DISCOID LUPUS ERYTHEMATOSUS
(also called “DLE,” “Nasal Solar Dermatitis,”
LUPUS – WHAT IS THIS DISEASE?
SYSTEMIC LUPUS VERSUS DISCOID LUPUS
When people use the term “lupus,” they are referring to systemic lupus, or “SLE” as described above. Discoid lupus is a form of lupus that is confined to the skin and is substantially more benign because of this confinement. Discoid lupus, or “DLE” is almost exclusively a canine disease and is almost always limited to the leather of the nose, called the “nasal planum.”
DLE does not progress to SLE.
Discoid lupus is a condition with many treatment options depending on the severity of symptoms.
Avoid Strong Sunlight
Since this is a condition made worse by the sun, it is important to avoid intense sunlight. Sunscreens have been advocated but it is important to realize that there are toxic ingredients in many human sunscreens and anything one applies to a dog’s nose will be licked off. Pet sunscreens are expected to be licked.
For an FDA pet approved sun protector endorsed by the AAHA (American Animal Hospital Association) and the SPCA, visit:
Other sun shielding products of interest include nose shields and uv light filtering sun visors:
The immune-suppressive effects of steroids are very helpful in DLE but the systemic side effects are undesirable. Side effects are minimized by using topical steroids, typically starting twice a day and eventually dropping to an “as needed” basis for maintenance after the nose is healed.
Vitamin E or Omega 3 Fatty Acids
These nutritional supplements are generally inadequate as sole therapy but may be able to reduce the need for other medications later on. It takes 1-2 months for these supplements to show their effect.
Tetracycline is an antibiotic with immunomodulating properties separate from its antibiotic properties. Niacinamide (also called “nicotinamide”) is a B vitamin supplement related to niacin (vitamin B3). The combination of these two medications has been found effective in 70% of dogs with DLE though it can take up to 2 months to see an effect. Treatment is given three times daily which is relatively inconvenient for most people so alternatives have been sought. Doxycycline, which can be used twice a day, is frequently substituted for Tetracycline.
Oral steroids are often used to get the condition under control relatively quickly (within a month) and can be used after that as the sole therapy after the lowest effective maintenance dose is determined. Side effects include panting, excessive thirst and urination, and increased appetite. None of these effects are particularly desirable so often steroids are used in conjunction with one of the other therapies with the idea of dropping back the steroids when the second therapy can take over.
Cylosporine is an immunomodulator that has found extensive use in veterinary medicine for a number of immune-mediated conditions including allergy. It can be used to control DLE but has some potential for side effects (mostly upset stomach) that might not be worthwhile for milder cases.
0.1% Tacrolimus (Protopic®)
This is a topical immunomodulator made for human use. It is very effective for use in DLE and does not cause problems if licked. Only small amounts of ointment are needed and the tube should last a long time which is good news since it is not inexpensive. The person applying the medication should wear gloves to avoid unneeded exposure.
If your dog is diagnosed with discoid lupus, please discuss therapy options with your veterinarian. If your dog has a crusty nose or ulcerated nose, expect a biopsy to be needed to sort out the diagnosis properly before treatment can be prescribed.
Page posted: 12/20/2012