Skin conditions are commonly seen in veterinary practice, and allergies are most often the cause. But there are a host of other skin conditions that may affect our pets. One such class of skin diseases is auto immune skin diseases, otherwise known and Pemphigus and Lupus.
What are the signs of Pemphigus or Lupus?
The most common signs of so-called immune mediated skin disease are:
- Loss of hair (alopecia) – the various forms of these diseases often have specific patterns of hair loss, such as around the eyes and lips, or all over the body.
- Ulcerations – the skin can look ulcerated or have open sores that do not seem to heal.
- Infections – secondary infections can occur
- Itchiness – can be variable, ie some may itch, some may not.
So, what is Pemphigus or Lupus?
Immune mediated skin disease, in a nutshell, occurs when the body’s immune system mounts an inappropriate immune reaction to certain cells in the skin. This causes severe inflammation, and damage to the skin cells that results in the symptoms seen.
The reason for the immune reaction is usually unknown. Some breeds show some genetic predisposition which means that they are more often affected. It is most often seen in middle age to older dogs.
There are various forms of immune mediated disease, classified according to which parts of the body and which part of the skin is affected:
- Pemphigus foliaceous – most common form found in dogs and cats that can affect any part of the body particularly around the eyes, ears, foot pads, nose and inner thighs.
- Pemphigus vulgaris – fluid filled blisters are seen around the eyes, mouth, ears, foreskin, and vulva. This is quite rare.
- Pemphigus erythematosus – Redness, crusting and ulcers affect the nose, often in German Shepherd dogs and Collies.
- Bulbous pemphigoid – Large blisters develop, mainly in the armpits and groin that pop quickly, and are associated with severe itchiness. It is rare in cats and dogs.
- Systemic Lupus erythematosus – This is a systemic illness that can look like virtually any disease. Skin lesions, stiff legs, and persistent fevers are some of the most common symptoms. Diagnosis can be difficult due to the waxing and waning nature.
- Discoid Lupus Erythematosus – also called Collie nose. It starts with a loss of dark pigment on the nose, and can end up with severe ulcers, bleeding and even distortion to the nose. UV light has been suggested as a trigger.
How is auto immune skin disease diagnosed?
The only way to diagnose these conditions and distinguish between the various forms of the disease is to take a skin biopsy and have it analysed by a pathologist. This is done under sedation or light general anaesthetic. One cannot treat these conditions without a definitive diagnosis as the treatment involves suppressing or altering the functioning of the immune system.
What are the treatment options?
The principle of treatment is suppressing and augmenting the immune system. Various medications are available, with cortisone often being the cornerstone of the treatment protocol.
Treatment is often long term, and in some cases even life-long. It is essential that this treatment is done under the supervision of a vet as close monitoring is vital. Some medications used to treat these conditions may interfere with other medications and vaccinations so best to always discuss this with your vet.
Can my pet recover?
The good news is that most pets with milder forms of pemphigus can recover very well with medication. Patients with systemic disease such as lupus unfortunately do not always do well. But treatment is always worth trying.
