Advice on dog's snout

Hello everyone! My dog has had this issue on her snout for over a year now. We've been to two different vets who have told us two completely different things. We've tried switching food, giving allergy meds, she's been treated with antibiotics and antifungals when sores appear. She receives heartgard and nexgard monthly. There have been times where she bleeds and one or two instances where pus has appeared. My first vet said it was simply an allergy and not a big deal. The second vet said it was pemphigus something(I forget the second word). They said it would cost thousands to biopsy and then treat. I went back to the first vet and they said the issue wasn't that serious and since it's not bothering her there was no need to do that. I really don't want to spend all that money if she isn't bothered at all - we never see her scratching or seeming uncomfortable. Part of me wonders if it could be anxiety but I'm not sure. The other thing I've thought is that she often engages in digging her face into sheets and blankets, mostly on the bed. She'll click her teeth and presses her snout into the bedding over and over. She's not chewing and she does it when we're with her and when she's alone. Any ideas or suggestions would be great!! (We do offer bones and chews for her too).

Hello - this does indeed look a lot like pemphigus, which does tend to spread around the body.  There are of course differentials (things that can look like it but are in fact something else) including various cancers, endocrine disease, demodex mites so its always safest to get a proper diagnosis.  However, I always beleive that communication is key and if you let the vet know that the cost of the biopsy is a problem and ask whether it would be reasonable to trial-treat rather than do biopsies, they may be happy to discuss the advantages and disadvantages of that.

There are a couple of other things that you ought to be aware of:  First, you say that the face doesn't see to be painful or annoying her, but then you describe the behaviour of digging her face into bedding and clicking her teeth. These are likely to be signs of pain and discomfort.

The other is that pemphigus is an autoimmune condition and if unchecked, tends to spread around the body.  Therefore it may seem minor at the moment, but if this is pemphigus then it could well get worse.

(Trial-treat:  to treat what you think it is, and see if it gets any better, rather than doing tests to diagnose).