C H A P T E R | 8

Autoimmune and ImmuneMediated Skin Disorders

Pemphigus Foliaceus
Pemphigus Erythematosus
Pemphigus Vulgaris
Bullous Pemphigoid and Subepidermal Blistering
Dermatosis
Discoid Lupus Erythematosus
Systemic Lupus Erythematosus
Canine Subcorneal Pustular Dermatosis
Sterile Eosinophilic Pustulosis

Sterile Nodular Panniculitis

Idiopathic Sterile Granuloma and Pyogranuloma
Canine Eosinophilic Granuloma
Cutaneous Vasculitis
Erythema Multiforme and Toxic Epidermal
Necrolysis
Cutaneous Drug Reaction (Drug Eruption)
Injection Reaction and PostRabies Vaccination
Alopecias

AUTHORS NOTE
The most efficient way to confirm an autoimmune skin
disease is through biopsy of appropriate lesions; however,
using a dermatopathologist will greatly increase the usefulness of reported results. Unfortunately, there is a
paucity of dermatohistopathologists; currently, vin.com
and itchnot.com provide the most current listings.
Historically, steroid therapy has been the mainstay
of treatment for these diseases. We are beginning

to realize the usefulness of nonsteroid alternatives (Table

8-1) in many cases, with mild cases often not requiring any
steroid therapy.
The goal of therapy is to control 90% of the symptoms
90% of the time while minimizing the adverse effects of
treatments. Normally, flare-ups will occur, and it is important to differentiate infection (especially pyoderma and
demodicosis) from an actual disease flare.

Pemphigus Foliaceus
Features
Pemphigus foliaceus is an autoimmune skin disease that is
characterized by the production of autoantibodies against a
component of the adhesion molecules on keratinocytes. The
deposition of antibody in intercellular spaces causes the
cells to detach from each other within the uppermost epidermal layers (acantholysis). Pemphigus foliaceus is probably
the most common autoimmune skin disease in dogs and
cats. Any age, sex, or breed can be affected, but among dogs,
Akitas and chow chows may be predisposed. Pemphigus foliaceus is usually idiopathic, but some cases may be drug induced,
or it may occur as a sequela to a chronic inflammatory skin
disease.
The primary lesions are superficial pustules. However,
intact pustules are often difficult to find because they are
obscured by the hair coat, are fragile, and rupture easily. Secondary lesions include superficial erosions, crusts, scales,

epidermal collarettes, and alopecia. Lesions on the nasal

planum, ear pinnae, and footpads are unique and characteristic of autoimmune skin disease. The disease often begins on
the bridge of the nose, around the eyes, and on the ear pinnae
before it becomes generalized. Nasal depigmentation frequently accompanies facial lesions. Skin lesions are variably
pruritic and may wax and wane. Footpad hyperkeratosis is
common and may be the only symptom in some dogs and
cats. Oral lesions are rare. Mucocutaneous involvement is
usually minimal in dogs. In cats, lesions around the nail beds
and nipples are a unique and common feature of pemphigus.
With generalized skin disease, concurrent lymphadenomegaly,
limb edema, fever, anorexia, and depression may be present.

Top Differentials
Differentials include demodicosis, superficial pyoderma, dermatophytosis, other autoimmune skin diseases, subcorneal

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