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Pemphigus in Dogs

What Is Pemphigus in Dogs?

Pemphigus in dogs manifests as an autoimmune disorder affecting the skin. This condition results in the breakdown of connections (desmosomes) between skin cells, leading to blistering, lesions, hair loss, and skin redness.

Although autoimmune skin diseases are uncommon in dogs, pemphigus ranks as the most frequently observed among them. However, the majority of dogs will not encounter pemphigus in their lifetime.

While dogs affected by pemphigus may experience discomfort, it typically does not necessitate immediate emergency attention. If your pet exhibits signs of discomfort due to their skin condition, contacting your veterinarian for an appointment is advisable. However, if your pet appears to be in significant distress, experiencing worsening sores, or demonstrating lethargy, seeking care from an urgent-care veterinarian is recommended.

Types of Pemphigus in Dogs

There exist five distinct types of pemphigus conditions in dogs, with the most prevalent being pemphigus foliaceus and pemphigus vulgaris. The three less common variants are pemphigus erythematosus, pemphigus vegetans, and paraneoplastic pemphigus. Each type carries specific characteristics:

Pemphigus foliaceus typically manifests on the head, face, and ears, displaying symmetrical lesions on both sides of the head. Additionally, a dog’s footpads are often affected, while trunk involvement may not be immediately evident unless the fur is removed. Lesions commonly resemble pustules.

Pemphigus vulgaris represents a more severe form of the condition, primarily affecting the mouth and areas where mucous membranes meet the skin, such as the lips, genitals, and anus. Footpads and clawbeds may also be involved. Lesions initially appear as blisters, quickly progressing into painful open sores. Unlike pemphigus foliaceus, pemphigus vulgaris affects deeper layers of the skin and is challenging to resolve. Even with improvement, scarring may persist.

Pemphigus erythematosus is characterized as a combination of pemphigus foliaceus and another autoimmune skin condition known as discoid lupus erythematosus. Affected areas commonly include a dog’s nose, face, and ears, where sores develop. Exposure to sunlight may exacerbate pemphigus erythematosus.

Pemphigus vegetans is exceedingly rare in dogs, featuring lesions that evolve into wart-like growths.

Paraneoplastic pemphigus emerges as a secondary condition in conjunction with cancer elsewhere in the body. It is exceptionally uncommon and typically results in a poor prognosis for affected dogs.

Symptoms and Types

The symptoms of pemphigus in dogs vary depending on the specific type they have. Key signs to monitor include:

  • Hair loss occurring on the nose, ears, and around the eyes.
  • Presence of blisters, lesions, or crusting on the face, paw pads, inside the mouth, or around the genital area.
  • Appearance of blisters, lesions, or crusting on the dog’s body, which may become more evident post-shaving.
  • Itchiness leading to scratching, licking, or biting by the dog.
  • Development of lameness, limping, or changes in gait if the footpads are affected.
  • Excessive salivation and halitosis in cases where lesions are present in the mouth.
  • Onset of fever.
  • Loss of appetite, particularly if lesions are present in the mouth.

Causes

The causes of pemphigus in dogs vary. While most cases are considered idiopathic, meaning the cause is unknown, others are believed to be triggered by reactions to medications, topical parasite preventives, or chronic skin diseases like allergies.

Paraneoplastic pemphigus has been associated with cancers such as lymphoma, thymoma, and splenic tumors (sarcoma).

Certain breeds are more predisposed to developing pemphigus. Typically, pemphigus onset occurs in middle-aged to older dogs, although it can affect dogs of any age.

Any breed can develop pemphigus foliaceus, but Akitas and Chow Chows are the most susceptible. Breeds at higher risk for pemphigus erythematosus include Collies and German Shepherds.

Diagnosis

The diagnosis of pemphigus in dogs typically involves cytology, which entails examining cells under a microscope, and biopsy, which involves analyzing a tissue sample under a microscope, taken from an active lesion.

Cytology aids in identifying potential infections, often occurring as secondary conditions. While many veterinarians conduct cytology tests in their offices, some may opt to send the sample to a pathologist for analysis.

In some cases, veterinarians may perform a culture, a test aimed at identifying germs, from a lesion on the dog to monitor the effectiveness of antibiotics administered. These cultures are usually conducted at off-site laboratories, and results may take several days to be obtained.

Biopsy samples are sent to pathology labs for a definitive diagnosis. Depending on the severity of the dog’s condition and the location of the lesions, veterinarians may perform biopsies under general anesthesia or with light sedation and local anesthesia.

Before initiating any treatment, veterinarians typically conduct routine bloodwork. It is important for pet owners to disclose the following information to their veterinarian:

  • Any medications currently administered to the pet
  • Changes in parasite preventives or dietary habits
  • Any history of skin conditions

Treatment

Treatment for pemphigus in dogs aims to suppress the immune system, considering it as an autoimmune condition. Your dog might require referral to a veterinary dermatologist for ongoing care.

Prednisone or prednisolone, administered orally, represents the most common medication used to treat pemphigus. Steroids are usually tapered to the lowest effective dose. In some cases, veterinarians may initiate treatment with injectable steroids like dexamethasone. If steroids prove ineffective, azathioprine, an immunosuppressant, is often added to the treatment regimen. Similar to steroids, azathioprine is gradually tapered over time.

Chlorambucil and cyclosporine serve as alternative immunosuppressants that may replace azathioprine.

For cases of pemphigus foliaceus or pemphigus erythematosus, topical steroids such as triamcinolone can be applied to lesions. Once effective control is attained, treatment may transition to a topical hydrocortisone.

In the event of a skin infection, dogs will receive oral antibiotics like cephalexin or cefpodoxime. Antibiotic selection may be based on culture results if a lesion culture has been conducted by the veterinarian.

Recovery and Management

Recovery and management of pemphigus in dogs involve achieving remission, where signs and symptoms disappear, although the condition is typically not cured. Many patients necessitate lifelong medical management to sustain remission.

Treatment typically proves effective for pemphigus foliaceus, even in severe cases. Most dogs with milder forms of pemphigus exhibit improvement within two to six weeks of initiating treatment.

Regrettably, the prognosis for most patients with pemphigus vulgaris remains poor, often leading to humane euthanasia despite aggressive treatment.

Immune system suppression can yield side effects. Dogs undergoing lifelong steroid treatment may develop Cushing’s disease or experience urinary tract infections. Dogs treated for pemphigus should undergo checkups with their veterinarian at least every six months.

For dogs with pemphigus, it’s advisable to minimize sunlight exposure, particularly during warmer months. Pet-safe sunscreens may offer some assistance, though precautions must be taken to prevent the sunscreen from entering their eyes.

Continuing year-round parasite prevention is crucial for most dogs with pemphigus. Fleas can exacerbate discomfort by causing itchiness, secondary infections, and allergic reactions. Pet owners should consult with their veterinarian regarding the appropriate preventative measures for their dog.

Prevention

Preventing pemphigus in dogs is not feasible.

Pemphigus in Dogs FAQs

How long can a dog live with pemphigus?

Dogs with milder forms of pemphigus—such as pemphigus foliaceus or pemphigus erythematosus—can lead normal lives with proper management of their condition. However, dogs that do not respond adequately to treatment are often humanely euthanized due to their condition within a year of diagnosis.

What makes pemphigus worse in dogs?

Certain forms of pemphigus, like pemphigus vulgaris, tend to be more severe. Pemphigus can worsen due to secondary issues such as skin infections, sun exposure, or an ineffective treatment regimen.

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