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Pemphigus Complex 769

Technician Tips • Stress the importance of follow-up to assess AUTHOR: Kinga Gortel, DVM, MS, DACVD
• Clients become understandably concerned efficacy because treatment failures are possible. EDITOR: Manon Paradis, DMV, MVSc, DACVD
VetBooks.ir may inquire whether a household pet could SUGGESTED READING Diseases and Disorders
about a diagnosis of lice in their pet. They
be the source of a human infestation (no).
Miller WH Jr, et al, editors: Muller & Kirk’s Small
Counsel clients about the highly host-specific
320-322.
nature of this parasite. animal dermatology, St. Louis, 2013, Mosby, pp

Pemphigus Complex Bonus Material Client Education
Online
Sheet

BASIC INFORMATION reactions. PF cases in dogs after various topical The initial complaint can be lameness due
ectoparasiticides have been well documented. to footpad disease.
Definition Chronic skin disease may be a risk factor. • PV, PNP: intraoral lesions are common, and
The pemphigus complex is a group of PNP in dogs has been associated with under- presenting signs include hypersalivation,
autoimmune skin diseases characterized by lying lymphoma, thymoma, and Sertoli cell halitosis, anorexia, and weight loss.
acantholysis. The two major subsets are tumor. • Fever, anorexia, lethargy, and limb edema
pemphigus foliaceus (PF) (most common) are reported in severe cases of pemphigus.
and pemphigus vulgaris (PV). Rare variants GEOGRAPHY AND SEASONALITY
are pemphigus vegetans (PVeg), paraneoplastic Prevalence of PF appears higher in warmer PHYSICAL EXAM FINDINGS
pemphigus (PNP), and pemphigus erythema- regions. Seasonal exacerbation of lesions may • PF: a pustular and crusting dermatitis, with
tosus (PE). Spontaneous, drug-induced, and occur during months of increased sunlight crusts on the trunk and/or the facial area
paraneoplastic forms are reported. exposure. being the most common lesion. Concave
pinnae and dorsal muzzle are often the
Epidemiology Clinical Presentation first areas affected, and the disease can stay
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES restricted to the head and face. Other com-
Dogs and cats; PF is the most common Subsets of pemphigus, in decreasing order of monly involved areas are the footpads and
autoimmune skin disease, typically affecting frequency: nail beds (nail beds often affected in cats;
middle-aged animals (range, 0.5-16 years) • Superficial pemphigus complex: PF, PE sometimes the only physical exam abnormal-
(possible local and milder variant of PF), ity). The disease progresses and becomes
GENETICS, BREED PREDISPOSITION panepidermal pustular pemphigus (PPP; multifocal or generalized in most cases.
• PF: Akita, chow chow, and many other breeds possibly a more extensive subtype of PF) Range of lesions noted includes erythema;
(drug-induced PF in Doberman pinscher • Deep variants: PV, PVeg, and PNP pustules; dry, honey-colored crusts; scales;
and Labrador retriever) alopecia; and erosions bordered by collarettes.
• PE: collie and German shepherd HISTORY, CHIEF COMPLAINT Secondary bacterial pyoderma (≈one-third of
• PF: progressive multifocal or generalized PF cases) and peripheral lymphadenopathy
RISK FACTORS skin disease, often with facial and footpad are common.
PF and PE may be aggravated by sunlight. involvement. Degree of pain is variable. • PE: a milder form of PF with crusts, erosions,
Some cases of pemphigus are triggered by drug Pruritus occurs in 30%-50% of the cases. alopecia, and scales restricted to the face

PEMPHIGUS COMPLEX Impression smear of a pustule from a dog with PEMPHIGUS COMPLEX Pemphigus foliaceus in 4-year-old Bichon frisé: close-up
pemphigus foliaceus shows numerous acantholytic keratinocytes and neutrophils. view of typical lesions on the abdomen. Note pustules, epidermal collarettes, and
(Courtesy Dr. Manon Paradis.) honey-colored crusts. (Courtesy Dr. Caroline de Jaham.)

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