Pemphigus Complex

Emily Rothstein, DVM, DACVD

BASIC INFORMATION • Fever, poor appetite, and depression may occur in severely Description affected animals. The term pemphigus complex is used to describe an uncommon Pemphigus vegetans is a pimply-to-blistering disease in which the group of autoimmune skin diseases in the dog and cat. Five forms spots may develop into warty-like skin lesions that ooze liquid. have been identified: • Affected animals generally feel well otherwise. • Pemphigus foliaceus is the most common form in dogs • Pain and itch are variable. and cats, and the dachshund, schipperke, Finnish spitz, Paraneoplastic pemphigus resembles pemphigus foliaceus but bearded collie, chow chow, Akita, and Newfoundland are occurs in dogs with certain tumors. predisposed. Diagnostic Tests • Pemphigus erythematosus is a mild form of pemphigus folia- ceous that affects primarily the Shetland sheepdog, collie, and Examination of the contents of a pimple or the debris under the German shepherd dog. scab of a lesion may reveal cells called acantholytic cells , which • Pemphigus vulgaris is the second rarest and most severe form. are highly suggestive of pemphigus complex. Skin biopsies confirm • Pemphigus vegetans is the rarest form and is considered to be the diagnosis and often determine which form is present. Other tests a benign variant of pemphigus vulgaris. may be needed to rule out similar-appearing skin diseases and to • Paraneoplastic pemphigus has been described in dogs with evaluate the general health of the animal prior to starting therapy. cancer. Causes TREATMENT AND FOLLOW-UP An autoimmune problem occurs when the body’s own immune system attacks normal body tissues. In pemphigus complex, the Treatment Options “glue” that holds the skin cells together is attacked and destroyed. For pemphigus foliaceus and vulgaris, initially high doses of oral steroids are given to turn the immune system down. If oral steroids Clinical Signs do not control the disease or cause unacceptable side effects, other Pemphigus foliaceus usually causes pimples and honey-colored to immunosuppressive drugs may be tried. brown scabs, which often begin on the face and ears. For pemphigus erythematosus and vegetans, topical steroids • Loss of pigment (the dark color) on the nose is common; are usually started, and exposure to the sun is limited, especially involvement of the mouth is rare. between 10 AM and 4 PM. This combination may resolve the prob- • Feet, foot pads, nail beds, and the groin may be affected. lem; if needed, sunscreens that have an SPF value of 15 or greater • Cats tend to have lesions of the toenails and adjacent skin, as and contain titanium dioxide may be beneficial when applied two well as the nipples. to three times daily. Topical or systemic vitamin E may also help. • The disease generally progresses over 6 months but may wax If these measures do not achieve a satisfactory result or the signs and wane and may be accompanied by secondary bacterial skin recur, oral steroids may be added. infections (pyoderma), enlarged glands (lymph nodes), loss of For paraneoplastic pemphigus, treatment is directed at the appetite, and fever. underlying cancer. • Severe pain and itch can occur in some cases. Pemphigus erythematosus often produces redness and pimples on Follow-up Care the skin of the face and ears. Since all of the medications used to treat pemphigus have potential • Loss of pigment of the nose may be the initial lesion. side effects, blood and urine tests are monitored, sometimes every 2 • Occasionally, the foot pads, scrotum, or vulva may be involved. weeks. Animals on potent topical steroids are monitored similarly to • Pain and itch are variable. those on oral steroids, because topical steroids can be absorbed into the Pemphigus vulgaris is a blistering disease that often progresses system. The medication doses are tapered as the pet’s signs improve. to raw, ulcerated patches of skin. Lesions may be present in the Prognosis mouth (most cases), armpits, and groin. Prognosis is fair to good for control of pemphigus foliaceus, • Claws that are loose and fall off, or infection and inflammation erythematosus, and vegetans, depending on the severity of the of the skin around the claws, may be the only presenting sign. disease. The disease is never cured but can often be controlled; • Secondary bacterial infection and enlarged lymph nodes may therapy may be required for life, and signs may wax and wane. be present. For pemphigus vulgaris, the prognosis is poor. The chances of • Pain and itch are variable. managing the disease and keeping the pet comfortable are not good.