Professional Documents
Culture Documents
A Review of Autoimmune Skin Diseases in Domestic Animals - I - Superficial Pemphigus (Pages 291-305)
A Review of Autoimmune Skin Diseases in Domestic Animals - I - Superficial Pemphigus (Pages 291-305)
A Review of Autoimmune Skin Diseases in Domestic Animals - I - Superficial Pemphigus (Pages 291-305)
Abstract
In humans, the pemphigus denomination encompasses
a group of autoimmune blistering skin diseases with
intraepidermal separation resulting from cellcell
detachment by acantholysis. Entities are classified
based on the level of blistering in the epidermis, and
both superficial (pemphigus foliaceus, IgA pemphigus)
and deep (pemphigus vulgaris, pemphigus vegetans
and paraneoplastic pemphigus) variants are recognized.
In domestic animals, subsets of pemphigus have been
recognized since the mid-1970s, and the disease classification resembles that used for human patients. This
article reviews up-to-date knowledge on the epidemiology, clinical signs, histopathology, immunopathology
and treatment outcome of superficial pemphigus in
domestic animals. Detailed information on canine,
feline, equine and caprine pemphigus foliaceus, canine
and feline pemphigus erythematosus and canine
panepidermal pustular pemphigus is provided.
Accepted 01 August 2006
Introduction
Epidermal cells possess structures that are involved
either in cellcell (desmosomes) or in cellmatrix adhesion
(hemidesmosomes-anchoring fibrils complex). Whenever
autoantibodies target proteins in these adhesion structures, intra- or sub-epidermal separation often occurs, and
clinical signs of an autoimmune blistering skin disease
usually develop.1 In the last 30 years, the identification of
antigens targeted by circulating autoantibodies has helped
reshape the classification of autoimmune blistering skin
diseases in humans. Based on clinical signs, histopathology
and immunological characteristics, several entities are now
well recognized. For example, the most common diseases
associated with autoantibodies against epidermal basement
membrane antigens are bullous pemphigoid (target: collagen
XVII), mucous membrane pemphigoid (laminin-5, collagen
XVII, integrin alpha-6 beta-4) and epidermolysis bullosa
Pemphigus foliaceus
History
The first article describing the existence of PF in dogs was
published in 1977 by Halliwell and Goldschmidt.4 Since
then, this canine disease has been reported worldwide in
countless articles, each reporting one or few cases. Only
three retrospective studies of large series of subjects (37,
26 and 91 cases) have been published in English.5 7 The
first report of feline PF was in 1982,8 and there are only
two papers describing more than 10 cases each.6,9 Pemphigus foliaceus was recognized in horses in 1981,10 and
three articles report multiple patients.6,11,12 Finally, PF is a
rare autoimmune disease of goats and only scattered
reports exist.1316
Incidence and prevalence
Very little epidemiological information on canine PF is
available, unfortunately. In a veterinary teaching hospital
(New York State College of Veterinary Medicine at Cornell
University), PF was diagnosed in 26 of 9750 dogs between
1975 and 1984. This proportion results in an estimated
incidence of PF of approximately three per 1000 canine
patients referred for skin diseases per year.6 In another
institution (Michigan State University College of Veterinary
Medicine), PF was the diagnosis made in 1% of surgical
skin biopsies read by veterinary pathologists (R. W.
Dunstan, personal communication, WSAVA meeting, 1997).
Finally, in a retrospective study of 84 dogs with auto immune skin diseases, PF was the diagnosis given to
26 subjects, nearly one third of all dogs with autoimmune
skin diseases.17
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology. 17; 291305
291
Olivry
Signalment
Genetic factors are likely to predispose to the development
of canine PF. Indeed, data gathered from several studies
suggest that PF is more frequently diagnosed in dogs from
certain breeds. For example, in one group of 37 dogs with
PF, six breeds (bearded collie, Akita, Newfoundland,
Schipperke, Doberman and Finnish Spitz) exhibited a significant risk to develop the trait compared to the control
population.5 However, only two of these breeds (Dobermans
and Akitas) had more than one representative affected,
and both breeds exhibited a high odds ratio (OR) to develop
PF (OR = 29).5 In a second group of 26 dogs,6 Akitas and
dachshunds were the only breeds with more than one
individual diagnosed with PF. For dogs reported in this
article, we calculated the OR for PF development in Akitas
to be 3.0 with a large confidence interval (0.712.9).6 Using
data from the University of Pennsylvania Veterinary Hospital, breeds at significant risk of PF development included
Akitas (OR = 38; 95% confidence interval: 13 99), English
cocker spaniels (21; 888), chows (12; 4 49), shar-peis (8;
230) and collies (4; 214). Finally, in a University surgical
pathology service, three breeds of dogs accounted for one
third of all cases of PF, and OR for the diagnosis of PF were
23, 16 and 7 in Akitas, chows and Australian shepherds,
respectively (R. W. Dunstan, personal communication,
WSAVA meeting, 1997). Interestingly, two female Shetland
sheepdog littermates were reported to develop PF simultaneously at 6 months of age.18 In summary, over the years
and in various geographical locations in the USA, chows
and Akitas appear to be at high risk to develop PF. This
common predisposition may not be surprising in light of
the recent discovery that these two breeds exhibit closely
related genotypes and are in close phylogenetic linkage.19
In the three largest case series of dogs with PF, the
male to female sex ratios were 13:24 (0.5), 14:12 (1.2) and
46:45 (1.0), and these proportions suggest that a sex predisposition is unlikely to occur in this species.5 7 In these
reports, the age of onset of canine PF was very variable,
as it ranged from less than one up to 16 years (means: 4.2,
6 and 6 years).5 7
A breed predisposition for PF has not been reported
definitively in the feline species even though domestic
short-haired cats were found to be most commonly affected
with this disease in two case series.6,9 The male to female
sex ratios were 5:5 and 27:30, suggesting that a sex
predisposition for development of PF in cats also was
unlikely.6,9 In these two studies, the age of onset of feline
PF ranged from less than 1 to 9 and 17 years, respectively
(medians: 5 years).6,9
In the first study of equine PF, Appaloosas accounted for
one third of the patients, a proportion five times higher
than that of the general equine hospital population.6 However, such breed predisposition was not confirmed in the
other two case series.11,12 In none of these three papers
was a sex predisposition apparent.6,11,12 While no article
reported an age predilection for disease development, all
292
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
mentioned above could have suffered from natural autoimmune PF that went into prolonged remission after immunosuppression was discontinued, as has been shown
recently in several dogs with PF.31
To evaluate the probability of association between the
administration of a medication and the development of a
particular event, an assessment of likelihood of drug reaction must be made using adverse drug reaction probability
scales such as the one developed years ago by Naranjo
et al.32 When this scale is applied to all previous cases of
putative drug-related pemphigus in dogs and cats2530 only
low scores interpreted as possible probabilities of drug
reaction are obtained. Therefore, at this time, the strength
of evidence supporting drug causation for rare cases of PF
in dogs and cats is weak at best, and further documentation of canine and feline cases with highly probable drugrelated PF is critically needed.
Clinical signs
Clinical signs of PF appear to be similar across domestic
animal species. In most dogs, lesions initially appear on
the face, principally on the dorsal muzzle, planum nasale,
periocular skin and ears.5,6 In these areas, the pattern usually is strikingly bilateral and symmetrical (Fig. 1).5 In the
largest case series, lesions were restricted to the face in
15 of 91 dogs (16%) (Fig. 2).7 In rare canine patients, the
dermatosis exhibits a generalized distribution from the
onset, but in most cases, lesions will develop towards
regionalization (Fig. 3) or generalization (Fig. 4) over 3 to 12
months.5,7 In the largest retrospective study, generalized
skin lesions were present in 60/91 dogs (66%), and in
these dogs, crusts were most prevalent on the trunk (58%).7
A remarkable finding of canine PF is the predilection of
lesions for the footpads (Fig. 5).5 Indeed, footpad involve-
Figure 1. Canine PF. A 2-year-old chow crossbred dog exhibits crusting and erosions bilaterally and symmetrically distributed on the dorsal
muzzle, dorsal nasal planum and periocular areas.
ment is seen in one third of dogs with PF,7 and rare canine
patients exhibit lesions restricted solely to this location
(Fig. 5; right).6,7,3336 Of note is that mucosal lesions are
only rarely seen in dogs with PF (2/91; 2%).7 Pemphigus
foliaceus confined to the claws has been observed in one
dog.37
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
293
Olivry
294
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
Figure 9. Feline PF. Yellowish crusts are present on the convex (left)
or concave aspects of the pinnae of two cats with PF (left: courtesy
of Dr Barbara Atlee; right: case material from the University of
California Davis).
Figure 10. Feline PF. Crusting can be seen around footpads and
claws (left) or on pads themselves (right).
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
295
Olivry
Figure 13. Canine (left) and feline (right) PF. In these early microscopic lesions, fluid-filled vesico-pustules contain few neutrophils and acantholytic
keratinocytes. The sample on the right was obtained as a shave biopsy from an auricular lesion not existing 2 h before (haematoxylin and eosin).
apoptosis may reflect the phenomenon of anoikis that follows the rupture of desmosomal cadherin adhesion during
acantholysis.50 Alternatively, activation of the apoptotic
pathway could be an early consequence of the binding of
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
Direct immunofluorescence
Direct immunofluorescence (IF) or immunoperoxidase
have been used to detect antikeratinocyte autoantibodies
deposited in vivo in the skin of animals with PF. Skin-fixed
intercellular epidermal IgGs were found in most cats,
horses and goats with PF.6,15 Similarly, intercellular epidermal IgG autoantibodies were detected in 66 80% of
canine specimens examined (Fig. 17).5,6,17,39,53 One study
established that, in some dogs with PF, skin-fixed autoantibodies belonged to IgG2 and/or IgG4 subclasses.54 In rare
instances, intercellular deposits of IgA or IgM and activated
complement (C3 fraction) were observed.6,39 In one third
of canine specimens, intercellular fluorescence was
restricted to the upper half of the epithelium.5 In some
dogs with PF, direct IF testing of skin biopsy specimens
has remained negative, and these results were attributed
to glucocorticoid therapy administered prior to specimen
collection.6 Unfortunately, intercellular epidermal IgG also
can be found in biopsy specimens obtained from dogs with
dermatoses other than PF.6,17 These findings markedly
reduce the specificity of direct IF testing for the diagnosis
of canine PF.
Indirect immunofluorescence
The identification of circulating pemphigus autoantibodies
has been performed historically by means of indirect IF
testing of the animals sera. For many years, this tech-
Immunopathology
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
297
Olivry
Figure 19. Canine PF. Only rare sera from dogs with PF recognize
canine dsg1 expressed ectopically on the surface of transfected 293T
human kidney cells. These results indicate that dsg1 is only a minor
antigen in dogs with PF (indirect IF, anticanine IgG-fluorescein).66
Figure 18. Canine PF. Serum IgG recognize antigen(s) present on the
membrane of superficial epidermal keratinocytes (arrowheads), and
also, in some patients, in the cytoplasm of basal and follicular
keratinocytes (arrows, bottom) (indirect IF, neonatal mouse skin
substrate).59
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
Figure 20. Canine PF. The intradermal injection of IgG from dogs with
PF into neonatal mouse skin results in subgranular blister formation,
thereby confirming the pathogenicity of serum autoantibodies
(haematoxylin and eosin).68
More recently, 43 dogs with PF were seen at the University of Pennsylvania between 1994 and 2000.73 Of these
patients, only 17 of 43 subjects (40%) were still alive at the
end of the study period. Most dogs died during the first
year of treatment. Of the dogs that died, 18 of 26 (69%)
were euthanized because of lack of response of lesions to
therapy, poor quality of life or adverse effects of treatment.73 Interestingly, the addition of antibiotics during the
induction of immunosuppression was associated with a
significant improvement in survival rate in this cohort of
patients.73
In contrast to such results that suggest a poor outcome
following standard-of-care therapy with combined oral
immunosuppression, Rosenkrantz reported a 71% survival
rate after one year in 31 dogs with PF with only four dogs
euthanized because of poor response to therapy or treatment discontinuation with subsequent relapses.69 Similarly,
the latest series of 91 dogs with PF reported by Mueller
and colleagues provided additional data on favourable
treatment outcome.7 Of 88 dogs treated for PF, 46 underwent complete remission (52%), 31 (35%) achieved
partial remission of lesions, and only 11 (13%) were euthanized.7 Reasons for euthanasia included lack of response
to treatment (4/11; 36%), unacceptable side-effects of
medications used (2/11; 18%) and unrelated or unknown
causes.7 Complete remission was achieved with oral glucocorticoids in 15 of 39 dogs (38%) within 1.512 months
of treatment initiation (average: 7 months), and this occurred
with a glucocorticoidazathioprine combination in 18 of 33
dogs (55%) within 229 months (average: 12 months) of
starting therapy. Therefore, the addition of azathioprine did
not lead to a significant difference in the time needed to
achieve remission compared to the use of glucocorticoids
alone.7 In five dogs, however, the sole administration of
prednisolone was unsuccessful, and the addition of azathioprine led to complete lesion remission.7 Remarkably,
adverse drug events occurred significantly more often with
prednisoloneazathioprine combination than glucocorticoids
alone. These observations suggest that a prospective
study must be undertaken to determine whether or not
the addition of azathioprine offers any benefit to glucocorticoid monotherapy in dogs with PF.
In this series of dogs with PF, there were no significant
differences in either rate of complete remission or death
between dogs with facial localized vs. generalized lesions,
dogs treated with prednisolone alone vs. prednisolone and
azathioprine combination, or dogs treated with immunosuppression with or without antibiotics.7 In summary, the
review of treatment outcome in this cohort of dogs with
PF suggests that the benefit of azathioprine addition to
oral glucocorticoid regimens must be weighed carefully
against the cost of treatment monitoring and additional
risk to patients.
Finally, the persistence of long-term remission of canine
PF after discontinuation of immunomodulating therapy
has been reported in 722% of dogs with PF.31 Similar
results were obtained in two of 88 dogs (2%) in the most
recent case series. 7
In cats with PF, glucocorticoid monotherapy usually is
effective for achieving clinical remission. Historically, the
oral glucocorticoids of choice have been prednisone (4
5 mg kg1 daily) and triamcinolone (0.62 mg kg1 daily).9
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
299
Olivry
Pemphigus erythematosus
In humans, PE is a controversial clinically heterogeneous
entity that has been historically linked to both discoid
lupus erythematosus (DLE) and superficial pemphigus.81
Supporting the current concept that human PE in fact represents a variant of PF, immunological investigations have
confirmed the identity of the main human PE autoantigen
as dsg1, the major PF antigen.82,83 Additionally, serum
autoantibodies targeting the basement membrane zone
antigens bullous pemphigoid antigen 1 (230 kDa) and periplakin (190 kDa) have been identified in rare patients.83
The first mention of the existence of PE in animals was
in a general review article of immunological skin diseases
by Scott in 1978.84 Two years later, the same author included
previously reported cases in an article describing clinical,
histopathological and immunological characteristics of
four dogs and one cat with PE.85 In June 2006, the search
of several reference databases identified in addition to
the original princeps descriptions only one case series of
nine dogs6 and scattered case reports of canine39,86 90
and feline PE.91
In the largest case series, PE was reported to be the
third most common form of pemphigus seen at Cornell
University Veterinary Teaching Hospital, yet patients with
PE only accounted for less than one of 1000 dogs and cats
presented with skin diseases over 10 years.6 Unfortunately,
due to the scarcity of information on canine and feline PE,
detailed information on any breed, age and sex predisposition for this disease cannot be provided.
Clinically, dogs and cats with PE are reported to present
with pustules erosions and crusts localized to the face
and pinnae along with depigmentation, erythema and
erosion/ulceration of the nasal planum and dorsal muzzle
(Fig. 21).6,39,8591 Only rare patients exhibit nonfacial lesions.6
Microscopic examination of skin biopsies of dogs and cats
with PE reveals intragranular to subcorneal neutrophilic
and eosinophilic acantholytic pustules suggestive of PF
along with a lichenoid interface dermatitis that resembles
that of DLE.6,39,8591
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
301
Olivry
Conclusions
The last decades have seen the discovery of canine, feline,
equine and caprine homologues of superficial pemphigus
in humans. The 1980s and early 1990s saw the separation
of several subtypes of pemphigus (PF, PE and PPP)
because of minor differences in gross and microscopic
lesions. However, the recent observation of clinical, histological or immunological overlap between these three
entities and the discovery of marked heterogeneity among
dogs with PF suggests that, until further investigations
have characterized the major autoantigens in this group of
diseases, there is not enough evidence to warrant individualizing subsets within the superficial pemphigus group in
animals. The terminology of PF remains most appropriate
at this time, keeping in mind that this denomination might
represent a syndrome rather than a homogeneous entity.
References
1. Fassihi H, Wong T, Wessagowit V et al. Target proteins in inherited
and acquired blistering skin disorders. Clinical and Experimental
Dermatology 2006; 31: 2529.
2. Stannard AA, Gribble DH, Baker BB. A mucocutaneous disease in
the dog resembling pemphigus vulgaris in man. Journal of the
American Veterinary Medical Association 1975; 166: 57582.
3. Hurvitz AI, Feldman E. A disease in dogs resembling human pemphigus vulgaris: case reports. Journal of the American Veterinary
Medical Association 1975; 166: 58590.
4. Halliwell REW, Goldschmidt MH. Pemphigus foliaceus in the
canine: a case report and discussion. Journal of the American Animal Hospital Association 1977; 13: 4316.
5. Ihrke PJ, Stannard AA, Ardans AA et al. Pemphigus foliaceus in
dogs: a review of 37 cases. Journal of the American Veterinary
Medical Association 1985; 186: 5966.
6. Scott DW, Walton DK, Slater MR et al. Immune-mediated dermatoses in domestic animals: ten years after Part I. Compendium
on Continuing Education for the Practicing Veterinarian 1987; 9:
42435.
7. Mueller RS, Krebs I, Power HT et al. Pemphigus foliaceus in 91
dogs. Journal of the American Animal Hospital Association 2006;
42: 18996.
8. Manning TO, Scott DW, Smith CA et al. Pemphigus diseases in
the feline: seven case reports and discussion. Journal of the
American Animal Hospital Association 1982; 18: 43343.
9. Preziosi DE, Goldschmidt MH, Greek JS et al. Feline pemphigus
foliaceus: a retrospective analysis of 57 cases. Veterinary Dermatology 2003; 14: 31321.
10. Johnson ME, Scott DW, Manning TO. A case of pemphigus
foliaceus in the horse. Equine Practice 1981; 3: 405.
11. Zabel S, Mueller RS, Fieseler KV et al. Review of 15 cases of
pemphigus foliaceus in horses and a survey of the literature.
Veterinary Record 2005; 157: 5059.
12. Vandenabeele SIJ, White SD, Affolter VK et al. Pemphigus foliaceus
in the horse: a retrospective study of 20 cases. Veterinary Dermatology 2004; 15: 3818.
13. Scott DW, Smith MC, Smith CA. Pemphigus foliaceus in a goat.
Agri Practice 1984; 5: 3845.
14. Jackson PGG, Lloyd S, Jeffries AR. Pemphigus foliaceus in a
goat. Veterinary Record 1984; 114: 479.
15. Valdez RA, Gelberg HB, Morin DE et al. Use of corticosteroids and
aurothioglucose in a pygmy goat with pemphigus foliaceus. Journal
of the American Veterinary Medical Association 1995; 207: 7615.
16. Pappalardo E, Abramo F, Noli C. Pemphigus foliaceus in a goat.
Veterinary Dermatology 2002; 13: 3316.
17. Werner LL, Brown KA, Halliwell REW. Diagnosis of autoimmune
skin disease in the dog: correlation between histopathologic,
direct immunofluorescent and clinical findings. Veterinary Immunology and Immunopathology 1983; 5: 4764.
18. Noxon JO, Myers RK. Pemphigus foliaceus in two Shetland
sheepdog littermates. Journal of the American Veterinary Medical
Association 1989; 194: 5456.
19. Parker HG, Kim LV, Sutter NB et al. Genetic structure of the purebred domestic dog. Science 2004; 304: 11604.
20. Rosenkrantz WS. Pemphigus foliaceus. In: Griffin CE, Kwochka
KW, MacDonald JM, eds. Current Veterinary Dermatology the
Science and Art of Therapy. St Louis, MO: Mosby Year Book,
1993, 1418.
21. Pascal A, Shiebert J, Ihrke P. Seasonality and environmental risk
factors for pemphigus foliaceus in animals: a retrospective study
of 83 cases presented to the Veterinary Medical Teaching Hospital,
University of California Davis from 1976 and 1994 (abstract). Proceedings of the American Academy of Veterinary Dermatology
and American College.of Veterinary Dermatology Annual Meeting.
Santa Fe, NM: American Academy of Veterinary Dermatology,
1995: 245.
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
303
Olivry
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
Rsum Chez lhomme, la dnomination pemphigus regroupe un ensemble de dermatoses autoimmunes caractrises
par une sparation intrapidermique rsultant dun dtachement cellulaire par acantholyse. Ces entits sont classes en
se basant sur la profondeur du clivage pidermique, et des formes superficielles (pemphigus foliac, pemphigus IgA) et
des formes profondes (pemphigus vulgaire, pemphigus vegetant et pemphigus paranoplasique) sont dcrites. Chez les
animaux domestiques, des formes de pemphigus ont t rapportes depuis le milieu des annes 70 et la classification
animale ressemble celle utilise chez lhomme. Cet article dcrit les donnes rcentes sur lpidmiologie, les signes
cliniques, lhistopathologie, limmunopathologie et le traitement des pemphigus superficiels chez les animaux domestiques. Des donnes dtailles sur le pemphigus foliac canin, flin, quin et caprin, sur le pemphigus rythmateux canin
et flin et sur le pemphigus panpidermique pustuleux canin sont prsentes.
Resumen En humanos la denominacin pnfigo engloba un grupo de enfermedades vesiculares de la piel con separacin intraepidermal resultando en desunin intercelular y acantolisis. Las entidades se clasifican en base al nivel de formacin de vesculas en la epidermis, y tanto variantes superficiales (pnfigo foliceo, pnfigo con deposicin de IgA) como
profundas (pnfigo vulgar, pnfigo vegetativo y pnfigo paraneoplstico) son reconocidas. En animales domsticos,
variantes de pnfigo han sido reconocidas desde la mitad de la dcada de 1970, y la clasificacin de las enfermedades se
asemeja a la utilizada en seres humanos. Este artculo revisa el conocimiento actual sobre la epidemiologa, signos clnicos,
304
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
histopatologa, inmunopatologa y resultados del tratamiento de las variantes de pnfigo superficial en animales domsticos.
Se ofrece asmismo una informacin detallada sobre pnfigo foliceo en perros, gatos, caballos y cabras, pnfigo eritematoso
en perros y gatos, y pnfigo pustuloso panepidermal en perros.
Zusammenfassung Beim Menschen umfasst die Pemphigus-Bezeichnung eine Gruppe von autoimmunen blasenbildenden Hauterkrankungen mit intraepidermaler Separation, welche aus einer Zell-Zell Loslsung durch Akantholyse
resultiert. Die Gruppen werden nach dem Ausma der Blasenbildung in der Epidermis eingeteilt, wobei sowohl oberflchliche
(Pemphigus foliaceus, IgA Pemphigus) als auch tiefe (Pemphigus vulgaris, Pemphigus vegetans und paraneoplastischer
Pemphigus) Varianten anerkannt sind. Bei Haustieren sind Untergruppen von Pemphigus seit der Mitte der 1970er Jahre
bekannt, und die Klassifizierung der Erkrankung ist jener hnlich, die fr humane Patienten verwendet wird. Dieser Artikel
berarbeitet das neueste Wissen in bezug auf Epidemiologie, klinische Symptome, Histopathologie, Immunpathologie und
Behandlungserfolge von oberflchlichem Pemphigus bei Haustieren. Detaillierte Informationen ber Pemphigus foliaceus
beim Hund, bei der Katze, beim Pferd und bei der Ziege, ber Pemphigus erythematosus beim Hund und bei der Katze,
sowie ber den panepidermalen pustulsen Pemphigus beim Hund werden geliefert.
2006 The Author. Journal compilation 2006 European Society of Veterinary Dermatology.
305