CONCLUSION
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
REFERENCES
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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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