What Are Those Crusty Scabs on Your Dog's Nose and Face?

If your dog has crusty scabs around their nose, face, or ears that won’t heal, it’s worth knowing about pemphigus foliaceus, the most common autoimmune skin disease in dogs. Here’s what’s happening: the immune system starts attacking the connections between your dog’s own skin cells, causing blisters, pustules, and thick crusts to form, especially on the face and feet. It’s not contagious, it’s not your fault, and it’s manageable with the right treatment plan. Here’s what you need to know.

What does pemphigus foliaceus look like in dogs?

The first signs of pemphigus in dogs are easy to confuse with a skin infection or allergies. You might notice small, pus-filled bumps (pustules) that break open and leave behind crusty scabs. The skin underneath can look raw, flaky, or thickened. Hair loss often follows as the crusts expand and the skin becomes more irritated.

The most telling detail is where these lesions show up. Canine pemphigus foliaceus typically targets:

• The bridge of the nose and around the nostrils
• The face, muzzle, and around the eyes and ears
• The footpads, which often become thickened, cracked, and painful from crusting
• Sometimes the groin, armpits, or across the back in more widespread cases

Your dog may also seem uncomfortable or itchy, though some dogs tolerate the skin changes without much visible distress, at least early on. Footpad crusting can make walking painful, which is often what prompts owners to seek a vet visit.

What causes pemphigus foliaceus in dogs?

In most cases, the cause is idiopathic, meaning no specific trigger is ever identified. The immune system simply starts misfiring, targeting proteins that hold skin cells together as if they were foreign invaders.

That said, a few things are known to trigger or worsen the condition:

• Genetics and breed: Some breeds are genetically predisposed, meaning the condition runs in certain bloodlines.
• UV light exposure: Sunlight can trigger flares in some dogs, which is why nose and face lesions are so common. Limiting sun exposure during peak hours is sometimes part of the management plan.
• Certain medications: In rare cases, specific drugs can trigger a pemphigus-like reaction. If this is suspected, your vet will review your dog’s medication history.

Which dog breeds are most prone to pemphigus foliaceus?

While any dog can develop this autoimmune disease, certain breeds show up in the data far more often than others:

• Akita
• Chow Chow
• Cocker Spaniel
• Dachshund
• Labrador Retriever
• Bearded Collie
• Finnish Spitz

If you have one of these breeds and notice any persistent crusting around the nose or face, it’s worth getting it checked sooner rather than later. Early diagnosis makes treatment easier to manage.

How do vets diagnose pemphigus foliaceus?

The only way to confirm pemphigus foliaceus is with a skin biopsy, where the vet takes a small sample of affected skin tissue and sends it to a veterinary pathologist (a specialist who examines tissue under a microscope). This step matters because several other conditions, including ringworm, bacterial skin infections, and lupus, can look nearly identical.

Your vet will likely also run blood work and a urinalysis to get a baseline on your dog’s overall health before starting immunosuppressive treatment. This baseline is important because it gives you a comparison point for future monitoring.

Treatment options for canine pemphigus foliaceus

The goal of treatment is to dial down the immune system’s attack on the skin without suppressing it so much that your dog becomes vulnerable to infections. Your vet may recommend one or a combination of:

• Prednisone (a corticosteroid): Often the first drug used. It calms the immune response relatively quickly but carries side effects with long-term use, including increased thirst, hunger, and urination, as well as potential liver changes over time.
• Azathioprine (an immunosuppressant): Often added to allow a lower prednisone dose, which reduces steroid-related side effects. Requires regular blood monitoring because it can affect bone marrow and liver function.
• Cyclosporine (another immunosuppressant): Targets a specific part of the immune response. Common side effects include nausea and digestive upset, especially early in treatment.
• Oclacitinib (sold under the brand name Apoquel): Originally developed for allergic itch, it’s increasingly used in pemphigus management for its targeted immune-modulating effect.

Treatment almost always starts at a higher dose to get the disease under control, then gradually steps down to the lowest effective maintenance dose. This process can take months.

Managing long-term treatment at home: a practical guide

Living with a dog on long-term immunosuppressants takes some getting used to, but it becomes routine quickly. Here’s what to expect and what to do.

Side effects to watch for

Medication	What to watch for
Prednisone	Increased drinking, urinating, and appetite are common. A pot-bellied appearance and muscle weakness can develop over time. Let your vet know if any of these become severe.
Azathioprine	Lethargy, vomiting, or unusual bruising can signal bone marrow suppression. Don’t wait these out. Call your vet.
Any immunosuppressant	Your dog’s immune system is intentionally lowered, which makes secondary infections more likely. New sores, discharge, or fever all warrant a prompt vet call.

Keeping up with rechecks

Most dogs on azathioprine or cyclosporine need bloodwork every 2 to 4 weeks during the first few months of treatment, then every 3 to 6 months once stable. Mark these on your calendar and don’t skip them, even when your dog looks great. Catching a medication side effect early is far easier than managing one that’s had time to develop.

Daily skin care

Don’t pick or pull at crusts, especially on the nose or footpads. Soaking the area with a warm, damp cloth first softens them and makes removal much less uncomfortable for your dog. Keep footpads moisturized with a vet-approved balm to reduce cracking. Limit sun exposure between 10am and 4pm for dogs with nose and face lesions, and ask your vet about a UV-blocking sunscreen formulated for pets.

Taking a photo of the lesions once a week in good light is one of the most useful habits you can build. It helps your vet track progress at rechecks and helps you catch a flare before it becomes severe. A simple log with the date, any new lesions, behavior changes, and medication doses takes two minutes and saves a lot of guesswork at appointments.

Pemphigus foliaceus dog prognosis and life expectancy

Many dogs with pemphigus foliaceus live comfortable, full lives with the right treatment plan. The condition itself is rarely life-threatening, but the medications used to control it carry real long-term risks, which is why consistent monitoring matters. Some dogs eventually achieve remission and can be tapered off medication entirely. Others need lifelong treatment to keep things stable. Flares happen, particularly after sun exposure or stress, but with good management most dogs get to a place where life feels pretty normal.

Does pet insurance cover pemphigus foliaceus in dogs?

Yes, pemphigus foliaceus is eligible for coverage under a Lemonade Pet accident and illness policy, as long as the condition isn’t pre-existing. That means your dog shouldn’t be showing any signs or symptoms before your policy starts or during your waiting period.

Between skin biopsies, dermatology visits, regular bloodwork, and ongoing medications like prednisone, azathioprine, or cyclosporine, the costs of managing this condition add up quickly, especially when treatment spans years. Getting coverage in place while your dog is healthy is what makes it actually useful when you need it. If you have an Akita, Chow Chow, or another breed with a known predisposition, enrolling sooner rather than later is especially worth thinking about. 

Before we go

Pemphigus foliaceus is a long-term condition, but it’s also a manageable one. With the right medications, consistent monitoring, and a few thoughtful habits at home, many dogs live comfortably for years after diagnosis. Stay on top of rechecks, watch for side effects, protect that nose from the sun, and don’t skip the blood work. And if your dog isn’t already covered, now is a good time to look into it.

Frequently Asked Questions

A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of the policies issued, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage may not be available in all states. Please note that statements about coverages, policy management, claims processes, Giveback, and customer support apply to policies underwritten by Lemonade Insurance Company or Metromile Insurance Company, a Lemonade company, sold by Lemonade Insurance Agency, LLC.  The statements do not apply to policies underwritten by other carriers.