Symmetrical lupoid onychodystrophy in dogs: a retrospective analysis of 18 cases (1989-1993)

Evidence-base for the beneficial effect of nutraceuticals in canine dermatological immune-mediated inflammatory diseases - A literature review

BACKGROUND

Immune-mediated inflammatory diseases (IMIDs) are associated with an abnormal immune response, resulting in a disturbed homeostasis and chronic inflammation. Most canine dermatological IMIDs (cDIMIDs), such as allergies, autoimmune and immune-mediated diseases, require long-term treatment with immunosuppressive drugs with potential adverse effects. In general, nutraceuticals are thought to be safe. As a result, there is a tendency for the more frequent use of nutraceuticals in veterinary medicine.

OBJECTIVES

The aim of this review was to present evidence-based proof for the use of various nutraceuticals in the treatment of cDIMIDs and, where possible, to provide conclusions to guide their use in veterinary dermatological practice.

METHODS

A comprehensive literature search on common cDIMIDs and nutraceuticals was performed. Only peer-reviewed articles published in English and related to the study topic were included. A total of 64 eligible publications were classified in five categories based on study design and substantively assessed on additional criteria such as standardisation of diets and number of included animals. For final appraisal, classification of major, minor or no evidence was used whereby efficacy was based on clinical outcome measurements.

CONCLUSIONS

Minor evidence for the beneficial use of several nutraceuticals, including essential fatty acids, niacinamide and probiotics, was found for treatment of specific cDIMIDs. These nutraceuticals may improve clinical signs or reduce the required dose of concurrent medication (e.g. drug-sparing effect) in some dogs. Some nutraceuticals also may be used for long-term maintenance therapy. Despite some promising findings, major evidence for the use of nutraceuticals in cDIMIDs is lacking, warranting further research.

Looking back on 45 years of canine dermatology

In June 2018, I was honored (and flabbergasted!) to receive the Kennel Club Charitable Trust's Lifetime Achievement Award for research in the field of canine health, sponsored by Vernon and Shirley Hill of Metro Bank, and administered by the Kennel Club Charitable Trust. I entered the arena of veterinary dermatology in 1971, a graduate of the University of California, Davis. I retired from Cornell University as the James Law Professor Dermatology Emeritus in 2016. During my 45-year career in veterinary dermatology, I worked with all species, especially dogs, cats, and horses, eventually authoring or co-authoring 694 publications including 12 textbooks. For this personal view I will limit my comments to canine dermatology. I was asked to make this article 'a more reflective piece on my lifetime's work'. This is not at all comfortable for me, as my upbringing encouraged me not to 'toot my own horn'. However, 'toot' I must. Hence, indulge me as I share these very personal views on where we were, where we went, and some of my own dabblings along the way. If I fail to mention one of your favorite remembrances, I apologize. Don't let it get under your skin!

Exploring the use of essential fatty acids in veterinary dermatology

BACKGROUND

The aim of the study was to discover the extent of use of essential fatty acids (EFAs) in veterinary practice, conditions used in, preparation of EFA supplement used and rationale for their use and to investigate the awareness of the oxidation of some commercial fish oil supplement preparations.

METHODS

A web-based questionnaire was distributed via email to a dermatology list server and posted to veterinary Facebook groups with questions relating to the use of EFAs, supplement choice, conditions used in, the level of importance of various factors regarding their use and awareness of their oxidation.

RESULTS

There were 309 responses from 32 countries. EFA supplements were used by 92.2 per cent of respondents. The most commonly used preparation of EFA supplementation was veterinary oral supplements (75.1 per cent), followed by veterinary diets (14.4 per cent), shop bought fish oil supplements (7.7 per cent), enhancing the diet with oily fish (2.5 per cent) and finally using a commercial pet food (0.3 per cent). Only 46.3 per cent of respondents who used them were aware of the oxidation of EFAs. Veterinary oral supplements were perceived to be the best preserved, followed by veterinary diets and lastly commercial fish oil supplements.

CONCLUSION

A large number of respondents advised the use of EFAs for veterinary dermatological conditions but less than 50 per cent were aware of the potential for EFAs to oxidise.

Novel Locus Associated with Symmetrical Lupoid Onychodystrophy in the Bearded Collie

Symmetrical lupoid onychodystrophy (SLO) is characterized by inflammation of the nail bed and nail sloughing that causes affected dogs considerable pain. Disease etiology remains unclear, although an autoimmune component is suspected. A genome-wide association study on Bearded Collies revealed regions of association on canine chromosomes (CFA) 12 and 17. The large region of association on CFA12 likely consists of two smaller linked regions, both of which are also linked to the dog leukocyte antigen (DLA) class II genes. Dogs homozygous for the alternate allele at the top CFA12 SNP also carried two DLA class II risk haplotypes for SLO, and this locus explained most of the increased risk for disease seen throughout the CFA12 region of association. A stronger peak was seen on CFA17 when analysis was done solely on dogs that carried DLA class II risk haplotypes for SLO. The majority of SLO dogs carried a homozygous alternate genotype on CFA12 and at least one CFA17 risk haplotype. Our findings offer progress toward uncovering the genetic basis of SLO. While the contribution of the CFA17 region remains unclear, both CFA12 and CFA17 regions are significantly associated with SLO disease expression in the Bearded Collie and contain potential candidate genes for this disease.

Canine symmetrical lupoid onychomadesis in bearded collies

BACKGROUND

Symmetrical lupoid onychomadesis (SLO) is a disease not infrequently seen in bearded collie dogs in Germany.

OBJECTIVES

The aim of this study was to compare historical and clinical data, as well as the mineral content of the hair and claws of bearded collies with SLO with that of normal control dogs.

ANIMALS

Twenty-eight affected bearded collie dogs and 39 control dogs.

METHODS AND MATERIALS

Owners completed an extensive questionnaire regarding upbringing, environmental conditions and diets. Claw specimens were obtained by claw trimming or gathering lost claws; hairs were obtained by plucking samples from several areas of the body; samples were converted to ash and evaluated in an atomic absorption spectrophotometer.

RESULTS

Clinical signs in affected dogs eventually involved all claws on all paws. In twelve dogs recurrence of onychomadesis was observed. There was no relevant association between gender, housing, diet and health management, physical stress and the development of SLO with exception of the age at which more intense exercise began. The most commonly used treatment combination was fatty acids, pentoxifylline and tetracycline; improvement occurred in 17 animals. Calcium, sodium and phosphorus concentrations were higher in the claws of affected dogs, whereas zinc concentrations were lower. The mineral content of hair samples of the affected dogs was not significantly different than controls.

CONCLUSION AND CLINICAL IMPORTANCE

Symmetrical lupoid onychomadesis in bearded collies is clinically similar to what has been described in other breeds with regard to clinical signs and response to treatment. Early strenuous activity may increase the risk for disease occurrence in this breed.

DLA class II risk haplotypes for autoimmune diseases in the bearded collie offer insight to autoimmunity signatures across dog breeds

BACKGROUND

Primary hypoadrenocorticism (Addison's disease, AD) and symmetrical lupoid onychodystrophy (SLO) are two clinical conditions with an autoimmune etiology that occur in multiple dog breeds. In man, autoimmunity is associated with polymorphisms in immune-related genes that result in a reduced threshold for, or defective regulation of, T cell activation. The major histocompatibility complex (MHC) class II genes encode molecules that participate in these functions, and polymorphisms within these genes have been associated with autoimmune conditions in dogs and humans. Bearded collies have a relatively high prevalence of autoimmune diseases, particularly AD and SLO. Our study assessed the relationship between particular MHC (dog leukocyte antigen, DLA) class II haplotypes and the two autoimmune diseases most common in this breed. Moreover, five unrelated breeds at increased risk for AD were studied for comparative purposes and analyzed in the context of extant literature.

RESULTS

A single DLA class II three-locus haplotype, determined by sequence-based typing, was associated with increased risk for AD (DLA-DRB1*009:01/DQA1*001:01/DQB1*008:02) in bearded collies. Comparative analysis with the five additional breeds showed limited allele sharing, with DQA1*001:01 and DQB1*002:01 being the only alleles observed in all breeds. A distinct three-locus risk haplotype (DLA-DRB1*001:01/DQA1*001:01/DQB1*002:01) was associated with AD in the West Highland white terrier and Leonberger. Two different risk haplotypes were associated with increased risk for SLO in the bearded collie (DLA-DRB1*018:01/DQA1*001:01/DQB1*002:01 and DLA-DRB1*018:01/DQA1*001:01/ DQB1*008:02).

CONCLUSION

Two-locus DQ haplotypes composed of DLA-DQA1*001:01 in association with DLA-DQB1*002:01 or DLA-DQB1*008:02 make up the four risk haplotypes identified in the present study and are also found in other risk haplotypes previously associated with diabetes mellitus and hypothyroidism across different dog breeds. Our findings build upon previously published data to suggest that this two-locus (DQ) model serves as a good indicator for susceptibility to multiple organ-specific autoimmune diseases in the canine population. However, it is also clear that additional loci are necessary for actual disease expression. Investigation of affected and unaffected dogs carrying these predisposing DQ haplotype signatures may allow for the identification of those additional genetic components that determine autoimmune disease expression and organ specificity.

A genome-wide association study identifies a region strongly associated with symmetrical onychomadesis on chromosome 12 in dogs

Symmetrical onychomadesis causes periodic loss of claws in otherwise healthy dogs. Genome-wide association analysis in 225 Gordon Setters identified a single region associated with symmetrical onychomadesis on chromosome 12 (spanning about 3.3 mb). A meta-analysis including also English Setters indicated that this genomic region predisposes for symmetrical onychomadesis in English Setters as well. The associated region spans most of the major histocompatibility complex and nearly 1 Mb downstream. Like many other autoimmune diseases, associations of symmetrical onychomadesis with DLA class II alleles have been reported. In this study, no associated markers were revealed within any of the DLA-DRB1, -DQA1 or -DQB1 genes, and the odds for symmetrical onychomadesis in the Gordon Setters were much higher, carrying significant single nucleotide polymorphisms compared to the odds of any of the recorded DLA-DRB1/DQA1/DQB1 haplotypes. We noticed that some of the associated DLA haplotypes were different between the English Setters and the Gordon Setters. Interestingly, associated SNP chip markers showed a more consistent pattern of allelic variants related to cases or controls regardless of breed. In conclusion, the associated genetic markers identified in this study hold the potential to aid in selection of breeding animals to reduce the frequency of symmetrical onychomadesis in the dog.

Immunohistochemical Evaluation of Mononuclear Infiltrates in Canine Lupoid Onychodystrophy

Claw biopsy samples of 11 dogs with lupoid onychodystrophy were evaluated. They were stained with hematoxylin and eosin and with antibodies against CD 3 as a T-cell marker, BLA 36 and HM 57 (CD 79α) as B-cell markers, and lysozyme, Mac 387, and major histocompatibility complex (MHC) class II as a marker for histiocytes using an immunoperoxidase and avidin-biotin technique. Inflammatory cells were counted in five high-power fields. The inflammatory infiltrate comprised predominantly B cells and T cells. Macrophages were typically only present in small numbers. CD 3, BLA 36, lysozyme, and MHC class II preserved significant antigenicity during formalin fixation and short decalcification for 24–48 hours, whereas CD 79α and particularly Mac 387 seemed to be more susceptible to denaturation by the decalcification process.

A treatment study of canine symmetrical onychomadesis (symmetrical lupoid onychodystrophy) comparing fish oil and cyclosporine supplementation in addition to a diet rich in omega-3 fatty acids

BACKGROUND

Treatment of symmetrical onychomadesis (symmetrical lupoid onychodystrophy) is a challenging task for dermatologists. The acute phase is characterized by sloughing of claw plates and loose claws have to be removed and secondary infections treated. The goal of long-term treatment is to allow claws to re-grow with normal quality and to achieve life-long lack of recurrence. The aim of this randomized treatment trial was to see if adding fish oil or cyclosporine to a diet rich in omega-3 could improve the treatment outcome of symmetrical onychomadesis in Gordon and English setters. All dogs were fed Eukanuba Veterinary Diets Dermatosis® exclusively during the six month treatment trial. The treatment outcome was measured as the change in number of healthy claws during treatment, as well as the long-term effect on hunting ability and recurrence of onychomadesis. The hypothesis was that cyclosporine provides a stronger and different immune modulating property than fish oil and therefore would give a better treatment outcome in dogs with symmetrical onychomadesis eating a diet rich in omega-3 fatty acids.

RESULTS

Six Gordon setters and one English setter were treated with 5 mg/kg cyclosporine once daily for six months and seven Gordon setters were treated with 10 ml Dr Baddaky fish oil® once daily for six months. All dogs were evaluated every month and the numbers of healthy claws were recorded.

CONCLUSION

Cyclosporine and fish oil appeared to be equally effective in treating symmetrical onychomadesis when the dog is fed a diet high in omega-3.

DLA class II alleles are associated with risk for canine symmetrical lupoid onychodystrophy [corrected](SLO)

Symmetrical lupoid onychodystrophy (SLO) is an immune-mediated disease in dogs affecting the claws with a suggested autoimmune aethiology. Sequence-based genotyping of the polymorphic exon 2 from DLA-DRB1, -DQA1, and -DQB1 class II loci were performed in a total of 98 SLO Gordon setter cases and 98 healthy controls. A risk haplotype (DRB1*01801/DQA1*00101/DQB1*00802) was present in 53% of cases and 34% of controls and conferred an elevated risk of developing SLO with an odds ratio (OR) of 2.1. When dogs homozygous for the risk haplotype were compared to all dogs not carrying the haplotype the OR was 5.4. However, a stronger protective haplotype (DRB1*02001/DQA1*00401/DQB1*01303, OR = 0.03, 1/OR = 33) was present in 16.8% of controls, but only in a single case (0.5%). The effect of the protective haplotype was clearly stronger than the risk haplotype, since 11.2% of the controls were heterozygous for the risk and protective haplotypes, whereas this combination was absent from cases. When the dogs with the protective haplotype were excluded, an OR of 2.5 was obtained when dogs homozygous for the risk haplotype were compared to those heterozygous for the risk haplotype, suggesting a co-dominant effect of the risk haplotype. In smaller sample sizes of the bearded collie and giant schnauzer breeds we found the same or similar haplotypes, sharing the same DQA1 allele, over-represented among the cases suggesting that the risk is associated primarily with DLA-DQ. We obtained conclusive results that DLA class II is significantly associated with risk of developing SLO in Gordon setters, thus supporting that SLO is an immune-mediated disease. Further studies of SLO in dogs may provide important insight into immune privilege of the nail apparatus and also knowledge about a number of inflammatory disorders of the nail apparatus like lichen planus, psoriasis, alopecia areata and onycholysis.

Unusual dermatological toxicity of hydroxyurea in two dogs with spontaneously occurring tumours

Hydroxyurea is a chemotherapeutic agent used to treat hypereosinophilic syndrome, mast cell tumours and many myeloproliferative disorders. It is usually well tolerated; however, reported side effects include myelosuppression and gastrointestinal complications as well as cutaneous toxicity, in very rare cases. We report the unusual appearance of onychomadesis involving several claws on all feet in two canine patients receiving long-term hydroxyurea treatment. The healing of nail lesions required cessation of treatment in one dog and dose reduction in the second animal, supporting a strict relationship between onychopathy and administration of hydroxyurea. The aim of this case report is to increase clinical awareness of dermatological toxicity associated with long-term administration of hydroxyurea.

A retrospective study regarding the treatment of lupoid onychodystrophy in 30 dogs and literature review

The treatment records of 30 dogs with lupoid onychodystrophy were evaluated retrospectively. Dogs were treated with fatty acid supplementation (n=18), doxycycline and niacinamide (n=12), tetracycline and niacinamide (n=10), pentoxifylline (n=6), prednisolone (n=5), azathioprine (n=1), clofazimine (n=1), or with combinations thereof. An excellent response was seen in almost half of the patients treated with tetra- or doxycycline in combination with niacinamide. Six of the dogs were maintained successfully on fatty acid supplementation. Spontaneous remissions and recurrences made evaluation of success rates difficult and emphasized the varied and often unclear etiology and natural course of the syndrome.

Canine symmetrical lupoid onychodystrophy: a retrospective study with particular reference to management

The records of six dogs in which a diagnosis of symmetrical lupoid onychodystrophy (SLO) had been made were examined retrospectively. The age at onset ranged from six months to eight years. All the dogs had been presented with onycholysis, onychomadesis, onychalgia and onychodystrophy. The diagnosis of SLO was confirmed in all cases by histological examination. Histological features were similar in all cases and included hydropic degeneration of the basal cell layer, pigmentary incontinence and a cell-rich interface dermatitis. Response (defined as good, partial or failure) to various therapies was compared. Treatments (as initial therapy or following previous treatment failure) included essential fatty acids (EFA) (three cases), a combination of tetracycline and nicotinamide (four cases) and azathioprine and/or prednisolone (one case each). EFA therapy resulted in one good response, one partial and one failure, tetracycline and nicotinamide in two good responses, one partial and one failure, and azathioprine and/or prednisolone in one good and one partial response. Although all treatments were successful in some cases, none was universally effective.

Antinuclear antibodies (ANA) in Gordon setters with symmetrical lupoid onychodystrophy and black hair follicular dysplasia

Antinuclear antibodies (ANA) were demonstrated in 3 out of 10 Gordon setters with symmetrical lupoid onychodystrophy and in 5 out of 13 Gordon setters with black hair follicular dysplasia. Two dogs showed both symmetrical lupoid onychodystrophy and black hair follicular dysplasia, and one of these was ANA positive. The results suggest that symmetrical lupoid onychodystrophy and black hair follicular dysplasia in the Gordon setter might be autoimmune diseases that are pathogenetically related, which might indicate a common genetic predisposition.

Diagnosis and management of canine claw diseases

The diagnostic workup for canine claw disease consists of a good history and complete clinical examination which may provide clues for a possible underlying disorder. In dogs with claw disease but no other clinical or historical signs, further recommended diagnostic procedures include cytological evaluation of impression smears or discharge from the claw fold, bacterial culture and sensitivity testing, biopsy of the claw matrix, and an elimination diet for 6 to 8 weeks. If no underlying disease can be identified, trial treatment with essential fatty acid supplementation, vitamin E, or a combination of doxycycline hydrochloride and niacinamide may be useful. In some patients, onychectomy of all claws may be considered.