Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review.
Authors: Tham Heng L, Linder Keith E, Olivry Thierry
Journal: BMC veterinary research
Summary
# Editorial Summary: Deep Pemphigus in Companion and Equine Species Deep pemphigus encompasses a group of rare autoimmune blistering conditions (pemphigus vulgaris, pemphigus vegetans, and paraneoplastic pemphigus) where pathogenic autoantibodies target desmosomal proteins in the deeper epidermal layers, resulting in mucocutaneous ulceration and erosion. This comprehensive review synthesised clinical presentation, histopathological findings and treatment responses across canine, feline and equine cases, drawing parallels with documented human disease to provide a framework for recognition and management. Dogs, cats and horses exhibit clinical and pathological features remarkably similar to their human counterparts, though specific prevalence data and breed/species predispositions remain poorly characterised in the veterinary literature. Management of the vulgaris and vegetans variants typically requires aggressive glucocorticoid therapy, often combined with adjunctive immunosuppressants, with many patients achieving partial to complete remission; paraneoplastic pemphigus carries a significantly graver prognosis and frequently proves refractory to treatment. For equine practitioners and veterinarians managing these conditions, recognition of the chronically relapsing nature of these dermatoses and the necessity for sustained, high-dose immunosuppression is essential, particularly given the welfare implications of long-term systemic corticosteroid use in horses and the need for careful monitoring of secondary complications.
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Practical Takeaways
- •Suspect deep pemphigus in horses presenting with chronic flaccid blisters and erosions of mucous membranes or skin; confirm with histopathology showing intraepidermal acantholysis in deep epidermal layers
- •Aggressive long-term glucocorticoid therapy is the cornerstone of treatment for pemphigus vulgaris and vegetans, often requiring adjunct immunosuppressants due to the relapsing nature of these conditions
- •Paraneoplastic pemphigus in horses has a poor prognosis; consider underlying neoplasia when deep pemphigus presents atypically or fails to respond to standard immunosuppressive protocols
Key Findings
- •Pemphigus vulgaris and pemphigus vegetans in dogs, cats and horses share clinical and histopathological features with human forms of these diseases
- •Partial-to-complete remission of pemphigus vulgaris and pemphigus vegetans can be achieved with high-dose glucocorticoid therapy, with or without adjunct immunosuppressants
- •Paraneoplastic pemphigus carries a grave prognosis in animals
- •Deep pemphigus variants are chronic and often relapsing conditions requiring aggressive immunosuppressive therapy