Treatment of discoid lupus erythematosus in a dog with human intravenous immunoglobulin

Background: Discoid lupus erythematosus (DLE) is a common canine autoimmune skin disease, in which systemic manifestations are absent. Skin Lesions are usually present on the nasal planum, and characterised by erythema, depigmentation, erosion, ulceration, and crusting. The diagnosis is based on histopathological results, which should demonstrate lymphoplasmacytic lichenoid-interface dermatitis. Human intravenous immunoglobulin (hIVIg) has been used in veterinary medicine to treat cutaneous diseases including erythema multiforme, PF, and severe adverse cutaneous drug reactions. In human medicine, it has been effective to treat DLE. This report firstly describes the clinical response to hIVIg in a dog with DLE resistant to common immunosuppressive drugs. Case: A 5-year-old, intact female Shih Tzu presented with a 1-month history of slowly progressive black crusting on the nasal planum, chin, and claw. Based on the results of a dermatologic examination, superficial pyoderma was diagnosed. The skin lesions did not improve during and after anti-infective treatment. After removing the crusts, a skin biopsy was obtained from the muzzle. Histopathology of lesional skin biopsy specimens revealed lymphoplasmacytic interface dermatitis at the dermoepidermal junction. Microscopic examination also revealed vacuolar changes and pigmentary incontinence of the basal layer as a lichenoid tissue reaction. No mites or fungi were detected on the skin section. The absence of acantholytic cells excluded pemphigus foliaceus, which is also characterised by the lesions of the nasal planum. Based on the distribution of the lesions, histopathology and exclusion of other dermatoses, the dog was diagnosed with DLE. The skin lesions temporarily improved after treatment with prednisolone (2 mg/kg PO q12h). However, after tapering the dose of prednisolone, new black crusts developed on the nasal planum and claw. Although the dog was successively treated with other immunosuppressive drugs, including azathioprine, cyclosporin with dexamethasone, and mycophenolate mofetil, black crusts still remained. Due to the low efficacy of these immunosuppressive drugs, hIVIg was administered at 0.5 g/kg once daily for 4 days, for a total dose of 2 g/kg. During hIVIg administration, the crusted lesions gradually improved. After the hIVIg administration, the dog was treated with prednisolone (1 mg/kg PO q12h). The lesions were almost in complete remission at 21 days after an additional application of prednisolone. The skin lesions did not recur, and the treatment was eventually discontinued after 6 weeks of additional prednisolone application. Discussion: The standard treatment of canine DLE includes glucocorticoids, and second-line immunosuppressive drugs, such as azathioprine and cyclosporine, are usually added in cases resistant to steroids. This case suggests that hIVIg may be beneficial as an adjunctive treatment option for canine DLE, especially when the application of standard immunosuppressive drugs is limited due to adverse effects or low efficacy. There is evidence from several studies that the steroid-sparing effect of hIVIg is significant in human patients. In the current case, the effective dose of prednisolone was reduced to 2 mg/kg/day after hIVIg administration, and prednisolone therapy was finally discontinued completely. The hIVIg appears to lower the daily steroid dose requirement in this dog.

Lúpus eritematoso discoide em cão / Dischoid erythematosus lupus in dog

O Lúpus Eritematoso Discoide (LED) é uma doença autoimune que causa alterações no sistema tegumentar dos animais. Ela acomete cães, gatos, equinos e humanos. Sua etiologia ainda não é bem elucidada, mas acredita-se que fatores genéticos, hormonais e ambientais possam possivelmente desencadeá-la. Essa enfermidade é caracterizada por despigmentação, eritema e descamação nas áreas acometidas, podendo em casos crônicos úlceras serem observadas. Seu diagnóstico baseia-se nos resultados obtidos na anamnese, histórico, exame físico e no exame histopatológico. Por se tratar de uma doença autoimune não há cura definitiva, ocorre apenas o controle, que para tal, pode-se utilizar drogas imunossupressoras e restrição solar. Objetiva-se com presente trabalho relatar um caso de Lúpus Eritematoso Discoide em um cão. No caso relatado o animal apresentava lesões com aspecto eritematoso, descamativo e ulcerado, na região nasal, nos lábios e gengiva, região perianal e na região abdominal caudal. O diagnóstico confirmatório da doença foi realizado por meio do exame histopatológico. Como tratamento foi instituído a corticoterapia a base de prednisolona na dose de 2mg/kg, BID, por 10 dias, posteriormente a dose foi reduzida para 1mg/kg, BID, por mais 10 dias e depois 1mg/kg, em dias alternados, também foi recomendado a restrição solar. O animal respondeu positivamente ao tratamento instituído com melhora significativa dos sinais clínicos apresentados. Contudo, deve-se salientar que a terapêutica instituída com objetivo de controle, pois conforme já foi mencionado não há cura definitiva para a enfermidade.

Discoid Lupus Erythematosus (LED) is an autoimmune disease that causes changes in the integumentary system of animals. It affects dogs, cats, horses and humans. Its etiology is still not well understood, but it is believed that genetic, hormonal and environmental factors may possibly trigger it. This disease is characterized by depigmentation, erythema and desquamation in the affected areas, and in chronic cases ulcers may be observed. Its diagnosis is based on the results obtained in the anamnesis, history, physical examination and histopathological examination. Because it is an autoimmune disease, there is no definitive cure, only control occurs, for which, immunosuppressive drugs and solar restriction can be used. The objective of this work is to report a case of Discoid Lupus Erythematosus in a dog. In the case reported, the animal presented lesions with an erythematous, scaly and ulcerated aspect, in the nasal region, on the lips and gums, perianal region and in the caudal abdominal region. The confirmatory diagnosis of the disease was performed by means of histopathological examination. As treatment, prednisolone-based corticosteroids were administered at a dose of 2mg / kg, BID, for 10 days, then the dose was reduced to 1mg / kg, BID, for another 10 days and then 1mg / kg, every other day, as well. solar restriction was recommended. The animal responded positively to the treatment instituted with a significant improvement in the clinical signs presented. However, it should be noted that the therapy instituted for the purpose of control, as as already mentioned, there is no definitive cure for the disease.

Lúpus eritematoso discoide em cão / Dischoid erythematosus lupus in dog

O Lúpus Eritematoso Discoide (LED) é uma doença autoimune que causa alterações no sistema tegumentar dos animais. Ela acomete cães, gatos, equinos e humanos. Sua etiologia ainda não é bem elucidada, mas acredita-se que fatores genéticos, hormonais e ambientais possam possivelmente desencadeá-la. Essa enfermidade é caracterizada por despigmentação, eritema e descamação nas áreas acometidas, podendo em casos crônicos úlceras serem observadas. Seu diagnóstico baseia-se nos resultados obtidos na anamnese, histórico, exame físico e no exame histopatológico. Por se tratar de uma doença autoimune não há cura definitiva, ocorre apenas o controle, que para tal, pode-se utilizar drogas imunossupressoras e restrição solar. Objetiva-se com presente trabalho relatar um caso de Lúpus Eritematoso Discoide em um cão. No caso relatado o animal apresentava lesões com aspecto eritematoso, descamativo e ulcerado, na região nasal, nos lábios e gengiva, região perianal e na região abdominal caudal. O diagnóstico confirmatório da doença foi realizado por meio do exame histopatológico. Como tratamento foi instituído a corticoterapia a base de prednisolona na dose de 2mg/kg, BID, por 10 dias, posteriormente a dose foi reduzida para 1mg/kg, BID, por mais 10 dias e depois 1mg/kg, em dias alternados, também foi recomendado a restrição solar. O animal respondeu positivamente ao tratamento instituído com melhora significativa dos sinais clínicos apresentados. Contudo, deve-se salientar que a terapêutica instituída com objetivo de controle, pois conforme já foi mencionado não há cura definitiva para a enfermidade.(AU)

Discoid Lupus Erythematosus (LED) is an autoimmune disease that causes changes in the integumentary system of animals. It affects dogs, cats, horses and humans. Its etiology is still not well understood, but it is believed that genetic, hormonal and environmental factors may possibly trigger it. This disease is characterized by depigmentation, erythema and desquamation in the affected areas, and in chronic cases ulcers may be observed. Its diagnosis is based on the results obtained in the anamnesis, history, physical examination and histopathological examination. Because it is an autoimmune disease, there is no definitive cure, only control occurs, for which, immunosuppressive drugs and solar restriction can be used. The objective of this work is to report a case of Discoid Lupus Erythematosus in a dog. In the case reported, the animal presented lesions with an erythematous, scaly and ulcerated aspect, in the nasal region, on the lips and gums, perianal region and in the caudal abdominal region. The confirmatory diagnosis of the disease was performed by means of histopathological examination. As treatment, prednisolone-based corticosteroids were administered at a dose of 2mg / kg, BID, for 10 days, then the dose was reduced to 1mg / kg, BID, for another 10 days and then 1mg / kg, every other day, as well. solar restriction was recommended. The animal responded positively to the treatment instituted with a significant improvement in the clinical signs presented. However, it should be noted that the therapy instituted for the purpose of control, as as already mentioned, there is no definitive cure for the disease.(AU)

Lúpus Eritematoso Discóide em cão: relato de caso / Discoid lupus erythematosus in a dog: a case report

O Lúpus Eritematoso Discóide (LED) é uma enfermidade benigna da pele que não apresente acometimento sistêmico, caracterizada pela ocorrência de lesões cutâneas faciais. Um cão da raça Pastor Alemão foi atendido apresentando histórico de descamação, alopecia, áreas de hipopigmentação, dermatite ulcerativa, crostas e fissuras no espelho nasal e orelhas. O diagnóstico de LED foi estabelecido pelo histórico, exame clínico e avaliação histopatológica. O tratamento do LED baseou-se no uso de medicamentos imunossupressores, antibacterianos (tópicos e sistêmicos) e bloqueadores solares

Discoid lupus erythematosus (DLE) is a bening illness confined to skin. A German shepherd dog was consulned with history of scalling off, alopecia, áreas of hypopigmentation, ulcerative dermatitis, crusts and fictions in nasal mirror and ears. Diagnostic of DLE was perfomed by history and evaluation of clinicalç and histopathological exams.the treatment of DLE was based on immunosuppressive drugs, antibacterial therapy (topic and systemic) and solar blocking agents

Lúpus Eritematoso Discóide em cão: relato de caso / Discoid lupus erythematosus in a dog: a case report

O Lúpus Eritematoso Discóide (LED) é uma enfermidade benigna da pele que não apresente acometimento sistêmico, caracterizada pela ocorrência de lesões cutâneas faciais. Um cão da raça Pastor Alemão foi atendido apresentando histórico de descamação, alopecia, áreas de hipopigmentação, dermatite ulcerativa, crostas e fissuras no espelho nasal e orelhas. O diagnóstico de LED foi estabelecido pelo histórico, exame clínico e avaliação histopatológica. O tratamento do LED baseou-se no uso de medicamentos imunossupressores, antibacterianos (tópicos e sistêmicos) e bloqueadores solares(AU)

Discoid lupus erythematosus (DLE) is a bening illness confined to skin. A German shepherd dog was consulned with history of scalling off, alopecia, áreas of hypopigmentation, ulcerative dermatitis, crusts and fictions in nasal mirror and ears. Diagnostic of DLE was perfomed by history and evaluation of clinicalç and histopathological exams.the treatment of DLE was based on immunosuppressive drugs, antibacterial therapy (topic and systemic) and solar blocking agents(AU)