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Discoid lupus erthyematosus (DLE)

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01 May 2014, at 1:00am

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.