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Canine Discoid Lupus
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Nasal Solar Dermatitis (Collie Nose)
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Side View
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Collie Nose is a discoloration of the nose pigment diagnosed as Discoid
Lupus Erythematosus. Originally thought to be an allergic reaction to sunlight,
the condition is only aggravated by prolonged sun exposure. Though not
painful, the lighter colored areas are very sensitive to sunlight and can
be sunburned. The dog should be kept out of bright sunlight as much as
possible or the affected area should be protected with a sun screen lotion.
Though it is known as Collie nose it is not indigenous to the Collie breed
as it also appears in the Shetland Sheepdog and any mixed breed farm shepherd
type dogs. One Disease know as DM (Dermatomyositis) in it's early stages,
has been mistaken for Collie Nose.
reprinted with kind permission from Becky Vaughan-Curran
Garwood Kennels, Garwood Web Design, CKC member, AWCA member
www.garwoodkennels.com
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Discoid lupus
Michael Richards, DVM
Discoid lupus is an immune mediated
skin disease that is probably related to systemic lupus erythematosus
(SLE) but instead of affecting the whole body as SLE does, it primarily
affects the nose and face. As far as I know, there is no known cause
of this problem but it does seem more frequent in dogs of the German
shepherd, collie, Brittany spaniel. Shetland sheepdog, Siberian husky
and German shorthaired pointer breeds.
The disease
normally starts as loss of pigment around the nose. There may be
scabby sores or just scaling of the nasal tissue. The surface of the
nose may change from its typical cobblestoned appearance to a smooth
surface. As this disease progresses it can cause deep sores on the borders
of the nose where it meets normal skin and the sores start to progress
up the bridge of the nose. Some dogs seem to be really bothered by this
condition and others show little reaction to the sores.
Ultraviolet light seems to make the sores worse, so the
disease may appear to be seasonal. It is more common in areas in
which exposure to ultraviolet light is increased, such as high altitudes.
If the depigmentation leads to sunburn, squamous cell carcinoma becomes
more likely than in other dogs. Topical sunscreens can be very beneficial,
although it is hard to get dogs to leave them on. Keeping the dog in
during the peak sunlight hours is probably the most effective way to
prevent excessive exposure to UV light.
Treatment depends
on the severity of the disease. In many cases, topical treatment
will be all that is necessary, using a corticosteroid ointment (Panalog,
Synalar and others). It is usually necessary to use a fairly potent
corticosteroid. Vitamin E supplementation is sometimes beneficial but
can take several months to show much effect. Severe cases require treatment
with corticosteroids. It is possible that other immunosuppressive therapy
such as gold salts or azathioprine (Immuran) could be beneficial but this
is rarely necessary to consider. In people, this condition is often responsive
to antimalarial medications but I do not know if this is safe or effective
therapy for dogs.
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Systemic Lupus Erythematosus
Mike Richards, DVM
This is a rare
disease of the immune system. In this disease, the immune system forms
antibodies against the nuclear component of its own cells. This can
cause a variety of effects but the most common ones are arthritis,
kidney disease, skin disease and blood disorders (anemia and/or decreased
in platelet numbers). A great number of other effects and side effects
of this disease can occur so it is hard to rule in or rule out when faced
with a multi-systemic disease. In general, this disease is not considered
to be present unless testing to determine if antibodies against the nuclear
elements of the cells are present (positive ANA test) AND clinical signs
of at least two of the common disorders are present. Even then, it is hard
to be sure that this disease is actually the problem. Some drug reactions
and cancers can produce almost identical clinical signs and many problems
produce some of the clinical signs. Treatment usually involves the use
of immunosuppressive medications, most commonly corticosteroids such as
prednisone. Often, a second immunosuppressive agent must also be used.
Azathioprine, cyclophosphamide and cyclosporine are examples of these
medications.
Lupus is not curable but it is often possible for a
dog to live with it successfully. Some of the disorders that resemble
lupus are curable, especially if a cause can be identified. Continuous
monitoring of patients suspected of having lupus should be part of
the treatment, due to the possibility of another problem, the multitude
of side effects that can occur and the potential for problems from
the medications used to treat it.
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Systemic lupus erythematosus (SLE)
possible in working German Shepherd
Question:
My K-9 is a long haired male neutered G/S 6.5 years old 90 lbs.
After seeing the dog the vet. suspected SLE, due to his platelet count
being low and skin conditions. A battery of tests were conducted including
ANA test, all have been normal. His platelets have been in and around
the 150's. I have also noticed a slow down in his drive. All these things
have transpired since June. The vet is confident he has SLE but is unsure
how to 5proceed, should he treat it conservatively as SLE or not at
all and monitor the dog. Some say because he is a working dog, and it
is early in the diagnosis, treat him for SLE, he stands a better chance
of continuing to work then. The other choice is to do nothing and see
what develops. The bad thing about that is if he worsens he will be removed
from service. Would the proper thing to do be to refer it to a Specialist
to review. Wait a month and retest the blood? Start treatment conservatively?
Is there a test that will clear this up? I know that I am not giving
you much medically, but I believe the vet has made all the right moves.
Any advice you can offer would be greatly apprieciated. My supervisors
will be making a decision soon as to Deiter's future, I just want to
help make the right one! Thank you!
James-
Answer: Systemic lupus erythematosus (SLE) is very
hard to diagnose with certainty. The "major" signs of SLE are arthritis
affecting multiple joints, without evidence of cartilage erosion,
multiple painful muscles, skin sores with bullae (blisters), increased
protein in the urine, immune-mediated hemolytic anemia (IMHA), decreased
platelet numbers (thrombocytopenia) and decreased white blood cell count.
The "minor" signs of SLE are fevers for no apparent reason,
oral ulcers, inflammation of the pleura (the lining of the chest
cavity) or pericardium (lining around the heart), heart muscle inflammation,
enlarged lymph nodes,
dementia and seizures. Most dogs with SLE will test positive
on anti-nuclear antibody (ANA) testing. Even a weak positive ANA is
considered significant in dogs. Not all dogs with SLE have positive
ANA tests, though.
To make a diagnosis of SLE in dogs, the recommended criteria
are: the presence of two major signs and a positive ANA test
OR one major sign, two minor signs and a positive ANA test OR two major
signs that aren't
explained by another condition even if there isn't a positive
ANA test.
German shepherds are prone to discoid lupus, which looks
like SLE but is usually confined to the face, especially the area
around the nose. Dogs with discoid lupus usually have negative ANA tests.
They also get
phemphigus, which is another immune mediated disease.
I don't think of platelet counts in the 150,000 range
as being low but it is apparent from answering questions on line
that many vets do.
Due to the significance of the diagnosis in a working
dog, I do think that it is worthwhile to get the opinion of a specialist.
In this case, it is probably acceptable to consider a board certified
dermatologist or an internal medicine specialist.
Hope this helps some.
Mike Richards, DVM
9/15/2000
Question: Dear Dr. Richards,
I have had a biopsy done on my German Shepherd and
found out that she does in fact have Discoid Lupus. My question
now relates to treatment. The clinic I took her to told me that
the pathologist said that my dog's case is very mild and in the very
beginning stages so they suggested I go for the lowest type of treatment.
I went by the clinic the other day and what they are telling me to give
her is 4 capsules of Tetracycline 250 mg. each day (2 capsules 2 times
a day) and also Vitamin E, Vitamin B and some fish oil capsules also
twice a day. I have no problem with the vitamin supplements but
I am concerned about giving her so many antibiotics for the rest of her
life. I am not much for medications even for myself and I don't
feel comfortable giving my dog so many pills each day. My question,
therefore, is...Is it absolutely necessary for her to take the Tetracycline
or are there other options. Can I just give her the vitamins
and not the Tetracycline? I would appreciate any advice or referral you
can give me.
Thank you, Sheryl
Answer: Sheryl-
It helps a lot when thinking of the use of tetracyline
to think of it as an immune modulator with minimal side effects rather
than an antibiotic. The effects it has on the immune system are probably
why tetracycline can be helpful in cases of discoid lupus rather than
its antibiotic effect. When compared to other drugs with immune system
effects it is very unlikely to cause problems, except for causing
vomiting in some patients.
Another medication sometimes used for discoid lupus is
niacinamide. At the present time I think it is usually used at the
same time as tetracycline, with both medications dosed at about 250mg
(small dog) or 500mg (large dog) three times a day. It is also
relatively unlikely to cause serious side effects, when compared to medications
such as corticocsteroids but it also causes vomiting in a fair number
of dogs.
Discoid lupus can often be treated with topical medications.
A sunblocker can be helpful. You have to use a waterproof one and
it should have an SPF of 30 or greater. Some dogs do better with oral
supplementation of Vitamin E, usually 400 to 800 IU per day.
Keeping affected dogs indoors helps a lot, too.
Topical application of a potent corticosteroid, like fluocinolone
acetonide or betamethasone dipropionate applied twice daily will
often control the symptoms of discoid lupus and is preferable to using
oral or injectable
corticosteroids.
It would really surprise me if the vitamins and fatty
acid supplementation would work alone but it might, if you also
use sunblock and try to avoid exposure to the sun, too. Topical corticosteroids
work for many dogs and the combination of these things and tetracycline
and niacinamide works for most dogs.
Mike Richards, DVM
7/14/2000
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Discoid Lupus Erythematosus
Also called:
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DLE
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Discoid Lupus
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Collie Nose
What is Discoid Lupus Erythematosus?
Discoid Lupus Erythematosus (DLE) is a skin condition of
dogs. It typically causes a loss of color in the hairless,
moist part of the nose. A normally black nose may fade to gray
or pink. The discoloration can be accompanied by ulcers and bleeding.
The skin around the nose may also look abnormal, and rarely, the disease
affects other parts of the skin. It does not affect other organs.
What causes Discoid Lupus Erythematosus?
The skin lesions in DLE arise when the animal’s immune
system targets the skin. The immune system normally
clears infections and any substances that are “foreign”
to the body, while ignoring, or tolerating, substances that are normally
found there. In DLE, we believe that the immune system considers
some of the normal components of the skin as foreign. It uses
the mechanisms normally launched at foreign invaders to try to “clear”
these skin components. The resulting inflammation and skin damage
lead to the visible changes seen on the surface.
Unfortunately, we do not know all the factors that contribute
to this error. We do know that some breeds of dogs seem more
prone to developing the disease. In many dogs, sunlight exacerbates
the disease. Once DLE has developed, it tends to be a lifelong
condition due to the long-lasting “memory” of the immune system.
How is Discoid Lupus Erythematosus diagnosed?
The diagnosis is based on skin biopsies. Due to the
location of the skin lesions, general anesthesia or sedation may
be required to collect the biopsies.
How is Discoid Lupus Erythematosus treated?
Treatment consists of oral medications, topical therapy,
or a combination of both. Oral medications are usually
prescribed, as dogs tend to resist the application of medications
to the nose, and can also quite easily remove them. Since DLE
can be exacerbated by sun exposure, a sunscreen (not containing zinc
oxide) should be applied to the nose when the dog goes outside.
It is best to keep your dog indoors during the peak daylight hours.
The treatment for DLE may need to be continued for life,
but serious side-effects from the treatments are uncommon.
Routine rechecks are recommended to enable the dose of medications
to be kept as low as possible.
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Note
for Pet Owners:
This
information is provided by Provet for educational purposes only.
You
should seek the advice of your veterinarian if your pet is ill as only he
or she can correctly
advise on the diagnosis and recommend the treatment that is
most appropriate for your pet.
Topics on this Page:
Description
Cause
Breed Occurrence
Signs
Complications
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Diagnosis
Treatment
Prognosis
Long-term problems
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Description
Systemic lupus erythematosus (commonly known as SLE) is
a rare autoimmune-mediated disease which is seen in dogs and very
rarely in cats.. SLE causes a variety of signs and most often cases
are presented because of lameness or skin disorders.
Cause
The primary cause of SLE is unknown in animals and humans
although several factors have been suggested, including :
Genetic inheritance
Exposure to environmental factors - eg ultraviolet light
- which definitely induces a photosensitivity reaction in affected
animals
Exposure to viral infections
Endocrine factors
Drug administration (anticonvulsants, contraceptives, hydralazine,
isoniazid, penicillamine, procainamide and vaccinations (dogs)
Suppressor T cell deficiency and other immunological disorders
Whatever the primary cause the disease is characterised
by the production of non-specific antibodies (called antinuclear
antibodies - ANAs) by the animal which may attack specific cells
or tissues, for example :
Red blood cells - erythrocytes
White blood cells - leukocytes
Platelets
These ANAs combine with free DNA to form DNA-antiDNA complexes
and can become deposited in a variety of tissues causing a Type III
hypersensitivity reaction, including :
The walls of arterioles causing necrosis and fibrosis
The synovial membrane
The glomeruli - resulting in glomerulonephritis
It is interesting to note that both dogs and humans with
SLE have low concentrations of thymic factors in their blood.
Breed Occurrence
SLE usually occurs in middle-aged dogs (range 2-12 years,
mean 5.8 years) and certain breeds are reported to be over-represented
in population studies of the disease, including : Afghan Hounds,
Beagles, German Shepherd Dogs, Irish Setters, Old English Sheepdogs,
Poodles, Rough Collies and Shetland Sheepdogs.
In cats the condition is very rare, but the Himalayan, Persian
and Siamese cats may be predisposed to develop SLE
There is no age or sex predilection .in dogs or cats.
Signs
The clinical signs associated with SLE in dogs include :
Anaemia - due to haemolysis of red blood cells *
Coagulopathy due to thrombocytopenia
Fever *
Recurrent shifting lameness associated with a polyarthritis
- seen in 75% of cases *
Recurrent shifting lameness associated with a polymyositis
Lymphadenopathy
Myocarditis and pericarditis
Neurological signs including seizures, psychoses and polyneuropathies
Oral ulcers *
Pneumonitis or pleuritis
Polydipsia and polyuria with proteinuria due to glomerulonephritis
*
Skin lesions including alopecia, cellulitis, crusting, erythema,
furunculosis, panniculitis, seborrhoea, ulcers (mucocutaneous junctions
and footpads), scar formation -50% of cases * The lesions can affect
the face, ears , limbs, and body Splenomegaly
Thyroiditis
(* Most common signs)
Signs in the cat include :
Anaemia
Coagulopathies due to thrombocytopenia
Conjunctivitis
Fever
Lung disease
Lymphadenopathy
Myopathy
Neurological disorders (including behavioural changes)
Oral ulcers
Polyarthritis
Skin lesions - in about 20% of cats with SLE
Renal failure
Complications
Multiple organ system involvement makes diagnosis complicated.
Diagnosis
Diagnosis is made by identification of ANAs by an indirect
immunofluorescent test, and by histopathological examination of skin
biopsies.
Treatment
Treatment of SLE includes :
Corticosteroids - prednisone, prednisolone, methylprednisolone
Other immunomodulating drugs eg azathioprine, chlorambucil
- sometimes in combination with corticosteroids.
Levamisole - has been beneficial in some canine cases -
2.5mg/kg every 48 hours
Aspirin has been beneficial in some canine cases
Splenectomy
Management of secondary disease eg renal failure
Prognosis
The prognosis is unpredictable to poor - and it is worse
if coagulopathy or haemolytic anaemia
are present. It is reported that over 40% of cases die
in the first 12 months following diagnosis,
but long term remission does occur in some dogs.
Long term problems
Euthanasia is often requested in animals that are refractory
to treatment.
Copyright
(c) 1999 - 2007 Provet. All rights reserved. Email: info@provet.co.uk
reprinted with
kind permission of Provet
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The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist you
in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.
