Download discoid lupus erythematosus (dle)

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VETERINARY PRACTICE MAY 2014
DERMATOLOGY
DISCOID LUPUS ERYTHEMATOSUS (DLE)
DISCOID lupus erythematosus
nose, pinnae and distal limbs are
(also known as cutaneous lupus
affected. Lesions may consist of the
erythematosus) is considered to be following:
an auto-immune
n depigmentation
disease and a
and loss of
DAVID GRANT
benign form of
cobblestone
continues the series of
systemic lupus
appearance of nasal
dermatology briefs
erythematosus.
planum;
Although rare, it is
n the nose may take
on a blue colour followed later by –
one of the more common auton erythema;
immune skin diseases seen in
practice and more cases are seen in n scaling;
n crusts.
the summer suggesting that UV
light is a contributing factor in the
pathogenesis.
Main differential diagnoses
n Pemphigus erythematosus
Clinical features
n Pemphigus foliaceus
The nasal planum is the site most
n Dermatomyositis
commonly affected (Figure 1). More
n Uveodermatologic syndrome. The
rarely other parts of the body such as
nasal planum lesions are very similar
the lips, periocular skin, bridge of the
but anterior uveitis develops with the
skin lesions or soon after
David Grant, MBE, BVetMed, CertSAD,
n Nasal pyoderma
FRCVS, graduated from the RVC in
n Demodicosis
1968 and received his FRCVS by
examination in
1978. He was
hospital director
at RSPCA
Harmsworth for
25 years until his
retirement from
the RSPCA and is
currently
engaged in
writing and lecturing internationally,
mainly in veterinary dermatology.
WEBINARS
“More bespoke”
approach to obesity
ROYAL Canin is hosting a webinar to
challenge vets to approach the problem
of obesity in a more bespoke way.
Starting at 8.30pm on Wednesday
7th May, the hour-long webinar will
feature Alex German from the
University of Liverpool’s Weight
Management Clinic alongside Royal
Canin’s veterinary support manager,
Lee Danks.
Alex will introduce a nine-point
body condition score developed in
conjunction with the company, which is
modelled on more than 3,000 photos
taken of dogs and cats with weight
management issues.
These images are brought together
in a new software programme which is
said to allow greater accuracy in
recognising and then diagnosing
obesity.
Lee will then outline a new online
weight management tool which has
been created to boost client interaction,
allowing pet owners to track and input
Diagnosis
n History
n Physical examination
n Rule out differentials
n 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.
their pet’s weight at home once a
diagnosis and treatment plan has been
agreed, with information relayed to and
from the practice.
Vets and nurses interested in
attending can register for the free
webinar by visiting
www.royalcanin.co.uk/targetweight.
Two further
cardiology sessions
CEVA Animal Health is hosting two
more free cardiology webinars
On 14th May Anne French will
discuss Monitoring heart failure patients,
and on 4th June Chris Little will
present interactive cardiology case
studies.
The interactive webinars will start at
8pm and last for 1.5 hours. To register,
visit www.cardaliscpd.co.uk.
Latest information
on canine epilepsy
VÉTOQUINOL is holding a free
webinar at 7.30pm on 13th May on The
latest in comparing treatment options for
canine epilepsy.
Treatment
n Avoid sunlight as much as
possible.
n 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. The dog in Figure
1 was in remission after
three weeks of prednisolone
at 0.5mg/kg and the dose
was then tapered to an every
Nasal planum of a six-year-old German
other day dose of
shepherd female dog. The nose has lost its
0.25mg/kg in conjunction
cobblestone appearance. Note the blue
with Cortavance spray
appearance ventrally. Dorsally there is
(Virbac).
erythema, ulceration and crusts.
n Topical glucocorticoids.
Topical products are limited in efficacy
Prognosis
due to the dog licking them off. The
The prognosis is good. Many dogs
dog in Figure 1 tolerated Cortavance
achieve remission on a short course of
spray on an alternate day dose enabling
glucocorticoids. Life-long intermittent
the dose of prednisolone to be further
treatment is usually necessary
reduced.
however. Possible sequelae include
n Topical 0.1% tacrolimus has been
permanent depigmentation and
reported to be of benefit in some cases. scarring. There have been rare cases
n Tetracycline-niacinamide in
that have developed squamous cell
combination with both given at a dose
carcinoma.
of 250mg three times daily for several
Further reading
months has also been advocated.
Hnilica, K. A. (2011) Small Animal
n Cyclosporine (Atopica, Novartis)
Dermatology. A Color Atlas and Therapeutic
5mg/kg once daily is an option in
Guide 3rd ed. pp248-250. Elsevier.
severe cases that do not respond to
Miller, W. H., Griffin, C. E. and Campbell,
glucocorticoids or suffer unacceptable
side effects. The drug is not licensed for K. L. (2013) In Muller and Kirk’s Small
Animal Dermatology 7th ed. pp459-460.
this disease and informed consent is
Elsevier.
necessary.
This webinar will provide a detailed
and balanced view on the latest
information available on canine
epilepsy, says the firm.
The speaker will be Dr Luisa De
Risio, European and RCVS recognised
specialist in veterinary neurology who is
head of neurology at the Animal
Health Trust.
To register go to
www.epilepsytreatment.co.uk.
Promoting foraging
and enrichment
LAFEBERVET is running a free,
interactive webinar on “Avian foraging
and enrichment” on 1st June “to learn
about the importance of enrichment
and its proper implementation”.
The speaker, avian veterinarian Dr
Scott Echols, will highlight the basic
principles of enrichment and discuss
methods to enrich the lives of captive
animals, particularly birds.
Details are on LafeberVet’s
continuing education page on
www.lafebervet.com/continuingeducation-2/. Registration opens in
mid-May.
BEVA launches
online learning site
THE British Equine Veterinary
Association (BEVA) has launched a
new online learning site “to help busy
practitioners gain all their equine CPD
in their own time and at their own
pace”.
The new site, ebeva.org, is the
online home of BEVA education,
providing a substantial library of
presentations given by some of the
leading experts in the equine veterinary
world.
Every month a new webinar will be
added to the library and presentations
from the BEVA congress will also be
made available annually.
All the sessions are available on
demand, with the option of subscribing
to an individual talk or a whole
package. At the end of each
presentation there is a CPD certificate
to download.
The webinars are free to BEVA
members and there is a 50% discount
for congress lectures.
For full details or to register, go to
ebeva.org.