Bailey is an 8 year old female spayed Pit bull, who presented for dermatologic evaluation. She had a recent history of a Methicillin-resistant Staphylococcus pseudintermedius, resistant Proteus, and E. coli pyoderma, and based on that culture, doxycycline had been prescribed which so far had been ineffective. Recent bloodwork revealed increased liver enzyme levels (ALT of 312 U/L and ALP of 1926 U/L) with a mild hypoalbuminemia (2.1 g/dl). However, hyperglycemia (116 mg/dl) was not present.
On presentation, her feet were edematous and extremely painful. Physical examination revealed: compact hyperkeratosis with fissuring of all foot pads, severe erythema and crusting of the interpedal areas, crusting of the lateral elbows and lateral stifles, crusting with erythema of the perioral area and ventral chin, and pustules and papules on the ventral abdomen, ventral thorax and axillary areas.
Biopsy for histopathology was performed and revealed a diagnosis of superficial necrolytic dermatitis.
Superficial necrolytic dermatitis (SND) is also known as hepatocutaneous dermatitis or necrolytic migratory erythema (NME). SND is generally considered an outward symptom of advanced hepatic disease, or of concurrent hepatic disease and diabetes mellitus. Prognosis of this condition is guarded due to the underlying liver disorder, and treatment generally involves attempted correction of the underlying hepatic or pancreatic disorders, along with clearing secondary bacterial and fungal infections and supplementation with amino acids.
Therapy with fluconazole and gabapentin was added to Bailey’s treatment along with supplementing her diet with cottage cheese, calves’ liver and an amino acid supplement obtained at GNC. After two weeks, the owners noted improvement in Bailey’s attitude and that the lesions on top of the feet were improving. Way to go Bailey!