Page 1555 - Clinical Small Animal Internal Medicine

169 Superficial Necrolytic Dermatitis 1493

been especially more beneficial than any other. Because Oral supplementation with egg whites (cooked), zinc
VetBooks.ir of the hyperosmolarity of the solutions, they should be (e.g., zinc methionine 2 mg/kg PO q24h), powdered
amino acid commercial supplements, and essential fatty
administered via a central venous catheter over an
extended period of time (6–12h) and are repeated every
all efficacy so far has been anecdotal.
1–2 weeks until improvement is noted. The infusions are acids has been used and may be of some benefit though
then repeated as necessary to help control relapses. Many dogs are treated with corticosteroids but this
Various doses have been suggested including 25 mL/kg practice should be discouraged. The beneficial effects and
or 500 mL per dog. Some dermatologists advocate improvement of clinical signs are short‐lived and the cor-
administering the infusions three days in a row followed ticosteroid may increase the patient’s risk for developing
by once‐ to twice‐weekly treatments thereafter and diabetes mellitus. Secondary bacterial and/or fungal
repeating as signs relapse. Clinical improvement may be infections should be treated with appropriate antibiotics
noted within 5–10 days. If there is minimal to no or antimycotics.
response after four or more infusions, the therapy is
unlikely to be of benefit to the patient. One dog was
reported to survive for 24 months but was also treated Prognosis
with intravenous lipid infusions (Intralipid®, Baxter
Healthcare) at 1.4 g/kg every 6.5 weeks. In that dog, it The prognosis is grave, with most dogs dying or being
was proposed that the addition of the lipids was respon- euthanized within a few months after the beginning of
sible for the extended survival time. clinical signs.

Further Reading

Bach J, Glasser SA. A case of superficial necrolytic Dermatology, 7th edn. St Louis, MO: Elsevier, 2013,
dermatitis managed for 24 months with intravenous pp. 501–53.
amino acid and lipid infusions. Can Vet J 2013; 54(9): Nam A, Han SM, Go, D-M, et al. Long-term management
873–5. with adipose tissue-derived mesenchymal stem cells and
Cave TA, Evans H, Hargreaves J, Blunden AS. Metabolic conventional treatment in a dog with hepatocutaneous
and epidermal necrosis in a dog associated with syndrome. J Vet Intern Med. 2017; 31(5): 1514–1519.
pancreatic adenocarcinoma, hyperglucagonemia, Oberkirchner U, Linder KE, Zadrozny L, Olivry T.
hyperinsulinemia and hypoaminoacidemia. J Small Successful treatment of canine necrolytic migratory
Anim Pract 2007; 48(9): 522–6. erythema (superficial necrolytic dermatitis) due to
Hall-Fonte DL, Center SA, McDonough, et al. metastatic glucagonoma with octreotide. Vet Dermatol
Hepatocutaneous syndrome in Shih Tzus: 31 cases 2010; 21(5): 510–16.
(1996-2014). J Am Vet Med Assoc2016; 248(7): 802–13. Outerbridge CA. Cutaneous manifestations of internal
Isidoro‐Ayza M, Lloret A, Bardagi M, Ferrer L, Martinez J. diseases. Vet Clin North Am Small Anim Pract 2013;
Superficial necrolytic dermatitis in a dog with insulin‐ 43(1): 135–52.
producing islet cell carcinoma. Vet Pathol 2014; 51(4): Outerbridge CA, Marks SL, Rogers QR. Plasma amino acid
805–8. concentrations in 36 dogs with histologically confirmed
Loftus JP, Center SA, Lucy JM, et al. Characterization of superficial necrolytic dermatitis. Vet Dermatol 2002;
aminoaciduria and hypoaminoacidemia in dogs with 13(4): 177–86.
hepatocutaneous syndrome. Am J Vet Res. 2017; Papadogiannakis E, Frangia K, Matralis D. Superficial
78(6):735–744. necrolytic dermatitis in a dog associated with hyperplasia
Miller WH, Griffin CE, Campbell KL. Endocrine and of pancreatic neuroendocrine cells. J Small Anim Pract
metabolic diseases. In: Muller and Kirk’s Small Animal 2009; 50(6): 318.