two phases and explains why stopping early is a mistake

What happened

On 3 November 2026 the American veterinary journal dvm360 published an analysis of new guidelines from the International Committee on Allergic Diseases of Animals (ICADA) on treating atopic dermatitis in dogs. The document came out on 28 September 2026 in the journal Veterinary Dermatology, and takes in research up to July 2026. It's the first major update since 2015.

The authors rated the evidence on an accepted scale, from level A, based on high-quality systematic reviews and several controlled studies, to level D, based on expert consensus.

What atopic dermatitis is

This is a chronic skin disease in which a dog's immune system overreacts to ordinary substances such as pollen, house dust mites and mould. The dog scratches constantly and licks its paws, its skin turns red and ear infections keep coming back. The disease can't be cured once and for all, but it can be kept under control with the right treatment.

What's changed in the approach

Treatment used to be divided into acute flare-ups, chronic lesions and prevention of relapse, and the main criterion was how quickly a medicine acted. In the authors' view, this ignores differences between breeds, dogs and stages of the disease and doesn't give enough attention to long-term prevention. Methods are now grouped by how they work.

Four treatment groups

The new scheme covers skin barrier care, antimicrobial therapy and work on the skin's microflora, allergen avoidance and allergen-specific immunotherapy, and anti-inflammatory and anti-itch medicines. The authors also describe each product's range of action: a narrowly targeted medicine may relieve itching well, but have little effect on chronic inflammation and ear infections.

Two treatment phases

The first, reactive phase clears the itching and skin lesions to bring the dog into remission. The second, preventive phase involves regular long-term treatment that maintains remission and reduces the number of flare-ups. The authors stress that it's better to prevent bouts of itching and inflammation than to treat chronic skin changes, which are much harder to control later.

Why treatment shouldn't stop early

The guidelines advise continuing flare-up treatment at an effective dose until the itching and lesions have completely gone, even at the cost of some short-term side effects. If treatment is reduced too soon, the risk of the disease quickly returning is higher. It's important to understand that an improvement after a few days doesn't mean treatment can stop. Talk to your vet about when and how to change the plan.

How flare-ups are treated

For the reactive phase, fast-acting broad-spectrum medicines are recommended, above all glucocorticoids. Topical forms received the highest level of recommendation for flare-ups, chronic lesions and maintenance. Tablets also work for flare-ups, but long-term use calls for care because side effects are common. Long-acting injections are best avoided, because their dose can't be tapered gradually.

What about the new JAK inhibitors?

Janus kinase inhibitors are medicines that block itch and inflammation signals. The guidelines give level A to oclacitinib and ilunocitinib. In one blinded comparison, the latter reduced itching more than oclacitinib, but there's no safety data yet beyond six months. Atinvicitinib received level C, as data so far come only from brief reports. Long-term use requires monitoring of blood and urine tests.

What about monoclonal antibodies?

Lokivetmab, an antibody against interleukin-31, which is linked with itching, received level A for flare-ups and maintenance treatment, especially when itching is the dog's main problem. It reduces itching quickly and combines well with other treatments. But skin lesions heal more slowly with it, so chronic changes, ear infections and inflamed paws may need extra treatment.

Which treatments don't suit the acute phase

Cyclosporine and topical tacrolimus aren't recommended for flare-ups, as they act slowly, with the former often needing 2–4 weeks. Antihistamines aren't recommended for reactive therapy either. The authors also warn against long-term combined use of glucocorticoid tablets, cyclosporine and oclacitinib, which can suppress immunity too much and raise the risk of severe infections.

What to do about infections

Secondary bacterial and yeast infections make itching worse and should be confirmed by testing a skin sample. Topical antiseptics, such as special shampoos, are recommended first. This matters for antibiotic resistance: antibiotic tablets shouldn't be the first choice for a simple skin infection in a dog with atopy.

What helps in the maintenance phase

Once symptoms have gone, fast action is no longer needed and the choice is wider: skin care, infection control, allergen avoidance, immunotherapy, topical medicines, cyclosporine and newer treatments. In one study, a spray containing a mild topical corticosteroid, used intermittently, maintained remission for an average of 115 days against 33 with placebo.

Why bathing matters

The guidelines give their highest level to weekly bathing as an additional treatment. Bathing washes away allergens and restores the skin, but choose a shampoo on your vet's advice, as ordinary products can dry the skin out. Essential fatty acids may also help. The dog feels better, and the need for medicines may fall.

What allergen-specific immunotherapy is

This is the only method aimed at the actual cause of the disease. First the vet works out what the dog reacts to, then small doses are used to get its immune system used to those allergens. The effect comes after months and isn't always complete, but fewer medicines are then needed. The method is especially valuable for young dogs facing years of treatment.

How to tell atopy from other causes of itching

Itching also occurs with fleas, mange, food allergy and infections. Before diagnosing atopy, the vet rules out parasites and may prescribe a strict diet for 8 weeks. Allergy tests don't make a diagnosis on their own, as they're used to choose treatment. If a dog is treated only for the itching, the real cause may go unnoticed.

What you can do

1. Protect against fleas regularly, even in winter.
2. Keep an itching diary: when, where and how badly your dog scratches.
3. Bathe as your vet advises and rinse thoroughly.
4. Check ears and paws every week.
5. Don't change doses or stop medicines yourself.

How to reduce contact with allergens

Wash your dog's bed in hot water, vacuum often and keep humidity low at home. In pollen season, wipe the paws and belly after walks, and don't walk your dog while grass is being cut. Allergens can't be avoided completely, but even a lower load often reduces the need for medicines. Ask your vet which measures suit your dog.

Which breeds are affected more often

Atopic dermatitis is common in labradors, French bulldogs, pugs, West Highland white terriers, boxers and many other breeds, as well as crossbreeds. The first signs usually appear in young dogs, between six months and three years old. If itching starts in a dog over seven, the vet will look for other causes first, such as skin tumours.

What treatment costs

Atopy needs treating for years, and the costs become a noticeable part of the budget. Newer medicines are often more expensive than familiar ones. Ask your vet about different options and about a plan for the year, not just the coming month. Sometimes a combination of bathing, parasite control and less frequent injections costs less than daily tablets. Insurance may cover such costs, but check the exclusions.

Differences in the rules

The guidelines note that in the USA the FDA advises stopping ilunocitinib before and after vaccination, but that this requirement doesn't apply in the EU and UK. It's a good example of how product information and rules depend on the country. Ask your vet what applies to you, and don't rely on foreign forums.

How to judge the result

Ask your vet for a simple itch scale from 0 to 10, and note the score every week. This makes it easier to see whether treatment is working.

What this means for Europe

ICADA guidelines are used by vets around the world, including in Europe. For European owners the general ideas matter most: treat flare-ups fully, maintain remission long term and use antiseptics rather than unnecessary antibiotics. The newer medicines are authorised in the EU and UK, so vets now have a wider choice. But the decision is always made for the individual dog.

When to see a vet

See your vet if your dog scratches constantly, licks its paws, keeps getting ear infections or has red or smelly skin. See a vet urgently if there are open wounds, pus, lethargy or refusal to eat. If the current treatment has stopped working or side effects appear, don't change it yourself, but book an appointment.