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Bullous Pemphigoid in Dogs

Bullous Pemphigoid in Dogs: Causes, Symptoms, and Treatment

Bullous pemphigoid in dogs, or BP, is a rare autoimmune disease affecting the skin. Bullous pemphigoid occurs when the immune system mistakes its skin cells as a threat. 

A flawed immune system is the main cause of bullous pemphigoid in dogs. Solar UV exposure, sun damage, and certain medications trigger BP episodes in affected dogs. 

Skin blisters, epidermal collarettes, itchy skin, hives, oral or nasal lesions, anorexia, depression, and fever are common signs of bullous pemphigoid in dogs

Diagnosing bullous pemphigoid autoimmune conditions is multifaceted. Treatment requires a combination of immune-suppressants, antibiotics, and topical therapies. 

Bullous pemphigoid in dogs must be differentiated from pemphigus canine. Dog pemphigus is a separate autoimmune condition with different triggers. 

What is Bullous Pemphigoid in Dogs?

Bullous pemphigoid in dogs is a rare autoimmune skin disease that clinically manifests with blisters. The short-term name for bullous pemphigoid is BP. 

Bullous pemphigoid may sound like a form of pemphigus, but it is actually a different type of autoimmune skin disease, state Malcolm Weir, DVM, and Ernest Ward, DVM, in an article on “Autoimmune Skin Disease in Dogs” for VCA Animal Hospitals.  

Bullous pemphigoid is one of several known autoimmune subepidermal blistering diseases (AISBDs), together with mucous membrane pemphigoid (MMP) and epidermolysis bullosa acquisita (EBA). 

“Clinical signs of BP usually include severe dermatological alterations with a variable prognosis,” according to a study, “Bullous Pemphigoid in a Dog,” published in Acta Scientiae Veterinariae in 2021. 

Immediate and aggressive treatment is necessary for a bullous pemphigoid dog diagnosis. BP in dogs is life-threatening if left untreated. 

What are the other terms for Bullous Pemphigoid in Dogs?

There are no other terms for bullous pemphigoid in dogs. The condition is sometimes classified under immune-mediated conditions or skin blisters and pustules. 

Bullous pemphigoid manifests as a common blister or a long-term form. The blister form is called “bullous” and is more widespread. The rarer long-term form is classified as “chronic.”

How does Bullous Pemphigoid differ from other Autoimmune conditions in dogs?

Bullous pemphigoid differs from other autoimmune conditions by being self-limiting. BP resolves independently in some cases, which is not the case with other autoimmune subepidermal blistering diseases (ASBDs). 

Bullous pemphigoid is often mistaken for pemphigus due to their naming conventions. Pemphigus is a separate autoimmune skin disease in dogs. The immune system in pemphigus attacks the skin cells’ connections. 

Bullous pemphigoid is similar in etiology and clinical signs with other autoimmune conditions in dogs and is identical in presentation with atopic dermatitis and contact skin allergy. 

How Bullous Pemphigoid in Dogs developed?

Bullous pemphigoid in dogs develops slowly. The condition starts when the immune system mistakes its skin cells as an external threat. 

The immune system creates pemphigoid antibodies that attack the skin's surface and mucosal barriers. 

The attack triggers inflammation and skin lesions. The lesions impair the dog’s protective skin barrier and increase the risk of secondary bacterial and fungal skin infections. 

Who is at risk of developing Bullous Pemphigoid in Dogs? 

Dogs of all ages and breeds are at risk of developing bullous pemphigoid, which is frequently reported in certain breeds. 

Commonly affected breeds include Dachshunds, German Shepherds, Akitas, Collies, Shetland Sheepdogs, and Doberman Pischers. BP in dogs is too low to determine exact breed predisposition. 

Males are affected by bullous pemphigoid twice as often as females, according to a study, “Spontaneous Autoimmune Subepidermal Blistering Diseases in Animals: A Comprehensive Review,” issued in BMC Veterinary Research in 2023. 

How common are Bullous Pemphigoid in Dogs?

Bullous pemphigoid in dogs is rare. The condition is the third most common form of AISBD (autoimmune subepidermal blistering disease). 

Bullous pemphigoid accounts for 10% of all AISBD cases in dogs, according to a study, “An Autoimmune Subepidermal Blistering Skin Disease in a Dog? The Odds are that it is not Bullous Pemphigoid,” published in Veterinary Dermatology in 2014. 

The common AISBD forms in canines are mucous membrane pemphigoid (MMP - 48%) and epidermolysis bullosa acquisita (EBA - 26%). The group of AISBDs includes several other rarer forms than bullous pemphigoid. 

What does Bullous Pemphigoid in Dogs look like?

Bullous pemphigoid (BP) in dogs looks like blisters, open sores, and circular red lesions on the skin. BP manifests quickly. The hallmark sign is blisters (vesicles) that burst, forming ulcers or open sores. 

The blisters and circular red lesions are found on the head, neck, abdomen, groin, and feet. Blisters and ulcers are frequently visible on the skin-to-mucosal barrier of the lips and nose.

Pet owners ask, “What does bullous pemphigoid look like?” Answering the question is difficult because the blisters disappear quickly, changing the disease’s clinical manifestation. Here are some pemphigus dog photos to illustrate the various stages of the condition.

What are the Causes of Bullous Pemphigoid in Dogs?

The causes of bullous pemphigoid in dogs are listed below. 

  • Faulty Immune System: A defective immune system is the leading cause of dog BP. The immune system misidentifies a protein structure beneath the skin's surface and inner mucus lining as a threat and triggers an attack. The attack is coordinated by an autoantibody called the pemphigoid antibody. 
  • Genetic Predispositions: A study titled “Spontaneous Autoimmune Subepidermal Blistering Diseases in Animals: A Comprehensive Review,” published in BMC Veterinary Research in 2023, identified a strong genetic predisposition to BP. 
  • Environmental Triggers: A complex interplay between environmental factors such as seasons and autoimmune conditions was reported in a human study, “Environmental Factors in Autoimmune Bullous Diseases with a Focus on Seasonality: New Insights,” published in Dermatology Reports in 2023. Pet owners who ask, “What causes bullous pemphigoid?” must consider that environmental factors, like sun exposure and certain medications, are crucial in dogs. 
  • Infections: Infections are the answer to “what triggers bullous pemphigoid” in predisposed dogs. Bacterial and viral infections provoke the immune system, triggering and worsening BP in dogs and autoimmune conditions in general. 

What are the Symptoms of Bullous Pemphigoid in Dogs?

The symptoms of bullous pemphigoid in dogs are listed below. 

  • Blisters (Vesicles): Blisters or vesicles are large and thin-walled bubbles filled with a transparent fluid. Blisters are a telltale sign of bullous pemphigoid with a short lifespan. The blisters form and burst quickly, transforming into open sores and ulcers.  
  • Epidermal Collarettes: Epidermal collarettes are large circular skin lesions with peeling edges and well-defined rims. The epidermal collarettes are widespread and most present on the dog’s head, neck, abdomen, groins, and feet.  
  • Itchy Skin: The skin of dogs with bullous pemphigoid is very itchy. The dog scratches or licks itself to relieve the itchiness, causing damage when it accidentally bursts the blisters. 
  • Hives: Hives or welts are red and raised bumps or splotches. Hives in dogs with bullous pemphigoid develop before, during, and after the blisters. 
  • Oral and Nasal Lesions: Blisters and ulcers develop in the moist tissue lining between the skin and mucosal membrane of the mouth and nose. The blisters are short-lived and form ulcers after bursting. 
  • Anorexia: Dogs with advanced forms of bullous pemphigoid exhibit reduced appetite or refusal to eat entirely. The pain associated with oral lesions and ingestion is the leading cause of the dog’s unwillingness to eat. 
  • Depression: Depression that manifests with low energy and increased sleepiness is common in dogs with BE. The itchy skin and painful lesions make dogs disinterested in daily activities. 
  • Fever: Fever occurs in dogs with secondary skin infections of bacterial or fungal origin. Dogs with bullous pemphigoid are susceptible to secondary infection. 

When does Bullous Pemphigoid in Dogs Symptoms usually occur?

Bullous pemphigoid symptoms in dogs usually occur when the dog is around five years old. Five years is the median age of onset. Uncommon cases are reported in dogs aged 10 months to 15 years. 

Dogs predisposed to bullous pemphigoid do not develop blisters and other skin lesions until provoked in some cases. Common triggers include skin damage and certain medications. 

What are the Risk Factors of Bullous Pemphigoid in Dogs?

The risk factors of bullous pemphigoid in dogs are listed below. 

  • Genetics: Certain dog breeds are commonly diagnosed with bullous pemphigoid, indicating a genetic risk factor. Affected breeds include Doberman Pinschers, Collies, Shetland Sheepdogs, Dachshunds, German Shepherds, and Akitas. 
  • Certain Medications: Antibiotics (sulfonamide, penicillin, and cephalosporin) and topical medications for parasite prevention (amitraz, pyriproxyfen, permethrin, S-methoprene, dinotefuran, and fipronil) trigger bullous pemphigoid in predisposed dogs. 
  • Skin Damage: Skin damage is a risk factor for provoking bullous pemphigoid episodes. One of the most essential skin damage factors is sunburn. Sunburns or exposure to UV light triggers and worsens already existing skin lesions. 
  • Other Health Problems: Risk factors for people with bullous pemphigoid include diabetes, rheumatoid arthritis, and ulcerative colitis, but studies have yet to confirm if their occurrence applies to dogs. 

How is Bullous Pemphigoid in Dogs Diagnosed?

Bullous pemphigoid in dogs is diagnosed based on clinical manifestations, lesion types, risk factors, and various tests and procedures. 

The veterinarian starts with the dog’s history and a complete body examination. The vet takes a skin or lesion biopsy and collects a blister fluid sample for evaluation.  

Blood tests, urine analysis, and bacterial cultures are conducted to determine the dog’s overall status and the presence of secondary skin infections. 

Modern veterinary medicine does not provide a specialized test for diagnosing bullous pemphigoid in dogs. 

The veterinarian must combine the clinical features (breed, age, lesion distribution) with results from histological analysis to diagnose BP and differentiate it from the other forms of AISBDs.  

Where can you seek a diagnosis for Bullous Pemphigoid in dogs?

You can seek a diagnosis for bullous pemphigoid in dogs at the vet’s office. Diagnosing BP is complex and challenging. 

“For diagnosing AISBDs in dogs, as in other species, clinicians are to remain kings for years to come! The diagnosis of these diseases shall not, and never will be made from a blood test result,” declares a study “An Autoimmune Subepidermal Blistering Skin Disease in a Dog? The Odds are that it is not Bullous Pemphigoid,” published in Veterinary Dermatology in 2014. 

General veterinary practitioners regularly send dogs with suspected bullous pemphigoid to vets specializing in dermatology. 

What are the Treatments for Bullous Pemphigoid in Dogs?

The treatments for bullous pemphigoid in dogs are listed below. 

  • Immunosuppressants: Immunosuppressants are the standard treatment for autoimmune issues. Low doses of different immune-suppressing drugs reduce the risk of side effects. Protocols include prednisone (glucocorticoid) used alone or with more potent drugs, such as azathioprine or cyclosporine (Atopica). Careful monitoring is vital during the use of steroids and immunosuppressants to avoid adverse reactions. 
  • Topical Steroids or Immunomodulators: Topical steroids and immunomodulators such as tacrolimus are used in cases of mild and localized skin issues. The short-term topical therapy keeps the condition in remission for some time. 
  • Systemic Antimicrobials: Systemic antibiotics or antifungals are recommended for dogs with secondary bacterial or fungal skin infections. The veterinarian performs culture or sensitivity testing to determine the best antimicrobial. 
  • Antibacterial Soaks: Medicated shampoos with hydrocortisone and antibacterial agents are helpful products that must be used appropriately. Autoimmune skin is fragile, and the mechanical action of rubbing shampoos and rinsing them does more harm than good in some cases. Practice gentle soaks instead of vigorous washing when using shampoos. 
  • Alternative Therapy: Acupuncture is a novel treatment approach for autoimmune skin diseases in dogs. The method shows promise but requires more in-depth research to determine its exact impact on pemphigus dogs treatment. Acupuncture combines herbs such as Tripterygium wilfordii, Berberis vulgaris, Artemisia annua, and Curcuma wenyujin

How to boost the dog’s immune system to prevent Bullous Pemphigoid?

To boost the dog's immune system to prevent Bullos Pemphigoid, follow the steps below.

  1. Exercise the Dog. Maintaining a healthy body weight boosts the dog’s immune system. Excess fat increases the production of inflammation-promoting hormones. Consult the veterinarian and request an exercise program tailored to the dog’s breed, age, and overall health. Make the exercise regimen a habit to keep the dog fit and healthy.  
  2. Provide a Healthy Diet. A nutritious, balanced diet of proteins, fats, vitamins, minerals, and antioxidants promotes immune strength. Apples, berries, carrots, sweet potatoes, and pumpkin are among the best immune-boosting foods for dogs. 
  3. Use Supplements. The modern pet market offers plenty of supplements for boosting dogs' immune systems. Consult the veterinarian and choose natural supplements such as CBD products and probiotics. 
  4. Visit the Vet Regularly. Preventing diseases and parasite infestations helps boost dog immune system. Use veterinary visits to have the dog thoroughly examined. The vet exam is the perfect time to catch issues early on and prevent them before they advance. 

Can CBD Oil Help Reduce Bullous Pemphigoid in Dogs?

Yes, CBD oil can help reduce bullous pemphigoid in dogs. CBD does not directly cure bullous pemphigoid or other autoimmune diseases but helps with addressing the symptoms and effects. 

CBD has immune-modulating solid and anti-inflammatory effects. The anti-inflammatory and immuno-modulating properties of CBD directly in dogs' immune cells are shown in a study “Effect of Cannabidiol (CBD) on Canine Inflammatory Response: An Ex Vivo Study on LPS Stimulated Whole Blood,” published in Veterinary Sciences in 2021. 

CBD promotes skin health and reduces itchiness. Cannabidiol decreases pruritus, according to a study, “The Effect of a Mixed Cannabidiol and Cannabidiolic Acid Based Oil on Client‐Owned Dogs with Atopic Dermatitis,” published in Veterinary Dermatology in 2021. 

CBD (cannabidiol) is sourced from the hemp plant. CBD oil for dogs is non-psychoactive and non-addictive and works through the dog’s endocannabinoid system (ECS). CBD is safe to use simultaneously with mainstream medications. 

What is the recovery time after treatment for a Bullous Pemphigoid in Dogs?

The recovery time after treatment for bullous pemphigoid in dogs is between three and eight weeks. The exact time frame depends on the severity of the lesions.  

Skin lesions resolve slowly, and the autoimmune component prolongs healing. Keep the dog from targeting the blisters to avoid healing complications. 

Wearing an Elizabethan collar prevents the dog from biting and licking the wounds. Limit sun exposure during recovery because ultraviolet (UV) light worsens skin lesions.   

How can you boost a dog's immune system to prevent Bullous Pemphigoid?

You can boost a dog’s immune system to prevent bullous pemphigoid by making minor lifestyle changes. Exercise the dog regularly, provide nutritious food, and add natural immune-boosting supplements to its daily intake. 

Consult the veterinarian about the best supplements for immune support in dogs. Pet CBD oil and probiotics are popular options, and their effectiveness is scientifically supported. 

Regular veterinary checkups must be practiced to detect underlying health conditions before they progress and weaken the dog’s immune system. 

Is Bullous Pemphigoid in Dogs Contagious?

No, bullous pemphigoid in dogs is not contagious. Bullous pemphigoid is an autoimmune skin condition. The disease develops when the immune system mistakes the skin cells for external threats and targets them. 

Bullous pemphigoid does not spread from sick dogs to other canines or humans. It is not associated with allergies or affected by diet and lifestyle.