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228 Cutaneous Lupus Erythematosus

• Consider short-term glucocorticoid or PEARLS & CONSIDERATIONS SUGGESTED READING
immunosuppressive therapy if severe pruritus Comments Miller WH, et al: Muller & Kirk’s Small animal
VetBooks.ir • Immunomodulatory therapy can be beneficial • Avoid future use of the offending medication AUTHOR: Frédéric Sauvé, DMV, MSc, DES, DACVD
or immune-mediated dermatosis exists and
dermatology, ed 7, St. Louis, 2013, Saunders, pp
concurrent infection is absent.
466-472.
or chemically related drugs.
for EM, SJS/TEN, injection-site reactions,
or vasculitis. • Hospitalization may be indicated. EDITOR: Manon Paradis, DMV, MVSc, DACVD
Technician Tips
PROGNOSIS & OUTCOME If ulcers/wounds are present, they should
be kept clean and protected from potential
Good, unless internal organs are affected or self-mutilation.
there is extensive epidermal necrosis

Cutaneous Lupus Erythematosus

BASIC INFORMATION scaling (ECLE), or ulcerative skin lesions of are subsequently damaged. This results in
the axillae and groin (VCLE) subepidermal vesicle formation and immune
Definition complex deposition in the basement mem-
• Cutaneous lupus erythematosus (CLE) is a PHYSICAL EXAM FINDINGS brane zone.
chronic, inflammatory, autoimmune skin • DLE: usually localized to the nasal planum
disease with a broad spectrum of clinical (unhaired, rostral surface of the nose). Less DIAGNOSIS
manifestations and a variable course. None commonly, lip folds, oral cavity, periocular
of the five forms described to date progress area, pinnae, genitalia, and rarely distal limbs Diagnostic Overview
to systemic lupus erythematosus (SLE). ○ Erythema, depigmentation, and scaling of A strong suspicion exists on physical examina-
○ Discoid lupus erythematosus (DLE) is the nasal planum with or without involve- tion alone. The differential diagnosis varies
a relatively benign skin disease with no ment of the bridge of the nose. Early according to the type of CLE. Biopsy for
systemic involvement. A generalized form depigmentation manifests as a change in histopathologic evaluation is the confirmatory
of DLE (GDLE) has been characterized. color from normal black to gray/white; test of choice.
○ Mucocutaneous lupus erythematosus there is a change in surface texture of the
(MCLE) manifests as chronic juxtamu- nasal planum from the normal, rough, Differential Diagnosis
cosal erosive lesions. cobblestone-like appearance to a smooth, • Bacterial infection: mucocutaneous pyoderma
○ Two other forms, exfoliative cutane- shiny surface. (DLE), staphylococcal folliculitis
ous lupus erythematosus (ECLE) and ○ Scaling and crusting may be present at • Immune-mediated diseases: systemic lupus
vesicular cutaneous lupus erythematosus the junction between nasal planum and erythematosus, pemphigus foliaceus and
(VCLE), can be debilitating and poten- haired skin. Dogs with DLE are otherwise erythematosus
tially fatal. healthy. • Drug reaction, uveodermatologic syndrome
• GDLE: generalized multifocal, annular • Vitiligo
Epidemiology (discoid) to polycyclic plaques with pigment • Neoplasia: squamous cell carcinoma, epith-
SPECIES, AGE, SEX changes, erythematous margin, adherent eliotropic lymphoma (DLE)
• Uncommon in dogs; rare in cats scaling, follicular plugging, and central alopecia • Trauma
• Adults (DLE and VCLE); female/male ratio • MCLE: erosions and ulcers in the perigenital, • Dermatophytosis
= 2.4 : 1 (VCLE) perianal regions. Affects dogs most com- • Demodicosis
monly in mid-adulthood • Dermatomyositis (collie and Shetland
GENETICS, BREED PREDISPOSITION • ECLE: initially there is scaling on the sheepdog)
Breeds include German shepherd (MCLE), face, pinnae, and dorsum, progressing to • Nasal parakeratosis in Labrador retriever
Siberian Husky, Brittany spaniel, collies, and a more generalized distribution. Peripheral (DLE)
Australian herding breeds (DLE); German lymphadenopathy and fever may be present.
short-haired pointer (ECLE); rough collie and • VCLE: characteristic lesions include annular, Initial Database
Shetland sheepdog (VCLE). polycyclic, and serpiginous ulcerations • Deep skin scrapings (p. 1091)
distributed over sparsely haired areas of the • Skin cytology (impression smear)
RISK FACTORS body, specifically the ventral abdomen, axilla, • Dermatophyte culture
Breed, exposure to ultraviolet (UV) light groin, and concave aspects of the pinna. • Routine CBC, serum biochemistry profile,
and urinalysis: generally unremarkable
GEOGRAPHY AND SEASONALITY Etiology and Pathophysiology • Serum antinuclear antibody test: usually
More common in summer months and sunny • Pathogenesis is thought to involve autoreac- negative (helps rule out SLE)
climates tive T cells that stimulate B cells to produce
antibodies to a number of nuclear proteins. Advanced or Confirmatory Testing
Clinical Presentation • UV light may initiate the process of expres- • Biopsy (under general anesthesia for DLE) for
HISTORY, CHIEF COMPLAINT sion in photosensitive individuals (50% of histopathologic evaluation, which is the gold
Lesions on the nasal planum +/− bridge of the cases). standard for diagnosis. The typical lesional
nose (DLE), multifocal to generalized (GDLE), • Antibodies are deposited in the basement patterns are a lymphocyte-rich interface der-
urogenital or perianal (MCLE), generalized membrane, and epidermal basal layer cells matitis along the dermoepidermal junction,

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