Pemphigus Foliaceus in Dogs

Pemphigus foliaceus is an autoimmune skin disease that typically begins in middle age dogs.  Pemphigus foliaceus usually starts off as small, red patches, which quickly become pustules (pus filled blisters) and burst open.  Thick crusts (scabs) form after the pustules bursts. The skin beneath the crusted area can be swollen and may be painful. The blisters typically begin along the nasal bridge, around the eyes, and the ears.  The dog’s foot pads may become thickened and crack, which will make walking very painful.

In pemphigus the autoimmune antibodies form against the desmoglein I. Desmoglein I is what helps the epidermal cells to adhere to each other. When the desmoglein I is disrupted, the cells become separated from each other and the epidermis loses its intercellular connections. The breakdown of this component causes the outer layer of skin to split apart and blister.

The disease is most common in the Akitas, Chow Chows, Bearded Collies, Dachshunds, Doberman Pinschers and in the Newfoundland breed.

Pemphigus foliaceus (PF) is the most common autoimmune disease in dogs. It is characterized by pustules, ulcers and crusts (scabs) developing on the canine’s skin surface.

• Redness
• Blisters
• Pus
• Yellow-brown crust (scabs)
• Depression
• Lethargy
• Fever
• Sometimes itchy
• Hair loss
• Ulcers
• Lack of appetite
• Swollen lymph nodes

There are 4 different types of pemphigus in dogs.

• Pemphigus foliaceus affects the top layer of skin; it is the most common type of pemphigus in dogs
• Pemphigus erythematosus commonly shows itself through pale dog gums and attacks the skin on the face and on the ears
• Pemphigus vulgaris is the most serious type of pemphigus, and can include painful ulcer formation in the mouth; it can also affect the nose, prepuce, anus and vaginal area
• Pemphigus vegetans is very rare, it causes wart-like growth that may ulcerate

• Pemphigus foliaceus can develop spontaneously, without a discernible cause
• Breed disposition
• The disease may be triggered by a reaction to a prescribed medication; penicillin, cephalosporins, and sulfonamides have been linked to the development of pemphigus
• Pemphigus foliaceus can develop in dogs with a history of chronic conditions such as allergies
• Ultra-violet lights may be a trigger factor

The veterinarian will go over your pet’s medical history.  Let the veterinarian know if your dog is currently on any medications. He will ask you when the condition first started.  The veterinarian will perform a physical examination of your pet.

Bloodwork such as a complete blood count (CBC) and a urinalysis will help determine if there are any other health issues involved. If your veterinarian suspects your pet has pemphigus foliaceus he may recommend a skin biopsy.  In most cases a local anesthetic is used, but if the patient is anxious, general anesthesia may be required. A small block of skin is removed from your pet and the tissue sample is sent to a veterinary pathologist.  Cytology of an intact pustule can be a helpful diagnostic test that can be done by your veterinarian, pending the biopsy results.

There is no known cure for pemphigus foliaceus. The objective is to keep the disease in remission.  In cases where pemphigus foliaceus is confined to a certain area on the dog’s body, it can be treated with topical steroids. For more generalized cases a combination of oral glucocorticoids and non-steroid immunosuppressive medications will be prescribed. The non-steroidal immunosuppressive drugs are used to minimize the side effects of glucocorticoids (liver enlargement, weight gain, increased drinking and urinating). Your veterinarian will start your pet with a higher dosage of medication until the disease is in remission.  This may take 4 to 12 weeks; then the medication will be tapered down to a lower dosage that maintains remission.

Ingestion of gold salts (chrysotherapy) has been successful as a treatment aid. Reducing the exposure to ultraviolet light can help the healing process. A sunscreen that does not contain zinc oxide can be used to protect the affected areas.  If there is a secondary bacterial infection, antibiotics will be prescribed. It will be very important that you follow your veterinarian’s treatment plan.

The prognosis from Pemphigus foliaceus is usually good.  Lifelong treatment is required to maintain the remission of the disease. Follow up visits will be necessary monitor your pet’s progress and to check on any side effects from the medications.