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If titers are not sufficient to maintain proper immunity, a risk vs. benefit assessment should be performed before considering re-vaccination. ■ Specific diseases Pemphigus foliaceus The most common autoimmune skin disorder in the dog, pemphigus foliaceus (PF) is a pustular to crusting autoimmune dermatitis. PF affects the epidermis, targeting various adhesion molecules, especially desmosomes, which hold keratinocytes together. In human PF, the desmoglein-1 glycoprotein (DSG1) in the desmosome is the primary target of autoantibodies and the same glycoprotein was previously suspected to be the primary target in dogs ; however, it is now believed to be a minor autoantigen, with current evidence suggesting that desmocollin-1 is a major autoantigen in canine PF. Genetic factors appear to play a role in the development of PF, with Akitas and Chow Chows the breeds considered most at risk . Triggers include chronic allergic skin disease and drugs (antibiotics, NSAIDs, topical flea spot-ons), but the most important one is ultraviolet light . The initial lesion is a macule that rapidly progresses to pustules, which are often large and coalesce. The pustules are frequently fragile and easily ruptured, resulting in crusting. As a result, crusts are the most common clinical sign. Erosions may be noted; ulcerations are rare but can be present in cases complicated with a deep pyoderma. Canine PF is often characterized by crusting, initially involving the face (especially dorsal muzzle and nasal planum, peri-ocular region and pinnae), and subsequently progressing to a generalized form. Cytology of an intact pustule or of the skin below a crust will often reveal the presence of numerous non-degenerate neutrophils surrounding individual or rafts of acantholytic keratinocytes, which appear as large, rounded basophilic nucleated keratinocytes. Histological evaluation reveals subcorneal pustules containing neutrophils and variable numbers of eosinophils, and acantholytic keratinocoytes. Treatment often involves high doses of steroids with an adjunctive immunosuppressant and topicals for localized treatment. Discoid lupus erythematosus Also referred to as “collie nose” or cutaneous lupus erythematosus, discoid lupus erythematosus (DLE) is a benign ulcerative disease without systemic manifestations . DLE is generally localized to the nasal planum, but can involve the sun-exposed areas of the pinnae and periocular region and there are reports of generalized variants. The most common clinical sign is initial loss of the cobblestone architecture of the nasal planum progressing to depigmentation and scaling.
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