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Pemphigus in Cats
Pemphigus foliaceous in Birman
Pemphigus
also see Immune problems
also see allergy
Pemphigus foliaceous in BirmanQuestion: Dear Dr. Michael,
My 8 year old Birman male cat has just been diagnosed with Pemphigus Foliaceous. He has constant
infections of the toes, has acne around his mouth and nazal passage, and some inflamation around his
penis.I cannot find a reference to this illness anywhere, and apart from treatment with steroids, I cannot find out
what this illness is. Could you please explain what this is, is there any other recommended treatment and what the long term prognosis would be.Thank you so much, Jane
Answer: Jane-
Pemphigus foliaceous is an uncommon immune mediated skin disease that can occur in either
dogs or cats. The symptoms are pretty much what you have described, sores that form around
areas in which normal skin meets specialized skin. Most commonly this includes the face, feet,
rectal, inguinal and genital regions. Cats often have irritation around their nipples. In dogs and
cats this condition usually has pustules and skin crusts or ulcerations rather than blisters, as is
seen in humans. There may be some waxing and waning over the course of these disease but in
general it is a lifelong problem. I do not think that there are any known predisposing causes
(except possibly food allergies as discussed below). I think that this condition is more common
in Siamese and other oriental breed cats but I'm not sure that is true.Skin biopsy is necessary to diagnose pemphigus with certainty and sometimes special fixatives
have to be use (Michel's fixative).Pemphigus foliaceus sometimes responds to topical corticosteroids, especially when the number
of sore areas is small. More commonly systemic treatment is required, though. Oral
corticosteroids, usually prednisone, are used most commonly. If corticosteroids are not sufficient
alone, there are other therapies. Chlorambucil (Leukeran Rx) can added to prednisone usage.
The dose for chlorambucil when used with prednisone for pemphigus is 0.2mg/kg every 24 to
48 hours (Helton-Rhodes 1994). Some vets use azathioprine (Imuran Rx) but there are reports
of this causing severe side effects, including death, in cats, so it should be used cautiously or as a
last resort. Chrysotherapy (gold salt therapy) has been used in cats and is reported to work
well.Some people feel that food allergies may play a role in pemphigus diseases in cats and there
probably isn't any reason not to try a food trial to rule this out. Vitamin E supplementation may
be helpful.In our practice we have had pretty good luck with prednisone but we had one cat who did not
respond to prednisone or to prednisone/chlorambucil combinations. The owners elected to
euthanize this cat without pursuing gold salt therapy. So far, that is the only cat I can remember
that didn't respond to treatment and I suppose it might have responded to gold salt therapy,
although that wasn't tried.I hope this helps some.
Mike Richards, DVM
11/15/2001
Question: Dear Dr. Richards, My girlfriend has recently had one of her cats diagnosed with
phemphigus folliaceous based on clinical exam and skin biopsy. I am an orthopedic
surgeon and have some experience with patients with related auto-immune diseases.
Her cat seems to have responded well to steroids (high dose from what I would see
in people) and my question is several part. 1) Do steriods have all the negative side
effects in cats as people. e.g. osteoporosis, skin fragility, muscle atrophy, ect? 2)
She is going to begin gold salt rx. This has been used in the past with human
rheumotoids but has falling into some disuse lately with more emphasis on the
"disease modifying agents" such as methotrexate, imuran, and now arava. Are any
of these "dma" agents being used in cats for treatment of this disease?
ps. I can't tell how excited we are about your web site. She has three cats and I
have six. As I'm sure with most subscribers, they are more like children than pets so
it's great to see someone giving them serious consideration.
Answer: J.
Cats are much less sensitive to side effects from corticosteroids than other animals (and I assume people, too). I am not at all sure why this is the case. But they do still experience all the same effects, just less severely or requiring much higher dosages to cause them.
There is an article on using gold salts in cats for pemphigus that I found in one of the databases. I have been under the impression that reaction to gold salts was more common in cats than in dogs (and there are several reports of deaths associated with gold salt therapy in dogs) but there is no mention of this in the report. I think that it is recommended that a small test dose be used prior to initiating therapy, in order to evaluate the potential for adverse reactions.
Chlorambucil is recommended as an adjunct to prednisone by several veterinary dermatologists. The protocol for this is in Kirk's Current Veterinary Therapy XII but that book is at my office and I am at home. Your vet would probably have this reference, though. I can't recall any mention of methotrexate use. Azathioprine (Imuran Rx) has been used in cats and can also be used in conjunction with corticosteroids, if necessary. Leflunomide (Arava Rx) has been used in dogs but I have not seen any reports of its use in cats. Due to the numerous oddities in cat's ability to process medications it is best to wait until someone else tries things first unless you get really desperate.
We have had pretty good luck treating pemphigus in cats with prednisone, alone. We have tried prednisone and azathioprine in at least one patient who was refractory to prednisone alone and it seemed to help. Hopefully you will experience similar success.
Mike Richards, DVM
10/15/99
Last edited 08/01/05
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