# Lupiod Onychodystrophy



## Tonks (Jan 17, 2010)

I posted earlier this month about my sister's dog Bristol and about how he was chewing off his nails. Well, we first took him to our usual vet and she said that it was because his nails were "too long and they were getting caught on things and getting ripped off." -- Well, we knew this wasn't true because we had sat there and watched him chewing off his nails and no matter what we did to try to stop him, he wouldn't quit. That vet put him on an antibiotic, because she said that -one- of his nails were infected. Well, Bristol never got better. He continued to chew off his nails and had almost no nails left. We needed to do something else, so we decided to take him to a vet in a different town not far from where we lived. The vet looked at his nails and saw how bloody and sore they were and she automatically knew this wasn't caused because they were getting caught on things and he was just tearing them off. She told us that Bristol has an auto-immune disease called Lupoid Onychodystrophy. She tried to remove the rest of his nails that he had left, but it was just too painful for Bristol, so she put an E-collar on him, and prescribed him some medication. He's on an antibiotic because -all- of his nails are infected, and she put him on a steriod. She also told us that he needs to take Pepcid, and she wants us to put him on Omega-3. Well, all that is alright, but the E-collar just isn't stopping him from chewing on his paws. We took Bristol back and she put him to sleep (sleep, sleep. She didn't kill him) and removed the remainder of his nails. She doesn't want him licking his paws, picking at them, chewing on them, or even in contact with them for AT LEAST 14 days.. But we just can't get him to stop chewing on them! No matter what we do, he just won't stop. 

Has anyone ever had a dog with Lupoid Onychodystrophy?
Have you had this same problem with your dog chewing his nails?
*Was your dog on medication for the rest of his life? (Our vet told us that he might be on the steriod for the rest of his life.)

Edit #1: Our "usual vet" also didn't believe us that Bristol was actually CHEWING off his nails.


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## GreatDaneMom (Sep 21, 2007)

thats very interesting... im sorry i have nothing to offer you as far as help and any insight.... but my one dane does chew her nails when they are too long, so i will watch to make sure something like this doesnt happen.... good luck with everything and hopefully someone will have some insight for you here.


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## Mr. V (Jan 28, 2010)

Just went over this one a few weeks ago in dermatology class and I am very sorry you and Bristol have to deal with this. Here is a little information article.

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Contributors:
Anne G. Evans, DVM, MBA, Board Certified, Veterinary Dermatology
Linda G. Shell, DVM, DACVIM (Neurology)

Disease description:
Lupoid onychodystrophy (LO) is a lupus-like syndrome, recognized in dogs, that involves multiple nails/claws on all four paws with age of onset typically between 3 and 8 years of age. LO causes widespread onychoschizia (fissured or split nails), onychorrhexis (breaking of a nail which has become brittle), onychomadesis (sloughing process of nails), and/or onychogryphosis (deformation of the claw). Affected claws can be painful or pruritic and result in lameness or the patient may be asymptomatic. Nail loss may be acute or protracted with the most common presentation being a single abnormal claw on 2 or more paws with progression to involvement of all claws within 1-2 months. Paronychia (inflammation of the nail fold) is usually absent as is proximal reactive lymphadenopathy or systemic signs. Left untreated, the tendency is to have partial re-growth of abnormal, friable nails that continue to be sloughed/pulled off. The pathogenesis of this condition is unknown but hereditary and immune-mediated processes are suspected.

The diagnosis is often based on characteristic clinical signs and the response to treatment. A definitive diagnosis is based on surgical removal of an affected P3 with histopathological evaluation that shows hydropic degeneration of the basal cell layer, pigmentary incontinence and a lichenoid interface dermatitis. Submitting an avulsed nail for histopathologic examination is generally insufficient because the nail bed matrix is not included in the sample.

If there is not significant paronychia and if most nails on more than one paw are involved, the presumptive diagnosis of LO is usually made. However a dermatophyte infection should be ruled out by submiting nail shavings for a fungal culture. If there is significant paronychia, appropriate diagnostics (skin scrapings, cytology, biopsy and bacterial/dermatophyte cultures) should be performed.

Disease description in this species:

Breed predilection:
Boxer
German shepherd
Golden retriever
Greyhound
Labrador retriever
Miniature schnauzer
Rottweiler
Schnauzer
Siberian husky

Age predilection:
Young adult

Clinical findings:
AFEBRILE
ANOREXIA, HYPOREXIA
Cachexia, weight loss
Nail bed crusts
Nail bed, paronychial inflammation
Nails, claws absent; anonychia
Nails, claws broken; onychorrhexis
Nails, claws deformed; onychodystrophy
Nails, claws pain
Nails, claws sloughed; onychomadesis
Nails, claws split; onychoschisis
Nails, claws thickened; pachyonychia
PAIN

Treatment/Management/Prevention:
SPECIFIC
Various treatments have been used although it generally takes 6 - 12 weeks to recognize clinical response. If little or no response after 6-8 weeks, consider switching to or adding another medication. *Any successful medical therapy should be continued for at least six months and potentially for the rest of the dog's life to maintain remission*. Once the nails appear to be normal, try to taper the medications slowly. Choices are as follows:

# Omega-3 and Omega-6 Fatty Acids: 180 mg EPA/5 kg/d PO: This is often used in conjunction with vitamin E. 1,4

# Vitamin E: 200 to 400 IU PO q 12h: 7

# Tetracycline and Niacinamide: 250 mg of each q8h PO for dogs weighing less than 10 kg; 500 mg of each q8h for dogs weighing more than 10 kg. Doxycycline can be substitued for tetracycline.

# Pentoxifylline (Trental): 20 mg/kg q 8-12 h PO: Give with food since it may cause nausea. Pentoxifylline has the ability to increase erythrocyte flexibility and reduce viscosity of whole blood which results in a decrease in total systemic vascular resistance and subsequent improvement in blood flow. Thus, it has been used to treat vasculopathies. It is available as a 400 mg time-released tablet that, ideally, should not be cut or crushed (unless absolutely necessary to achieve correct dosing) as this may change the time-released activity. However it is often necessary to break the tablets for correct dosing. It has rapid intestinal absorption and is metabolized by RBC's and the liver and is excreted in the urine. It is unusual to see side effects in animals although hyperactivity and nausea have been reported and may be dose-dependent.

# Prednisolone: 2-4 mg/kg/day for 2-4 weeks, then half this dose for 2-4 weeks, then gradually reduce to the lowest every other day dose required for maintenance. Prednisolone is usually reserved for those cases that have failed treatment with the above therapies.

SUPPORTIVE
1) If there are loose nails causing pain, they should be removed under general anesthesia. If there are exposed nail beds causing pain or lameness, the feet may have to be bandaged afterwards.
2) Use appropriate antibacterials if history and diagnostics indicate a secondary bacterial infection.
3) Initiate food elimination trial if history and diagnostics indicate suspicion as an underlying cause.

Differential Diagnosis:
Onychomycosis
Bacerial paronychia
Vasculitis

References:
1) Scott DW, Rousselle S, Miller WH: Symmetrical lupoid onychodystrophy in dogs: A retrospective analysis of 18 cases (1989-1993). J Am Anim Hosp Assoc 1995 Vol 31 (3) pp. 194-201.
2) Mueller RS, Rosychuk RAW, Jonas LD: A retrospective study regarding the treatment of lupoid onychodystrophy in 30 dogs and literature review. J Am Anim Hosp Assoc 2003 Vol 39 (2) pp. 139-50.
3) Auxilia ST, Hill PB, Thoday KL: Canine symmetrical lupoid onychodystrophy: a retrospective study with particular reference to management. J Small Anim Pract 2001 Vol 42 (2) pp. 82-7.
4) Bergvall K: Treatment of symmetrical onychomadesis and onychodystrophy in five dogs with omega 3 and omega 6 fatty acids. Vet Dermatol 1998 Vol 9 (4) pp. 263-268.
5) Rosychuk RAW: Pododermatitis In Dogs And Cats-Part II. ACVIM 2002.
6) Scott DW, Miller WH: Disorders of the claw and clawbed in dogs. Compend Contin Educ Pract Vet 1992 Vol 14 (11) pp. 1448-1459.
7) Lower K, Medleau L, Hnilica KA: A Shetland sheepdog with crusty, deformed toenails. Vet Med 1999 Vol 94 pp. 860-864.


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## Tonks (Jan 17, 2010)

Thanks, Mr V. :] That was awesome of you to provide me some information on the disease. Our vet forgot to give us the papers on information about it, but somehow, I managed to remember the name of it. 

Do you have any suggestions as to what to do about him continuing to bite/chew on his paws?
Just tonight he made another one of his paws start bleeding and we called the vet - but she wasn't in her office. Hopefully she'll be there tomorrow. 
The E-collar isn't big enough and he can still get access to his paws, but the vet said that's the biggest size they come in.
I could really use any suggestions at all!


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## lucidity (Nov 10, 2009)

Do you think you could get him some booties? Or wrap his feet or something? It really sounds like you need to do a whole lot more than just an e-collar to stop him from chewing on his nails.


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## Xie (Feb 5, 2009)

Could you post a pic of him with the e-collar on? I'm wondering if there might be a different type that would work better. There are different designs of e-collars and changing that out might be the best thing for now.

Would it be possible to have the paws bandaged and then use an anti-lick on them like bitter apple or cayenne? That might help to deter the chewing.


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## crittermom (Jan 14, 2010)

Try putting socks on his feet and taping the top of the sock to his leg (just make sure it isn't tight at all!) Many dogs will leave their feet alone this way. Just make sure if he still licks and soaks the socks that you remove them. Don't want his feet staying moist. Good luck!


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## Tonks (Jan 17, 2010)

Wow, sorry I haven't been back to respond in a couple of days. Things went from bad - to worse.
My sister couldn't have Bristol stay at her house anymore "because everytime he shakes his head the e-collar hits things and wakes the baby up," or so she says. I don't know. So Bristol is staying here now. He got here tonight and my sister had told us that he's "acting different." All he does it "stand and stare, pace, or whine." She says he hasn't been eating, but he drinks a lot of water. Well, he got here tonight and the first thing I noticed is he's lost *a lot *of weight. He's extremely anxious, and he's in a lot of pain. I watched for a while to make sure that I didn't need to call an E-vet, and that he would be okay tonight. 
Well, I got him to eat a little! (Yay!!) and he has been drinking a lot. I've checked out his paws - they seem to be okay, some of them are bloody and they're all agitated, but they'll be okay for the night, until the morning when we can get to a vet. 
Right now, we're downstairs in the livingroom and I made a little bed for Bristol right next to me on the couch. He's laying on it, sleeping. The poor dog. It breaks my heart seeing him like this.
I've been giving him a lot of attention. Petting him and telling him what a good dog he is. Hopefully in a little bit we can both get some sleep.
I'll let everyone know what the vet says tomorrow.!
Thanks for trying to help, guys.


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## Suzi Learning Peace (Apr 26, 2013)

Hello... I read the posts about Lupoid Onychodystrophy (Canine Lupus) that causes nails to grow deformed, break off, painful... The last post was way back in 2010... I believe the original post was a member named Tonka...? I can't see the post right now to verify... If you happen to read this, please write an update on the dear dog that was having all the pain and trouble with his nails... I hope you've been able to find a way to give him as good a life as possible since... My dog Emma has this disease... and it is very painful for her (and me to witness). Sending you my thoughts and hope to hear from you...

Sincerely,

Suzi


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