Generalized Canine Discoid Lupus Erythematosus Responsive to Tetracycline and Niacinamide Therapy

Abstract

Discoid lupus erythematosus (DLE) is a commonly reported canine autoimmune disease that normally presents with a phenotype consisting of erythema, depigmentation, scaling, erosions/ulcers, and scarring over the nasal planum and the proximal dorsal muzzle. Recently, two cases of a generalized variant of this disease have been reported, whose lesions responded to either systemic glucocorticoids or a combination of topical corticosteroids, topical tacrolimus, and the oral antimalarial hydroxychloroquine. The purpose of this report is to describe an 11 yr old shih tzu that presented with skin lesions consisting of multiple annular, erythematous papules and plaques, hyperpigmentation, adherent scaling, and atrophic scars over the caudal dorsum, flanks, craniodorsal thorax, and lateroproximal extremities. A diagnosis of generalized DLE was made based on the clinical presentation, histopathology, laboratory values, and direct immunofluorescence findings. Treatment consisted of oral tetracycline and oral niacinamide, which resulted in complete remission of clinical signs. This is the first documented report of generalized canine DLE responding to the described immunomodulating regimen. Such a combination might therefore be considered as a glucocorticoid and/or antimalarial alternative for the management of generalized DLE.

Ciclosporin therapy for canine generalized discoid lupus erythematosus refractory to doxycycline and niacinamide

“…This dog's skin lesions closely resembled those uniquely described in canine generalized DLE . There were subtle differences, however, as erosions and prominent scarring were not a feature in the present case.…”

“…This dog's skin lesions closely resembled those uniquely described in canine generalized DLE. 4,5 There were subtle differences, however, as erosions and prominent scarring were not a feature in the present case. Previous treatment could have influenced the aspect of skin lesions prior to the examination by the authors, although this dog was referred due to the progressive worsening and spreading of new skin lesions in spite of glucocorticoid, niacinamide and doxycycline therapy.…”

“…Previous treatment could have influenced the aspect of skin lesions prior to the examination by the authors, although this dog was referred due to the progressive worsening and spreading of new skin lesions in spite of glucocorticoid, niacinamide and doxycycline therapy. Interestingly, the dog initially presented with moderate pruritus, a characteristic described in 45% of human cutaneous lupus erythematosus patients, but not reported previously for this variant of canine DLE . The localization of pruritus, as well as its resolution in parallel with the remission of skin lesions, is very suggestive of pruritic DLE; however, concurrent atopic dermatitis cannot be excluded even though the distribution of skin lesions in this dog would be inconsistent with this latter diagnosis.…”

“…In humans, the distinction between localized discoid lupus erythematosus (DLE), where skin lesions are confined to the head and neck, and the generalized form, where skin lesions occur below the neck, with or without involvement of the head, has prognostic implications because the risk of developing systemic lupus erythematosus is only 5% for the localized versus 28% for the generalized form . Canine nasal planum‐predominant localized DLE has been reported in two large case series, while generalized DLE mirroring its human counterpart has been reported in only two dogs . Here we describe a pruritic generalized variant of DLE in a dog, in which doxycycline and niacinamide therapy was unsuccessful while long‐lasting remission was achieved with the combination of ciclosporin and ketoconazole without any further disease flares.…”

“…1 Canine nasal planum-predominant localized DLE has been reported in two large case series, 2,3 while generalized DLE mirroring its human counterpart has been reported in only two dogs. 4,5 Here we describe a pruritic generalized variant of DLE in a dog, in which doxycycline and niacinamide therapy was unsuccessful while long-lasting remission was achieved with the combination of ciclosporin and ketoconazole without any further disease flares.…”