Discoid Lupus (aka Crusty Booger Nose)

Posted by Aaron

Thursday, June 11, 2009

Also known as Cutaneous Lupus, is an autoimmune disease that occurs when the immune system begins to attack the skin around the nose. Autoimmune means that the bodies own immune system begins to attack “self” instead on only attacking “non-self.” The body usually makes antibodies to attack foreign invaders like bacteria or virus. If the body makes a mistake and begins to make antibodies to itself, the immune system is directed to damage tissues it should normally leave alone.

Discoid lupus (DL) is most common in collie dogs, Shetland sheepdogs, German shepherds, and Alaskan malamutes (and crosses of these breeds). Because there is such a breed predisposition, this probably has a genetic component to its cause. The disease is also heavily influenced by ultraviolet light. Increased exposure to direct sunlight will worsen disease, so these patients need to avoid mid-day sun as much as possible.

Discoid lupus should NOT be confused with systemic lupus erythematosis (SLE) which is the type of “lupus” that most people are familiar with. SLE is much more dangerous and affects the entire body. DL is much more limited in its affect.

Most owners first notice problems along the moist portion of the nose or on the tissues immediately adjacent to the edge of the nose. This area is known as a mucocutaneous junction (an area where moist skin transitions to dry skin). The pigment of the nose or skin starts to fade and turn pink. The same area usually becomes angry, crusted, and often some mucous is seen collecting in the nostril (Thus, my other name for the disease - Crust Booger Nose). The lesions can also extend up the bridge of the nose and along the lips in more severe cases. Some of these guys have ulcerations and are fairly painful, but they are usually more uncomfortable/irritated - like with a cold sore.

Diagnosis is often made based on breed, history, and appearance in mild cases. However, since many different immune conditions can mimic each other, biopsy is required to confirm the diagnosis. If there are lesions found on other portions of the body (ears, feet, prepuce, vulva, anus, eyelids) then other autoimmune conditions are more likely.

We treat all autoimmune diseases by using medications to suppress the immune response. Sometimes these medications have to be used systemically (to effect the entire body), but it is much more desirable if we can use the medication ONLY at the site of disease. Topical steroids are usually our first line treatments. Oral steroids may be necessary if the condition is severe enough. Tacrolimus (Protopic) is amazingly effective in most patients. I love using it, but since it is usualy $90 per bottle, we often start with simple topical steroids. Other medication options include cyclosporine, niacinamide, doxycycline, and prednisone. The choice of one medication over another is made based on severity of disease and what the patient will allow the owner to do.

Topical sunscreen can also be used. Moisturizing products with an SPF of 15 can be used in sparing amounts. I've had owners use Nutrogena or Oil of Olay daily moisturizing creams with SPF and be pretty happy with it. It only takes a small amount, but that additional protection from UV light seems to help tremendously when we have the disease under control and are trying to keep it that way.

Autoimmune diseases are controlled, not cured. You have to keep ahead of the disease. It is always easier to keep it under control than it is to try and get it back under control. With successful response to medications and continuing treatment, most DL patients live long, happy lives.