Comparative analysis of canine dermatophytosis and
Blackwell Publishing Ltd
superficial pemphigus for the prevalence of
dermatophytes and acantholytic keratinocytes:
a histopathological and clinical retrospective study
Jeanine Peters*, Danny W. Scott*,
Hollis N. Erb† and William H. Miller Jr*
Department of *Clinical Sciences, †Population Medicine and
Diagnostic Sciences, College of Veterinary Medicine, Cornell
University, Ithaca, NY 14853, USA
Correspondence: Danny W. Scott, Cornell University, College of
Veterinary Medicine, Department of Clinical Sciences, Box 34, Ithaca,
NY 14853, USA. Tel: 607 253–3029; E-mail: shb3@cornell.edu.
What is known about the topic of this paper
• Dermatophyte organisms can produce acantholysis in
skin lesions of animals.
• Trichophyton spp. have been most commonly implicated
in acantholytic dermatophytosis.
• Acantholytic dermatophytosis clinically and histopatho-
logically mimics superficial pemphigus.
What this paper adds to the field of veterinary
dermatology
• Acantholytic dermatophytosis is rare in dogs in the
northeastern USA as none were identified in the 95
cases of canine dermatophytosis that we examined.
• Of the 95 cases of canine dermatophytosis that we
examined, there was no difference between Grocott’s
methenamine-silver and periodic acid-Schiff stains, in
identification of dermatophyte organisms.
Abstract
Acantholytic dermatophytosis is a rarely reported
condition of dogs that clinically and histopathologic-
ally mimics superficial pemphigus (erythematosus,
foliaceus). Histologically, periodic acid-Schiff (PAS)
and Grocott’s methenamine-silver (GMS) are often
necessary to show the fungus. A retrospective his-
topathological study was conducted on 190 canine
skin biopsy specimens: 95 each with the diagnosis of
canine dermatophytosis or of superficial pemphigus.
All specimens were stained with haematoxylin and
eosin, PAS, and GMS. Dermatophytes were not
seen in any superficial pemphigus cases. Acantholytic
keratinocytes were noted in 14% of the dermatophytosis
cases, none of which had clinical signs consistent with
superficial pemphigus. Among cases with acantholytic
keratinocytes, superficial pemphigus had significantly
more acantholytic cells than dermatophytosis (P = 0.02).
This information was presented at the North American Veterinary
Dermatology Forum, April 2006 in Palm Springs, California, USA.
This study was self-funded.
234 © 2007 The Authors. Journal compilation © 2007 ESVD and ACVD. 18; 234–240
When comparing face and nonface cases, there was
no difference in prevalence of acantholytic keratino-
cytes in dermatophytosis or number of acantholytic
keratinocytes in superficial pemphigus. All dermato-
phyte cases were both GMS and PAS positive with
neither stain being visually superior. No dermatophyte
cases where acantholytic keratinocytes were noted
had a history, clinical signs and histopathological fea-
tures compatible with acantholytic dermatophytosis.
Accepted 3 May 2007
Introduction
Clinical differential diagnoses for a bilaterally symmetrical
facial dermatitis characterized by pustules and crusts with
involvement of the planum nasale on a dog most commonly
include autoimmune diseases such as pemphigus erythema-
tosus or pemphigus foliaceus. Infectious causes such as
Staphylococcus intermedius pyoderma, demodicosis, and
dermatophytosis would be less likely, especially with the
bilateral symmetry and involvement of the nasal planum,
as these are generally follicularly orientated diseases. How-
ever, certain dermatophytes, especially Trichophyton spp.
and Microsporum persicolor, can preferentially colonize
the epidermal surface keratin and therefore are not always
associated with a primary folliculitis.1–3 In general, these
infectious causes of facial dermatitis can be differentiated
from the autoimmune causes by cytology or histopathology.
However, Trichophyton spp. have been associated with a
newly described disorder known as ‘acantholytic dermat-
ophytosis’ which both, clinically and histologically resemble
superficial pemphigus.4–7 Like superficial pemphigus, this
syndrome often starts on the face, has bilateral symmetry,
can involve the nasal planum, presents with pustules and
crusts, and numerous acantholytic keratinocytes can be
present histopathologically.
Acantholytic keratinocytes derive from the loss of
cohesion between epithelial cells, a process known as
acantholysis. In the pemphigus complex, acantholysis is
due to autoantibodies against desmoglein or other cellular
adhesion molecules and is the histological hallmark of this
group of autoimmune diseases.8 Acantholysis can also be
a feature of some inflammatory, infectious, or drug-induced
dermatoses.9 Proteolytic enzymes resulting in acantholysis
may be released from neutrophils, eosinophils, or infectious
agents such as fungi. In bacterial folliculitis, neutrophils
release hydrolytic enzymes that can disrupt intercellular

adhesions resulting in acantholysis.9,10 In dogs, acantholytic
keratinocytes are generally seen in much lower numbers in
superficial bacterial folliculitis than in pemphigus foliaceus.10
Many Microsporum spp. and Trichophyton spp. dermato-
phytes produce keratinase and other proteolytic enzymes,11,12
and proteolytic enzymes from dermatophytes can produce
acantholysis in vitro.11 In 1994, one of the authors (DWS)
described two horses with rapidly progressive, generalized,
painful, pruritic, papular, crusting dermatitis with cytological
evidence of acantholysis suggestive of pemphigus
foliaceus.6 However, skin biopsies revealed dermatophy-
tosis, Trichophyton equinum was cultured, and the horses
recovered after receiving lime sulphur dips.
Recently, a total of four dogs were described with
acantholytic dermatophytosis that clinically and histopatho-
logically resembled a facially orientated autoimmune
disease and, without special fungal stains the diagnosis
of dermatophytosis might have gone unrecognized.4,5
Histopathologically, all of the cases had subcorneal pustules
with neutrophils and varying numbers of acantholytic
keratinocytes. Some also had varying degrees of lymphocytic
interface dermatitis, mural folliculitis, eosinophilic pustules,
follicular pustules of the outer root sheath and pigmentary
incontinence. All of the dogs presented with a predominantly
facially orientated pustular crusting dermatosis. One of
the dogs was reported to have a solitary lesion of the
muzzle for several years that recently enlarged.4 In all cases,
fungal organisms were not noted on the haematoxylin and
eosin (H&E)-stained tissue sections. Periodic acid-Schiff
(PAS) or Grocott’s methenamine-silver (GMS) stains were
needed to demonstrate fungal hyphae in all cases. In three
of the cases, hyphae were reported to occur only in the
follicular or surface keratin. The location of hyphae was not
reported in the fourth case. Trichophyton mentagrophytes
was cultured in all four cases.
The purposes of this retrospective, light microscopic
canine study were to: (1) document the prevalence of
dermatophytes in biopsy specimens with a histopathological
diagnosis of superficial pemphigus, (2) document the
prevalence of acantholytic keratinocytes in specimens
diagnosed as dermatophytosis, (3) compare between biopsy
specimens taken from the face and other body sites
(nonface) the prevalence of acantholytic keratinocytes (if
these were present) in cases of dermatophytosis and
the number of acantholytic keratinocytes in superficial
pemphigus, and (4) compare the efficacy of GMS and PAS
in detecting dermatophytes.
Materials and methods
A retrospective, histopathological study of a total of 190 canine skin
biopsies: 95 cases of superficial pemphigus and 95 cases of dermato-
phytosis, was performed using biopsy specimens submitted to the
Surgical Pathology Service at the Cornell University College of Veterinary
Medicine (CUCVM) from 1988 to 2005 for dermatophytosis cases and
1996–2005 for pemphigus cases. The specimens had been procured
using either 4- to 6-mm punch biopsy instruments or a scalpel blade
(wedge sections). All biopsy specimens had been fixed in 10% buffered
formalin, embedded in paraffin wax, cut into 4-µm sections, placed on
glass slides and stained with H&E, PAS, and GMS. If there was more
than one tissue section on the slide, the section with the best quality
of lesions and the greatest number of acantholytic keratinocytes, was
selected. Inclusion in the study was based on histopathological and
clinical findings. One author (JP) evaluated all the slides.
© 2007 The Authors. Journal compilation © 2007 ESVD and ACVD.
Dermatophytes, acantholysis, and pemphigus
Histopathology
Histopathologically, all superficial pemphigus cases contained one or
more pustules or microabscesses in the epidermis or follicular epithelium.
Pustules contained nondegenerate neutrophils and or eosinophils and
five or more single or clusters of acantholytic keratinocytes. In order
to be considered a dermatophyte case, fungal hyphae or arthroconidia
characteristic of a dermatophyte7 had to be demonstrated on the
H&E-, PAS-, or GMS-stained tissue section. In addition, there had to
be inflammatory changes associated with the fungal elements.7
All H&E-stained sections were scrutinized for acantholytic kerat-
inocytes. Acantholytic keratinocytes were defined as cells that were
detached from other surrounding epidermal or follicular epithelial
cells. These cells were round with normal to hyper-eosinophilic
cytoplasm and round central nuclei. Clusters (‘rafts’) of acantholytic
cells, if present, were noted.10 These were defined as three or more
attached acantholytic keratinocytes free floating within a pustule or
adhered to the wall of the pustule. In the cases that had acantholytic
cells, the greatest number of acantholytic keratinocytes per pustule
was identified, and the number of acantholytic keratinocytes was
counted per 0.5 mm2 within that pustule.10 The number of acantholytic
keratinocytes was divided into small (5–15), moderate (16–59), and
large (greater or equal to 60). This grading scheme was based on the
numbers seen in the superficial pemphigus cases.
In order to be considered a dermatophytosis case with acantholysis,
a minimum of five acantholytic cells per 0.5 mm2 was required.
Historical and clinical information and response to treatment were
reviewed in all the cases of dermatophytosis that had histological
evidence of acantholysis. The number of acantholytic keratinocytes in
the superficial pemphigus cases was compared to the number seen
in dermatophytosis cases containing acantholytic keratinocytes.
Biopsy location
Because all of the reported cases of acantholytic dermatophytosis
began on the face, another goal of this study was to determine if there
is something unique about facial dermatophytosis and if acantholysis
is more common in this location of the body. In most cases, biopsy
location was determined from the biopsy submission form, but in a
few cases the location was easily determined from the histopathology
(i.e. digital pad, pinnal cartilage). In these cases, biopsy location was
recorded and divided into lesions on the face (including head and
pinnae) vs. nonface (other body locations). In cases of dermatophytosis
in which acantholytic cells were present, prevalence of acantholytic
keratinocytes was compared between face and nonface sites. Since
acantholysis is a feature of superficial pemphigus, and thus all pem-
phigus cases had acantholytic keratinocytes, the number (rather than
prevalence) of acantholytic cells was compared between the face and
nonface sites of pemphigus cases. The median numbers of acantholytic
keratinocytes in facial and nonfacial lesions of superficial pemphigus
were compared to determine if acantholysis was more prominent in
facial skin.
Histochemical staining
All PAS- and GMS-stained cases were examined for fungal organisms.
In cases of dermatophytosis, the results of GMS and PAS stains were
compared to determine if one stain was better than the other in
identifying dermatophyte organisms.
Statistical analysis
Only the dermatophytosis cases that contained acantholytic keratinocytes
were included in the statistical analysis. The prevalence of acantholytic
keratinocytes in dermatophytosis cases and the prevalence of
dermatophytes in superficial pemphigus cases were each reported
as a percentage and a 95% binomial confidence interval (CI) was
calculated for each.13 When comparing the numbers of acantholytic
keratinocytes in dermatophyte cases to pemphigus cases, the numbers
were clearly skewed and therefore Wilcoxon rank–sum test was used
to analyse the data.14 Wilcoxon rank–sum test was also used to
compare the number of acantholytic keratinocytes in face lesions and
nonface lesions of pemphigus cases. Fisher’s exact test was used to
compare the prevalence of acantholytic cells in the face lesions of
235
Peters et al.

Table 1. Canine dermatophytosis cases with acantholytic keratinocytes

Biopsy
Case location Acantholytic No. of No. of
no. Signalment Lesion distribution (face/nonface) rafts (yes/no) AK/0.5 mm2 pustules
1 1.5 y F Pit bull mix Nonpruritic eruptions, left side; 3 days Unknown Yes 14 8
2 5 y MC Beagle Lump, bridge of nose; 6 weeks Face Yes 14 4
3 7 y FS Beagle Focal nodule, left thorax; 1 week Non-face No 10 8
4 5 m F mix ‘Lumps’ on back, moist and crusty; 1 day Non-face Yes 13 3
5 7 y FS Golden retriever Pruritic nodule on paw Non-face Yes 13 5
6 14 y FS Golden retriever Focal nonpruritic area on one paw, Non-face No 14 1
hyperpigmented and lichenified
7 3 y F Boxer Mass on jaw; 2 weeks Face Yes 85 14
8 9 y M Poodle mix Focal pruritic nodule on hock Non-face Yes 15 66
9 1 y F Cocker spaniel Nodular lesions over back; 1 week Non-face No 20 9
10 5 y M Labrador retriever Focal nodule, left shoulder Non-face Yes 12 3
11 5 y MC Labrador retriever Focal nodule, leg; 1 week Non-face No 12 11
12 10 y F Corgi Focal painful nodule, interdigital Non-face Yes 52 7
13 Adult M GSD Focal ulcerated nodule, head Face Yes 24 11
Acantholytic keratinocytes were counted within a single pustule with the highest density of acantholytic keratinocytes in 0.5 mm2.
F, female; M, male; FS, female spayed; MC, male castrated; GSD, German Shepherd dog; y, year; m, month; AK, acantholytic keratinocytes.

dermatophyte cases with the prevalence of those in the nonfacial
lesions of dermatophytosis cases.14 All tests were performed using
STATISTIX © 8.0 (Analytical Software, Tallahassee, FL, USA). For all
analyses, a P-value less than 0.05 was considered significant.
Results
Histopathology
Among the canine dermatophytosis cases, between one
and 66 pustules per biopsy section were seen histopatho-
logically. All pustules were either within the surface or
follicular epithelium. Most of the pustules had few to no
acantholytic cells. Acantholytic keratinocytes (greater or
equal to 5 per 0.5 mm2) were identified in 13 of the 95
cases of canine dermatophytosis (14%; CI = 6 –21%).
Among these 13 cases, acantholytic keratinocytes were
seen in no more than one or two pustules per case. In 11
of the cases, acantholytic keratinocytes were present only
within the follicular lumen. In one case they were present
within a subcorneal pustule and in another case acantholytic
cells were present within an intra-epidermal pustule and
within the follicular lumen. All 13 cases had variable degrees
of the following histopathological features: moderate irregular
epidermal and follicular acanthosis, focal to diffuse surface
parakeratosis, superficial dermal oedema, perivascular to
interstitial lymphoplasmacytic dermal infiltrates, lympho-
plasmacytic periadnexal infiltrates (some with neutrophils
and eosinophils), and neutrophilic luminal folliculitis. Twelve
of the 13 cases had lymphocytic exocytosis and infiltrative
lymphocytic mural folliculitis. Eleven of the 13 cases had
sequential follicular pyogranulomatous furunculosis in a
kerion reaction pattern.7 In 10 of the cases, acantholytic
keratinocytes were closely associated with fungal elements
on the H&E-stained sections. In the other three cases, fungal
elements were seen elsewhere in the same tissue section.
Clusters of acantholytic keratinocytes were noted in nine
of 13 (69%) canine dermatophytosis cases (Table 1). Sixty-
nine per cent (nine of 13) of canine dermatophytosis cases
had small numbers of acantholytic keratinocytes. Three
of 13 (23%) and one of 13 (8%) of the dermatophytosis
cases had moderate and large numbers of acantholytic
cells, respectively (Fig. 1). None of these cases had a
history, clinical signs, or follow-up data consistent with
superficial pemphigus (Table 1). Clinically, most of the
dermatophytosis cases containing acantholytic keratinocytes
(12 of 13; 92%) had focal to nodular (kerion) lesions. One
case had nonpruritic pustular eruptions over the left side
of the neck and thorax.
Among the superficial pemphigus cases, one to 14
pustules were seen histologically per biopsy section. All
pustules were either within the surface or follicular epithe-
lium. Most pustules contained acantholytic keratinocytes.
Clusters of acantholytic keratinocytes were noted in 25 of
95 (26%) of the cases. Moderate numbers of acantholytic
keratinocytes were seen in 52 of 95 (55%), small numbers
in 24 of 95 (25%), and marked numbers of acantholytic
keratinocytes in 19 of 95 (20%) of the superficial pemphigus
cases. Superficial pemphigus cases had significantly more
acantholytic keratinocytes than the dermatophytosis cases
(P = 0.02, Fig. 2).
Biopsy location
Of the 95 cases of canine dermatophytosis, 23 (24%)
were wedge or elliptical sections and 72 (76%) were
4- to 6-mm punch biopsy sections. The location of the
biopsy was determined in 73 of the cases (73 of 95, 77%).
Biopsies taken from the face accounted for 26 of 73 (36%)
and those occurring on body sites other than the face for
the rest. Of the 95 cases of superficial pemphigus, four
(4%) were wedge or elliptical sections and 91 (96%) were
4- to 6-mm punch biopsy sections. The location of the
biopsy was determined in 65 of the cases (65 of 95, 68%).
Biopsies taken from the face accounted for 23 of 65 (35%)
and those occurring on nonface regions accounted for
the rest.
Of the dermatophytosis cases, three of 26 (12%) biopsy
specimens from the face and nine of 47 (19%) nonface
biopsy specimens had acantholytic keratinocytes. This
difference in the prevalence of acantholytic keratinocytes
between the face and nonface lesions was not significant
(Fisher’s exact test, P = 0.52). There was no significant differ-
ence (P = 0.82) in the number of acantholytic keratinocytes
on the face (median = 30) as compared to nonface (median =
31) among pemphigus cases. A comparison between

236 © 2007 The Authors. Journal compilation © 2007 ESVD and ACVD.

Figure 1. Photomicrographs: Canine skin, case no. 12. (a) Intrafolli-
cular pustule containing many neutrophils and moderate numbers of
acantholytic keratinocytes (arrow head). Fungal hyphae (arrow) are
present in the follicular keratin (haematoxylin and eosin, ×20; bar =
50 µm). (b) Periodic acid-Schiff (PAS)-stained section of Figure 1a.
Note the magenta-stained fungal hyphae (arrow) in the follicular
keratin and in the surrounding pustule (×20; bar = 50 µm). (c) Grocott’s
methenamine-silver-stained section of Figure 1a. Note the black-
stained fungal hyphae (arrow) in approximately the same areas as
those seen in the PAS-stained section (×20; bar = 50 µm).
the number of acantholytic keratinocytes on the face and
nonface of canine dermatophytosis cases was not done
because the number of dermatophytosis cases containing
acantholytic keratinocytes was so small.
© 2007 The Authors. Journal compilation © 2007 ESVD and ACVD.
Dermatophytes, acantholysis, and pemphigus
Figure 2. Box and whisker plot of the number of acantholytic kerati-
nocytes per 0.5 mm2 (in a pustule) in cases of canine dermatophytosis
with acantholytic keratinocytes and cases of canine superficial
pemphigus. Boxes represent the 25th to 75th percentiles of dogs, and
whisker bars represent the 5th and 95th percentiles of dogs. Circular
datum points represent outliers in a category. The line in the middle of
each box represents the median number of acantholytic keratinocytes
in each group. Median number of acantholytic keratinocytes: superfi-
cial pemphigus = 30; canine dermatophytosis with acantholysis = 14
(P = 0.02).
Histochemical staining
No dermatophyte organisms were identified by GMS
and PAS staining (zero of 95, 0%; CI = 0–0.5%) in the skin
biopsy sections of cases diagnosed as superficial pemphigus.
In all canine dermatophytosis cases, fungal hyphae and/or
arthroconidia were recognized on H&E-stained sections
and were equally positive for GMS and PAS (Fig. 1).
Discussion
In this study, the presence of dermatophytes and the
number of acantholytic keratinocytes in epidermal and
follicular pustules were evaluated. It is known that dermat-
ophytosis and superficial pemphigus can frequently affect
the epidermis, hair follicle, or both.7,8,15–17 There was no a
priori reason to believe that inflammatory reactions seen
with either disease would be different in the epidermis
compared with the hair follicle. Hence, we did not individu-
ally evaluate surface vs. follicular pustules.
It has been suggested that pemphigus foliaceus and
pemphigus erythematosus may not be different diseases.18
It has also been suggested that the interface tissue reaction
classically associated with pemphigus erythematosus may, in
fact, be a typical and thus nondiagnostic reaction pattern seen
on the nasal planum and at mucocutaneous junctions.17,18
For the purposes of this study, the diagnosis ‘superficial
pemphigus’18 was used and the presence or absence of
an associated interface reaction was not considered.
Although superficial pemphigus can be misdiagnosed
in rare cases of acantholytic dermatophytosis, this study
237
Peters et al.
suggests that the risk is very low in the northeastern
USA. No cases of acantholytic dermatophytosis were
identified in the 9 years (1996–2005) of cases accessioned
through the CUCVM pathology service. Two of the authors
(DWS and WHM) have diagnosed acantholytic dermat-
ophytosis in only three dogs during a combined 65 years
of dermatological practice in the northeastern USA. This
may be due to the fact that the most common cause of
canine dermatophytosis in the northeastern USA is
Microsporum canis,7,19 whereas all reported cases of
acantholytic dermatophytosis have been associated with
Trichophyton spp. infection.
In some countries, dermatophytes such as, M. persicolor
(England, France)2,3 and T. mentagrophytes var. erinacei
(England, New Zealand),1,2 produce dermatoses that clinically
resemble superficial pemphigus. However, acantholysis is
not a feature of these infections. Microsporum persicolor
and T. mentagrophytes var. erinacei have not been reported
to infect dogs in the northeastern USA.
This study also suggests that acantholytic keratinocytes
are uncommon in cases of canine dermatophytosis in
the northeastern USA. As previously mentioned, both
Trichophyton spp. and Microsporum spp. produce
keratinases and other proteolytic enzymes and, as such,
can cause acantholysis.11,12,20 This would suggest that
acantholysis should be a relatively common lesion seen in
cases of dermatophytosis. Thirteen cases (14%) of canine
dermatophytosis in this study had anywhere from 10 to
85 acantholytic keratinocytes per 0.5 mm2. Acantholytic
keratinocytes were found in only one to two pustules per
case. None of these cases had any clinical resemblance to
superficial pemphigus, and all had readily identified fungal
elements seen in H&E-stained specimens.
It is well known that many different types of inflammatory
conditions can produce acantholytic keratinocytes, but
superficial pemphigus will generally have the most.8–10
Kuhl et al. determined that pemphigus foliaceus had a
mean of 226 ± 22.9 acantholytic keratinocytes/mm2 biopsy
specimen, whereas there were only 11.8 ± 4.6 acantholytic
keratinocytes/mm2 found in biopsy specimens from
superficial bacterial folliculitis.10 In this study, 13 cases of
dermatophytosis had acantholytic keratinocytes, although
most (69%) had only small numbers of acantholytic
keratinocytes affecting one pustule. Only four of the 13
cases (31%) of dermatophytosis with acantholytic kerati-
nocytes had greater than 15 acantholytic keratinocytes/
0.5 mm2, whereas 75% of the superficial pemphigus cases
had more than 15 acantholytic keratinocytes/0.5 mm2 in
a given pustule. The two most reproducible features of
pemphigus foliaceus as determined by Kuhl et al. were
large numbers of acantholytic keratinocytes and clusters
(rafts) of acantholytic keratinocytes.10 In our study, there
were surprisingly more clusters of acantholytic keratinocytes
in the dermatophytosis than the superficial pemphigus
cases. Most importantly, all of these dermatophytosis
cases had readily identified fungal elements (including
fungal hyphae and arthroconidia) in H&E-stained specimens,
so that a false diagnosis of superficial pemphigus would
not have occurred. Furthermore, the history, clinical lesions,
and histopathological features in our dermatophytosis
cases were consistent with dermatophytosis, not superficial
pemphigus, thus not fulfilling all the observed criteria for
238
acantholytic dermatophytosis, which have clinical and
histological resemblance to superficial pemphigus.4–8
Although the face is a common site for dermatophytosis
and superficial pemphigus, only 26 of 73 (36%) biopsy
specimens from dermatophytosis cases and 23 of 65
(35%) biopsy specimens from superficial pemphigus cases
were taken from the face. The relatively low numbers of
specimens known to be from the face likely reflect the
simple fact that if similar lesions were present in other
areas of haired skin, those would likely be biopsied first.
Facial, footpad, tail, perianal, and genital skin biopsies
often require general anaesthesia while other haired skin
areas can usually be biopsied with local analgesia with or
without mild sedation.
Of the 12 cases of dermatophytosis with acantholytic
keratinocytes in which the biopsy site was known, three
occurred on the face and nine elsewhere. Because reported
cases of acantholytic dermatophytosis initially had facial
involvement, another goal of the study was to determine
if facial skin might somehow be ‘more susceptible’ to
acantholysis. Although the case numbers were small,
significant differences were not found in the prevalence of
acantholytic keratinocytes on the facial vs. nonfacial skin
in the dermatophytosis cases with acantholysis. Additionally,
in cases of superficial pemphigus, there was no difference
in the numbers of acantholytic keratinocytes between the
face and the nonface lesions. Interestingly, however, of
the three cases of dermatophytosis with acantholytic
keratinocytes occurring on the face, one had large numbers
of acantholytic keratinocytes (85), one had moderate numbers
(24), and only one had small numbers (14). Seventy-eight
per cent (seven of nine) of the nonface dermatophytosis
cases with acantholysis had small numbers (five to 15) of
acantholytic keratinocytes. Eighty-five was the highest
number of acantholytic keratinocytes seen in any dog with
dermatophytosis in this study and it was seen on the face.
No subjective difference was found in the quality or
quantity of staining with GMS vs. PAS for fungal hyphae
in dermatophytosis cases. Either stain used alone was
considered equally useful in identification of dermatophyte
organisms.
One criticism of this study is the lack of information
concerning fungal culture. Because of the retrospective
nature of the study, we were not able to determine whether
or not fungal cultures had been performed and what results
had been obtained. Could the diagnosis of dermatophytosis
have thus been missed in some of the superficial pemphigus
cases? While it is possible, missing a case of acantholytic
dermatophytosis seems highly unlikely. In previously
reported cases, dermatophytes were always seen in PAS-
or GMS-stained skin biopsy specimens. Dermatophytes
were not seen in our cases of superficial pemphigus.
Furthermore, two of the authors (DWS and WHM) read
virtually all non-neoplastic skin biopsy specimens submitted
to the CUCVM pathology service. These authors are
routinely contacted for consultation by practitioners when
they receive uncommon pathological diagnoses, such as
superficial pemphigus. They are also routinely contacted
for consultation when treatment for a given diagnosis is not
going well, which would clearly be the case if acantholytic
dermatophytosis were being treated as superficial
pemphigus.4,5
© 2007 The Authors. Journal compilation © 2007 ESVD and ACVD.
 Dermatophytes, acantholysis, and pemphigus

In summary, although the occasional case of dermato-
phytosis can have numbers of acantholytic keratinocytes
equal to or surpassing those in some cases of superficial
pemphigus, clinical and other histopathological findings
(the presence of fungal elements) will routinely distinguish
the two conditions. Although 14% of the dermatophytosis
cases had acantholytic keratinocytes, we found no cases
fitting the description of the clinicopathological entity
called acantholytic dermatophytosis. These data support
the conclusion that acantholytic dermatophytosis is a very
rare syndrome in dogs in the northeastern USA.
References
1. Fairley RA. The histological lesions of Trichophyton mentagrophytes
var erinacei infection in dogs. Veterinary Dermatology 2001; 12:
119–22.
2. Bond R, Middleton DJ, Scarff DH et al. Chronic dermatophytosis
due to Microsporum persicolor infection in three dogs. Journal of
Small Animal Practice 1992; 33: 571–6.
3. Carlotti DN, Bensignor E. Dermatophytosis due to Microsporum
persicolor (13 cases) or Microsporum gypseum (20 cases) in
dogs. Veterinary Dermatology 1999; 10: 17–27.
4. Parker W, Yager J. Trichophyton dermatophytosis – a disease easily
confused with pemphigus erythematosus. Canadian Veterinary
Journal 1997; 38: 502–5.
5. Poisson L, Mueller R, Olivry T. Dermatophytose pustuleuse
cornéophilique canine évoquant un pemphigus foliacé. Pratique
Médicale et Chirurgicale de L’animal de Compagnie 1998; 33:
229–34.
6. Scott DW. Marked acantholysis associated with dermatophytosis
due to Trichophyton equinum in two horses. Veterinary Dermatology
1994; 5: 105–10.
7. Scott DW, Miller WH, Griffin CE. Fungal skin diseases. In: Muller
and Kirk’s Small Animal Dermatology, 6th edn. Philadelphia, PA:
W.B. Saunders, 2001: 339–53.
8. Scott DW, Miller WH, Griffin CE. Immune-mediated disorders. In:
Muller and Kirk’s Small Animal Dermatology, 6th edn. Philadelphia,
PA: W.B. Saunders, 2001: 686–92.
9. Scott DW, Miller WH, Griffin CE. Diagnostic methods. In: Muller
and Kirk’s Small Animal Dermatology, 6th edn. Philadelphia, PA: W.B.
Saunders, 2001: 71–206.
10. Kuhl KA, Shofer FS, Goldschmidt MH. Comparative histopathology
of pemphigus foliaceus and superficial folliculitis in the dog.
Veterinary Pathology 1994; 31: 19–27.
11. Hino H, Ammitzboll T, Svejgaard E et al. Acantholysis induced by
proteolytic enzymes. II. Enzyme fractions produced by Trichophyton
mentagrophytes. Acta Dermatovener (Stockholm) 1982; 62: 283–8.
12. Viani FC, Dos Santos JI, Paula CR et al. Production of extracellular
enzymes by Microsporum canis and their role in its virulence.
Medical Mycology 2001; 39: 463–8.
13. Dawson B, Trapp RG. Research questions about one group. In:
Basic and Clinical Biostatistics, 4th edn. Norwalk, CT: Appleton &
Lange, 2004: 93–133.
14. Dawson B, Trapp RG. Research questions about two separate or
independent groups. In: Basic and Clinical Biostatistics, 4th edn.
Norwalk, CT: Appleton & Lange, 2004: 134–61.
15. Gross TL, Ihrke PJ, Walder EJ et al. Pustular diseases of the
epidermis. In: Skin Diseases of the Dog and Cat. Clinical and
Histopathologic Diagnosis, 2nd edn. Ames, IA: Blackwell Publishing
Ltd., 2005: 9–19.
16. Gross TL, Ihrke PJ, Walder EJ et al. Pustular and modular dis-
eases without adnexal destruction. In: Skin Diseases of the Dog
and Cat. Clinical and Histopathologic Diagnosis, 2nd edn. Ames,
IA: Blackwell Publishing Ltd., 2005: 413–6.
17. Ihrke PJ, Stannard AA, Ardans AA et al. Pemphigus foliaceus in
dogs: a review of 37 cases. Journal of the American Veterinary
Medical Association 1985; 186: 59–66.
18. Olivry T. Review of autoimmune skin diseases in domestic animals:
1 – superficial pemphigus. Veterinary Dermatology 2006; 17:
291–305.
19. Foil CS. Dermatophytosis. In: Griffin CE, Kwochka KW, Macdonald
JM, eds. Current Veterinary Dermatology. Toronto: Mosby Year
Book, 1993: 22–33.
20. Dobson RL, Bosley L. The effect of keratinase on human epidermis.
Journal of Investigative Dermatology 1963; 41: 131–5.

Résumé Les dermatophytoses acantholytiqyes sont rares chez le chien; elles miment cliniquement et
histopathologiquement un pemphigus superficiel (erythematosus, foliaceus). Histologiquement, la reaction
à l’acide periodique-Schiff (PAS) et la coloration Grocott’s methenamine-silver (GMS) sont souvent
nécessaires pour visualiser les champignons. Cette étude rétrospective histopathologique a été réalisée sur
190 biopsies cutanées canines : 95 diagnostiquées comme dermatophytose et 95 comme pemphigus
superficiel. Tous les prélèvements ont été colorées avec l’haematoxyline et l’éosine (H&E), le PAS, et le
GMS. Des dermatophytes n’ont jamais été observés dans les pemphigus. Des kératinocytes acantholytiques
ont été notés dans 14% des cas de dermatophytose, sans signe clinique de pemphigus superficiel. Parmi
les cas avec des kératinocytes acantholytiques, les pemphigus superficiels présentaient significativement
plus de cellules acantholytiques que les dermatophytoses (P = 0.02). en comparant les cas avec ou sans
atteinte faciale, aucune différence n’a été observée pour la prévalence des kératinocytes acantholytiques.
Tous les cas de dermatophytose étaient positifs avec le GMS et le PAS sans supériorité d’une coloration
par rapport à l’autre. Aucun cas de dermatophytose associé à des kératinocytes acantholytiques n’avaient
d’anamnèse, de signe clinique ou histopathologique compatible avec une dermatophytose acantholytique.

Resumen La dermatofitosis acantolítica es una condición raramente reportada en perros que en la

presentación clínica y en histopatología asemeja pénfigo superficial (eritematoso y foliaceo). En el análisis
histopatológico, las técnicas ácido periódico de Schiff (PAS) and plata-metenamina de Grocott (GMS) son
habituálmente necesarias para demostrar el hongo. Se llevó a cabo un estudio histopatológico retrospectivo
en 190 biopsias caninas de piel: 95 casos para cada diagnóstico de pénfigo foliaceo o dermatofitosis. Todas
las preparaciones se tiñeron con hematoxilina-eosina (H&E), PAS y GMS. No se observaron dermatofitos
en ninguno de los casos de penfigo superficial. Se observaron queratinocitos acantolíticos en un 14% de
los casos de dermatofitosis, ninguno de los cuales tenía signos clínicos consistentes con pénfigo superficial.
Entre los casos con queratinocitos acantolíticos pénfigo superficial tenía significativamente más células
acantolíticas que la dermatofitosis (P = 0.02). Cuando se compararon casos faciales con no faciales no
hubo diferencias en la prevalencia de queratinocitos acantolíticos en la dermatofitosis o en el número de
queratinocitos acantolíticos en pénfigo superficial. Todos los casos de dermatofitosis fueron positivos con

© 2007 The Authors. Journal compilation © 2007 ESVD and ACVD. 239
Peters et al.

PAS y GMS sin ninguna de las dos técnicas siendo superior a la otra visualmente. Ninguno de los casos de
dermatofitosis en los que se observaron queratinocitos acantolíticos tenía historia, signos clínicos ni
características histopatológicas compatibles con la dermatofitosis acantolítica.

Zusammenfassung Die akantholytische Dermatophytose ist eine selten beschriebene Erkrankung bei
Hunden, welche klinisch und histopathologisch oberflächlichen Pemphigus (erythematosus, foliaceus)
imitiert. Histologisch sind oft eine Periodic-Acid-Schiff (PAS) Färbung und Grocott Methenamin-Silber
(GMS) notwendig, um den Pilz zu demonstrieren. Eine retrospektive histopathologische Studie wurde an
190 Hautbiopsien von Hunden durchgeführt: es handelte sich um jeweils 95 Proben mit der Diagnose einer
caninen Dermatophytose oder von oberflächlichem Pemphigus. Alle Proben wurden mit Hämatoxylin-Eosin
(H&E), PAS und GMS gefärbt. In keinem der Fälle mit oberflächlichem Pemphigus wurden Dermatophyten
gesehen. Akantholytische Keratinozyten wurden in 14% der Fälle mit Dermatophytose bemerkt, von denen
keiner klinische Symptome zeigte, die mit oberflächlichem Pemphigus vereinbar waren. Bei Fällen mit
akantholytischen Keratinozyten hatten jene mit oberflächlichem Pemphigus signifikant mehr akantholytische
Zellen als jene mit Dermatophytose (P = 0.02). Der Vergleich von Fällen, bei denen das Gesicht betroffen
bzw. nicht betroffen war, ergab keinen Unterschied in der Prävalenz von akantholytischen Keratinozyten bei
der Dermatophytose oder der Anzahl der akantholytischen Keratinozyten beim oberflächlichen Pemphigus.
Alle Fälle mit Dermatophytose waren sowohl GMS als auch PAS positiv, wobei keine der Färbungen optisch
besser war. Keiner der Fälle mit Dermatophytose, wo akantholytische Keratinozyten gefunden wurden,
hatte eine Anamnese, klinische Symptome und histopathologische Veränderungen, die mit akantholytischer
Dermatophytose kompatibel waren.

240 © 2007 The Authors. Journal compilation © 2007 ESVD and ACVD.