Discoid lupus erthyematosus (DLE) - Veterinary Practice
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InFocus

Discoid lupus erthyematosus (DLE)

David Grant continues the series of dermatology briefs

DISCOID lupus erythematosus
(also known as cutaneous lupus
erythematosus) is considered to be
an auto-immune
disease and a
benign form of
systemic lupus
erythematosus.
Although rare, it is
one of the more common auto-
immune skin diseases seen in
practice and more cases are seen in
the summer suggesting that UV
light is a contributing factor in the
pathogenesis.

Clinical features

The nasal planum is the site most
commonly affected. More
rarely other parts of the body such as
the lips, periocular skin, bridge of the nose, pinnae and distal limbs are
affected. Lesions may consist of the
following:

  • depigmentation
    and loss of
    cobblestone
    appearance of nasal
    planum;
  • the nose may take
    on a blue colour followed later by –
  • erythema;
    n scaling;
  • crusts.

Main differential diagnoses

  • Pemphigus erythematosus
  • Pemphigus foliaceus
  • Dermatomyositis
  • Uveodermatologic syndrome. The
    nasal planum lesions are very similar
    but anterior uveitis develops with the
    skin lesions or soon after
  • Nasal pyoderma
  • Demodicosis

Diagnosis

  • History
  • Physical examination
  • Rule out differentials
  • Histopathological examination.
    Interface dermatitis involving the
    dermo-epidermal junction. Apoptosis
    of the basal cells may be seen.
    Immunofluorescence or
    immunohistochemistry will in some
    cases demonstrate deposition of
    immunoglobulin or complement at the
    basement membrane zone.

Treatment

  • Avoid sunlight as much as
    possible.
  • Systemic glucocorticoids.
    As DLE is a relatively
    benign disease
    glucocorticoids can be tried
    initially at a lower dose than
    is usual for auto-immune
    diseases.
  • Topical glucocorticoids.
    Topical products are limited in efficacy
    due to the dog licking them off.
  • Topical 0.1% tacrolimus has been
    reported to be of benefit in some cases.
  • Tetracycline-niacinamide in
    combination with both given at a dose
    of 250mg three times daily for several
    months has also been advocated.
  • Cyclosporine (Atopica, Novartis)
    5mg/kg once daily is an option in
    severe cases that do not respond to
    glucocorticoids or suffer unacceptable
    side effects. The drug is not licensed for
    this disease and informed consent is
    necessary.

Prognosis

The prognosis is good. Many dogs
achieve remission on a short course of
glucocorticoids. Life-long intermittent
treatment is usually necessary
however. Possible sequelae include
permanent depigmentation and
scarring. There have been rare cases
that have developed squamous cell
carcinoma.

Further reading

Hnilica, K. A. (2011) Small Animal
Dermatology. A Color Atlas and Therapeutic
Guide 3rd ed. pp248-250.

Elsevier.
Miller, W. H., Griffin, C. E. and Campbell,
K. L. (2013) In Muller and Kirk’s Small
Animal Dermatology 7th ed. pp459-460.
Elsevier.

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