# Pemphigus - any experiences?



## Box_Of_Frogs (12 December 2010)

Asking on behalf of a friend. 6 weeks ago they took pity on a terribly sick looking TB and bought him. Owners said he was "poor" because had recently been on long term box rest, possibly cross tied, not sure. Friends have been trying all the usual things to get weight and condition back on him but to their horror he has suffered an almost complete systems shut down. He has developed a very rare auto-immune condition called pemphigus. He has coronitis in all 4 feet, with pus oozing out continuously. Ergots and chestnuts oozing serum and blood. Skin flaking. All mucus membranes inflamed and raw. Symptoms of belly ache too. He's eating like mad but it all just comes squirting out the other end. He's put on the tiniest amount of condition in the 6 weeks but he's in a bad place, sometimes driven so mad by the coronitis that he lies down and chews his feet. This has given him awful sores around his mouth. He's been on antibx which help but the minute he's taken off them, he deteriorates again. He's only 6 love him. They've spoken to Prof Knottenbelt who has advised it is a very serious disease with a guarded-to-poor prognosis. He has said they need a peritoneal tap to be performed asap to look for free blood in the abdomen and some other diagnostic procedures that I can't remember. Of course, he wasn't insurable.

I know this is desperate and the friend - very experienced horse owner - knows that there may come a time when they need to call it a day. But if there is the tiniest hope of a recovery they want to offer it to this lovely chap. Has anyone had any experience of this awful disease, good or bad? If good, do you have any idea what it was that "turned the corner"? Thanks all.


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## JanetGeorge (12 December 2010)

Thankfully I have never seen this condition!  There is a Yahoo group - http://pets.groups.yahoo.com/group/EquinePemphigusFoliaceus/

Might be worth joining and having a look there for people's experiences.


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## Box_Of_Frogs (12 December 2010)

Janet, that's amazing. Many many thanks for the link. Will pass it straight on x


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## brucea (12 December 2010)

I wonder if prednisilone would help him?

Where is Imogen when you need her


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## misst (12 December 2010)

I "think" a pony at a yard I was on some years ago had had this. She had been very very poorly. She was an older mare (in her teens) but much loved. She definitely had coronitis and lots of skin problems. She also had had laminitis due to the medication and the stress. She had to have a special diet I think. 

She is still going strong and I passed her out hacking today and she looked fine. I know she was on massive doses of steroids and lots of other meds and I do not know how much she is on now. Her owner nearly lost her several times. 
If it is the same thing then I wish your friend luck - but there is some hope. This mare had this many years ago and is now in her 20s.


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## kazhar (12 December 2010)

I havnt seen it in a horse but several years ago, I had a patient with it. her skin was literally sperating from her body. I can remember she was on huge amonts of prednisolone and had some skin wash made from potassium permanganate which had to be applied several times a day. sorry cant be more help and dont know if the skin wash is ok for horse use but just thought I would mention.


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## Box_Of_Frogs (13 December 2010)

Thanks again all x


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## GreedyGuts (13 December 2010)

Certainly sounds like pemphigus, and a fairly severe case at that. As others have said, immunomodulatory drugs such as steroids are the treatment most likely to have an effect. If they are keen to give him every chance then I would suggest refarral to a medicine specialist. I believe you are in West Wales; have they spoken to anyone at Cotts Farm? I understand that Shaun McKane who used to work with D Knottenbelt is now based there and may be of help.


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## cptrayes (13 December 2010)

The only one I know got it immediately after having his penis amputated because of cancer. I always wondered if his immune system was so ramped up to attack the cancer that when it was suddenly gone it took against the rest of the horse instead. I'm sorry to say that the horse was put down because its symptoms were too difficult to control and its life was a misery.


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## Llwyncwn (30 December 2010)

GreedyGuts said:



			Certainly sounds like pemphigus, and a fairly severe case at that. As others have said, immunomodulatory drugs such as steroids are the treatment most likely to have an effect. If they are keen to give him every chance then I would suggest refarral to a medicine specialist. I believe you are in West Wales; have they spoken to anyone at Cotts Farm? I understand that Shaun McKane who used to work with D Knottenbelt is now based there and may be of help.
		
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Thank you to everyone who posted and for those who are interested.  Troy was PTS yesterday as all treatments failed.  Thank you GreedyGuts, owner spoke at length with Shaun on your advice.  

I hope that more people become aware of this awful desease which could happen to any one's neds.  My equine vets see 1-2 cases each year, which is 1-2 cases too much.  RiP Troy and sympathy to his owners who tried every avenue.


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## Box_Of_Frogs (31 December 2010)

Oh no. And they tried so hard to save him. He was only 6 I think. RIP Troy and hugs to C and K x


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## chunky11 (21 July 2011)

My 3 year old thoroughbred gelding has been battling this for 3 weeks now Pemphigus coronitis.

 He is now on prednisolone and I am not sure what else to do it is awful, I dont really have anything to go off - what is a bad case or mild case?
I have never seen or head of this before, and I have read up a lot about the human form as little to go off on the equine, also in touch with D Knottenbelt over it,

If anybody has any advice on there experience's with this horrible disease I would be grateful, it is the cornonitis form but his skin is affected by lesions along with his mucous mebranes,

I think due to discomfort and pain and as a result of the medication he has become extremely difficult to handle, I cant wash his wounds on his pasterns and worried they will get infected (he is 16.3hh and means to kick) he is usually the sweetest but this has really turned the poor guy sour.

Wondering if I am doing the right thing here keeping him going??


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## popularfurball (22 July 2011)

Did you look at my thread? 

I don't wash her sores just apply flamazine cream to help them heal. I find them getting wet pulls scabs off and that then leaves wounds open. I leave them open to the air as they heal faster.


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## chunky11 (22 July 2011)

popularfurball said:



			Did you look at my thread? 

I don't wash her sores just apply flamazine cream to help them heal. I find them getting wet pulls scabs off and that then leaves wounds open. I leave them open to the air as they heal faster.
		
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Yes I read your thread, and joined Yahoo one - still need to get some pics up although his is coronitis - 

ok, the only problem with cream is that I can no longer get near him, combination of the steroids and being messed with so much as he is usually so mannerly and gentle.

The only way I can get round him is to hose off then squirt a weak solution of hibiscrub around the lesions and just leave them to dry, this doesnt seem to sting /  bother  him - and then try and puff some veterinary wound powder on, he did have a lesion that looks better and dry today as it was looking quite proud.

Do you treat her with prednisolone? This has changed him so much and hoping his system will settle down so he is more manageable - at over 16.2 and still growing hes far to big to be barging, kicking, its a shame as I know this isnt him it must cause him so much pain! xx


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## popularfurball (22 July 2011)

Yes we used prenisolone. Fab stuff though it has left impressive marks on her feet even though we dodged lami. I wa advised that the lami often comes after the steroids Finish just continue those precautions for a little while longer to let them out the system.

Hibiscrub kills healthy tissue as well as bacteria so slows the healing down. Would ask about something like flamazine cream which promotes healing and then just rinse legs with water once a week. 

Silver behaves like she is on fire - she can only have hard brushes, and can't tolerate leather bridle or metal in headcollars. 

I've also used the global herbs restore to good effect with her and use the immuplus though any results were not as easily visible. 

Keeping out of sunlight seems to really help us - though it's not an obvious link for us, having stabled her for a week the improvement is massive.


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## chunky11 (22 July 2011)

popularfurball said:



			Yes we used prenisolone. Fab stuff though it has left impressive marks on her feet even though we dodged lami. I wa advised that the lami often comes after the steroids Finish just continue those precautions for a little while longer to let them out the system.

Hibiscrub kills healthy tissue as well as bacteria so slows the healing down. Would ask about something like flamazine cream which promotes healing and then just rinse legs with water once a week. 

Silver behaves like she is on fire - she can only have hard brushes, and can't tolerate leather bridle or metal in headcollars. 

I've also used the global herbs restore to good effect with her and use the immuplus though any results were not as easily visible. 

Keeping out of sunlight seems to really help us - though it's not an obvious link for us, having stabled her for a week the improvement is massive.
		
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I know what you mean about the hibiscrub, just do it weak and rinse, I could actually cry at not being able to get near them, I have everything to hand and could get some of that cream but I cant get near!

Being out at night definatly suits him and hes in in the day away from the flies, also hes exhausted and likes the rest. His heels are in a pretty bad state but I can not pick them up to spray them or even pick them out.
Did your mares attitude change on the pred? He is literally a nightmare bless him, known him since he was a foal and he has never put his ears back at another horse let alone people...


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## HBM1 (6 October 2012)

Sorry resurrecting this as it is highly likely what my mare has developed. I got a second opinion from a new vet as first vet was doing nothing and it is heartbreaking to see her coronets and being driven insane chewing.  he did a full work up and sent bloods and photos to liverpool..missed vet phoning last night so hope to catch him soon but he had left me the practice's own lotion and her coronet bands stopped oozing overnight..i know the outcome for troy was tragic..i am hopeful my mare can be well managed and get over this even if on daily meds..


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## chunky11 (7 October 2012)

HBM1 said:



			Sorry resurrecting this as it is highly likely what my mare has developed. I got a second opinion from a new vet as first vet was doing nothing and it is heartbreaking to see her coronets and being driven insane chewing.  he did a full work up and sent bloods and photos to liverpool..missed vet phoning last night so hope to catch him soon but he had left me the practice's own lotion and her coronet bands stopped oozing overnight..i know the outcome for troy was tragic..i am hopeful my mare can be well managed and get over this even if on daily meds..
		
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What is happening to her coronets?
My boy was three years old when I had to put him down, I since made a page https://www.facebook.com/pages/Equine-Pemphigus-Coronitis-awareness/126090464145296?ref=hl although it was actually Paraneoplastic Pemphigus which Chunky had, the most agressive form.
I had every determination to save him, the whole ordeal lasted 5 weeks from him looking healthy to lesions all over coronets and bleeding, blistered and swollen skin, gradually to skeletal and his digestive system failing.
It was the worst thing I have had to experience and watch my horse go through this dreadful pain, at the time I was still in determined mode, giving up on that is hard, letting him go was so hard but the only good thing let to do by him.
Please look at the facebook and look through his pictures.
You also need to contact Professor Derek Knottenbelt from Liverpool university / leahurst referal hospital, he is one of few that knows anything about this, google his contact.
If you want to investigate this you need an applecore biopsy and tell them that you are suspecting Pemphigus - please be aware that this also may be inconclusive as it was for me, bloods will show very little also but symptoms will be nothing less than horrible.

Be strong for your mare,

Please keep us updated, good luck Ax


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## chunky11 (7 October 2012)

http://www.horseandhound.co.uk/forums/picture.php?albumid=2571&pictureid=13964


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## HBM1 (7 October 2012)

Thank you ChunkyII I will have a look through these.  Her symptoms first started 10 weeks ago.  Literally just some bumps under her skin and some mud fever-like looking scabs on her heels.  Nothing out of the ordinary for her each year.  However, on a hot Thursday she was literally eaten alive by flies, I have never seen anything like it.  She was bleeding from open sores on her body and legs were running blood.  I brought her in and washed her down, put some hydrocare on and later sudocrem.  She also lost weight in a week.  

I called the vet and she came on the Monday, by which time Sienna had sore and red gums and membranes.  Vet took bloods and gave her a steriod injection and some antibiotics as by now her coronet bands were oozing pus. he vet didn't want to give her anything else until the bloods came back.  Later in the day she rang to say her liver test was at 200 (I dont  know in comparison to normal) and she wanted to blood test her again in 6 weeks to see if it was recovering.  At that stage all she said was keep her in and give only happy hoof and milk thistle.  

6 weeks later she came back and took another blood test, this time liver was 69.  Vet was pleased with this although Sienna was getting more itchy and so had another steroid shot.  

Her legs were still bleeding and she would get spontaneous sores on her upper legs.  The coronet bands were the most worrying as they were literally oozing.

Fed up with seeing her like this I called in a completely different vet practice for a second opinion.  He came last Monday and took a full work up, of bloods and as I said above, many photos from various angles and sent it all off to Liverpool as he said they were the top specialists in the country for dermatology.  He does now have their opinion back but unfortunately I haven't been able to catch up with him and didn't like to call him today.  I will do so tomorrow morning.  The lotion he left her cleared up her coronet bands immediately, they went from oozing, to looking nice and flat, though pink.  She stopped itching completely.

What concerns me is he kept asking me if her face swelled up initially, I said no, only her back legs.  He seemed perterbed by this and he said liver problems usually would show in the face too wherever there is white (she has a big blaze).  For this reason he felt her issues were more skin disorder related than liver.  Not once did the first vet even consider a skin disorder and my worry is that Sienna has been suffering longer than she should because of this.

It is really helpful to see how other horses have reacted, the different levels of severity etc.  Sienna has never lost her appetite, if anything is ravenous on just the happy hoof.  I am hoping that she will get a firm diagnosis and we can treat her with medication and get her back outside, even if only at night.  

Thank you very much for your time in replying 

Edited to add I am very sorry about your boy, 3 is such a young age and it must have been very traumatic x

My vet didn't want to take a biopsy on his first visit because her skin was so sore, so he may have to do that now they have calmed down.


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## chunky11 (7 October 2012)

HBM1 said:



			Thank you ChunkyII I will have a look through these.  Her symptoms first started 10 weeks ago.  Literally just some bumps under her skin and some mud fever-like looking scabs on her heels.  Nothing out of the ordinary for her each year.  However, on a hot Thursday she was literally eaten alive by flies, I have never seen anything like it.  She was bleeding from open sores on her body and legs were running blood.  I brought her in and washed her down, put some hydrocare on and later sudocrem.  She also lost weight in a week.  

I called the vet and she came on the Monday, by which time Sienna had sore and red gums and membranes.  Vet took bloods and gave her a steriod injection and some antibiotics as by now her coronet bands were oozing pus. he vet didn't want to give her anything else until the bloods came back.  Later in the day she rang to say her liver test was at 200 (I dont  know in comparison to normal) and she wanted to blood test her again in 6 weeks to see if it was recovering.  At that stage all she said was keep her in and give only happy hoof and milk thistle.  

6 weeks later she came back and took another blood test, this time liver was 69.  Vet was pleased with this although Sienna was getting more itchy and so had another steroid shot.  

Her legs were still bleeding and she would get spontaneous sores on her upper legs.  The coronet bands were the most worrying as they were literally oozing.

Fed up with seeing her like this I called in a completely different vet practice for a second opinion.  He came last Monday and took a full work up, of bloods and as I said above, many photos from various angles and sent it all off to Liverpool as he said they were the top specialists in the country for dermatology.  He does now have their opinion back but unfortunately I haven't been able to catch up with him and didn't like to call him today.  I will do so tomorrow morning.  The lotion he left her cleared up her coronet bands immediately, they went from oozing, to looking nice and flat, though pink.  She stopped itching completely.

What concerns me is he kept asking me if her face swelled up initially, I said no, only her back legs.  He seemed perterbed by this and he said liver problems usually would show in the face too wherever there is white (she has a big blaze).  For this reason he felt her issues were more skin disorder related than liver.  Not once did the first vet even consider a skin disorder and my worry is that Sienna has been suffering longer than she should because of this.

It is really helpful to see how other horses have reacted, the different levels of severity etc.  Sienna has never lost her appetite, if anything is ravenous on just the happy hoof.  I am hoping that she will get a firm diagnosis and we can treat her with medication and get her back outside, even if only at night.  

Thank you very much for your time in replying 

Edited to add I am very sorry about your boy, 3 is such a young age and it must have been very traumatic x

My vet didn't want to take a biopsy on his first visit because her skin was so sore, so he may have to do that now they have calmed down.
		
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Hello,

Chunky's started as what seemed to be mud fever on his lower back legs which I was treating, I was perplexed at how he got this though but it turned out to be the start of the disease, he also lost weight literally over a few days and continued to loose it each day. 
He had the same with his coronets, firstly starting off on the inner coronets, I couldnt think for the life of me what he had done apart from severe brushing, my sister asked her vet who was out for her horse what he thought and he immediatly said auto-immune, so after a night googling I found out he had Pemphigus Coronitis - devastated I just knew it was that and contacted Derek (http://www.hoofcare.com/article_pdf/HoofcarePemphigusKnot7D4CD.pdf)
I wanted to keep a log so we could properly monitor any changes in him here is a video https://www.facebook.com/pages/Equi...8340363&set=vb.126090464145296&type=2&theater I took the first morning I realised what he had and he had already lost weight - id washed his coronets which were oozing with blood and puss when I got him from the field https://www.facebook.com/pages/Equi...4145296.-2207520000.1349643740&type=1&theater

He was eating like a horse right up until I put him to sleep, his temperature was also fine despite his skin feeling hot to the touch and gums toxic.
It sounds like your new vet has refered you straight to Knotty, he really is the best person for the job and the person who helped me and Chunky.

The fact that you have said ten weeks does fill me with some hope for your mare as this twice as long as Chunky had, 

Also, I suspected flies started this disease off too, I had treated him with sterois injections twice a few months earlier for allergic reaction to fly bites (horse flies) which were horiffic, I do think this is what upset his immune system and turned it Auto-immune.

No problems, if I can get anything good out of the whole thing its to help people dealing with their own horses who may have it and cut out the middle part of not knowing, many whom I have spoken to have had to change vets and chase up bloods and biosies only to be under diagnosed.
It is very stressful. 

To help there are many homeopathic remidies such as Aloe Vera juice which is an adaptogen and helps to balance immune system, I also a spoon of rice bran oil which is high in plant sterols along with vitamin E to cleanse system of free radicals, the milk thistle is good for cleansing the liver. Global Herbs SKratch has also had very good effects - according to the many people I have now spoken to about auto immune disorders - stress is also a massive factor in agrravating immune response so avoid anything that gets her stressed at all, also a fly rug to stop any mosquitos biting and remember that fly sprays are toxic / irritant.
Another product I would highly recommend is Gold Label Wonder Gel as its 100% natural and very soothing for skin. Your Vet will possibly prescribe Flamazine which is super stuff!!


Keep us posted!


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## Heather D (23 October 2012)

Hi

My daughter's horse suffered from pemphigus as a 4 year old.  He was treated with very high doses of steriods which helped but the condition came back with a vengence each time we tried to wean him off them.   I asked my vet to refer me to a homeopathic vet.  She spoke to Tim Couzens (a vet who has written books about homeopathic equine medecine) he referred her to a homeopathic vet in our area.  As soon as she started to treat him, weaning him off steriods at the same time, he started to get better almost in front of our eyes.  It is important to get treatment from a fully qualified homeopathic vet & not try to treat your horse yourself as not every case is treated with the same remedies.  I don't understand the science of it - all sounds a bit touchy feely - but it definitely worked for my daughter's horse.  The insurance paid for his treatment as our regular vet referred us to the homeopathic vet.
He is now 8 and never had any further problems.  He has competed at the BD Nationals in the last 2 years, had  write ups in Horse and Hound (including back from the brink).  H&H are also talking about using him as a study case.


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## chunky11 (24 October 2012)

Thats amazing, I do belive in my heart that the only cure is within homeopathy, steroids dont work just slow things down and once they are on a regular dose it can become impossible to wean them off due to adrenal gland atrophy, but there isnt really many alternatives without dreadful side effects - you wouldnt get these side effects in homeopathy. I was trying to search for a homeopthic vet for chunky but it all happened so quickly it was like we had no time to breathe and think.

I hope h&h do a case study for this and raise awareness of the treatments available - not just steroids, particularly after Chunkys case study they done last October, its much more common than I ever imagined I had never heard of this before my horse began showing symptoms!

Thank you for sharing this positive news with us! What kind was your horse diagnosed with and what kind of homeopathic treatment did she undergo?

 Andrea


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## Heather D (24 October 2012)

Hi

He was diagnosed with pemphigus foliaceus, however the it is very difficult to get a positive diagnosis due to the blisters being so fragile.  The biopsy has to capture a whole blister in order to get a diagnosis and they only last a couple of hours.  Zander was like a hat rack when he was on the steriods - he was on them for about 6 months, and caught everything going as his immune system was comprimies.  As soon as he was treated homeopathicly he put on condition and his other ailments cleared up as well as the pemphigus.  

He was treated with about 8 different remedies one after the other sometimes with breaks in between.  I remember arcinicum having quite a startling result.  The vet has warned me not to self administer as you can actually cause health problems if an incorrect rememdy is given.  If you are looking for a homeopathic vet, I would look up Tim Couzens on the internet and he will put you in touch with a homeopathic vet in your area.  The initial consultation was about £200.00 but the remedies were incredibly cheap (the bill for my normal vet ran to thousands)


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## popularfurball (25 October 2012)

I too have found that herbal type routes are the most successful management approach.

Simple diet and skin products are key. 

Have a trawl through my posts and you will see my photo diary there is also a yahoo group too xx


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## chunky11 (25 October 2012)

Yes of course the dosing has to be absolutly correct and only by vet. I have some work experience coming up with holisticvet Nick Thompson who is a homeopathic vet in Bath area, after all the other work experience I have done at referal hospitals with pemphigus im really keep to see how things are treated homeopathically and will be sure to pick his brains over the subject.
Unfortunatly Chunky displayed all 3 types of the pemphigus which started with oozing coronets and was systemic.
The yahoo group has many members and I often have a read through others experiences, be sure to have a look at the facebook group too and post some pictures, im sure the people on the page will be glad to see some positive treatments working well. http://www.bahvs.com/


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