The scabs are pretty much gone now. The skin is still a little fragile in a couple of spots though. Today she made her nose bleed when FedEx delivered a package. She got excited and was barking at the front window but was too close and was dragging her nose across the glass.
Yesterday was her 1-month re-check at the rehab vet. Her rehab vet was the one who made the diagnosis on September 22. The improvement in her nose surprised the vet tech and the vet. We now have a plan for seeing if we can take her off the Doxycycline.
Today she saw her holistic vet to have a spot on her left eye checked out. The vet was amazed at how good her nose is looking (and she thinks the spot is a lipid deposit.)
What Is Discoid Lupus Erythematosus (DLE)?
DLE is more correctly called Cutaneous Lupus Erythematosus. I’ll continue referring to it as Discoid because that seems to be the most commonly used name.
DLE is an autoimmune disease thought to be a non-systemic version of the much worse and potentially fatal Systemic Lupus Erythematosus.
DLE does not progress to SLE.
The way DLE was explained to us is the immune system has decided it is allergic to part of the skin structure and mounts an “appropriate” response in order to destroy the “foreign invader.” Unfortunately the “foreign invader” is part of the skin so it starts destroying the skin.
It is typically confined to the nose. Symptoms include loss of hair on the bridge of the nose, complete loss of nasal pigment, pigment may also become gray-black and shiny, the texture on the nose goes away, the skin cracks and/or becomes scaly and scab-like, painful and hard to heal lesions appear on the nose.
These skin problems can move to the eye area, ears, mouth, and, occasionally, the genital area.
Sun exposure can worsen an existing flare up of DLE or even trigger one if it is remission. The use of a pet-safe sunscreen on the nose is recommended. If this isn’t possible, avoid exposure to strong sunlight.
Lupus is a lifelong disease. There is no cure.
How Is It Diagnosed?
The only true way to diagnose DLE is via skin biopsy of the nose. This has to be done on areas that are not affected by lesions and have minimal flaking. More than one area of the nose may need to have a biopsy sample taken.
Since the biopsy is painful, and done on the nose which is already a sensitive area, sedation or anesthesia will likely have to be used.
Stitches to close the biopsy site, or sites, will be needed.
With Chance, the rehab vet did not think a biopsy would be a good idea. Her nose was very inflamed and painful plus she had the painful lesions she was dealing with.
Based off her classic DLE symptoms (which matched no other skin diseases or conditions), the rehab vet opted to start treatment and see how she responded. A definite improvement would show that it was DLE.
Conventional Treatments And Therapies For DLE (As Described By Chance’s Vets)
Initial: An antibiotic/B vitamin supplement combination. The purpose of this combination is to stop modulate the immune system response and to stop the immune system’s attack on the skin. This combination helps about 70% of dogs. Some dogs go into lifelong remission and never need the antibiotic again. Some may need antibiotics periodically for flare ups. Some dogs may never be able to stop the antibiotics.
- Tetracycline Antibiotics: These are fairly hard on the dog’s system and must be given 3 times a day so Doxycycline is usually substituted as it has the same properties for fighting DLE.
- Doxycycline Antibiotic: Has immunomodulating properties and this is why it is used. Its purpose is to try to regulate the immune system’s response to the condition.
- Niacinamide: A B-vitamin that has immunomodulating properties, anti-inflammatory properties, and anti-histamine properties.
1.) Steroids: Prescribed for their immunosuppressive properties. They do have unwanted side effects and should only be used in conjunction with other therapies and only when absolutely needed.
- Topical Steroids: A safer choice than oral and should be tried 1st. Applied to the nose and other affected areas.
- Oral Steroids: Have the most side effects.
There are many “alternative” treatments and therapies that can be used in conjunction with the conventional ones. The ones Chance is on will be discussed in the next post.