Rx for lupus

RE: Rx for lupus

Judith Joyce — Mon, 19 Oct 2020 18:48:04 GMT

Although I have minimal experience of dermatopathology, I agree with David. A couple of points: my experience is more of dermatopathologists and 'consistent with all forms of lupus erythematosis’ is quite a bold statement, if made without qualification, or suggestions for confirming a diagnosis, compared with many made by the dermatopathologists I know. Also I am wary if that is the dermatopathologist's speling of lupus erythematosus, but spell checkers can be mischief makers. I too have used off label azathioprine as prednisolone sparing with some success but, I think with this degree of difficulty in treating the patient, I would go back and review the case with a fresh pair of eyes from the start, looking for initiating and potentiating causes, including bacterial/yeast/fungal/parasitic conditions and treatments used in the early days of the disease before the diagnosis was reached in case of drug reactions which can mimic LE clinically, as can a number of others

RE: Rx for lupus

David Scarff — Mon, 19 Oct 2020 14:42:13 GMT

I would also add that having some experience if dermatophathology, the presence of concurrent bacterial infection would make interpretation of 'signs consistent with lupus' very difficult, and would consider taking further biopsy samples once secondary infection had been controlled.

RE: Rx for lupus

David Scarff — Mon, 19 Oct 2020 14:38:37 GMT

When using anything like immunosuppressive dose of prednisolone I have regularly seen GI side effects that are not present when enteric coated preparations were used.

RE: Rx for lupus

Richard Carter — Mon, 19 Oct 2020 14:19:29 GMT

Enteric coating make a difference?

RE: Rx for lupus

Richard Carter — Mon, 19 Oct 2020 14:17:24 GMT

Thanks- the bacteria cultures were mixed with staph inter mediums and pseudomonas, both fairly susceptible to most abs so been on 2 weeks while on the higher dose preds but itch breaking through the moment the dose dropped

the histo report is ‘consistent with all forms of lupus erythematosis’

the liquid cyclosporine arrived today so will start 1/2 dose first few days and titrate up to the 5 mg, hoping to titrate preds down in other direction

thanks - will go doxy / niacinamide if not good response

RE: Rx for lupus

Mark Craig — Mon, 19 Oct 2020 09:36:44 GMT

Crusting on very pruritic dogs often spells bacterial infection which leads to poor clinical response to Apoquel etc... and necessitating a higher dose of pred. Might be worth swabbing, and considering an extended course of an appropriate systemic antibiotic along with topical antimicrobials. Did the biopsy confirm lupus or identify changes consistent with?

RE: Rx for lupus

David Scarff — Mon, 19 Oct 2020 09:30:41 GMT

Have you considered either tetracycline or doxycycline combined with niacinamide, or alternatively adding azathioprine to a low dose of enteric coated prednisolone?