Abstract
A 7-year-old female Cocker spaniel-cross was referred with an 8-month history of mucocutaneous erosive dermatitis. On physical examination, skin lesions affected the eyelids and periocular area, lips and vulva. Lesions were symmetrical with small diffuse superficial ulcers, haemorrhagic crusts, adherent purulent exudation in haired skin, and alopecia with hyperpigmentation and scarring. Histopathologic evaluation showed multiple, non-intact dermoepidermal junction vesicles and ulceration associated with a dermal lichenoid infiltrate. Immunohistochemistry showed strong to moderate reactivity in the dermoepidermal junction for the antibodies directed against canine IgG, human IgG lambda light chains and C3, respectively. A diagnosis of autoimmune subepidermal blistering dermatosis was made. Treatment with oral prednisone at 2 mg/kg and mycophenolate mofetil (MMF) at 20 mg/kg twice daily was initiated and after 4 weeks the ulcers and erosions were cured. During the rest of treatment, MMF was maintained at 10 mg/kg twice daily and prednisone could be tapered to 0.25 mg/kg once every other day without recurrences. In conclusion, this case report shows that MMF was well tolerated and might be effective as steroid-sparing agent in the long-term treatment of this autoimmune subepidermal blistering disease.
Highlights
Bullous skin diseases are characterised by the formation of clefts, leading to vesicles or bullae
The therapies based on mycophenolate mofetil (MMF) were the second-most successful after those based on cyclophosphamide and the best tolerated with the least side effects of all therapies used[16]
In this case report the use of MMF as steroid sparing agent in a dog diagnosed with Subepidermal bullous diseases (SEBD) is described
Summary
Bullous skin diseases are characterised by the formation of clefts, leading to vesicles or bullae. Subepidermal bullous diseases (SEBD) have been described mostly in the dog. Bullosa acquisita (EBA), linear IgA disease and bullous drug eruptions are SEBD described in the dog[6]. Linear IgA disease was described in 2 dogs[11], and MMP was established as the most common autoimmune disease of the basement membrane zone in the dog and cat[12,13]. A retrospective study evaluated the effectiveness and toxicity of immunosuppressive therapies in the treatment of 338 human ocular MMP cases. The therapies based on MMF were the second-most successful after those based on cyclophosphamide and the best tolerated with the least side effects of all therapies used[16] In this case report the use of MMF as steroid sparing agent in a dog diagnosed with SEBD is described. Prednisone was tapered to 0.5 mg/kg s.i.d. before the patient was referred to the University hospital
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