llergies. Allergies. Allergies. That seems to be all we hear when it comes to skin diseases, and they are all treated similarly. The big question is, how did the veterinarian or dermatologist conclude that the pet has allergies when there is no test that definitively determines whether a skin condition or itching is due to allergies (food or inhalant)?
We can check for environmental allergens (things they are allergic to), but that doesn’t guarantee that to be the source of the problem. This leads to some misdiagnoses and treatments that only partially work—or don’t work at all.
One of the classes of diseases that fall under this category is autoimmune disease or, in simple terms, when the animal has an allergic reaction to itself. These diseases do not show up on allergy tests, and often, you may see some response to the typical medications used for allergies. However, the problem is that they never seem to return to normal.
Why? Because the pet can’t get away from the source of the allergic reaction—themselves! Due to the nature of these diseases, they require very different treatments.
From a clinical standpoint, they appear like any other allergic skin disease on the surface level. The pets are itchy, there is skin debris and most have secondary infections. If they are treated with Apoquel (standard dose levels), antibiotics and chlorhexidine shampoo, you may see mild improvement. The issue is much bigger than a standard allergy, though, and has to be treated much more aggressively.
High levels of anti-inflammatories, such as Apoquel, steroids or cyclosporines, are necessary to quell the type of reactions these diseases produce. In some cases, we even have to reach for chemotherapy drugs like azathioprine, chlorambucil, cytarabine or cyclophosphamide. Most of the medicines are ones that most people have never heard of. And that’s because autoimmune diseases are often overlooked, missed or never treated.
To diagnose autoimmune disease, a biopsy of the skin is necessary. This involves surgically removing a small piece of skin, and through a process to “fix” the tissue in a specific form (that can be sliced very thinly), it is then examined under a microscope. In most cases, this is never done because the veterinarian is relying on the assumption that this is just a typical allergy.
- Pemphigus Foliaceus: This is often seen around the head, face, ears, and footpads as crusty debris, pustules and sores. Common dog breeds affected: Chows, Akitas, Bearded Collies, Doberman Pinschers and Newfoundlands. In cats: Domestic Short Hair and Long Hair are most common, but also Siamese, Himalayan, Persians, Maine Coon, American Blue, Scottish Fold, Ragamuffin and Somali cats.
- Pemphigus Erythematosus: Often seen around the face, ears and the bridge of the nose, this tends to be a less aggressive form. Common breeds affected: Collies and German Shepherds.
- Pemphigus Vulgaris: Rare, but this is the most severe form of Pemphigus, which causes sores/blisters in the mouth, lips, genitals and anal area. Common breeds affected: German Shepherds, Collies and Shetland Sheepdogs.
- Pemphigus Vegetans: This is the least common form of Pemphigus, but very aggressive in causing sores and wart-type growths. No breed predilection.
- Discoid Lupus Erythematosus (DLE): This causes sores and lesions on the nose (changes in color/depigmentation), face, eyes, ears and footpads, with crusty debris and hair loss also commonly associated with this form. Common breeds affected: German Shepherds, Collies, Shetland Sheepdogs and Siberian Huskies.
- Systemic Lupus Erythematosus (SLE): A more serious form of lupus affecting skin, joints, muscles and other organs, it can also be associated with lethargy and a fever. Common dog breeds affected: German Shepherds, Collies, Shetland Sheepdogs, Afghan Hounds, Beagles, Irish Setters and Poodles. In cats: Siamese, Himalayan and Persians.
- Puppy Strangles/Juvenile Cellulitis: A disease primarily affecting puppies, this is usually a sudden-onset disease that affects the ears, nose, eyes, mouth and lips. In addition, it is often accompanied by swollen lymph nodes, fever and lethargy, and the puppy may stop eating due to the sores.
- Sebaceous Adenitis: Although not proven, many believe this condition falls into the category of autoimmune diseases. This is an inflammatory process of the sebaceous glands which leads to scarring and non-function of the affected glands. Common breeds affected: Poodles, doodles, Akitas, Samoyeds and Vislas.
These are all severe diseases that not uncommonly end in euthanasia, mainly because they are misdiagnosed and are not given appropriate treatment. As groomers and pet advocates, we must be vigilant in educating our clients about the possibility of these diseases so that the owners seek second opinions with dermatologists or more advanced diagnostics to prevent fatal outcomes.
If a pet is not responding appropriately to treatment and belong to one of the common breeds mentioned, it is advisable to discuss the possibility of a deeper issue. Not all of these cases can be medically managed, but the vast majority can. However, the best chance of successful management is to recognize it early in the process.
The management of these diseases does require veterinary diagnostics and care to get started. The groomer can also play a vital role in the process. Once the veterinarian initiates systemic care, the groomer can focus on managing the infection and restoring the skin barrier, which is crucial to the process. This is where a groomer needs to obtain the necessary education on proper techniques and products to achieve great results.
The following indicate when we should consider autoimmune disease in a pet being treated for “allergies:”
- Lack of response to treatment.
- When the treatment that was previously working stops working and skin issues return with a vengeance.
- Skin issues keep reoccurring even when not in allergy season.
- The dog or cat breed is prone to the disease.
Remember, this is not about diagnosing! This involves making observations and guiding the client to seek appropriate help. There is no way to tell just by looking at a pet whether it has an autoimmune condition or not. That can only be determined with further diagnostics performed by a veterinarian.
Dr. Cliff Faver graduated with a BS in Biology/BA in Chemistry before getting a Veterinary degree in 1987. He is the past owner of Animal Health Services in Cave Creek, Arizona and now the US distributor for Iv San Bernard products, teaches the ISB Pet Aesthetician Certification program, and speaks internationally on hair and skin. His passion is to merge groomers and veterinarians to aid in helping and healing pets. He is also a member of AVMA, AAHA, AZVMA, Board member with Burbank Kennel Club, and has served on Novartis Lead Committee, Hill’s International Global Veterinary Board, and a Veterinary Management Group.