CIMDA

Hi Rebecca

I am sorry that your girl has a sore crusty nose.  Yes, it certainly could be DLE, but to get a confirmed diagnosis the vet will probably want to do a biopsy, and to be honest the results often don't come back as conclusive, so personally, I would want the vet to treat speculatively rather than use a general anaesthetic and do a biopsy that may not show a conclusive result.

Some AI skin diseases can be successfully brought into remission without using very high doses of steroids. Doxycycline and niacinamide, along with Natural Vitamin E, and Omega 3 & 6 supplements have been very successful with some AI diseases.  I have known many dogs to be successfully treated in this way.

See the information below and have a chat to your vet about starting your girl on this regimen.

I hope your vet will work with you.

Jo


Here is an example:

: Manual of skin diseases of the dog and cat by Sue Paterson Table 11.1 

Doxycycline/niacinamide

Doxycycline: 5-10mg/kg twice a day
Niacinamide: Dogs over 10kg 250mg 4 times a day

Natural Vitamin E 400iu twice a day (see ref. below)

I would also give fish oil (Omega 3) and evening primrose oil (Omega 6)

Manual of Skin Diseases of the Dog and Cat by Sue Paterson
Essential Fatty Acid    Dosage differs with individuals   
EPA 400mg/10kg    (Omega 3 -  e.g., fish oil etc.)
GLA 100mg/10kg    (Omega 6 – e.g., evening primrose oil etc.)

•   Natural Vitamin E (400-800iu/12hrs) encourages new cell growth.  (Ref: Clinical Immunology of the Dog and Cat by Michael J Day). 

See this link:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952581


Below is an extract from my seminar notes for AI skin disease.


Discoid Lupus Erythematosus – DLE  (Cutaneous Lupus)
Discoid lupus is an autoimmune skin disease that causes depigmentation, and ulceration and crusting of the lips, nose and nasal planum, with loss of the 'cobblestone' appearance. It also affects areas around the eyes and sometimes the ears, often causing hair loss in these areas. Although the dog is not systemically ill, this condition is very painful, especially if the dog 'knocks' its nose and, as always with severe pain, this can make the dog very depressed.


A combination of tetracycline or doxycycline and niacinamide (Vitamin B3), and 'steroid sparing' supplements such as essential fatty acids and natural Vitamin E in therapeutic doses.
   
There is a group of five antibiotics that go under the heading of 'Tetracyclines'.  From this group, there is a choice of using one of the following:  Doxycycline, Tetracycline or Minocycline.  These antibiotics are not used for their antimicrobial properties but for their anti-inflammatory and immunomodulating effects, and the ability to suppress antibody production.  Any one of these three drugs can be used in combination with niacinamide (vitamin B3) for the treatment of immune mediated skin diseases.  It should be noted that food or dairy products can reduce the amount of tetracycline absorbed by 50% or more.  To maximise bioavailability it is recommended to administer the drug two hours before or after food. Unlike tetracycline, doxycycline is not affected by food or dairy products to the same extent (no more than 20% reduction) and this is thought to be insignificant. Doxycycline is also more convenient to administer because it is given only once a day, therefore Doxycycline is  preferred.

It takes 1-3 months before positive results are seen and treatment is likely to be continued for 6 months or more. Doxycycline with niacinamide seems to be a good treatment choice as it avoids the use of steroids and other stronger drugs.

 

Hi I am a new member, my Bearded Collie (female aged 2.5yrs) has developed scabs on her nose that just won't heal, vet prescribed steroid cream and antibiotics for 2weeks these'd have made no difference and I am wondering if is could be DLE and if anyone has experience of this and best treatment? Thank you

Hi Jenny and welcome

A daily dose of prednisolone is the recommended way to provide a replacement dose of glucocorticoid.  It is usual, when starting treatment for Addison's disease,  for the dose to be on the higher side as this will address the stress that the dog is experiencing at this time of diagnosis, but as the DOCP starts to become effective, and the dose of replacement mineralocorticoid hormone is satisfactory, as long as the clinical signs and the blood results are within normal limits, then the daily dose of prednisolone can be reduced to the lowest replacement dose.  See this reference:

https://todaysveterinarypractice.com/endocrinology/diagnosis-and-management-of-hypoadrenocorticism-in-dogs/

For glucocorticoid replacement, oral prednisone at a starting dose of 0.5 to 1.0 mg/kg/day is usually recommended. This dose should be gradually lowered (over several weeks) to an optimal dose that controls signs of hypoadrenocorticism and avoids side effects (e.g., polyuria, polydipsia, polyphagia, panting). Larger dogs seem to be more sensitive to the side effects of glucocorticoids. Although published maintenance doses are usually 0.1 to 0.22 mg/kg/day,4 we have managed a number of patients with lower doses (as low as 0.03 mg/kg/day). Dosage adjustments should be based on clinical signs only; for dogs with confirmed naturally occurring hypoadrenocorticism, an ACTH stimulation test should not be repeated for monitoring purposes.


I have never known an Addisonian dog to be put on every other day dosing of prednisolone in order to provide sufficient replacement glucocorticoid hormone. The general opinion is that this will not be sufficient because prednisolone has a biological 'half life' of 12-36 hours, so a daily dose is required.

Personally, I would always carry a little extra prednisolone when out on walks etc., because if Yanka becomes stressed for whatever reason (her body is unable to produce the required increase in glucocorticoid to combat the stress) then you will have the extra prednisolone to hand. This extra dose doesn't need to be continued after the event is over, it will do no harm, and it will support her through the stressful event, so you can resume with usual daily dose of prednisolone the following day.

It can take a few months to establish the right dose of DOCP, but when that is achieved Yanka should be able to live a normal, happy life.  I have known dogs to live until they are 16 years of age with well controlled Addison's disease.

I hope this is useful.

Best wishes
Jo

Jo Tucker should be able to help you more with that. She should be along soon. Meanwhile you can use the search facility on the main page which may give more information.

My dog Yanka was diagnosed with Addisons April 20th. She is one year old and weighs 14 lbs. She was in the doggie ER for a few days with an Addisonian crisis. She was started on 2.5 mg of Prednisone and the Zycortal injection. She went in yesterday to our normal vet, for bloodwork and her 2nd injection. Her bloodwork came back fine. The vet wants to gradually reduce her Prednisone dosage. I was told to start giving her the 2.5 mg every other day. But everything I've read, says they should be on it daily. Any input?

Hi Alistair

Your poor girl has been through a lot.  The good news is the SRMA seems to be in remission, and in herself she is very well and happy. 

Years ago it was usual to prescribe Omeprazole or other gastroprotectants when on high doses of prednisolone because of the potential issues that you have described.  In recent years, giving a gastroprotectant when on high doses of preds, is no longer practiced and therefore gastric ulcers are not uncommon.  Omeprazole is given to heal the ulcers.

I am sure you have tried everything, so please forgive me if you have considered the following.

Give smaller meals and more often.
Do you know if the gastric ulcers are healed and no longer present?   
Is the vomiting that she is producing digested or undigested food?  Is it bile?
Have you recently changed her food?
Is she fed raw, wet or dried food?
Is she drinking enough, or could she be dehydrated?
Does she still need Omeprazole, or another proton pump inhibitor, to allow the ulcer to heal fully?
Does the diarrhoea indicate that there may be a bacteria present that needs an antibiotic such a metronidazole?  Metronidazole also has the ability to slow down the gut and allow more time for the water to be removed, thereby producing firmer stools.

My feeling is that her stomach, and probably her whole digestive system, has to be given more time to return to normal. It has been through a rough time.
 
When she is off preds, then perhaps a probiotic can be given, but this is not advised while there is some level of immunosuppression, although 5mg a day is not a high dose. Acidophilus is a very good gut bacteria. 

Is the vet intending to reduce the preds further?  If so then perhaps you could give 2.5mg a day (see the Prof. MJ Day Protocol) and then reduce to 2.5mg every other day and then leave it off altogether.  This will have a good effect on her stomach, but only if your vet is happy that she is in remission. It is always a balance between resolution of the disease, and the side effects of the drugs. Sometimes a different immunosuppressive drug has to be given to lessen the side effects of the steroids, and your vet did this with Atopica.  It is not a very well tolerated drug, so I am not surprised, but there are many other immunosuppressive drugs that are available now, should the need arise, but she now seems in a good place, so fingers crossed! .

Relapses are not uncommon, but it is hoped with SRMA that long term remission can be achieved, and there is no longer the need for steroids.  Anecdotally, SRMA is something that often occurs in a young dog and although in the first year or so relapses can occur, long term remission is expected to follow. A good immunosuppressive drug protocol is essential. 

Trigger factors are key to maintaining remission, and although it is impossible to protect from all potential triggers such as hormones and stress,  any potential known triggers should be avoided, these include regular spot on treatments, worming and vaccinations etc.  If a dog has worms or fleas then treatment has to be given, but only if necessary. I asked the head of the RVC, if a dog has an AI disease should they be vaccinated again, and he said NO! He said that the benefits and risks have to be considered, and in a dog with a genetic predisposition to AI disease the risks are too high.   So be mindful of these potential triggers.

I hope you had a positive experience at the vets today.

Best wishes
Jo

Regarding the Omeprazole, that did not agree with my dog so I changed to Zitac and she was able to keep her food down. Is she definitely vomiting or could it be regurgitating? I found feeding my dog with her bowl raised stopped the regurgitating. Also you could try feeding her smaller meals several times during the day although obviously away from any medication that must not be given around feeding times.

Hopefully Jo will be along soon to advise about the SRMA.

Hi all - I am looking for help for my 11 month old whippet. She was diagnosed with SRMA 3 moths ago. She was on the road to recovery with prednisolone. She relapsed, the pred was increased and she developed stomach ulcers. A week in hospital and discharged with Atopica, pred. And Cerenia and omeprazole. She would not tolerate Atopica and struggled with Omeprazole.

She is currently taking, pred 5mg (vet says CRP is very good less than 10) and Famotidine. She did have a feeding tube which has been remove as she is eating well. The problem that we have is that she cannot keep any food down. She vomits approx 1-2 hours after each meal regardless of what she eats - we have tried everything.

We are no out of ideas and out of money - maxed out the insurance plus another 6k !

Her current presentation is normal - energetic, Interested and friendly - eating and drinking well (probably due to pred) but she just wont keep ant food down. We have also tried several probiotics. Cerenia also works sometimes but it feels like we are just masking the problem. She also has intermittent diarrhoea.

Booked into the vets today - any ideas what I should be asking for? Or what might help?? Many thanks in advance.

Alastair

That information is appreciated Amy.

Thank you.

Jo

Thank you Jo and Catherine for your comments. My Skylar did go through a lot. I have only run into one other Husky owner whose dog also had Uveo Dermatologic Syndrome. Their dog also had eye issues, and I referred them to the same Veterinarian we used. In the end that owner chose to not do the iridectomy surgery on their dog's eye but instead had the eye removed. The surgery was a bit costly ($2500 US dollars) but the Veterinarian allowed for payments so for me that was worth it. 

I hope that original post I made might help anyone else dealing with issue and give them some hope.

 
~ Amy