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Pemphigus Foliaceus in Dogs

What Is Pemphigus Foliaceus in Dogs?

Pemphigus foliaceus stands as the most prevalent autoimmune skin disorder found in dogs, albeit remaining relatively uncommon. An autoimmune ailment manifests when the immune system, responsible for safeguarding the body against external threats such as bacteria or viruses, malfunctions. Instead of combatting external invaders, it begins to assault the body itself by targeting specific proteins or cells. In the instance of pemphigus foliaceus, the body directs its attack towards desmosomes, crucial proteins that uphold the cohesion of skin cells. Consequently, this process leads to the formation of cracks, fissures, pustules (pus-filled pimples), scaling, and subsequent infections. While it may not constitute a medical crisis, untreated instances of pemphigus foliaceus can escalate into severe infections, resulting in discomfort and a diminished quality of life. Therefore, treatment should be promptly administered.

Symptoms and Types

Pemphigus foliaceus predominantly affects the skin, leading to various skin-related manifestations. A primary symptom is the appearance of pustules, which manifest as reddish, yellow, or brown raised lesions resembling pimples. These pustules may emerge individually or in clusters, growing larger, deeper, and more discomforting over time. Initially, these sores tend to surface on the face and can subsequently spread to the head, ears, neck, trunk, groin, and feet. Typically, this condition displays a symmetrical distribution, occurring on both sides of the body.

Additional symptoms linked to pemphigus foliaceus in dogs encompass:

  • Presence of scales and crusts on the skin
  • Hair loss
  • Itching and scratching (pruritus)
  • Depigmentation of the nose or lips
  • Occurrence of fever
  • Lethargy
  • Decreased appetite
  • Weight loss
  • Sensations of pain

Causes

While pemphigus foliaceus can affect dogs of any breed and age, it appears to be more prevalent among middle-aged dogs of specific breeds, hinting at a potential genetic element in the disease. These breeds include:

  • Akitas
  • Chow Chows
  • Cocker Spaniels
  • Collies
  • Dachshunds
  • Dobermans
  • Newfoundlands
  • Shar-Pei

Moreover, pemphigus foliaceus tends to occur more frequently in dogs with a history of chronic skin conditions, such as allergies and other environmental factors, as well as in dogs with concurrent illnesses or autoimmune disorders.

Primarily categorized as an autoimmune disease, pemphigus foliaceus often lacks a discernible cause, rendering it idiopathic in many instances. However, certain cases have been associated with the use of specific medications, such as antibiotics, and are classified as adverse drug reactions.

Diagnosis

Given that symptoms and skin lesions can mimic those of other diseases, veterinarians typically suggest several basic bedside tests to discern the condition. These may involve:

  • Conducting a skin impression to identify abnormal skin cells and assess for secondary bacterial and/or yeast infections (pyoderma).
  • Performing skin scraping to check for external parasites like mites.
  • Employing some form of fungal test (culture/PCR/Wood’s lamp) to detect the presence of ringworm.
  • Additionally, veterinarians might advise blood tests to exclude other conditions and establish a baseline before commencing drug therapy. This precaution is important because the medications prescribed often lead to elevated organ values.

Ultimately, the diagnosis of pemphigus foliaceus necessitates a biopsy with histopathology. This entails the veterinarian extracting several skin samples, often under local sedation or general anesthesia, and submitting them for analysis to identify evidence of acantholytic skin cells (skin cells not adhering to one another). In some cases, veterinarians may opt to treat the secondary skin infection for a few days prior to obtaining a biopsy, as pyoderma can complicate the diagnostic process.

Treatment

The treatment of pemphigus foliaceus focuses on achieving two main goals:

  • Controlling the disease.
  • Promptly inducing remission.

As pemphigus foliaceus stems from an aberrant immune system, the treatment primarily revolves around suppressing immune functions with prescription medications known as immunosuppressants. Steroids, administered at high doses, stand as the most commonly prescribed and effective drugs, despite their numerous negative and undesirable side effects. These may include:

  • Increased thirst and urination
  • Gastrointestinal upset and ulceration
  • Lethargy
  • Heightened susceptibility to infections
  • Increased risk of developing hormone-related disorders
  • Liver toxicity
  • Bone marrow suppression

To mitigate or circumvent these adverse effects, other immunosuppressive medications such as azathioprine, chlorambucil, mycophenolate, or cyclosporine are often combined with steroids. Furthermore, steroids and other drugs are gradually tapered off over time, typically spanning several months, until the lowest effective dose is reached, where symptoms are under control and side effects are minimal.

It is crucial not to alter or discontinue the tapering regimen without consulting a veterinarian, as symptoms may resurface, and medical emergencies may arise. Many dogs with pemphigus foliaceus also contend with secondary bacterial and fungal infections, necessitating antibiotic prescriptions like cephalexin, Clavamox®, or clindamycin, as well as antifungals such as fluconazole or miconazole.

Moreover, topical therapies comprising ointments, shampoos, or conditioners are frequently recommended, containing antibacterial, antifungal, and/or steroidal properties. Under the guidance of a veterinarian, bathing your pet can alleviate symptoms and enhance comfort while reducing itchiness.

Incorporating fatty acids into your dog’s diet may enhance skin coat quality, fortify the skin barrier, and alleviate inflammation. Additionally, diets tailored to bolster the skin barrier, soothe and nourish the skin, and support the immune system, such as Hill’s Derm Defense, could prove beneficial for your dog. Consult with your veterinarian to determine the most suitable topicals, supplements, and diet based on your dog’s specific medical and nutritional requirements.

Recovery and Management

The overall prognosis for dogs diagnosed with pemphigus foliaceus ranges from fair to good, typically showing improvement within the initial few months of treatment and complete symptom remission within approximately five months. After the initial treatment, dogs often require a follow-up visit for stitches removal within the first month. Subsequently, monthly (or more frequent) follow-ups are necessary to monitor the dog’s response to treatment.

During these follow-up visits, the veterinarian will monitor the dog’s drug levels, assess blood and organ parameters, and consider medication tapering when appropriate. While some dogs may fully recover and discontinue medication, others may require lifelong treatment to manage symptoms. Dogs showing prompt response to initial treatment generally have better chances of achieving long-term remission.

It’s imperative not to modify or discontinue the dog’s medication regimen without consulting the veterinarian, as abrupt changes can lead to significant side effects. Additionally, dogs that achieve remission can potentially relapse at any time.

Given the potential risks and side effects associated with treatment, it’s vital to closely observe changes in the dog’s behavior and appetite. Any alterations may indicate the need for prompt medical attention, facilitating a quicker and safer recovery process for the dog.

Prevention

While pemphigus foliaceus cannot be prevented outright, adhering to the follow-up recommendations and guidelines provided by your veterinarian can help minimize the likelihood of recurrences or flare-ups in the future. It’s essential to exercise caution when administering medications, including vaccinations, as they have the potential to exacerbate the condition by triggering the immune system.

Pemphigus Foliaceus FAQs

What is the life expectancy of dogs with pemphigus foliaceus?

The prognosis for dogs with pemphigus foliaceus varies widely, with some studies indicating a 53% success rate for long-term follow-up (seven years post-diagnosis). However, the life expectancy of dogs with any autoimmune disease can fluctuate depending on factors such as remission, recurrence, and the presence of comorbidities (additional concurrent medical conditions). It’s estimated that euthanasia may be necessary in approximately 13% of cases, particularly for patients with poor quality of life, those who do not respond to appropriate treatment, or those who experience adverse effects from treatment itself.

What causes pemphigus foliaceus in dogs?

Pemphigus foliaceus typically stems from an excessive immune response, leading the body to initiate self-destruction of the proteins responsible for skin cell cohesion. While many cases arise spontaneously, some instances of the condition are triggered by adverse reactions to specific medications, such as antibiotics.

Is pemphigus foliaceus in dogs contagious?

Pemphigus foliaceus is an autoimmune disease and does not spread to other dogs or people as it is not contagious.

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