My dog was diagnosed with an autoimmune skin disease called Pemphigus foliacius, after 3 months of treatment for skin fungus. I had never heard of this disease until he was diagnosed. It apparently has a 50% mortality rate, mostly beacause of euthanasia. He has been taking prednisone, Azathioprine, and Tacrolimus Ointment for the past 9 months. His condition has improved to near normal. My question is wil lhe be on medication the rest of his life and what effect will continued therapy have?
Pemphigus foliaceus is a common immune mediated skin disease in dogs, and fortunately is controllable in most. Up to 15-20% of cases are euthanized due to uncontrollable disease or due to the difficulty and financial obligation of continuous medications and laboratory monitoring. Some cases of pemphigus are drug induced (ie. an unpredictable reaction to an antibiotic, non-steroidal medication, etc), but in many cases no identifiable cause is found. In the drug-induced cases, withdrawl of the offending drug and a course of immunosuppressive therapy can be curative, with no recurrence of skin disease after a very slow taper of immunosuppressive medications over several months. In other cases, skin pustules and crusts recur when immunosuppressive drugs are decreased or stopped, and in these cases medications such as prednisone and azathioprine are needed lifelong to control the disease, although usually at lower doses such as every 2-3 days. Prednisone typically causes elevated liver enzymes, and this effect is diminished as the dose is slowly decreased. Azathioprine can cause bone marrow suppression, which is why monitoring of the complete blood count is important, and adjusting/decreasing the dose if needed. Once I have a dog in remission, I usually decrease one drug slightly once a month, monitor for any flare of crusts, and if no flare occurs, then I try to decrease the dose or frequency again. Typically I aim for control of disease with prednisone given every 2-3 days, and azathioprine every 2-3 days (given on the day that prednisone is not given). If I have a dog that has not flared on q 3 day therapy, then I try q 5 days, etc. I had one very difficult Chow case that took 6 months to get into remission, and then over the next 2 years we decreased his immunosuppressive drugs ever so slowly to the point where we were finally able to stop all drugs, and he is now doing well; every case is different, and it takes close teamwork and monitoring by you and your veterinarian to determine the ultimate right dose/frequency of medications for control of disease.
Hope that helps,
Kimberly Coyner, DVM DACVD
Dermatology Clinic for Animals of Las Vegas
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