title: Ciclosporin therapy for canine generalized discoid lupus erythematosus refractory to doxycycline and niacinamide.
abstract: BACKGROUND
  Generalized discoid lupus erythematosus (DLE) is an autoimmune skin disease variant rarely reported in dogs. The antimalarial immunomodulator hydroxychloroquine has been suggested as maintenance therapy for generalized DLE in one dog, but several recurrences were noted in the 1 year follow-up of that patient.
  
  
  OBJECTIVE
  To describe the effective treatment of generalized DLE with ciclosporin in one dog.
  
  
  METHODS
  A 6-year-old, castrated male crossbred dog was presented with pruritic, well-demarcated annular to polycyclic, hyperpigmented plaques with marginal erythema on the dorsal head, neck, trunk and medial extremities; these had been nonresponsive to treatment with doxycycline and niacinamide.
  
  
  METHODS
  Investigation included complete blood count, serum chemistry profile, urinalysis, serum antinuclear antibody test, histopathological examination and direct immunofluorescence testing of skin biopsies.
  
  
  RESULTS
  The presence of lymphocyte-rich interface dermatitis on histology, together with generalized chronic recurrent hyperpigmented plaques, was consistent with the diagnosis of a generalized variant of DLE. The absence of systemic signs and unremarkable laboratory tests excluded concurrent systemic lupus erythematosus. Treatment was initiated with oral dexamethasone and ciclosporin. After 1 month, dexamethasone was discontinued and oral ketoconazole was added to the therapeutic regimen. Four months later, pruritus and erythema resolved, with most skin lesions becoming impalpable. Over the last 6 months, the patient's DLE was maintained in remission with oral ciclosporin and ketoconazole in combination every 3 days.
  
  
  CONCLUSIONS
  The combination of ciclosporin and ketoconazole appeared effective to induce and maintain lesion remission in this dog with generalized DLE.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA; Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, NC, USA.
authors.forename: Frane
authors.initials: F
authors.lastname: Banovic
authors.forename: Thierry
authors.initials: T
authors.lastname: Olivry
authors.forename: Keith E
authors.initials: KE
authors.lastname: Linder
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000662:veterinary; D007654:Ketoconazole / Q000008:administration & dosage / Q000627:therapeutic use; D008179:Lupus Erythematosus, Discoid / Q000188:drug therapy / Q000662:veterinary*; D008297:Male; D009536:Niacinamide / Q000008:administration & dosage / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D003879:Dermatologic Agents; D009536:Niacinamide; D016572:Cyclosporine; D004318:Doxycycline; D007654:Ketoconazole