# Pemphigus Foliaceus - Morgan Mare



## tealamutt (Aug 21, 2009)

I'm sorry you're going through this, it is probably very stressful for you to see her this way. What treatments are you using and how long have you been trying? Someone else on here was recently asking some similar questions, hopefully she can give you some hope. I spoke with some of the equine medicine specialists at school (I'm a vet student) about pemphigus foliaceus and they said that it is usually very responsive to treatment with all of the caveats of side effects to treatment (predisposed to laminitis). Maybe you just need to ride it out a little longer until she turns the corner?


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## My Beau (Jan 2, 2009)

Not to be a bad news bear, but I've read about 90% of horses with this don't survive past the first year. That's due to both the condition and the subsequent bouts of laminitis that are possible, like tealamutt mentioned.

I hope your girl responds well to any treatment! Please keep us updated!


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## tealamutt (Aug 21, 2009)

That figure is not at all correct, according to the internal medicine specialists here. Granted her prognosis may be different depending on her age and response to treatment and only the treating vet can give an accurate assessment but you are wrong, 90% is a figure that is much much too high.

http://www3.interscience.wiley.com/journal/118793368/abstract?CRETRY=1&SRETRY=0
http://www.laboklin.cz/pdf/en/publications/pemphigus_foliaceus_vetrec_2005.pdf

here are two peer reviewed journal articles with more accurate estimates of successful treatment.


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## My Beau (Jan 2, 2009)

Well, that's good! I got very nervous for the owner when I read this and remembered reading that. It was few months ago - stumbled across it when I was looking up some other skin issues online. But, thanks for telling me I'm wrong - really, I feel a lot better for the owner! 

I couldn't get the first link to open, but the second one was very interesting - that one got saved!


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## tealamutt (Aug 21, 2009)

sorry, I meant to say the numbers were wrong, not "YOU ARE WRONG", reading it again, it came out kind of snippy. I just didn't want the OP to see 90% don't make it and start panicking! =)


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## My Beau (Jan 2, 2009)

tealamutt said:


> sorry, I meant to say the numbers were wrong, not "YOU ARE WRONG", reading it again, it came out kind of snippy. I just didn't want the OP to see 90% don't make it and start panicking! =)


No worries, atleast her mare has a better chance! I hope she comes back and posts here again..


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## Lethak (Nov 11, 2009)

I'm new to this forum so sorry if I'm a little slow.

Yes, this is great news. But we did find when we tired to bring her off the dexamethisone, it returned and is being harder to calm back down. She is a real fighter and I'm not giving up, just trying to understand a condition that little answers are available. I would not wish this on anyone's horse. My horse was in a lot of pain before it was finally properly diagnosed. It appears to be a long road to walk but I'm determined to do all I can for my mare. She is a very strong horse.

Thank you all for responding.
Letha


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## Lethak (Nov 11, 2009)

To answer the question about what and how long:

She was diagnosed on 11/3/09, that night I have her 30mg dexamethisone (may be misspelling it) and 20 cc Baytril. At that point she could not walk, running fevers (was giving her alcohol baths that day and one prior), she had over 50% of her body in swollen sores (that are hard to explain) and all limbs swollen like telephone poles. Very lethargic and in pain. I was begging the vet to call the lab for results as I didn't think she would last many more days.

Within 12 hours of the inject, it was a big turn around. Next morning, it was 20mg of dex injected. By that evening, 50% of swelling was gone and she could walk easily 20cc Baytril again that night.

Day 2 - 20mg of dex injected and 20cc Baytril orally. By now, almost all swelling is gone, she is trotting and totally different horse.

Day 3 - 10 mg of dex injected and 20 cc Baytril orally. Bucking and looking great.

Day 4 - 10 mg of dex inject and last 20 cc Baytril orally.

Day 5 - 10 mg of dex orally

Day 6 - 10 mg of dex orally, she is starting not to look right, 

Day 7 - a.m., new sores appearing, slower to walk and swelling returned in rear legs. It's BACK....had given 10mg of dex orally in a.m. That p.m. vet had me give 20mg dex injected

Day 8 - didn't respond as well as before, injected 10mg dex and started 20 prednisolone tablets.

Day 9 - Injected 10 mg dex and 20 pred tablets, she is looking a little better, able to walk easily but still painful and some swelling in back legs.

Day 10 - Will give last 10 mg dex injection tonight and will stay on pred tablets for two weeks and reasses at that time. Assuming she is stable at this dose for now.

I hope it's ok to give a blow by blow description. What I'm learning is it is hard to decrease the meds (which have such bad side effects). And each time it come back, it's harder to settle down.

Thanks for any input, hopes, thoughts, and prayers.
Letha


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## tealamutt (Aug 21, 2009)

A lot of studies have had more success with prednisone or prednisolone which are both steroids (as is the dex you are currently using). Is your vet willing to try this medication instead? It is true that very often it is hard to back them off the meds but even if you can't they can usually be maintained on the steroids for some time. The fact that it responded so well to treatment makes me wonder if you just need a different steroid.


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## Lethak (Nov 11, 2009)

tealamutt said:


> A lot of studies have had more success with prednisone or prednisolone which are both steroids (as is the dex you are currently using). Is your vet willing to try this medication instead? It is true that very often it is hard to back them off the meds but even if you can't they can usually be maintained on the steroids for some time. The fact that it responded so well to treatment makes me wonder if you just need a different steroid.


Yes, we started her on prednisolone three days ago. We stopped the dex last night and will continue on prednisolone. I just hope it gets better. She is bright and eating well but the swelling in her back legs only goes down when you walk her. Guess I just need to give it some more time.

Thanks again,
Letha


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## Lethak (Nov 11, 2009)

Sorry, I'm trying to figure out this web site. I tried to reply and not certain where it ended up.

She has been on prednisolone for three days now. We stopped the dex im last night. She seems bright and eating well but still has swelling in the back legs. The swelling does go down if I walk her so will walk her a few times a day. The swollen sores are still all over her body. She is appearing to get itchy now. Don't know if this is a good or bad sign. Hopefully she continues to improve. She has never gotten back to the point she was three days post initial treatment. We are on day 8 today.
Thanks,
Letha


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## tealamutt (Aug 21, 2009)

Sometimes immune problems take some time to get under control. The itching could be a sign of healing in the sores which would be good. At least she seems fairly comfortable now, I guess all you can do is wait and see how the treatments go, keeping my fingers crossed for you girls!


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## Lethak (Nov 11, 2009)

Well, we tried the prednisolone tablets and tried removing the dex and she relapsed, new sores and all four limbs swollen. So back on the dex (Sat. night 30 mg IM, Sun. night 20 mg IM and then Mon. night 10 mg IM). As each time before, the dex IM does wonders for her but it appears she may be getting it back. I'll know for certain when I get home tonight. I hope to talk with vet today to determine what to do if she does relapse a third time.

She is eating well and gaining back some of the lost weight which is good news.
Letha


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## tealamutt (Aug 21, 2009)

hoping for good news for you, I'm sorry you guys seem to be fighting an uphill battle. Will keep my fingers crossed that you hear something positive from the vet.


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## Lethak (Nov 11, 2009)

*Sierra Update*

Well, it doesn't seem to be going well. She relapses about every 3 or 4 days off dexamethosone shots. She's been on 30 tablets to prednisolone daily and for the last four days, she is now also on 20 tablets of Azathioprine. She was backsliding again last night and had to give her another dex shot. We have been trying to get her in remission for 35 days now without any success. Some of the sores are healed but now they are also on her eye lids and anus area. She is sloughing off the skin on all four legs. The new skin appears thinner and not much hair. She often has the swollen legs, first the rear legs and then the front.

I'm considering putting her down. I feel I have to have some sort of good news by end of the year. I do believe she is in a certain level of pain. This is would not be a good life and these drugs will eventually destroy her insides or give her laminitis. I just don't know if I'm simply delaying the inevitable. 

Wish I had better news to relay.
Thanks for listening,
Letha


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## Jordi (Nov 29, 2009)

I'm so sorry to hear about your mare. :-( I'll definitely be keeping you both in my thoughts--hopefully she'll begin to feel some relief soon. It sounds like you're doing everything you can to help her.


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## Lethak (Nov 11, 2009)

Update on my mare, she might be backsliding. The vet has a resident and he didn't order the right amount of Azathioprine so we ran out. In 24 hours, it appears it might be coming back. I'm looking into homeopathic now as don't seem to be getting there plus I'm concerned about all the drugs we are giving her.

I'll keep you posted and thanks,
Letha


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## 5cuetrain (Dec 11, 2009)

Thinking about you and your mare.

Had a similar situation with a filly a few years back. Tried most of what you are doing.

Don't know why but she responded the best with a mix of benedryl, histamine blocker (like pepcid for heartburn) and prednezone.

had to inject her at first but then we could maintain with benedryl until it came back--usually 1 to 3 months--then back to the triple shot.


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## Lethak (Nov 11, 2009)

Hello 5cuetrain,

How old was your filly when she came down with pemphigus and is she still alive? 

She did back slide because the meds were two days late. But the sores were just starting back up so I think I caught it in time. Hopefully.

Thanks,
Letha


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## 5cuetrain (Dec 11, 2009)

This filly was owned by a client of mine. She was a race horse and was 4 years old when things started to happen. She was at the track and we brought her back to my barn. Kept her there for around 9 months and the owner decided to put her down.

Not my choice but I could understand it from the business side of things. I also agreed from the humane side of things also. She was a fighter and a trooper for sure.

She has a special place in my heart.


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## Lethak (Nov 11, 2009)

Thanks for the information. Wasn't what I wanted to hear but I'm finding that is why most are put down, they try for about a year and then give up. It's such a sad situation. A few can make it to the other side (remission) but what I know if, even if I get her there, I'll always be waiting for the "next time" it comes around.

Letha


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## 5cuetrain (Dec 11, 2009)

wish I could have had something more positive to tell you.

Keep whats best for her at the top. she will let you know.


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## Lethak (Nov 11, 2009)

I thought I'd better give an update on Sierra.

Today, Sierra is actually doing better but does appear to be getting aggressive to the other horses. I believe that is a side effect of these meds. We'll see.

The sores are slowly healing, the skin has stopped sloughing off and hair has grown in on most of the places where the skin came off. 

My big concern is she is on two powerful (and expensive) drugs and she cannot stay on them. My husband and I have decided if we can't get her off these meds or if the homeopathic doctor (who we are trying next) doesn't help and we have to take weeks to get her stable again, we will euthanize her. It's been a hard decision but we don't feel we can put her through this time and time again. But all that said, I'm still not giving up just yet. We just want her to have quality to her life if we can give her that. And not with lots of medications. Sooner or later, the medications will do damage to kidneys/liver and give her laminitis.

Who knows, we might be over the hump and don't know it yet. She does have a twinkle in her eye and she is running/bucking around with the herd like life is grand.

Letha


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## Lethak (Nov 11, 2009)

Just an FYI on Sierra, she appears to be going backwards WHILE on all the meds. The oozing sores are re-appearing. Not looking good.
Letha


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## SmoothTrails (Oct 1, 2009)

I'm very sorry. I will keep your horse in my prayers.


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## Walkamile (Dec 29, 2008)

Lethak, I am so sorry to hear this. I was just thinking about you both a few days ago. I'm keeping you both in my thoughts and prayers.


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## 5cuetrain (Dec 11, 2009)

Thinking about you and your mare.


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## Lethak (Nov 11, 2009)

Thank you for the thoughts and prayers. I am going to try some unconventional options as steroids didn't do it. Guess she has a pretty bad case. I should know in a month if this other option will work. I will update the site on the progress.
Regards,
Letha


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## HalfPass (Jun 12, 2009)

Hi there...
I am so sorry about Sierra! I felt the tears coming while I was reading. My thoughts and prayers go out to you all.
Sending out the good vibes.
Halfpass


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## Lethak (Nov 11, 2009)

Just an update on Sierra.

It turns out they filled my last prescription with prednisone rather than predisolone so I basically dropped her medication into a quarter dose over night. About a week after getting the refill, the sores started re-appearing. I now think it was due to the instant reduction of the medication. She is only at about 15% sores over her body (at worst, it was around 75%) so we are better. I've decided to take her off the steroids and try a couple of alternative treatments. So time will tell but right now, she isn't as aggressive, seems alert, clear eyes, running around and appears only slightly discomfort in back legs (she is almost always cocked on right back leg). No swelling so we are hanging in there.

I'll update again once I see what happens with the new treatments.
Letha


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## Lethak (Nov 11, 2009)

You all might remember I sought out information on this condition last November when Sierra (my 6 year old Morgan mare) was diagnosed with pemphigus folicaeus which is an autoimmune condition that the body attacks the second layer of skin. It’s a very rare and painful condition that can only be diagnosed by deep plug biopsies. We had been treating her for a couple months prior for gnat allergy (what the vet thought). In hindsight after dealing with this condition, studying it, etc., I now believe it was caused by the rattle snake bite when I got her home. This explains that cinchiness I had with her that I thought was an ill fitting saddle. The tail swishing and dancing when I saddled her was basically pain from this condition when I didn’t know it was there. Hers did not initially show as sores (never really made open sores). They get a “crusty” chunky type of dandruff but it’s really an amber liquid like in a blister that is coming through the top layer of skin. It cannot be treated externally, won’t do any good. I believe she had this condition at least a year before her actual diagnosis.

So after two months of standard treatment (dexamethosone shots, then prednisone (should have been prednisolone, was given the wrong pills at the pharmacy) and azthioprine (an anti-rejection drug) I decided to go with alternative treatment as we weren’t getting anywhere with the steroids. In defense of the steroids, if I had been given the correct drugs, she probably would have responded better. But with steroids, you always run the risk of laminitis. I then took a month or more to get her off the steroids. It was when I had her almost off the steroids that I found out I was giving the wrong one. I then went with Transfer Factor. She is now on day 54 of the treatment with this supplement and she is doing very well. I’ve documented most of the last 6 months in photos and journals. Lots of ups and downs. Initially, I was told only 10% make it over a year because of the steroid treatment and other complications that come with that along with what it takes to deal with this condition. I’ve found it’s more like 50% success now as more people are trying then immediately giving up and euthanizing their animals.

So here she is today. We aren’t totally there but close. You will see the one of her in flight,,,that is how she leaves her pen every morning to go into the large paddock. She has some dried up crusties on her sides and a small amount of tuffs of hair coming out in flank areas. She had swelling in front of her bag for about two days and it went away. Her condition as gone up and down but now seems to be staying in the right direction. The swelling in her back legs NEVER returned. At one time, she had 75% of her body reacting to this condition and she lost all the skin on her legs. It is said that it’s possible to get her in full remission and she will be like any other horse. The main exception is I will not give her vaccinations again (at least for four or five years) and will do fecal tests as not certain about worming her. This is so we don’t set this off in motion again. Today, she might have 5% of her body active with this.

If we continue on the path we are on, I should be able to ride her this summer.

Thank you all for prayers and good thoughts
Letha


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