Recognizing and treating ProMeris-triggered pemphigus foliaceus in dogs - Veterinary Medicine
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Recognizing and treating ProMeris-triggered pemphigus foliaceus in dogs
These two case reports outline a basic diagnostic and treatment plan—and, thus, should help you manage this unusual disease.



In dogs, spontaneously arising autoimmune pemphigus foliaceus typically begins and manifests with bilateral, symmetrical, pustular, erosive, and crusted lesions on the face and ears, while pedal or generalized lesions are seen in fewer patients.1 In contrast, as was shown in these two cases, ProMeris-triggered pemphigus foliaceus is unique in that lesions will first appear in the interscapular region—the usual site of ProMeris application—an area rarely affected by lesions of naturally occurring pemphigus foliaceus.5 As a result, it is important to obtain information about the first location of skin lesion development as it will help you differentiate natural pemphigus foliaceus from contact ProMeris-triggered pemphigus foliaceus.

Lesions of ProMeris-triggered pemphigus foliaceus can arise after the first application, but it usually takes more than one dose (up to eight in our series in some cases) for lesions to develop.5 Crusts are usually seen within 14 days of product application.


In our series of 22 dogs with ProMeris-triggered pemphigus foliaceus,5 most patients were older than 6 years of age, female, and heavier than 44 lb (20 kg). Even though a reference population was not available because of their diverse geographic origin, these observations suggest a higher risk of development in female dogs of large breeds, such as Labrador and golden retrievers, or it could merely reflect the higher usage of this product in large-breed dogs.5

Disease types

Two patterns of ProMeris-triggered pemphigus foliaceus have so far been identified: contact and generalized.5

Contact. In one-third of dogs with ProMeris-triggered pemphigus foliaceus, lesions are restricted to or extend from the application site on the proximal dorsal trunk, and systemic signs are seen in only one-third of these dogs.

The cutaneous histopathologic lesions in dogs with localized contact ProMeris-triggered pemphigus foliaceus are similar to those of autoimmune pemphigus foliaceus. In a previous study, skin-fixed antikeratinocyte autoantibodies were revealed in only half of the dogs, while similar autoantibodies were normally not detected in the serum of affected individuals by using indirect immunofluorescence testing.

Localized ProMeris-triggered pemphigus foliaceus has a favorable prognosis with complete remission seen in all dogs, but sometimes only after months of topical or systemic anti-inflammatory or immunosuppressive drugs. Medications can normally be stopped, without relapses, once lesions have resolved.5

Generalized. In two-thirds of dogs with ProMeris-triggered pemphigus foliaceus, lesions start at the application site, but at some point, lesions also erupt at areas distant from these initial sites.5 In this group of dogs, lesions are seen at body areas typically affected by lesions of spontaneous autoimmune pemphigus foliaceus, such as the ears, face, nose, trunk, and feet. Systemic signs (e.g. lethargy, anorexia, fever, lameness) are seen in three-fourths of these dogs.

In these cases, lesions at application sites and areas distant from it are not microscopically different from those of typical autoimmune pemphigus foliaceus. Furthermore, antikeratinocyte autoantibodies are detected in the skin and serum of most of these patients.

In most dogs with generalized lesions, treatment with glucocorticoids alone or with additional immunosuppressive drugs (e.g. azathioprine, cyclosporine) is needed to induce remission, which is not obtained in all patients. Some dogs require long-term treatment with immunosuppressants, and lesions may recur when the doses are decreased.


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