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What type of hypersensitivity reaction is Pemphigus foliaceus?
What is the pathophysiology for Pemphigus foliaceus?
Antibodies target desmosomal proteins which causes disruption of desmosomes. This leads to detachment of keratinocytes from each other creating acantholytic cells. Inciting inflammation, pustules form in the epidermis and rupture to create crusts and erosions.
T/F Pemphigus is the most common autoimmune skin disease in dogs and cats
True (most common)
What species can you see Pemphigus in?
Humans, dogs, cats, horses, goats and sheep
What causes pemphigus?
Most cases are idiopathic, but drug-induced cases have been reported
What are the clinical signs for pemphigus in a dog?
Symmetrical and pruritic pustules and crusts on the face, trunk, pinnae and paw pads.
What are the clinical signs for pemphigus in a cats?
Symmetrical and pruritic pustules and crusts on the face, pinnae, paw pads, and periareolar and paronychia
Inflammation of the claw folds (inflammation of skin around a nail or claw)
What systemic signs can we see with Pemphigus?
Fever, lethargy, anorexia and weight loss
Involvement of what anatomic locations is more suggestive of Pemphigus?
Pinnae, nasal planum and paw pads
T/F you typically don't see secondary bacterial infections with Pemphigus
False; they are very common
What does Pemphigus look like? What should your top three differentials be, before looking at cytology?
Cases of folliculitis; bacterial infection, demodicosis and dermatophytosis
What diagnostic tool should you use first when you see pustules and crusts?
For an animal with Pemphigus, what will the cytology of a pustule look like?
Neutrophils and acantholytic cells
If you see neutrophils and acantholytic cells on cytology, what should your differential list turn into?
Bacterial infection, dermatophytosis and Pemphigus foliaceus
How can you definitively diagnose Pemphigus foliaceus?
What do you need to do before moving Pemphigus foliaceus to the top of your differential diagnosis list?
Rule out bacterial infection and dermatophytosis
Is just seeing acantholytic cells diagnostic?
No, a biopsy is needed to confirm diagnosis
What samples and techniques should you use when a biopsy is needed to rule out/in Pemphigus?
Multiple intact pustules are the preferred sample, but crusts that are adhered to the skin are the next best thing. Do not clip or scrub skin before taking biopsy.
If the patient has a bacterial infection, what should you do before taking a biopsy?
Clear the infection with antibiotics for at least 2-4 weeks.
What medication should you avoid before biopsy?
How do you treat Pemphigus?
Immunosuppressive medications - glucocorticoids
What is the recommended dosing for pemphigus?
Start with immunosuppressive doses, then taper.
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