chapter 45 Superficial Necrolytic Dermatitis...........................
DEFINITION/OVERVIEW
Synonyms: hepatocutaneous syndrome; necrolytic migratory erythema; metabolic
epidermal necrosis.
Complex, progressive, and usually fatal disorder affecting the skin and liver (and
rarely pancreas).
Necrotizing dermatitis resulting from cutaneous nutritional deprivation.
Predominantly associated with hepatic disorder; rarely with glucagonoma.
ETIOLOGY/PATHOPHYSIOLOGY
Hypoaminoacidemia: amino acids involved in the urea cycle and synthesis of glu-
tathione or collagen are those predominantly measured as low.
Metabolic hepatopathy (not cirrhosis) resulting in increased hepatic catabolism of
amino acids proposed; variable high serum bile acids concentrations.
Predominantly associated with severe vacuolar hepatopathy:
Rarely associated with phenobarbital or phenytoin administration
Rarely associated with severe hepatic insult; mycotoxin
Rarely associated with glucagon-secreting pancreatic or extrapancreatic neopla-
sia; these cases do not exhibit signs of hepatopathy.
Occurs with or without diabetes mellitus; development of diabetes mellitus may be
an indicator of disease progression and worsening prognosis.
Hypoaminoacidemia, with or without deficiencies in zinc, essential fatty acids, or
other nutrients.
Clinical symptoms produced by keratinocyte degeneration from cellular starvation or
nutritional imbalance.
Resolution by excision of a glucagon-secreting pancreatic tumor reported.
Symptoms temporarily relieved by intravenous infusions of amino acid solutions.
Associated with secondary bacterial follicultis andMalasseziadermatitis.
Feline cases very rare; most often associated with neoplasia (pancreatic carcinoma,
intestinal lymphoma) and hepatopathy.
Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Dermatology, Third Edition.
Karen Helton Rhodes and Alexander H. Werner.
©2018 John Wiley & Sons, Inc. Published 2018 by John Wiley & Sons, Inc.
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