User:Chairomai/Autoimmune skin diseases in dogs: Difference between revisions

Browse history interactively

← Previous edit

Content deleted Content added

VisualWikitext

Inline

Latest revision as of 21:52, 16 April 2024

There are many autoimmune diseases, and they all vary in impact to the dog and progress at their own rates.^[1]

This is the sandbox page where you will draft your initial Wikipedia contribution.

If you're starting a new article, you can develop it here until it's ready to go live.

If you're working on improvements to an existing article, copy only one section at a time of the article to this sandbox to work on, and be sure to use an edit summary linking to the article you copied from. Do not copy over the entire article. You can find additional instructions here.

Remember to save your work regularly using the "Publish page" button. (It just means 'save'; it will still be in the sandbox.) You can add bold formatting to your additions to differentiate them from existing content.

Bibliography sandbox

Article Draft

Lead

Autoimmune skin diseases occur when the immune system of an infected animal attacks its own skin.^[2] In dogs, autoimmune skin diseases are usually not detected until visible symptoms appear, which differs from detection in humans who are able to verbally express their concerns.^[3] Genetics, nutrition, and external environmental factors all collectively contribute to increasing the probability an autoimmune skin disease occurring.^[4] The severity of symptoms varies based on the specific disease present and how far it has progressed. Diagnosis often requires the onset of visible symptoms and for a biopsy to be performed. For many diseases, the condition itself cannot be cured, but a veterinarian can prescribe medications and other forms of treatment to help manage the symptoms of the dog.^[5]

Article body

Overview

The immune system is a defense system that detects and protects against invaders that result in infections. It holds the ability to differentiate between the body's healthy cells from foreign cells.^[6] With autoimmune diseases, the immune system loses the ability to function appropriately to make this distinction, so the body begins to attack itself.^[7] Autoimmune skin diseases in the base layer of the epidermis are characterized by damage to the connective tissue and vesicle formation located below the epidermis layer and the dermis layer below it.^[8]There are many autoimmune diseases, and they vary in impact on the dog and progress at their own rates.^[9]Testing performed can include skin biopsy, scans, or bloodwork being collected and documenting onset symptoms to assist with diagnosis.

Clinical symptoms

Dogs suffering from autoimmune diseases of the skin may experience a variety of symptoms, including persistent itching and scratching, lesions, wounds, blisters, and other skin damage, as well as loss of skin pigment.^[10] Two cases of autoimmune diseases that are often found include Discoid lupus erythematosus (DLE) and Pemphigus. DLE can develop into Systemic Lupus Erythematosus (SLE).^[11]

Most symptoms occur after the outer epidermis and inner dermis of the skin are affected by the disease. When this happens, the layers of the skin begin to separate, leading to painful lesions and pustules. ^[12] The compromised integrity of the skin barrier not only exacerbates the discomfort experienced by the dog, but also heightens the risk of secondary bacterial infections. The weakening of the skin’s protective layers forms an environment susceptible to microbial infiltration, which could lead to severe complications. Intervening within an earlier time frame and targeted management strategies are essential to minimize further adverse effects.^[13]

Another autoimmune skin disease which can occur in dogs is vitiligo. In addition to humans, vitiligo can be found in a variety of animals, including cats, horses, and dogs. Vitiligo is a type of autoimmune disease that damages melanocytes in the skin, lips, and oral cavity. Melanocytes are cells that contain pigments such as melanin. These pigments give rise to an organism's phenotype, which determines skin and hair color.^[14] The affected melanocytes cause the skin and/or hair to become white or light pink. Melanocytes are also found in other parts of the body, such as the oral mucosa, eye, cochlea, and the meninges. In addition to vitiligo, there are other autoimmune diseases that target melanocytes, such as Vogt-Koyanagi-Harada (VKH) syndrome, and Uveodermatological (UDS) syndrome.^[15] Vogt-Koyanagi-Harada syndrome is an autoimmune disease that affects the eyes. In addition to depigmentation of the skin, the disease is characterized by a combination of conditions, including uveitis, acute iridocyclitis, choroiditis, and retinal detachment.^[16]

When pemphigus occurs in humans, the skin will begin to blister due to antibodies attacking the adhesive proteins in epidermal cells, which causes them to separate. Different types of pemphigus can be identified based on the depth of separation present in the skin. Many forms of pemphigus can be identified in dogs using methods similar to those employed for humans.^[17]

Pemphigus vulgaris is rare in humans and animals, but is often fatal if left untreated. In dogs, the disease presents itself so similarly to the way it occurs in humans that dogs can be used as research models for the human disease.^[18] When the disease first begins to manifest itself, lesions are usually evident in the oral cavity of the dog.^[19] Aside from these blisters, the dog may be mostly asymptomatic before the disease progresses further.^[18] The blisters are easily ruptured and become painful upon doing so,^[18] which can cause the dog to have difficulty eating.^[20] As the disease progresses, the infected dog can become severely infirm, and may succumb to further infection.^[18] Sometimes symptoms are characterized by lymphadenopathy, which involves loss of appetite, weakness, fever, and in rare cases, sepsis.^[19]

Pemphigus foliaceus is the most common autoimmune skin disease in dogs, making up around one-third of all canine autoimmune disorders.^[21] This disease usually affects areas of the ears and face.^[19] Early symptoms are characterized by depigmentation of the nasal palate, dorsal cleft in the mouth, the ear, and the periocular area around the eye. Itching, pain, and weakness of the body have been observed in some cases. Other symptoms of Pemphigus foliaceus include hair loss, formation of pustules, and erosions with ulcers. These symptoms can appear on the dog's feet, groin area, and trunk if left untreated.^[21]

Disease incidence process

The immune system functions in many ways to eliminate foreign substances and particles introduced to the body. This revolves around T-cell differentiation, where mature T-cells with receptors for non-self cells target foreign antigens and act with other cells to dispose of them.^[22] There are two mechanisms of tolerance found in the immune system. The first mechanism is positive selection by the thymus, where only T cells are selected. T cells recognize peptides in the Histocompatibility Complex (MHC).

Incidences of autoimmune skin diseases can vary based on several factors. Some of these factors include the breed, age, and sex of the dog, along with individual genetics and environmental factors.^[23] In terms of vitiligo, certain breeds of dogs have a higher chance of developing the disease based on their genetics. These breeds include Rottweilers, German Shepherds, Old English Sheepdogs, Doberman Pinchers, Dachshunds, and German Shorthaired Pointers.^[24] However, the exact prevalence of this disease in dogs is currently unknown, as it is likely under-reported.^[25] Certain dog breeds that have been documented with VKH syndrome include Akitas, Samoyeds, Irish Setters, Golden Retrievers, Saint Bernards, Australian Sheepdogs, and Shetland Sheepdogs.^[16]

Pemphigus vulgaris can occur in any breed of dog irrespective of its sex or age.^[18] However, it appears to occur more often in male dogs than females, which differs slightly from its occurrence in humans. In humans, women are more likely to be affected than men. In terms of age, the disease usually begins when the dog is at least five to seven years old. This correlates to the typical age in which it begins in humans as well, generally occurring in middle age.^[20]

Diagnosis

Since many autoimmune skin diseases have similar symptoms and usually affect the oral cavity, a biopsy must often be performed in order to correctly diagnose the disease.^[26] Due to the wide scale of clinical symptoms that can be present, along with the diverse variations of skin autoimmune dermatoses, a single symptom will more than likely not lead to a diagnosis. Instead, the results of the biopsy combined with the canine's history and other clinical signs can help in confirming the diagnosis of the disease. Breed predisposition and the age of the dog can also be indications of the various possibilities of autoimmune skin diseases. ^[27] Some common symptoms that can be used to lead to a confirmed diagnosis include alopecia, crusting, ulcerations, vasculitis, and many more. ^[27]

Histopathology evaluations can be done by extracting areas of the skin that show indications of being affected, such as taking biopsies of lesions, pustules, and sites of crustation. These tissue samples would then be typically examined under a microscope, where a clinician will form a conclusive diagnosis based on the observed cellular structures and abnormalities. ^[27] Additionally, other tests such as antinuclear antibody tests (ANA) and complete blood count with white blood cell differential tests can be used to gather more information. ^[28]

For Pemphigus vulgaris, after the skin begins to separate, Nikolsky's sign can be useful to help diagnose the disease. This involves placing pressure along the edge of a blister and observing if the skin separates further and if the blister increases in size.^[29] However, to diagnose the disease with complete certainty, biopsies must be taken from the edge of the blisters. The tissue sample must then be analyzed using a direct immunofluorscence technique and analyzed microscopically. The direct immunofluorescence technique should be used instead of indirect, as the results may be inaccurate before the disease has progressed to a certain point.^[18]

Treatment

For most autoimmune skin diseases, it is imperative to begin treatment as early as possible, as the progression of the disease can lead to severe complications and even death.^[18] Treatment for many diseases usually involves the use of immunosuppressants such as glucocorticoids.^[26] The immunosuppressants aid in suppressing the reaction of the immune system fighting against the body's healthy cells and tissues.^[30] This is done by the inhibition of calcineurin, an enzyme that controls and activates T-cell production. Without the consistent production of T-cells, a decrease of autoimmune activity can be observed, leading to less severe symptoms and potential remission of autoimmune diseases.^[31]

When treatment is first started for Pemphigus vulgaris, the dog will usually be given the corticosteroid prednisone for a limited time. This will be administered orally, and the amount given can vary between 1.5 to 13.3 milligrams for every kilogram of the dog's weight. This amount will continue until symptoms begin to subside. Afterward the dose will be lowered, and other medications will be used. The condition cannot be cured, so the dog will require immunosuppressants and steroids for the duration of its lifespan. The specific immunosuppressants used generally include cyclophosphamide, methotrexate, or azathioprine. Antibiotics may also be used to help reduce the risk of infection.^[18]

References

^ Pedersen, Niels C (1999-08). "A review of immunologic diseases of the dog". Veterinary Immunology and Immunopathology. 69 (2–4): 251–342. doi:10.1016/S0165-2427(99)00059-8. PMC 7119806. PMID 10507310. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
^ Gershwin, Laurel J. (2018-03). "Current and Newly Emerging Autoimmune Diseases". Veterinary Clinics of North America: Small Animal Practice. 48 (2): 323–338. doi:10.1016/j.cvsm.2017.10.010. ISSN 0195-5616. {{cite journal}}: Check date values in: |date= (help)
^ Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ Gershwin, Laurel J. (2010-05). "Autoimmune Diseases in Small Animals". Veterinary Clinics of North America: Small Animal Practice. 40 (3): 439–457. doi:10.1016/j.cvsm.2010.02.003. {{cite journal}}: Check date values in: |date= (help)
^ Fukushima, K. (1982-04). "Pathogenesis of pemphigus vulgaris in dog and man - a review". The Canadian Veterinary Journal = La Revue Veterinaire Canadienne. 23 (4): 135–137. ISSN 0008-5286. PMC 1790145. PMID 17422133. {{cite journal}}: Check date values in: |date= (help)
^ "Immune system", Wikipedia, 2019-10-30, retrieved 2019-11-09
^ "Auto-immune Diseases". Archived from the original on 2019-10-30. Retrieved 2019-10-27.
^ Papadogiannakis EI. 2005. Contemporary aspects of the immunopathogenesis of autoimmune diseases of the epidermal basement membrane in the dog. The Journal of the Hellenic Veterinary Medical Society 56(1) p 27-31.
^ "Structure of the Skin in Dogs - Dog Owners". Merck Veterinary Manual. Retrieved 2019-11-09.
^ "Auto-immune Diseases". Archived from the original on 2019-10-30. Retrieved 2019-10-27.
^ Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC
^ Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15: 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ "Canine skin autoimmune diseases". Cornell University College of Veterinary Medicine. 2022-05-16. Retrieved 2024-03-04.
^ Yamaguchi, Yuji; Hearing, Vincent J. (2014-5). "Melanocytes and Their Diseases". Cold Spring Harbor Perspectives in Medicine. 4 (5): a017046. doi:10.1101/cshperspect.a017046. ISSN 2157-1422. PMC 3996377. PMID 24789876. {{cite journal}}: Check date values in: |date= (help)
^ Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ ^a ^b "Handbook of Vertebrate Immunology". 1998. doi:10.1016/b978-0-12-546401-7.x5000-8. {{cite journal}}: Cite journal requires |journal= (help)
^ Olivry, Thierry (2006-09-04). "A review of autoimmune skin diseases in domestic animals: I – Superficial pemphigus". Veterinary Dermatology. 17 (5): 291–305. doi:10.1111/j.1365-3164.2006.00540.x. ISSN 0959-4493.
^ ^a ^b ^c ^d ^e ^f ^g ^h Fukushima, K. (1982-04). "Pathogenesis of pemphigus vulgaris in dog and man - a review". The Canadian Veterinary Journal = La Revue Veterinaire Canadienne. 23 (4): 135–137. ISSN 0008-5286. PMC 1790145. PMID 17422133. {{cite journal}}: Check date values in: |date= (help)
^ ^a ^b ^c Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC
^ ^a ^b Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2020-11-23). "Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review". BMC Veterinary Research. 16 (1): 457. doi:10.1186/s12917-020-02677-w. ISSN 1746-6148. PMC 7686683. PMID 33228633.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ ^a ^b "Canine skin autoimmune diseases". Cornell University College of Veterinary Medicine. 2022-05-16. Retrieved 2024-03-03.
^ Sprent, Jonathan; Kishimoto, Hidehiro (2001-05-29). Morris, P. J.; Wood, K. J. (eds.). "The thymus and central tolerance". Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 356 (1409): 609–616. doi:10.1098/rstb.2001.0846. ISSN 0962-8436. PMC 1088448. PMID 11375064.{{cite journal}}: CS1 maint: PMC format (link)
^ Gershwin, Laurel J. (2010-05). "Autoimmune Diseases in Small Animals". Veterinary Clinics of North America: Small Animal Practice. 40 (3): 439–457. doi:10.1016/j.cvsm.2010.02.003. {{cite journal}}: Check date values in: |date= (help)
^ "ScienceDirect.com | Science, health and medical journals, full text articles and books". www.sciencedirect.com. Retrieved 2024-02-25.
^ Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ ^a ^b Bizikova, Petra; Linder, Keith E.; Anderson, Jamie G. (2023-06-01). "Erosive and ulcerative stomatitis in dogs and cats: which immune-mediated diseases to consider?". Journal of the American Veterinary Medical Association. 261 (S1): S48–S57. doi:10.2460/javma.22.12.0573.
^ ^a ^b ^c "Canine cutaneous autoimmune disease | Vet Focus". vetfocus.royalcanin.com. Retrieved 2024-04-16.
^ "Autoimmune disorders Information | Mount Sinai - New York". Mount Sinai Health System. Retrieved 2024-04-16.
^ Maity, Subhadeep; Banerjee, Ishita; Sinha, Rupam; Jha, Harshvardhan; Ghosh, Pritha; Mustafi, Subhasish (2020-02). "Nikolsky's sign: A pathognomic boon". Journal of Family Medicine and Primary Care. 9 (2): 526. doi:10.4103/jfmpc.jfmpc_889_19. ISSN 2249-4863. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
^ "Autoimmune Skin Disease in Dogs | VCA Animal Hospital | VCA Animal Hospitals". Vca. Retrieved 2024-04-16.
^ "How Do Immunosuppressants Work? - Uses, Side Effects, Drug Names". RxList. Retrieved 2024-04-16.

[1] Pedersen, Niels C (1999-08). "A review of immunologic diseases of the dog". Veterinary Immunology and Immunopathology. 69 (2–4): 251–342. doi:10.1016/S0165-2427(99)00059-8. PMC 7119806. PMID 10507310. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)

[2] Gershwin, Laurel J. (2018-03). "Current and Newly Emerging Autoimmune Diseases". Veterinary Clinics of North America: Small Animal Practice. 48 (2): 323–338. doi:10.1016/j.cvsm.2017.10.010. ISSN 0195-5616. {{cite journal}}: Check date values in: |date= (help)

[:32-3] Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)

[:42-4] Gershwin, Laurel J. (2010-05). "Autoimmune Diseases in Small Animals". Veterinary Clinics of North America: Small Animal Practice. 40 (3): 439–457. doi:10.1016/j.cvsm.2010.02.003. {{cite journal}}: Check date values in: |date= (help)

[:12-5] Fukushima, K. (1982-04). "Pathogenesis of pemphigus vulgaris in dog and man - a review". The Canadian Veterinary Journal = La Revue Veterinaire Canadienne. 23 (4): 135–137. ISSN 0008-5286. PMC 1790145. PMID 17422133. {{cite journal}}: Check date values in: |date= (help)

[:22-6] "Immune system", Wikipedia, 2019-10-30, retrieved 2019-11-09

[Autoimun2-7] "Auto-immune Diseases". Archived from the original on 2019-10-30. Retrieved 2019-10-27.

[Papado-8] Papadogiannakis EI. 2005. Contemporary aspects of the immunopathogenesis of autoimmune diseases of the epidermal basement membrane in the dog. The Journal of the Hellenic Veterinary Medical Society 56(1) p 27-31.

[:52-9] "Structure of the Skin in Dogs - Dog Owners". Merck Veterinary Manual. Retrieved 2019-11-09.

[Autoimun-10] "Auto-immune Diseases". Archived from the original on 2019-10-30. Retrieved 2019-10-27.

[Mueller-11] Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC

[12] Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15: 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[13] "Canine skin autoimmune diseases". Cornell University College of Veterinary Medicine. 2022-05-16. Retrieved 2024-03-04.

[14] Yamaguchi, Yuji; Hearing, Vincent J. (2014-5). "Melanocytes and Their Diseases". Cold Spring Harbor Perspectives in Medicine. 4 (5): a017046. doi:10.1101/cshperspect.a017046. ISSN 2157-1422. PMC 3996377. PMID 24789876. {{cite journal}}: Check date values in: |date= (help)

[15] Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[:6-16] "Handbook of Vertebrate Immunology". 1998. doi:10.1016/b978-0-12-546401-7.x5000-8. {{cite journal}}: Cite journal requires |journal= (help)

[17] Olivry, Thierry (2006-09-04). "A review of autoimmune skin diseases in domestic animals: I – Superficial pemphigus". Veterinary Dermatology. 17 (5): 291–305. doi:10.1111/j.1365-3164.2006.00540.x. ISSN 0959-4493.

[:1-18] ^ ^a ^b ^c ^d ^e ^f ^g ^h Fukushima, K. (1982-04). "Pathogenesis of pemphigus vulgaris in dog and man - a review". The Canadian Veterinary Journal = La Revue Veterinaire Canadienne. 23 (4): 135–137. ISSN 0008-5286. PMC 1790145. PMID 17422133. {{cite journal}}: Check date values in: |date= (help)

[Mueller2-19] Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC

[:5-20] Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2020-11-23). "Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review". BMC Veterinary Research. 16 (1): 457. doi:10.1186/s12917-020-02677-w. ISSN 1746-6148. PMC 7686683. PMID 33228633.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)

[:0-21] "Canine skin autoimmune diseases". Cornell University College of Veterinary Medicine. 2022-05-16. Retrieved 2024-03-03.

[22] Sprent, Jonathan; Kishimoto, Hidehiro (2001-05-29). Morris, P. J.; Wood, K. J. (eds.). "The thymus and central tolerance". Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 356 (1409): 609–616. doi:10.1098/rstb.2001.0846. ISSN 0962-8436. PMC 1088448. PMID 11375064.{{cite journal}}: CS1 maint: PMC format (link)

[:4-23] Gershwin, Laurel J. (2010-05). "Autoimmune Diseases in Small Animals". Veterinary Clinics of North America: Small Animal Practice. 40 (3): 439–457. doi:10.1016/j.cvsm.2010.02.003. {{cite journal}}: Check date values in: |date= (help)

[24] "ScienceDirect.com | Science, health and medical journals, full text articles and books". www.sciencedirect.com. Retrieved 2024-02-25.

[:3-25] Tham, Heng L.; Linder, Keith E.; Olivry, Thierry (2019-07-19). "Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review". BMC Veterinary Research. 15 (1): 251. doi:10.1186/s12917-019-2003-9. ISSN 1746-6148. PMC 6639964. PMID 31324191.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)

[:2-26] Bizikova, Petra; Linder, Keith E.; Anderson, Jamie G. (2023-06-01). "Erosive and ulcerative stomatitis in dogs and cats: which immune-mediated diseases to consider?". Journal of the American Veterinary Medical Association. 261 (S1): S48–S57. doi:10.2460/javma.22.12.0573.

[:7-27] "Canine cutaneous autoimmune disease | Vet Focus". vetfocus.royalcanin.com. Retrieved 2024-04-16.

[28] "Autoimmune disorders Information | Mount Sinai - New York". Mount Sinai Health System. Retrieved 2024-04-16.

[29] Maity, Subhadeep; Banerjee, Ishita; Sinha, Rupam; Jha, Harshvardhan; Ghosh, Pritha; Mustafi, Subhasish (2020-02). "Nikolsky's sign: A pathognomic boon". Journal of Family Medicine and Primary Care. 9 (2): 526. doi:10.4103/jfmpc.jfmpc_889_19. ISSN 2249-4863. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)

[30] "Autoimmune Skin Disease in Dogs | VCA Animal Hospital | VCA Animal Hospitals". Vca. Retrieved 2024-04-16.

[31] "How Do Immunosuppressants Work? - Uses, Side Effects, Drug Names". RxList. Retrieved 2024-04-16.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

@@ Line 1: / Line 1: @@
-There are many autoimmune diseases, and they all vary in impact to the dog and progress at their own rates.
+There are many autoimmune diseases, and they all vary in impact to the dog and progress at their own rates.<ref>{{Cite journal |last=Pedersen |first=Niels C |date=1999-08 |title=A review of immunologic diseases of the dog |url=https://linkinghub.elsevier.com/retrieve/pii/S0165242799000598 |journal=Veterinary Immunology and Immunopathology |language=en |volume=69 |issue=2-4 |pages=251–342 |doi=10.1016/S0165-2427(99)00059-8 |pmc=PMC7119806 |pmid=10507310}}</ref>
-Reference Pedersen, Niels C. (1999) A Review of Immunologic Diseases of the Dog. Vet Immunol Immunopathol{{Dashboard.wikiedu.org draft template/about this sandbox}}
+{{Dashboard.wikiedu.org draft template/about this sandbox}}
 == Article Draft ==
 === Lead ===
-An autoimmune disease is a disease in which the immune system attacks the body of the infected animal.<ref>{{Cite journal |last=Gershwin |first=Laurel J. |date=2018-03 |title=Current and Newly Emerging Autoimmune Diseases |url=https://doi.org/10.1016/j.cvsm.2017.10.010 |journal=Veterinary Clinics of North America: Small Animal Practice |volume=48 |issue=2 |pages=323–338 |doi=10.1016/j.cvsm.2017.10.010 |issn=0195-5616}}</ref> In dogs, autoimmune skin diseases are usually not detected until visible symptoms appear, which differs from detection in humans who are able to verbally express their concerns.<ref name=":3" /> Autoimmune skin diseases are characterized by damage to the connective tissue and vesicle formation located below the epidermis layer and the dermis layer.<ref>Papadogiannakis EI. 2005. Contemporary aspects of the immunopathogenesis of autoimmune diseases of the epidermal basement membrane in the dog. The Journal of the Hellenic Veterinary Medical Society 56(1) p 27-31.</ref><ref>{{Cite web |title=Structure of the Skin in Dogs - Dog Owners |url=https://www.merckvetmanual.com/dog-owners/skin-disorders-of-dogs/structure-of-the-skin-in-dogs |access-date=2024-04-15 |website=Merck Veterinary Manual |language=en-US}}</ref> Genetics, nutrition, and external environmental factors all collectively contribute to increasing the probability an autoimmune disease occurring.<ref>{{Cite journal |last=Gershwin |first=Laurel J. |date=2010-05 |title=Autoimmune Diseases in Small Animals |url=https://linkinghub.elsevier.com/retrieve/pii/S0195561610000252 |journal=Veterinary Clinics of North America: Small Animal Practice |language=en |volume=40 |issue=3 |pages=439–457 |doi=10.1016/j.cvsm.2010.02.003}}</ref> The severity of symptoms varies based on the specific disease present and how far it has progressed. Diagnosis often requires the presence of visible symptoms and for a biopsy to be performed. For many diseases, the condition itself cannot be cured, but a veterinarian can prescribe medications and other forms of treatment to help manage the symptoms and discomfort of the dog.<ref name=":1" />
+Autoimmune skin diseases occur when the immune system of an infected animal attacks its own skin.<ref>{{Cite journal |last=Gershwin |first=Laurel J. |date=2018-03 |title=Current and Newly Emerging Autoimmune Diseases |url=https://doi.org/10.1016/j.cvsm.2017.10.010 |journal=Veterinary Clinics of North America: Small Animal Practice |volume=48 |issue=2 |pages=323–338 |doi=10.1016/j.cvsm.2017.10.010 |issn=0195-5616}}</ref> In dogs, autoimmune skin diseases are usually not detected until visible symptoms appear, which differs from detection in humans who are able to verbally express their concerns.<ref name=":32">{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://doi.org/10.1186/s12917-019-2003-9 |journal=BMC Veterinary Research |volume=15 |issue=1 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148 |pmc=PMC6639964 |pmid=31324191}}</ref> Genetics, nutrition, and external environmental factors all collectively contribute to increasing the probability an autoimmune skin disease occurring.<ref name=":42">{{Cite journal |last=Gershwin |first=Laurel J. |date=2010-05 |title=Autoimmune Diseases in Small Animals |url=https://linkinghub.elsevier.com/retrieve/pii/S0195561610000252 |journal=Veterinary Clinics of North America: Small Animal Practice |language=en |volume=40 |issue=3 |pages=439–457 |doi=10.1016/j.cvsm.2010.02.003}}</ref> The severity of symptoms varies based on the specific disease present and how far it has progressed. Diagnosis often requires the onset of visible symptoms and for a biopsy to be performed. For many diseases, the condition itself cannot be cured, but a veterinarian can prescribe medications and other forms of treatment to help manage the symptoms of the dog.<ref name=":12">{{Cite journal |last=Fukushima |first=K. |date=1982-04 |title=Pathogenesis of pemphigus vulgaris in dog and man - a review |url=https://pubmed.ncbi.nlm.nih.gov/17422133 |journal=The Canadian Veterinary Journal = La Revue Veterinaire Canadienne |volume=23 |issue=4 |pages=135–137 |issn=0008-5286 |pmc=1790145 |pmid=17422133}}</ref>
 === Article body ===
-Dogs suffering from autoimmune diseases of the [[skin]] may experience a variety of symptoms, including persistent [[itching]] and scratching, lesions, wounds, blisters, and other skin damage, as well as loss of skin [[pigment]].<ref name="Autoimun">{{Cite web |title=Auto-immune Diseases |url=http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |url-status=dead |archive-url=https://web.archive.org/web/20191030030740/http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |archive-date=2019-10-30 |access-date=2019-10-27}}</ref> Two cases of autoimmune diseases that are often found include ''[[Discoid lupus erythematosus]]'' (DLE) and ''[[Pemphigus]]''. DLE can develop into [[Systemic lupus erythematosus|Systemic Lupus Erythematosus]] (SLE).<ref name="Mueller">[http://www.ivis.org/proceedings/scivac/2005/Mueller1_en.pdf?LA=1 Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC]</ref> '''Most symptoms occur after the outer epidermis and inner dermis of the skin are affected by the disease. When this happens, the layers of the skin begin to separate, leading to painful lesions and pustules. The compromised integrity of the skin barrier not only exacerbates the discomfort experienced by the dog, but also heightens the risk of secondary bacterial infections. The weakening of the skin’s protective layers forms an environment susceptible to microbial infiltration, which could lead to severe complications. Intervening within an earlier time frame and targeted management strategies are essential to minimize further adverse effects.'''<ref>{{Cite web |date=2022-05-16 |title=Canine skin autoimmune diseases |url=https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/health-info/canine-skin-autoimmune-diseases |access-date=2024-03-04 |website=Cornell University College of Veterinary Medicine |language=en}}</ref>
+== Overview ==
-'''Another autoimmune skin disease which can occur in dogs is vitiligo. The exact prevalence of this disease in dogs is currently unknown, as it is likely under-reported.<ref name=":3">{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://doi.org/10.1186/s12917-019-2003-9 |journal=BMC Veterinary Research |volume=15 |issue=1 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148 |pmc=PMC6639964 |pmid=31324191}}</ref>''' '''In addition to humans, Vitiligo can be found in a variety of animals, including cats, horses, and dogs. Vitiligo is a type of autoimmune disease that damages melanocytes in the skin, lips, and oral cavity. Melanocytes are cells that contain pigments such as melanin. These pigments give rise to an organism's phenotype, which determines skin and hair color.<ref>{{Cite journal |last=Yamaguchi |first=Yuji |last2=Hearing |first2=Vincent J. |date=2014-5 |title=Melanocytes and Their Diseases |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996377/ |journal=Cold Spring Harbor Perspectives in Medicine |volume=4 |issue=5 |pages=a017046 |doi=10.1101/cshperspect.a017046 |issn=2157-1422 |pmc=3996377 |pmid=24789876}}</ref> The affected melanocytes causes the skin and/or hair to become white or light pink. Melanocytes are also found in other parts of the body, such as the oral mucosa, eye, cochlea, and the meninges. Certain breeds of dogs have a higher chance of developing Vitiligo based on their genetics. These breeds include Rottweilers, German Shepherds, Old English Sheepdogs, Doberman Pinchers, Dachshunds, and German Shorthaired Pointers.'''<ref>{{Cite web |title=ScienceDirect.com {{!}} Science, health and medical journals, full text articles and books. |url=https://www.sciencedirect.com/?ref=pdf_download&fr=RR-11&rr=85b34e9bf99b394c |access-date=2024-02-25 |website=www.sciencedirect.com}}</ref> '''In addition to Vitiligo, there are other autoimmune diseases that target melanocytes, such as Vogt-Koyanagi-Harada (VKH) syndrome, and Uveodermatological (UDS) syndrome.<ref>{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://doi.org/10.1186/s12917-019-2003-9 |journal=BMC Veterinary Research |volume=15 |issue=1 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148}}</ref>'''
+{{see also|Autoimmunity}}
+The immune system is a defense system that detects and protects against invaders that result in infections. It holds the ability to differentiate between the body's healthy [[Cell (biology)|cells]] from foreign cells.<ref name=":22">{{Citation |title=Immune system |date=2019-10-30 |work=Wikipedia |url=https://en.wikipedia.org/enwiki/w/index.php?title=Immune_system&oldid=923814247 |access-date=2019-11-09 |language=en}}</ref> With autoimmune diseases, the immune system loses the ability to function appropriately to make this distinction, so the body begins to attack itself.<ref name="Autoimun2">{{Cite web |title=Auto-immune Diseases |url=http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |url-status=dead |archive-url=https://web.archive.org/web/20191030030740/http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |archive-date=2019-10-30 |access-date=2019-10-27}}</ref> Autoimmune skin diseases in the base layer of the [[epidermis]] are characterized by damage to the connective tissue and vesicle formation located below the epidermis layer and the dermis layer below it.<ref name="Papado">Papadogiannakis EI. 2005. Contemporary aspects of the immunopathogenesis of autoimmune diseases of the epidermal basement membrane in the dog. The Journal of the Hellenic Veterinary Medical Society 56(1) p 27-31.</ref>There are many autoimmune diseases, and they vary in impact on the dog and progress at their own rates.<ref name=":52">{{Cite web |title=Structure of the Skin in Dogs - Dog Owners |url=https://www.merckvetmanual.com/dog-owners/skin-disorders-of-dogs/structure-of-the-skin-in-dogs |access-date=2019-11-09 |website=Merck Veterinary Manual |language=en-US}}</ref>Testing performed can include skin biopsy, scans, or bloodwork being collected and documenting onset symptoms to assist with diagnosis.
+== Clinical symptoms ==
-'''When pemphigus occurs in humans, the skin will begin to blister due to antibodies attacking the adhesive proteins in epidermal cells, which causes them to separate. Different types of pemphigus can be identified based on the depth of separation present in the skin. Many forms of pemphigus can be identified in dogs using methods similar to those employed for humans.'''<ref>{{Cite journal |last=Olivry |first=Thierry |date=2006-09-04 |title=A review of autoimmune skin diseases in domestic animals: I – Superficial pemphigus |url=https://onlinelibrary-wiley-com.uab.idm.oclc.org/doi/full/10.1111/j.1365-3164.2006.00540.x |journal=Veterinary Dermatology |volume=17 |issue=5 |pages=291–305 |doi=10.1111/j.1365-3164.2006.00540.x |issn=0959-4493}}</ref> '''Pemphigus vulgaris is rare in humans and animals, but is often fatal if left untreated. In dogs, the disease presents itself so similarly to the way it occurs in humans that dogs can be used as research models for the human disease.'''<ref name=":1">{{Cite journal |last=Fukushima |first=K. |date=1982-04 |title=Pathogenesis of pemphigus vulgaris in dog and man - a review |url=https://pubmed.ncbi.nlm.nih.gov/17422133 |journal=The Canadian Veterinary Journal = La Revue Veterinaire Canadienne |volume=23 |issue=4 |pages=135–137 |issn=0008-5286 |pmc=1790145 |pmid=17422133}}</ref> '''When the disease first begins to manifest itself,''' lesions are usually evident in the oral cavity '''of the dog'''.<ref name="Mueller2">[http://www.ivis.org/proceedings/scivac/2005/Mueller1_en.pdf?LA=1 Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC]</ref> '''Aside from these blisters, the dog may be mostly asymptomatic before the disease progresses further.'''<ref name=":1" /> '''The blisters are easily ruptured and become painful upon doing so,'''<ref name=":1" /> '''which can cause the dog to have difficulty eating.'''<ref>{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2020-11-23 |title=Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review |url=https://doi.org/10.1186/s12917-020-02677-w |journal=BMC Veterinary Research |language=en |volume=16 |issue=1 |pages=457 |doi=10.1186/s12917-020-02677-w |issn=1746-6148 |pmc=PMC7686683 |pmid=33228633}}</ref> '''As the disease progresses, the infected dog can become severely infirm, and may succumb to further infection.'''<ref name=":1" /> Sometimes symptoms are characterized by [[lymphadenopathy]], which '''involves''' loss of appetite, weakness, [[fever]], and in rare cases, [[sepsis]].<ref name="Mueller2" />
+Dogs suffering from autoimmune diseases of the [[skin]] may experience a variety of symptoms, including persistent [[itching]] and scratching, lesions, wounds, blisters, and other skin damage, as well as loss of skin [[pigment]].<ref name="Autoimun">{{Cite web |title=Auto-immune Diseases |url=http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |url-status=dead |archive-url=https://web.archive.org/web/20191030030740/http://www.thepetcheckup.com/works/screen/auto-immune_disease.html |archive-date=2019-10-30 |access-date=2019-10-27}}</ref> Two cases of autoimmune diseases that are often found include ''[[Discoid lupus erythematosus]]'' (DLE) and ''[[Pemphigus]]''. DLE can develop into [[Systemic lupus erythematosus|Systemic Lupus Erythematosus]] (SLE).<ref name="Mueller">[http://www.ivis.org/proceedings/scivac/2005/Mueller1_en.pdf?LA=1 Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC]</ref>
+'''Most symptoms occur after the outer epidermis and inner dermis of the skin are affected by the disease. When this happens, the layers of the skin begin to separate, leading to painful lesions and pustules.''' <ref>{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639964/ |journal=BMC Veterinary Research |volume=15 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148 |pmc=6639964 |pmid=31324191}}</ref> '''The compromised integrity of the skin barrier not only exacerbates the discomfort experienced by the dog, but also heightens the risk of secondary bacterial infections. The weakening of the skin’s protective layers forms an environment susceptible to microbial infiltration, which could lead to severe complications. Intervening within an earlier time frame and targeted management strategies are essential to minimize further adverse effects.'''<ref>{{Cite web |date=2022-05-16 |title=Canine skin autoimmune diseases |url=https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/health-info/canine-skin-autoimmune-diseases |access-date=2024-03-04 |website=Cornell University College of Veterinary Medicine |language=en}}</ref>
+'''Another autoimmune skin disease which can occur in dogs is vitiligo.''' '''In addition to humans, vitiligo can be found in a variety of animals, including cats, horses, and dogs. Vitiligo is a type of autoimmune disease that damages melanocytes in the skin, lips, and oral cavity. Melanocytes are cells that contain pigments such as melanin. These pigments give rise to an organism's phenotype, which determines skin and hair color.<ref>{{Cite journal |last=Yamaguchi |first=Yuji |last2=Hearing |first2=Vincent J. |date=2014-5 |title=Melanocytes and Their Diseases |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996377/ |journal=Cold Spring Harbor Perspectives in Medicine |volume=4 |issue=5 |pages=a017046 |doi=10.1101/cshperspect.a017046 |issn=2157-1422 |pmc=3996377 |pmid=24789876}}</ref> The affected melanocytes cause the skin and/or hair to become white or light pink. Melanocytes are also found in other parts of the body, such as the oral mucosa, eye, cochlea, and the meninges.''' '''In addition to vitiligo, there are other autoimmune diseases that target melanocytes, such as Vogt-Koyanagi-Harada (VKH) syndrome, and Uveodermatological (UDS) syndrome.<ref>{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://doi.org/10.1186/s12917-019-2003-9 |journal=BMC Veterinary Research |volume=15 |issue=1 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148}}</ref>''' '''Vogt-Koyanagi-Harada syndrome is an autoimmune disease that affects the eyes. In addition to depigmentation of the skin, the disease is characterized by a combination of conditions, including uveitis, acute iridocyclitis, choroiditis, and retinal detachment.'''<ref name=":6">{{Cite journal |date=1998 |title=Handbook of Vertebrate Immunology |url=http://dx.doi.org/10.1016/b978-0-12-546401-7.x5000-8 |doi=10.1016/b978-0-12-546401-7.x5000-8}}</ref>
+'''When pemphigus occurs in humans, the skin will begin to blister due to antibodies attacking the adhesive proteins in epidermal cells, which causes them to separate. Different types of pemphigus can be identified based on the depth of separation present in the skin. Many forms of pemphigus can be identified in dogs using methods similar to those employed for humans.'''<ref>{{Cite journal |last=Olivry |first=Thierry |date=2006-09-04 |title=A review of autoimmune skin diseases in domestic animals: I – Superficial pemphigus |url=https://onlinelibrary-wiley-com.uab.idm.oclc.org/doi/full/10.1111/j.1365-3164.2006.00540.x |journal=Veterinary Dermatology |volume=17 |issue=5 |pages=291–305 |doi=10.1111/j.1365-3164.2006.00540.x |issn=0959-4493}}</ref>
+'''Pemphigus vulgaris is rare in humans and animals, but is often fatal if left untreated. In dogs, the disease presents itself so similarly to the way it occurs in humans that dogs can be used as research models for the human disease.'''<ref name=":1">{{Cite journal |last=Fukushima |first=K. |date=1982-04 |title=Pathogenesis of pemphigus vulgaris in dog and man - a review |url=https://pubmed.ncbi.nlm.nih.gov/17422133 |journal=The Canadian Veterinary Journal = La Revue Veterinaire Canadienne |volume=23 |issue=4 |pages=135–137 |issn=0008-5286 |pmc=1790145 |pmid=17422133}}</ref> '''When the disease first begins to manifest itself,''' lesions are usually evident in the oral cavity '''of the dog'''.<ref name="Mueller2">[http://www.ivis.org/proceedings/scivac/2005/Mueller1_en.pdf?LA=1 Immune-mediated Skin Diseases. Rimini: 50th Congresso Nazionale Multisala SCIVAC]</ref> '''Aside from these blisters, the dog may be mostly asymptomatic before the disease progresses further.'''<ref name=":1" /> '''The blisters are easily ruptured and become painful upon doing so,'''<ref name=":1" /> '''which can cause the dog to have difficulty eating.'''<ref name=":5">{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2020-11-23 |title=Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review |url=https://doi.org/10.1186/s12917-020-02677-w |journal=BMC Veterinary Research |language=en |volume=16 |issue=1 |pages=457 |doi=10.1186/s12917-020-02677-w |issn=1746-6148 |pmc=PMC7686683 |pmid=33228633}}</ref> '''As the disease progresses, the infected dog can become severely infirm, and may succumb to further infection.'''<ref name=":1" /> Sometimes symptoms are characterized by [[lymphadenopathy]], which '''involves''' loss of appetite, weakness, [[fever]], and in rare cases, [[sepsis]].<ref name="Mueller2" />
 '''''[[Pemphigus foliaceus]]''''' '''is the most common autoimmune skin disease in dogs, making up around one-third of all canine autoimmune disorders.'''<ref name=":0">{{Cite web |date=2022-05-16 |title=Canine skin autoimmune diseases |url=https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/health-info/canine-skin-autoimmune-diseases |access-date=2024-03-03 |website=Cornell University College of Veterinary Medicine |language=en}}</ref> '''This disease''' usually affects areas of the ears and face.<ref name="Mueller2" /> Early symptoms are characterized by [[depigmentation]] of the nasal palate, dorsal cleft in the [[mouth]], the [[ear]], and the periocular area around the eye. Itching, pain, and weakness of the body have been observed in some cases. '''Other symptoms of Pemphigus foliaceus include hair loss, formation of pustules, and erosions with ulcers. These symptoms can appear on the dog's feet, groin area, and trunk if left untreated.'''<ref name=":0" />
 == Disease incidence process ==
-'''The immune system functions in many ways to eliminate foreign substances and particles introduced to the body. This revolves around T-cell differentiation, where mature T-cells with receptors for non-self cells target foreign antigens and act with other cells to dispose of them.'''<ref>{{Cite journal |last=Sprent |first=Jonathan |last2=Kishimoto |first2=Hidehiro |date=2001-05-29 |editor-last=Morris |editor-first=P. J. |editor2-last=Wood |editor2-first=K. J. |title=The thymus and central tolerance |url=https://royalsocietypublishing.org/doi/10.1098/rstb.2001.0846 |journal=Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences |language=en |volume=356 |issue=1409 |pages=609–616 |doi=10.1098/rstb.2001.0846 |issn=0962-8436 |pmc=PMC1088448 |pmid=11375064}}</ref> There are two mechanisms of tolerance found in the immune system. The first mechanism is positive selection by the [[thymus]], where only [[T cell|T cells]] are selected. T cells recognize peptides in the [[Major histocompatibility complex|Histocompatibility Complex]] (MHC). Foreign antigens possessing MHC molecules will then be
+'''The immune system functions in many ways to eliminate foreign substances and particles introduced to the body. This revolves around T-cell differentiation, where mature T-cells with receptors for non-self cells target foreign antigens and act with other cells to dispose of them.'''<ref>{{Cite journal |last=Sprent |first=Jonathan |last2=Kishimoto |first2=Hidehiro |date=2001-05-29 |editor-last=Morris |editor-first=P. J. |editor2-last=Wood |editor2-first=K. J. |title=The thymus and central tolerance |url=https://royalsocietypublishing.org/doi/10.1098/rstb.2001.0846 |journal=Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences |language=en |volume=356 |issue=1409 |pages=609–616 |doi=10.1098/rstb.2001.0846 |issn=0962-8436 |pmc=PMC1088448 |pmid=11375064}}</ref> There are two mechanisms of tolerance found in the immune system. The first mechanism is positive selection by the [[thymus]], where only [[T cell|T cells]] are selected. T cells recognize peptides in the [[Major histocompatibility complex|Histocompatibility Complex]] (MHC).
+'''Incidences of autoimmune skin diseases can vary based on several factors. Some of these factors include the breed, age, and sex of the dog, along with individual genetics and environmental factors.'''<ref name=":4">{{Cite journal |last=Gershwin |first=Laurel J. |date=2010-05 |title=Autoimmune Diseases in Small Animals |url=https://linkinghub.elsevier.com/retrieve/pii/S0195561610000252 |journal=Veterinary Clinics of North America: Small Animal Practice |language=en |volume=40 |issue=3 |pages=439–457 |doi=10.1016/j.cvsm.2010.02.003}}</ref> '''In terms of vitiligo, certain breeds of dogs have a higher chance of developing the disease based on their genetics. These breeds include Rottweilers, German Shepherds, Old English Sheepdogs, Doberman Pinchers, Dachshunds, and German Shorthaired Pointers.'''<ref>{{Cite web |title=ScienceDirect.com {{!}} Science, health and medical journals, full text articles and books. |url=https://www.sciencedirect.com/?ref=pdf_download&fr=RR-11&rr=85b34e9bf99b394c |access-date=2024-02-25 |website=www.sciencedirect.com}}</ref> '''However, the exact prevalence of this disease in dogs is currently unknown, as it is likely under-reported.<ref name=":3">{{Cite journal |last=Tham |first=Heng L. |last2=Linder |first2=Keith E. |last3=Olivry |first3=Thierry |date=2019-07-19 |title=Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review |url=https://doi.org/10.1186/s12917-019-2003-9 |journal=BMC Veterinary Research |volume=15 |issue=1 |pages=251 |doi=10.1186/s12917-019-2003-9 |issn=1746-6148 |pmc=PMC6639964 |pmid=31324191}}</ref>''' '''Certain dog breeds that have been documented with VKH syndrome include Akitas, Samoyeds, Irish Setters, Golden Retrievers, Saint Bernards, Australian Sheepdogs, and Shetland Sheepdogs.'''<ref name=":6" />
-A nose-to-tail annual examination is recommended yearly to assess the dog and if there are any concerns raised further test such as skin biopsy, scans, or bloodwork will be collected to assist with diagnosis and potential treatments.
+'''Pemphigus vulgaris can occur in any breed of dog irrespective of its sex or age.'''<ref name=":1" /> '''However, it appears to occur more often in male dogs than females, which differs slightly from its occurrence in humans. In humans, women are more likely to be affected than men. In terms of age, the disease usually begins when the dog is at least five to seven years old. This correlates to the typical age in which it begins in humans as well, generally occurring in middle age.'''<ref name=":5" />
 == '''Diagnosis''' ==
-'''Since many autoimmune skin diseases have similar symptoms and usually affect the oral cavity, a biopsy must often be performed in order to correctly diagnose the disease'''.<ref name=":2">{{Cite journal |last=Bizikova |first=Petra |last2=Linder |first2=Keith E. |last3=Anderson |first3=Jamie G. |date=2023-06-01 |title=Erosive and ulcerative stomatitis in dogs and cats: which immune-mediated diseases to consider? |url=https://avmajournals.avma.org/view/journals/javma/261/S1/javma.22.12.0573.xml |journal=Journal of the American Veterinary Medical Association |language=en |volume=261 |issue=S1 |pages=S48–S57 |doi=10.2460/javma.22.12.0573}}</ref>
+'''Since many autoimmune skin diseases have similar symptoms and usually affect the oral cavity, a biopsy must often be performed in order to correctly diagnose the disease'''.<ref name=":2">{{Cite journal |last=Bizikova |first=Petra |last2=Linder |first2=Keith E. |last3=Anderson |first3=Jamie G. |date=2023-06-01 |title=Erosive and ulcerative stomatitis in dogs and cats: which immune-mediated diseases to consider? |url=https://avmajournals.avma.org/view/journals/javma/261/S1/javma.22.12.0573.xml |journal=Journal of the American Veterinary Medical Association |language=en |volume=261 |issue=S1 |pages=S48–S57 |doi=10.2460/javma.22.12.0573}}</ref> '''Due to the wide scale of clinical symptoms that can be present, along with the diverse variations of skin autoimmune dermatoses, a single symptom will more than likely not lead to a diagnosis. Instead, the results of the biopsy combined with the canine's history and other clinical signs can help in confirming the diagnosis of the disease. Breed predisposition and the age of the dog can also be indications of the various possibilities of autoimmune skin diseases.''' <ref name=":7">{{Cite web |title=Canine cutaneous autoimmune disease {{!}} Vet Focus |url=https://vetfocus.royalcanin.com/en/scientific/canine-cutaneous-autoimmune-disease |access-date=2024-04-16 |website=vetfocus.royalcanin.com}}</ref> '''Some common symptoms that can be used to lead to a confirmed diagnosis include alopecia, crusting, ulcerations, vasculitis, and many more.''' <ref name=":7" />
+'''Histopathology evaluations can be done by extracting areas of the skin that show indications of being affected, such as taking biopsies of lesions, pustules, and sites of crustation. These tissue samples would then be typically examined under a microscope, where a clinician will form a conclusive diagnosis based on the observed cellular structures and abnormalities.''' <ref name=":7" /> '''Additionally, other tests such as antinuclear antibody tests (ANA) and complete blood count with white blood cell differential tests can be used to gather more information.''' <ref>{{Cite web |title=Autoimmune disorders Information {{!}} Mount Sinai - New York |url=https://www.mountsinai.org/health-library/diseases-conditions/autoimmune-disorders |access-date=2024-04-16 |website=Mount Sinai Health System |language=en-US}}</ref>
+'''For Pemphigus vulgaris, after the skin begins to separate, Nikolsky's sign can be useful to help diagnose the disease. This involves placing pressure along the edge of a blister and observing if the skin separates further and if the blister increases in size.<ref>{{Cite journal |last=Maity |first=Subhadeep |last2=Banerjee |first2=Ishita |last3=Sinha |first3=Rupam |last4=Jha |first4=Harshvardhan |last5=Ghosh |first5=Pritha |last6=Mustafi |first6=Subhasish |date=2020-02 |title=Nikolsky's sign: A pathognomic boon |url=https://journals.lww.com/jfmpc/fulltext/2020/09020/Nikolsky_s_sign__A_pathognomic_boon.15.aspx |journal=Journal of Family Medicine and Primary Care |language=en-US |volume=9 |issue=2 |pages=526 |doi=10.4103/jfmpc.jfmpc_889_19 |issn=2249-4863}}</ref> However, to diagnose the disease with complete certainty, biopsies must be taken from the edge of the blisters. The tissue sample must then be analyzed using a direct immunofluorscence technique and analyzed microscopically. The direct immunofluorescence technique should be used instead of indirect, as the results may be inaccurate before the disease has progressed to a certain point.<ref name=":1" />'''
 == '''Treatment''' ==
-'''For most autoimmune skin diseases, it is imperative to begin treatment as early as possible, as the progression of the disease can lead to severe complications and even death.<ref name=":1" /> Treatment for many diseases usually involves the use of immunosuppressants such as glucocorticoids.<ref name=":2" />'''
+'''For most autoimmune skin diseases, it is imperative to begin treatment as early as possible, as the progression of the disease can lead to severe complications and even death.<ref name=":1" /> Treatment for many diseases usually involves the use of immunosuppressants such as glucocorticoids.<ref name=":2" />''' '''The immunosuppressants aid in suppressing the reaction of the immune system fighting against the body's healthy cells and tissues.'''<ref>{{Cite web |title=Autoimmune Skin Disease in Dogs {{!}} VCA Animal Hospital {{!}} VCA Animal Hospitals |url=https://vcahospitals.com/know-your-pet/autoimmune-skin-disease-in-dogs |access-date=2024-04-16 |website=Vca |language=en}}</ref> '''This is done by the inhibition of calcineurin, an enzyme that controls and activates T-cell production. Without the consistent production of T-cells, a decrease of autoimmune activity can be observed, leading to less severe symptoms and potential remission of autoimmune diseases.'''<ref>{{Cite web |title=How Do Immunosuppressants Work? - Uses, Side Effects, Drug Names |url=https://www.rxlist.com/how_do_immunosuppressants_work/drug-class.htm |access-date=2024-04-16 |website=RxList |language=en}}</ref>
+'''When treatment is first started for Pemphigus vulgaris, the dog will usually be given the corticosteroid prednisone for a limited time. This will be administered orally, and the amount given can vary between 1.5 to 13.3 milligrams for every kilogram of the dog's weight. This amount will continue until symptoms begin to subside. Afterward the dose will be lowered, and other medications will be used. The condition cannot be cured, so the dog will require immunosuppressants and steroids for the duration of its lifespan. The specific immunosuppressants used generally include cyclophosphamide, methotrexate, or azathioprine. Antibiotics may also be used to help reduce the risk of infection.<ref name=":1" />'''
 === References ===