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Cutaneous Lupus Erythematosus 229

hair follicles, and adnexal glands in con-
junction with hydropic degeneration and
apoptosis in the basal cell layer in DLE
VetBooks.ir • Focal immunoglobulin G (IgG) deposition Diseases and Disorders
in the basement membrane zone for MCLE
(immunohistochemistry)
• Hyperkeratosis and lymphocytic interface
dermatitis in ECLE; and a lymphocyte-rich
interface dermatitis and folliculitis with
vesiculation at the dermal-epidermal junction
in VCLE
• Immunohistochemistry may be required.
• Biopsy for fungal and bacterial culture (DLE)

TREATMENT
Treatment Overview
Control and resolution of existing lesions are the
goals of treatment. More than one therapeutic
modality may be necessary. Typically, secondary/
concurrent infections are treated first if present,
and immunosuppression is the cornerstone of
treatment.
Acute General Treatment
DLE: CUTANEOUS LUPUS ERYTHEMATOSUS Discoid lupus erythematosus in a collie. Note the depigmentation,
erosion, and crusting of the nasal planum. (Copyright Dr. Manon Paradis.)
• Routine antibiotic therapy (e.g., cephalexin
22-30 mg/kg PO q 8-12h for 30 days) to
rule out mucocutaneous pyoderma combination therapy will likely be required PEARLS & CONSIDERATIONS
• If no or only partial improvement is noticed, in most cases.
a potent topical glucocorticoid (e.g., • Hydroxychloroquine 5 mg/kg q 24h. Assess Comments
betamethasone or 0.1% amcinonide) can retinal function (possibly toxic). • Dogs with DLE typically feel and act well;
be used. Switch to a low-potency product the disorder is usually confined to the nasal
(e.g., 1% hydrocortisone cream) after a Chronic Treatment planum.
favorable response is noted. If long-term • Avoid intense sunlight (e.g., 8 AM-5 PM). • Depigmentation on the inner surfaces of
topical glucocorticoid is not an option, the • Topical sunscreens if sunlight exposure is the nostrils accompanied by nasal discharge
following treatment can be attempted. unavoidable suggests an intranasal problem (e.g., nasal
• Topical tacrolimus, 0.1% ointment (Protopic) • Bilateral rotational nasal flaps for refractory aspergillosis) rather than DLE.
q 12h initially, wean based on a favorable cases (DLE) • In the past, many cases of mucocutaneous
response pyoderma and nasal parakeratosis have been
• Vitamin E 400-800 IU/day Possible Complications wrongly diagnosed as DLE.
• Essential fatty acids (n3 EFA, eicosapentae- • Nasal cartilage erosion and arteriole hemor- • Oral antibiotic trial is required before skin
noic acid) 30 mg/kg PO q 24h rhage (DLE) biopsies of the nasal planum, particularly in
• Tetracycline and niacinamide: dogs > 10 kg, • Squamous cell carcinoma (DLE) German shepherd dogs.
500 mg (<10 kg, 250 mg) of each drug • Septicemia (VCLE)
PO q 8h. May take 6-8 weeks to produce • Iatrogenic hyperadrenocorticism with chronic Technician Tips
improvement. If good response, wean gradu- glucocorticoid use Dogs may quickly lick topical medications
ally (several weeks). Doxycycline 5-10 mg/kg applied to the rostral nose, reducing their
PO q 24h as an alternative to tetracycline Recommended Monitoring efficacy (and causing systemic absorption).
• In refractory cases, systemic glucocorticoids: • Routine CBC and serum biochemistry Application of a thin film of topical creams or
prednisone 1.7-2 mg/kg/d PO initially, profiles if using azathioprine. Initially assessed liquids to the nasal planum (using gloves with
then wean based on a favorable response. q 14 days, reducing to q 3 months when immunosuppressant drugs such as tacrolimus)
Concomitant azathioprine 1-2 mg/kg PO condition is stable should be followed by distraction of the patient,
q 24-48h while administering prednisone • High-dose glucocorticoids are rarely required, feeding of a small treat, or other measures to
GDLE: but appropriate serum biochemistry profiles reduce the likelihood of immediately licking
• Lesions respond to a variety of treatments, and urinalysis should be used in such cases. away the medication.
including cyclosporine, hydroxychloroquine, • With chronic use of intermediate- or long-
topical tacrolimus, and oral tetracycline/ acting topical glucocorticoid application, Client Education
niacinamide adrenal function should be monitored. • Avoid intense ultraviolet light.
MCLE: as for DLE • Use sunscreen.
ECLE and VCLE: PROGNOSIS & OUTCOME
• Oral immunosuppressive doses of predni- SUGGESTED READING
sone 1.7-2 mg/kg are the first choice, with • DLE and GDLE: good, but may require Olivry T, et al. Cutaneous lupus erythematosus
appropriate antibiotic therapy (p. 851). chronic therapy in dogs: a comprehensive review. BMC Vet Res
• Cyclosporine 5-10 mg/kg q 24h • MCLE: good but relapses are common with 14:132-150, 2018.
• Azathioprine 1-2 mg/kg, q 24-48h or tapering therapy AUTHOR: Michael Hannigan, BVMS
cyclosporine 5 mg/kg PO q 12h may be • VCLE: guarded EDITOR: Manon Paradis, DMV, MVSc, DACVD
added if lesions persist. Some form of • ECLE: poor

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