Symmetrical Lupoid Onychodystrophy in Review: Lessons Learned From 31 Cases.

SLO can be diagnosed clinically, and EFA-based protocols often allow tetracycline omission, supporting antimicrobial stewardship.

This retrospective study reviews 31 canine cases of Symmetrical Lupoid Onychodystrophy (SLO) diagnosed at a veterinary hospital over a 20-year period (2004–2024). SLO is an immune-mediated condition exclusively affecting the claws, presenting a diagnostic and therapeutic challenge. The mean age at disease onset and diagnosis was 7 years, with 19 breeds represented, reflecting broad breed susceptibility. Thirty of 31 cases were diagnosed clinically without biopsy, supporting the growing consensus that the distinctive clinical presentation—primarily onychodystrophy and onychomadesis affecting multiple claws symmetrically—is sufficient for diagnosis. Histopathological examination of the third phalanx, while historically the gold standard, was performed in only one case. Treatment protocols varied considerably and included combinations of tetracyclines with or without niacinamide, pentoxifylline, essential fatty acids (EFAs), vitamin E, biotin, and ciclosporin. EFAs were among the most consistently utilized agents for both initial and maintenance therapy. Notably, tetracyclines could frequently be omitted from long-term maintenance protocols without compromising outcomes, an important consideration given increasing concerns regarding antimicrobial stewardship. Despite the heterogeneity in treatment approaches and dosing, medical management generally supported favorable long-term outcomes. The study reinforces clinical diagnosis as the pragmatic standard of care and highlights the importance of individualized, stewardship-conscious treatment strategies. Limitations include the retrospective design and the absence of a standardized treatment protocol, which constrains definitive conclusions about therapeutic superiority.

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