What is Hepatocutaneous Syndrome?
Hepatocutaneous syndrome (also known as necrolytic migratory erythema, superficial necrolytic dermatitis or metabolic epidermal necrosis) is a rare condition that mainly affects older dogs. The disease is chronic and progressive and in most cases, fatal. While hepatocutaneous syndrome is often linked to diabetes mellitus, the disease may also be connected to a pancreatic, liver or neuroendocrine tumor. Skin lesions are prevalent and are likely the most noticeable symptom, often presenting before lesions on the liver (a severe, degenerative, glycogen-like VH).
Often due to an underlying health condition like diabetes mellitus, hepatocutaneous syndrome is a rare, chronic and progressive disease that often initially presents with skin lesions.
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Symptoms of Hepatocutaneous Syndrome in Dogs
Most dogs with hepatocutaneous syndrome display skin disease; lesions are often found on the muzzle, lower legs or footpads, though the lesions can also be found on the mouth, ear flaps, elbows and genitals of your dog. The lesions will typically have crusting and display ulcerations and in some cases there may be blistering. If footpads are affected they will usually be thickened, possibly have an unpleasant odor and your dog may feel significant pain. Some dogs show signs of systemic illness; your dog may appear listless, have a poor appetite and be experiencing weight loss. Lesions may also be found on your dog’s liver.
There is typically an underlying liver or pancreatic problem in your dog that is leading to his developing hepatocutaneous syndrome. These include:
- Liver tumor
- Pancreatic tumor
- Diabetes mellitus
- Cushing’s disease
Causes of Hepatocutaneous Syndrome in Dogs
In hepatocutaneous syndrome, major liver dysfunction (whether due to a tumor or diabetes mellitus) or a pancreatic tumor cause problems with your dog’s metabolism, leading to a nutritional imbalance and the degeneration of his skin cells. In some dogs, long-term phenobarbital therapy has led to hepatocutaneous syndrome.
Diagnosis of Hepatocutaneous Syndrome in Dogs
Your veterinarian will conduct a physical examination of your dog, and inquire about your dog’s history. It is a good idea to be prepared to share with your veterinarian any changes you have noticed in your dog’s behavior and when you first noticed these changes, as well as when you first noticed the lesions. Your veterinarian will examine the lesions and consider whether your dog has been listless and not eating. Depending upon the physical examination, your veterinarian may request the following:
- Blood work - High liver enzymes and low protein levels are seen in hepatocutaneous syndrome. Blood work may also show increases in ALP, ALT and AST, hyperglycemia, a decrease in plasma amino acid concentrations by about 50% of what is typical and nonregenerative anemia.
- Skin biopsy - The results will lead to further exploration for liver or pancreatic issues.
- Abdominal ultrasound - This will be done to determine if there is a “honeycomb” or “swiss cheese” pattern of the liver caused by liver degeneration, or a pancreatic tumor (pancreatic tumor is a less common cause of hepatocutaneous syndrome).
Treatment of Hepatocutaneous Syndrome in Dogs
During diagnosis, should a pancreatic or liver tumor be found, the veterinarian will consider surgically removing it. In cases where the tumor is removed, the skin lesions may resolve for a time. Unfortunately, the tumors will typically spread to other parts of your dog’s body. In cases where the dog is suffering from a condition like diabetes mellitus or Cushing’s syndrome, once the underlying condition is under control, the skin lesions may then resolve.
When your dog is experiencing end stage liver disease, whether at the time of diagnosis or later in the course of the disease, surgery is not an option. At that time, the veterinarian will focus on improving the quality of your dog’s life and help keep him comfortable. Treatment at that time may include:
Ensuring your dog gets the protein, necessary minerals and enzymes needed through diet, zinc methionine supplements (1.5-2mg/kg/day), vitamins at double the usual dose, antioxidants like vitamin E and SAMe and intravenous amino acid infusions.
The amino acids are to be delivered through a jugular vein; for example, Aminosyn 10% crystalline amino acid solution (100 mL has 100 g of amino acids) can be administered intravenously. If skin symptoms don’t resolve, the infusion of amino acids can be repeated 7-10 days later for up to four cycles. If there is no resolution of the skin lesions after four infusions, further infusions will not be useful.
Providing care for the skin lesions through the use of ointments, shampoos and sprays may be recommended. Antifungals or antibiotics for superficial secondary bacterial or fungal infections will be prescribed as needed.
Recovery of Hepatocutaneous Syndrome in Dogs
Due to the severity of the disease and the likelihood of an underlying condition being present, follow up appointments will likely be necessary. It is important to work with your veterinarian to ensure the most positive outcome possible for your dog.
Liver disease will often lead to your dog feeling nauseous which may cause him to be uninterested in eating. Efforts to ensure that your dog gets the nutrition he needs are important. To help soften the crusted footpads, you can try foot soaks or moisturizers. Topical anti-yeast sprays or shampoos may be helpful in cases where secondary yeast is affecting your dog. The prognosis is for hepatocutaneous syndrome is guarded to poor and will depend upon the underlying condition.
Hepatocutaneous Syndrome Questions and Advice from Veterinary Professionals
My dog was diagnosed with a liver tumour and hepacutaneous syndrome but since been put to sleep on 25th March 18 l am beating myself up about it as l feel something more could have been done she was still of sound mind and still barking and mind alert had her good days and bad days feel l have prematurely put her to sleep
I would do it again, and became very knowledgeable about this disease. Anyone with questions, message me on FB. I would be honored to help another pet parent deal with this.
My Yorkie passed two months ago at 10 yrs after fighting HS valiantly for almost a year & half. We took her to 3 different vets who diagnosed allergies & paw infection before an internal medicine specialist got it right as HS. We aggressively treated her with every possible option and she responded well. It cost about $20,000 total with some complications and a couple of surgerys on eye & broken leg due to her weakened system. I work from home or could never have devoted the time to her care. Her quality of life was good to the end, sudden kidney failure took her in 48 hours, not in pain with good meds. Sadly, she was the best outcome patient DFA Phoenix had ever seen. There is no beating this disease & yes I think there are many misdiagnosis not reported as hepatocutaneous.
Our 13yo Chinese Crested Powderpuff named Milo was finally diagnosed with this. He had skin lessons for 18 months but our vet called them normal skin tags. They looked like cauliflower and would ooze and bleed. A month ago he started slowing down quite a bit but everyone said it was just his age. We took a 2k mi roadtrip and decided to leave him home with friends. When we got back he could barely walk and eat. His paws were inflamed and his pads were peeling. We blamed the groomer for what we were told was athletes foot. 2 weeks of antibiotics did no good. Started him on Monistat for a yeast infection. After x-rays and blood work out vet couldn't figure it out and we were sent to dermatology for animals. He was licking all his paws raw, rubbing his face on everything, his eyelids were red, lips encrusted and super low appetite. DFA took 3x skin biopsies and a week to confirm. Our poor dog was tormented by this horrible disease while we waited for clear answers. Since there is no cure and his pain so great we opted to help end his suffering through The Restful Paws home service. This is just a very confusing, mean, and fatal disease. Once diagnosed, the why doesn't matter, there is nothing anyone can do to stop this wrecking ball.
We lost our gentle, beautiful giant, Cesar on February 16th of this year to hepatocutaneous syndrome. He had skin itching, primarily on his foot pads, no appetite, and he had three seizures that left him with a permanent head twitch and lip smacking. One entire liver lobe was "swiss cheese" pattern, and it was infiltrating into the next lobe.... the weakness, unsteady gait, and lip smacking constantly caused our beautiful boy such discomfort. We decided to end his suffering. The whole process took three weeks.. from the beginning of the foot scratching and bleeding to his demise. He had a week long reprieve during a test treatment of steroids... but it was short-lived. His discomfort returned two days after the treatment stopped, and then he had the first full blown seizure... I am sorry for everyone who had to make the agonizing decision to end their suffering. I wonder if the condition is really that rare. It may be under reported. Thank you for listening.... I miss my boy.....
I’m sorry for your loss, and feel your pain. I just put my beautiful 6 year old boy down this passed Tuesday. I wish I would have seen the early signs. I treated his lesions, thinking they were hot spots. I had no idea that they may have been connect to liver disease. Last Sunday, I found out his liver enzymes were triple. I took him to my vet, and they did x-rays, which revealed a mass and an enlarged spleen. I made the decision to let him go, rather than taking him elsewhere for ultrasounds/biopsies. I just couldn’t afford it, either. This was so unexpected. I’m still in shock. I had been focusing on getting help for my Bassett Hound Jaydee. I thought he would be the one to let go, because he has a major tumor on the outside, and I have been trying to raise money for his surgery. For now, Jaydee and I are just trying to adjust without Leo. 😭
My little dog lasted 4 weeks before she told me she had enough. A very hideous awful thing for a dog to go through. I'm blessed her last 3 days were spent sleeping outside inmthe sun before her body took an awful turn overnight. Be at peace with that decision as it will have saved your dog a lot of pain.
Please dont feel bad for putting your dog to sleep , You have done the right thing for all ! Hindsight isnt worth the worry , the fact that Cassie is now resting in peace proves what you have done was the right thing to do !
Your concern now that more could've been done is grief , guilt is part of the grieving process .
You done well and should feel proud that you had the courage to let her go with dignity !
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How much is the cost for amino acid drip for a dog to control lesions as stated on this post for liver problems ..causing skin problems lesions.. Thank you..pat
My yorkie took weekly iv amino acid infusions and did well for a year until heart disease & kidney failure took her. The cost was $125 a week, she stayed 6-7 hours at the vet each time.
Thank you doctor
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My fox terrier has hepatocutaneous syndrome and my vet has put him on a hepatic diet. He is used to raw food and won't eat the dry food. My vet said he needs a low protein diet however I have been reading that he needs amino acids. If I give him tuna and eggs for his skin issues, is it going to harm his liver?
My female 10 year old yorkie survived a year on a high protein home cooked diet. Grass fed beef, chicken, pork mixed with vegetables. I strongly suggest taking your dog to a dermatologist experienced in Hepatocutaneous patients. Dermatology for Dogs has many locations around the country. It will make all the difference to have specialist treatment plan that you can work with your home vet.
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I have very little info on signs to watch for that it's the end. Please belp me to identify symptoms that he's near the end. He has skin patches of thickness. Paw pads are thick and tough. Sometimes an odor. On and off diarrhea. So far that's all. Thank you.
Take him to an internal medicine or dermatology specialist. Ask is they have experience with this disease and their outcomes positive. We worked with both for best treatment and ours lived a year longer than Anyone imagined she would.
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