Hepatocutaneous syndrome
The hepatocutaneous syndrome (Latin for ' liver - skin disease complex'; syn. Superficial necrolytic dermatitis , metabolic epidermal necrosis , diabetic dermopathy and necrolytic migratory erythema ) is a skin disease that occurs mainly in older dogs. Cats are rarely affected, and there are also individual reports for red fox and black rhinoceros . With the disease, liver or pancreatic diseases lead to skin changes, usually blistering with subsequent ulceration and excessive keratinization.
Disease emergence
The mechanism of its formation has not yet been clearly clarified. The hepatocutaneous syndrome occurs mainly in dogs with cirrhosis of the liver , occasionally also with a glucagonoma or diabetes mellitus . One case of a pancreatic tumor in cats has so far been described. Glucagon probably plays the decisive role, either due to excessive secretion or reduced breakdown in the liver as a result of the liver dysfunction. Glucagon increases the formation of new dextrose and reduces the amount of amino acids in the blood and thus leads to an undersupply of protein in the skin. A deficiency in essential fatty acids and zinc is also discussed. Zinc is mainly transported via albumin , and animals with hepatocutaneous syndrome often show hypoalbuminemia .
The insufficient supply of the skin leads to degeneration of the keratinocytes . Pathohistologically, there is intercellular edema , vacuolization of the keratinocytes, acanthosis and hyperplasia of the basal epidermal cells.
Clinical picture and diagnostics
The skin changes usually show up in affected animals before symptoms of a liver disease such as jaundice appear. As a primary lesion occur bubbles on. After they burst, they can become epithelial defects ( erosion ), ulcers ( ulcer ) and crusts . The changes occur primarily in the face, the skin-mucous membrane transitions, on the elbows , ankles , limb ends and genitals. A hyperkeratosis of the bales is also common.
If you have liver disease, the liver enzymes alkaline phosphatase and alanine aminotransferase (ALT) are usually also elevated. In addition, albumin deficiency , hypoglycaemia and regenerative normocytic anemia can occur. Cirrhosis of the liver can be detected using sonography . Typical here are hypoechogenic regenerated nodules that are surrounded by hyper- to normoechogenic parenchyma , which give the organ a "honeycomb" or "Swiss cheese" structure. In the case of pancreatic tumors, all laboratory values can be within the normal range except for the albumin deficiency.
In the differential diagnosis, pemphigus foliaceus , zinc-reactive dermatosis and systemic lupus erythematosus can be excluded.
treatment
A causal therapy is usually not possible and the prospect of treatment depends largely on the degree of liver disease. The therapeutic options are limited to the administration of nutritional additives such as amino acids, essential fatty acids, zinc and B vitamins .
With glucocorticoids , the skin changes can indeed usually improve in the short term, however, this leads to a further liver damage. Treatment of any secondary skin infections ( pyoderma , malassezia dermatitis ), however, makes sense.
literature
- Noli / Scarampella: Practical Dermatology in Dogs and Cats. Schlütersche Verlagsanstalt, 2nd edition 2005. ISBN 3-87706-713-1 , pp. 344–345
- ↑ a b c d Elisa Belaschik et al .: Hepatocutaneous syndrome in two dogs. In: Kleintierpraxis 59 (2014), pp. 539-548.