Erika: A dermatology case report
Name: Erika | Age: 6 years | Breed: German Shepherd
History: ‘Erika’ is a 6 year old female spayed German shepherd dog who presented for severe chronic perivulval dermatitis and pruritus non responsive to antibiotic therapy and corticosteroids
Diagnostics: Multiple biopsies were collected under general anaesthetic from the perivulval region and were submitted for histopathology. A sterile swab sample was also submitted for bacterial culture and sensitivity.
Image 1: Before treatment- severe ulceration, exudation, crusting and discharge affecting the perivulval region.
Diagnosis: Mucocutaneous lupus erythematosus (MCLE) with a secondary superficial bacterial pyoderma.
Mucocutaneous lupus erythematosus is an immune mediated disease. German shepherds or their crossbreds are predisposed. The disease affects mostly dogs in their mid-adulthood and females are predisposed. Erosions and ulcers predominate at genital/perigenital and anal/perianal areas, with a lower frequency of involvement of periocular, perioral and perinasal regions. In these dogs, there are no clinical signs suggestive of an associated systemic lupus erythematosus. MCLE is distinguished from cutaneous lupus erythematosus as lesions are normally restricted to the nasal planum and dorsal muzzle in the latter. The clinical appearance of MCLE is similar to that of mucocutaneous pyoderma, however a complete resolution of lesions to antibiotic therapy is seen in cases of mucocutaneous pyoderma. Histopathology remains the only definitive way to diagnose MCLE.
Microscopic lesions are specific for CLE, but they are patchy and often infected with bacteria. Lesions respond to varying interventions, but oral glucocorticoids lead to a shorter time to complete remission. Relapses are common upon treatment tapering.
Treatment: Systemic prednisolone therapy and a course of trimethoprim sulphonamide to control the secondary bacterial infection were commenced. Topical 2% mupirocin and chlorhexidine wipes were applied daily to the perivulval region to control infection and inflammation and to promote hygiene.
Follow Up: Erika presented to the dermatology clinic last week for a revisit consultation and we are delighted to report that she is now in remission. Over the next few weeks we will taper her prednisolone dose further and then discontinue oral steroids completely. Unfortunately, MCLE will often relapse if treatment is withdrawn all together, and so we will use topical steroid creams /sprays or topical tacrolimus ongoing as maintenance to reduce the likelihood of this occurring. Owner compliance is integral to lesion resolution when treating patients with MCLE. Clients must be educated that this immune mediated disease will require ongoing life long maintenance therapy.