Superficial necrolytic dermatitis
Superficial necrolytic dermatitis (hepatocutaneous syndrome, necrolytic migratory erythema, metabolic epidermal necrosis) is a skin reaction characterized by an erosive, crusting, and scaling dermatopathy distributed symmetrically over the face, distal paws, and inguinal area as well as in areas of constant friction.
Canine superficial necrolytic dermatitis is most often associated with a hepatopathy, which can be exacerbated by topical or parenteral drug-reactions (e.g. phenobarbital), mycotoxins or underlying bacterial or fungal infections.
In humans, SND is associated with glucagon-secreting tumors (glucagonoma), but this occurs only rarely in dogs. The majority of cases in dogs appears to involve an underlying hepatopathy due to an underlying metabolic or hormonal dysfunction rather than primary liver disease.
Diagnosis is based on identification of the skin lesions supported by demonstration of underlying liver disease. Histologically, SND has a pathognomonic appearance characterized by diffuse parakeratotic hyperkeratosis, intracellular edema of the granular epithelial cells, and basal cell hyperplasia ('red, white, and blue pattern').
A differential diagnosis would include erythema multiforme, bacterial pyoderma, pemphigus foliaceus, systemic lupus erythematosus, zinc-responsive dermatosis, vitamin A–responsive dermatosis, toxic epidermal necrolysis and drug eruptions.
Treatment of superficial necrolytic dermatitis can be problematic as the prognosis is poor, with survival time from the onset of skin lesions is about 6 months from the time of onset. However, successful treatment has been reported with subcutaneous octreotide (2 μg/kg twice daily).
If there is a secondary bacterial infection, broad-spectrum antimicrobials such as amoxycillin/clavulanate should be instituted. Removal of mycotoxins or drugs which exacerbated SND may alleviate clinical signs. Surgical removal of a glucagonoma may lead to remission of signs.
Use of additional dietary supplements such as zinc methionine (2 mg/kg/day]), omega-3 fatty acids, cooked or raw egg yolk (i.e., 3 to 6 per day) and a high quality, high-protein diet are recommended.
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