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.



The two dogs described in this article had histories and skin lesions typical of those of generalized ProMeris-triggered pemphigus foliaceus. In both dogs, oral prednisolone administered at immunosuppressive doses led to the progressive disappearance of skin lesions, the eventual cessation of treatment, and a lack of disease recurrence after glucocorticoid withdrawal. This rapid positive response to treatment is unusual for dogs with generalized ProMeris-triggered pemphigus foliaceus, which typically requires prolonged immunosuppressive therapy. In these two dogs, the excellent outcome might be related to the lack of detectable serum autoantibodies, which suggests that a systemic antikeratinocyte autoimmune response, if present, might have been mild or transient.

Our observations argue for the early recognition of interscapular lesions and evaluation of their association with a previous application of ProMeris. Once ProMeris-triggered pemphigus foliaceus is diagnosed, it is crucial to stop application of ProMeris, wash the area, and immediately start treatment with topical or oral glucocorticoids depending on lesion severity (see the Related Link below titled "How to manage suspected cases of ProMeris-triggered pemphigus foliaceus" this issue).

If lesions are seen at body areas distant from the product application site, then the patient should be considered as having a ProMeris-triggered autoimmune disease that mirrors spontaneous pemphigus foliaceus. In these cases, and pending additional information, diagnostic procedures and treatment are recommended to be similar to those for natural pemphigus foliaceus.

To the best of our knowledge, similar reactions have not been reported in cats with the ProMeris formulation that contains metaflumizone.

Editors' Note: In April, Pfizer Animal Health announced that it has decided to discontinue the distribution of ProMeris by the fall.

Ursula Oberkirchner, DrMedVet
Thierry Olivry, DrVet, PhD, DACVD, DECVD
Department of Clinical Sciences
College of Veterinary Medicine
North Carolina State University
Raleigh, NC 27606

Keith Linder, DVM, PhD, DACVP
Department of Population Health and Pathobiology
College of Veterinary Medicine
North Carolina State University
Raleigh, NC 27606


1. Olivry T. A review of autoimmune skin diseases in domestic animals: I - superficial pemphigus. Vet Dermatol 2006;17:291-305.

2. Medleau L, Shanley KJ, Rakich PM, et al. Trimethoprim-sulfonamide-associated drug eruptions in dogs. J Am Anim Hosp Assoc 1990;26:305-311.

3. Noli C, Koeman JP, Willemse T. A retrospective evaluation of adverse reactions to trimethoprim-sulphonamide combinations in dogs and cats. Vet Q 1995;17:123-128.

4. White SD, Carlotti DN, Pin D, et al. Putative drug-related pemphigus foliaceus in four dogs. Vet Dermatol 2002;13:195-202.

5. Oberkirchner U, Linder KE, Dunston S, et al. Metaflumizone-amitraz (Promeris)-associated pustular acantholytic dermatitis in 22 dogs: evidence suggests contact drug-triggered pemphigus foliaceus. Vet Dermatol 2011;Mar 21. [Epub ahead of print].


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