Superficial necrolytic dermatitis

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Superficial necrolytic dermatitis in the inguinal region of a dog[1]
Severe footpad hyperkeratosis with fissures in a dog with Superficial necrolytic dermatitis[2]
Pathognomonic red, white, and blue staining associated with superficial necrolytic dermatitis[1]

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[3], which can be exacerbated by topical[4] or parenteral drug-reactions (e.g. phenobarbital[5]), mycotoxins or underlying bacterial or fungal infections.

In humans, SND is associated with glucagon-secreting tumors (glucagonoma), but this occurs only rarely in dogs[6][7]. 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[8].

Some breeds such as terriers may be over-represented[9].

Clinically affected dogs present with erosions, ulcers and hyperkeratosis on the paws, secondary pododermatitis and calluses on pressure points, muzzle, periocular area and genitals.

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')[10][11].

Some dogs have concurrent diabetes mellitus or hyperadrenocorticism[12].

A differential diagnosis would include erythema multiforme[13], 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[14]. However, successful treatment has been reported with subcutaneous octreotide (2 μg/kg twice daily)[15].

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[1].

References

  1. 1.0 1.1 1.2 Cellio, LM & Dennis, J (2005) Canine Superficial Necrolytic Dermatitis. Compendium
  2. RVC.ac.uk
  3. Taboada J & Merchant S (2003) Superficial necrolytic dermatitis and the liver. Proc Int Vet Emerg Crit Care Symp
  4. Murayama N et al (2008) A case of superficial suppurative necrolytic dermatitis of miniature schnauzers with identification of a causative agent using patch testing. Vet Dermatol 19(6):395-399
  5. March PA et al (2004) Superficial necrolytic dermatitis in 11 dogs with a history of phenobarbital administration (1995-2002). J Vet Intern Med 18(1):65-74
  6. Papadogiannakis E et al (2009) Superficial necrolytic dermatitis in a dog associated with hyperplasia of pancreatic neuroendocrine cells. J Small Anim Pract 50(6):318
  7. Mizuno T et al (2009) Superficial necrolytic dermatitis associated with extrapancreatic glucagonoma in a dog. Vet Dermatol 20(1):72-79
  8. Gross TL et al (1993) Superficial necrolytic dermatitis (necrolytic migratory erythema) in dogs. Vet Pathol 30(1):75–81
  9. McNeil PE (1993) The underlying pathology of the hepatocutaneous syndrome: A report of 18 cases, in Ihrke PJ, Mason IS,White SD (eds): Advances in Veterinary Dermatology. Oxford, UK, Pergamon Press. pp:113–129
  10. Ghisleni G et al (2003) Symmetrical crusting rash in a dog. Vet Clin Pathol 32(1):19–21
  11. Yoshida M et al (1996) A case report of superficial necrolytic dermatitis in a beagle dog with diabetes mellitus. Toxicol Pathol 24(4):498–501
  12. Torres SM et al (1997) Resolution of superficial necrolytic dermatitis following excision of a glucagon-secreting pancreatic neoplasm in a dog. JAAHA 33:313–319
  13. Kimmel SE et al (2003) Clinicopathological, ultrasonographic, and histopathological findings of superficial necrolytic dermatitis with hepatopathy in a cat. JAAHA 39:23–27
  14. Miller WH et al (1990) Necrolytic migratory erythema in dogs: A hepatocutaneous syndrome. JAAHA 26:573–581
  15. Oberkirchner U et al (2010) Successful treatment of canine necrolytic migratory erythema (superficial necrolytic dermatitis) due to metastatic glucagonoma with octreotide. Vet Dermatol 21(5):510-516