Treatment Options – Discoid Lupus Erythematosus
Discoid lupus erythematosus cannot be cured but is more manageable than the systemic form of the disease. The goals of treating DLE are to control and resolve the facial skin lesions, particularly on the hairless areas of the top of the muzzle. Treatment protocols may include oral or topical antibiotics, topical lotions or ointments, oral vitamin E, oral fatty acid supplements and oral or topical corticosteroids. Affected dogs should be kept out of the sun as much as possible, because the symptoms of DLE worsen with exposure to ultraviolet light. Owners can apply waterproof, high SPF sunscreen to their dog’s face and ears to slow the progression of the disease. Dogs with DLE should be checked by a veterinarian regularly to assess their progress and to monitor the success of treatment. These dogs should not be used for breeding.
Treatment Options – Systemic Lupus Erythematosus
Systemic lupus erythematosus is also incurable. The goals of treating SLE are to manage the symptoms of the disease, relieve the dog from pain and lameness and prevent progressive renal or other organ failure if possible. Because the effects of SLE often wax and wane, not all cases need to be treated aggressively at all times. Dogs suffering from severe, acute-onset SLE may need to be hospitalized for initial management, until their condition is stabilized. There are a number of drugs that can be used to help manage SLE, including corticosteroids to suppress the abnormal immune reaction and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammatory response. NSAIDs and steroids normally are not given in combination, because of the increased risk of gastrointestinal ulceration. Secondary bacterial skin infections should be treated aggressively with appropriate antibiotics.
Dogs with SLE usually require chronic chemotherapeutic treatment to suppress their immune systems and manage the painful symptoms of the disease. Often, a combination of steroids and other immunosuppressant drugs is used to combat the effects of lupus. Supportive care, enforced rest and dietary restriction to reduce protein intake may also be recommended. In most cases, SLE must be managed for life, although sometimes the daily dosage of medication can be tapered if the disease goes into remission. Long-term immunosuppressive therapy can have adverse side effects that should be discussed by the veterinarian and owner when designing a treatment protocol for a dog with SLE. These can include bone marrow suppression and a dramatically increased risk of developing severe infections, such as bronchopneumonia and urinary tract infections, among other things. Weight gain is also common with steroid use. Unfortunately, lifelong immunosuppressive therapy is the only viable method for managing SLE at the present time. There is no surgical option. Regular physical examinations, urinalyses and blood tests (complete blood counts and serum biochemistry profiles) should be conducted to monitor the side effects of chronic chemotherapy. Affected animals should not be bred.
The prognosis for dogs with DLE is fairly good, since the disease is rarely life-threatening. Dogs with DLE often go into remission and normally do not require chronic immunosuppressive therapy. Moreover, dogs with DLE usually seem to feel fine, even though the condition can be disfiguring and distasteful to their owners.
Unfortunately, given the unpredictable and progressively debilitating course of SLE, the prognosis for dogs with this form of lupus is guarded to poor.