Hi Everyone,

I was wondering if any of you out there have ever attempted laser surgery removal of lesions caused by Pemphigus on the nose (or anywhere else)? If so, how was your success?

My Siamese cat is 6 years old and has had Pemphigus since she was 2. It's gotten progressively worse and worse throughout the years and is, by far, one of the most stubborn cases my vets have seen. She's been to countless dermatologists and specialists, and I've gotten 4th, 5th and 6th opinions.

Nothing seems to sufficiently work. She was on Atopica for about 2 years, but even with that, she would still have flareups out of absolutely nowhere (not to mention her digestion suffered). I was never able to get her to less than one pill a day with either that or prednisolone. It's an extremely acute, inflamed variation of the disease and it's stubbornly unresponsive to regular steroid or cyclosporine therapy, at least in the dosage that would be recommended (it's ok if I give her prednisolone every single day, a full tablet per day, which I know is way too high a dose for long term. But the second I start trying to taper to every other day dosing as recommended, we immediately flare up and go back to square one).

After almost 4 years of trying to resolve this with countless topical and oral medications (prednisolone, atopica, tresaderm, allergy shots, hypoallergenic diets, dexamethasone, topical atopica, and many others), I just made peace with the fact that she needs to have a daily medication longterm, most likely for the rest of her life. The only thing that truly works is full doses of prednisolone every day. However, when I tell my vets/specialists this, they are very uncomfortable with it. I understand they don't want my cat on full doses of steroids every day, but after 3 years of trial and error I can confidently say that when it comes to medication therapy, it is THE only thing that works.

Finally, due to the pushback I was getting about that dosing, I threw the idea of laser surgery out there. The reason I did so is because when she got her very first lesion years ago as a younger kitten, my vet at the time (in another city) surgically removed it and that lesion never came back, ever. She was totally fine for almost 3 years (the occasional flareup happened, but it would resolve quickly) until 2 years ago, when a stressful situation at home caused a huge flareup that's never gone away.

But my vets are pushing back on this now too, saying that since it's an autoimmune disease, the lesions will just come back and the surgery won't be successful. While I know I'm not the professional here, I don't see how they can be so sure when we actually DO have on a record an example of it being successful for her. The circumstances that caused this flareup will not repeat, and given that we have exhausted literally every option available, I don't see what choice we have other than to at least try at this point, if they're really insistent that she can't be on full steroids every day. My dermatologist is willing to try, and we have the procedure scheduled for the 29th. He has told me he doesn't think the procedure will be successful, but again, I don't know what else to do. It's either this, or let her be on prednisolone every day. If the latter is likely to be the outcome anyway, doesn't it make sense to at least try this last resort first, before sentencing her to a lifetime of medication with risky side effects?

I'm feeling hopeless, defeated, and just want to help my girl. Aside from this, she's a happy and healthy kitty, and while her nose itches, it doesn't appear to be torturing her or ruining her life. So far, at least. Have you tried this procedure before? Has it been successful? Am I (or everyone I've worked with so far) overlooking anything here? Did we miss anything else we can try? Can a kitty be okay on daily full steroid treatment, or is diabetes just inevitable for literally everyone if we do that (I have heard that cats are far less likely to get side effects than dogs, but don't know how true that is).

I'd love your thoughts. Thanks, guys.

Required info requested:

Species: Siamese Cat

Age: 6

Sex/Neuter status: Female, spayed

Body weight: 12 pounds

History: See above.

Clinical signs: See above

Duration: 3-4 years

Your general location: Seattle, WA