Pemphigus Foliaceus in Cats


Overview of Pemphigus Foliaceus

Pemphigus foliaceus is a severe skin disease that is characterized by pustules and blisters that rupture, causing damage to the skin of the face, ears, feet and eventually the entire skin.

This disease results when the animal recognizes a specific component of his own skin (desmoglein I) as foreign and makes antibodies against that component. Desmoglein I is important in attaching skin cells to each other. Lack of this component causes the outer layer of the skin to split apart and fill with fluid and cells leading to a blister or pustule. This abnormality of the immune system is an example of an autoimmune disorder.

Middle aged to older cats are more prone to this disease. This disease has a severe health impact on the animal and can be fatal if not treated aggressively.

What to Watch For

  • Blisters and pustules that rupture and crust over beginning on the face and ears, and progress to the legs, feet, and eventually the entire body.
  • These animals may be very ill in advanced stages of the disease, and may refuse to eat.
  • Diagnosis of Pemphigus Foliaceus in Cats

  • This disease is confirmed by skin biopsy, preferably of an intact pustule. It is important that a pathologist skilled in reading veterinary skin histopathology read the biopsy.

    Your veterinarian may puncture an intact pustule and collect the contents to put on a microscope slide for cytology (microscopic exam of the cells). This test may lead to a preliminary diagnosis that must be confirmed by biopsy. This test also helps to rule out other pustular skin diseases like pyoderma.

  • Treatment of Pemphigus Foliaceus in Cats

  • Immunosuppressive drugs. Since this disease is caused by an abnormality in the immune system, the immune system must be suppressed to treat the problem. Corticosteroids like prednisone are used at high doses for this reason. Although these drugs have the benefit of rapid suppression of the immune system, they have numerous side effects if used at this dosage long-term.

    Once the disease is successfully in remission, other immunosuppressive drugs like azathioprine in cats may be used to help lower the dose of corticosteroids needed.

  • Chrysotherapy. Injections of gold salts have been successful as an aid in treatment.
  • Antibiotics. These may be needed if the skin is secondarily infected with bacteria.
  • Topical steroids. If diagnosed early in the disease course, topical steroids may provide temporary relief.
  • Home Care and Prevention

    Give all medications as directed. Follow up appointments with your veterinarian are critical to allow for adjustment of drug dosages to maximize efficacy and minimize side effects.

    There is no known way to prevent the development of this disease.

    In-depth Information on Pemphigus Foliaceus in Cats

    Pemphigus foliaceus is an autoimmune disease. In other words, it is caused by the animal’s own immune system. In this case, the body recognizes a glycoprotein, desmoglein I, found in the skin as foreign and mounts an antibody response against it. This glycoprotein is involved in the attachment of one skin cell to another within the outer layer of the skin (epidermis).

    The result of the antibody binding to desmoglein I is a loss of attachment leading to a cleft within the epidermis. This cleft fills with fluid and white blood cells called neutrophils, which is the pustule that we see. Cells that are losing their ability to attach to one another round up and float into the middle of the fluid. These large, round cells are called acanthocytes. The pustules are very fragile and rupture easily leaving a lesion in the epidermis that is covered by a crust.

    This disease tends to begin on the bridge of the nose and the ears and progress to the feet, including the footpads, and legs. Eventually the skin of the trunk and the rest of the body are affected. Often the lesions will cross from the skin on the bridge of the nose to the nose itself causing a loss of the normal cobblestone appearance and loss of pigmentation. Skin lesions that involve the nose are seen almost exclusively with autoimmune skin diseases. Animals with pemphigus foliaceus may have a fever and refuse to eat.

    Other diseases that may be confused with pemphigus foliaceus are those that also have pustules as their major lesion. These include:

  • Pyoderma (bacterial infection of the skin)
  • Pemphigus erythematosus also begins on the head but fails to progress any further. Animals with pemphigus erythematosus are not usually as physically sick as those with pemphigus foliaceus.
  • Pemphigus vulgaris and pemphigus vegetans are also part of the pemphigus complex and are quite rare. The difference between the various pemphigus diseases is the depth of the ulcers. Pemphigus foliaceus has the most superficial ulcers. Pemphigus vulgaris has the deepest ulcers.
  • Discoid lupus erythematosus is an autoimmune disease that is often limited to the nose. Rarely, lesions may be seen on the ears, lips, and skin of the groin. This is a much less severe disease than pemphigus foliaceus.
  • Demodicosis, a skin problem caused by infestation with Demodex mites, often begins on the head and spreads to the legs and trunk. Secondary infection with bacteria can lead to pustules and make this disease look like pemphigus. There is no involvement of the nose with this disease.
  • Dermatophytosis (ringworm) is a fungal disease of the skin that can present as a pustular disease.
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