Understanding Hepatocutaneous Disease in Dogs

Hepatocutaneous disease, also recognized as superficial necrolytic dermatitis (SND), is a rare but significant condition affecting canines, linking liver issues with severe skin problems. Typically impacting older dogs, especially those over eight, this syndrome shows no strong breed preference, although purebred dogs might have a slightly higher susceptibility.

Clinical Presentation and Skin Problems

The defining feature of hepatocutaneous syndrome is the presence of bilaterally symmetric crusty and ulcerated skin lesions. These typically appear on:

  • Mucocutaneous junctions, where skin meets mucous membranes
  • Footpads, which often become thick, cracked, and painful
  • Trauma-prone areas like the muzzle, lower legs, ears, around the eyes, elbows, and genitalia

Footpad lesions can be so severe that walking becomes difficult for the affected dog. Besides, these lesions may emit a strong odor despite cleaning efforts. The distinctive "red, white, and blue" pattern seen under a microscope helps in confirming the diagnosis.

The Underlying Mechanism

Hepatocutaneous syndrome is rooted in a complex metabolic problem involving:

  • SND: The specific type of skin lesions seen
  • Hepatocutaneous-associated hepatopathy (HCH): A unique liver disease
  • Hypoaminoacidemia: Low amino acid levels in the blood
  • Aminoaciduria: Excessive loss of amino acids through urine

The liver condition often exhibits vacuolar hepatopathy, leading to alterations due to factors like diabetes, medication, cirrhosis, or other unexplained causes. Skin deterioration may occur because of nutritional imbalances stemming from significant liver problems.

Possible Causes and Related Conditions

Most cases arise from chronic liver diseases. A small percentage are linked with glucagon-secreting pancreatic tumours. Common causes include:

  • Various types of vacuolar hepatopathy
  • Development of diabetes mellitus
  • Cushing's disease
  • Chronic phenobarbital usage
  • Mycotoxin poisoning
  • Liver cirrhosis

Symptoms and Progression

Apart from skin issues, dogs often display systemic symptoms like:

  • Lethargy and weakness
  • Loss of appetite and notable weight decline
  • Hesitancy in walking due to painful footpads
  • Signs resembling diabetes, such as increased drinking, urination, and occasionally vomiting

Although not in liver failure at presentation, significant liver pathology is typically present.

Approach to Treatment and Prognosis

Effective treatment can greatly enhance recovery for dogs with hepatocutaneous syndrome. A "3-pillar" strategy includes:

  1. IV amino acid (and sometimes lipid) infusions
  2. Specific nutritional supplements like S-adenosylmethionine, arginine, and glutathione
  3. Balanced home-cooked diets

While previously survival averaged 3-6 months, with optimal treatment, median survival often exceeds several years, with some dogs achieving remission.

Diagnosis Process

Definitive diagnosis involves a combination of clinical observation, skin biopsies, and liver assessments. The recognizable microscopic skin pattern, paired with liver dysfunction markers and lesion distribution, helps differentiate it from other skin conditions. Advanced testing, though rare due to costs, might include plasma amino acid level evaluations.

This complex yet manageable disease requires a comprehensive therapy that tackles both the metabolic imbalance and nutritional deficits driving it.

 

Back to blog