Cross-posted from the FHL.
 
In Ferret-Health-list, "Mildred Moore" <ferretmom@m...>  wrote:
I really hate to bother you, but my Suzy seems to have pemphigus.  A biopsy
was not performed until after she had had a long and short term cortizone
shot.  The biopsy only showed that there was no bacteria in the sores.
 
The sores are located around, between, top and bottom of her paws, all
around her mouth, one ear, eyes, some near her vulva and anus, plus a
couple on her tail.  She has gotten this bad over a period of 3 months.
I recently changed vets because she kept getting worse.  Every time she
would show some improvemnet, he cut her Prednisolone back, then it would
get worse than before.
 
We are at a loss as to where to go from here.  Do you have any ideas on
what we can do to help her?  She is close to 5 years of age, and I can
tell that she is very unhappy about her problems.  I almost feel like she
wants to give up.
 
>She is on .5ml of Cefa Drops each morning to keep out any secondary
>infections.  She has stopped eating solid food, but does eat duck soup
>after each dose of pred (which I mix with Ferretvite).  And yes, she has
>gained weight, up from normal weight of 1 lb 12 oz to 2 lb 6 oz.
 
Dear Millie:
 
Pemphigus is not as uncommon in ferrets as one might think.  However, it is
rarely diagnosed in ferrets for a number of reasons.  first, very few vets
consider the diagnosis - it is not currently written in the literature,
so aside from the few vets that read lists such as this one, there aren't
going to be a lot of biopsies taken and sent in for diagnosis.  Another
problem with the diagnosis of pemphigus is that very, very few biopsies
are diagnostic.  I've seen many bipsies that hinted at the diagnosis, but
only one that confirmed it.
 
Let me explain.  Pemphigus is a disease in which the bodies own immune
system attacks substances in the epidermis.  Autoantibodies are produced
against components of the cells f the epidermis, literally digesting the
structures that holds the epidermis to the underlying dermis, resulting
in the formation of blisters.  If the intact blister is biopsied, the
diagnosis is very clear.  However, because these animals are scratching and
rubbing, the blisters often rupture, leaving an ulcer, which eventually
becomes a scab.  Once the blister is gone, the biopsy becomes virtually
useless, unless the pathologist knows exactly what he/she is looking for
and knows about pemphigus in ferrets.
 
Steroids are commonly used to treat pemphigus, as they inactivate the
inflammatory response generated against the skin.  There is no set dose, as
everycase is different.  The key is to find the lowest dose that controls
the signs - there is no cure, because as you decrease the pred below the
critical threshold, the lesions recur.  Your first vet was actually trying
to do the right thing - find that lowest dose, but was not having good
success.
 
If 2.25 mg twice a day controls the signs, then we go at that dose until
everything is cleared up.  Then I would try for a maintenance of 2 mg twice
a day for 30 days, and if that worked, we might try 1.75 twice a day, etc.
The key is no fast decreases, and realize from the start that you will
never be able to remove the steroids for the rest of this ferret's life.
 
There are other more expensive and potentially risky drugs that we can use
in very severe cases which are not touched by prednisone, but since it is
working here - there is no need to go to explore that at this point.
 
In the case of generalized scabbing, it is always a good idea to at least
ask your vet about this possibility.
 
If you have any photos of your ferret with this condition, or anyone else
in this thread has some, I would really appreciate them.  Non- or poorly
haired skin (or if the animal has been shaved prior to biopsy would make
for the best photos!
 
With kindest regards,
Bruce H. Williams, DVM
 
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[Posted in FML issue 3339]