Abstract
A 10-year old, castrated male, Bichon Frise with a history of hyperadrenocorticism and intrahepatic portal vein hypoplasia was diagnosed with superficial necrolytic dermatitis (SND). The dog exhibited thick crusts on the chin, muzzle, prepuce, and paws. In addition, the dorsal surfaces of all paws were erythematous while the palmar/plantar surfaces were hyperkeratotic, hardened, and painful. The dog was treated with intravenous amino acid infusions (AAI), raw egg yolks, as well as zinc and omega-3 fatty acid oral supplements. The dog required AAI once every 2–3 weeks because this coincided with recrudescence of painful skin lesions. The dog was subsequently diagnosed with diabetes mellitus. A consult with the Nutrition Service was pursued 220 days after the original SND diagnosis because of concern for feeding raw eggs and for malnutrition since appetite was variable, muscle condition was reduced, and greater than 50% of ingested calories were from foods that were not nutritionally complete. There was also concern regarding the variability of the diet and the impact it would have on the management of diabetes mellitus. The diet was prepared by the dog owner according to a provided recipe and presented twice daily. The diet was rich in high quality protein and fat. All other treatments including medications, supplements, and bathing schedule remained unchanged at the time of diet modification. The dog was subclinical for SND associated clinical signs approximately 3 weeks after the diet modification, which also coincided with the last AAI. The AAI was postponed and was next administered 7 weeks later (i.e., 10 weeks from the previous infusion). The dog remained subclinical for SND related clinical signs and continued to receive AAI once every 10–12 weeks until he was euthanized 718 days later for complications related to severe multi-drug resistant, skin infections. In conclusion, this report highlights a novel role for nutritionally balanced home-made diets designed by a board-certified veterinary nutritionist could substantially increase time interval between AAI and outcome in dogs with SND.
Highlights
Superficial necrolytic dermatitis (SND) known as hepatocutaneous syndrome, is an uncommon skin disorder in dogs
In this article we report, for the first time, the adjunctive role of a prescription home-cooked diet containing quality protein for the long-term management of a dog with superficial necrolytic dermatitis (SND) that yielded an improvement in clinical signs and a reduction in the frequency of amino acid infusions (AAI)
The dog was treated with oral amoxicillin/clavulanic acid (Clavamox, Zoetis Inc., Kalamazoo, MI; 15.6 mg/kg twice daily) until results from the liver biopsy returned. These results showed mild lymphoplasmacytic and suppurative hepatitis with severe edema or glycogen associated cell swelling
Summary
Superficial necrolytic dermatitis (SND) known as hepatocutaneous syndrome, is an uncommon skin disorder in dogs. In this article we report, for the first time, the adjunctive role of a prescription home-cooked diet containing quality protein for the long-term management of a dog with SND that yielded an improvement in clinical signs and a reduction in the frequency of AAI. Attempts were made over the 2 months to decrease the frequency of AAI but recrudescence of clinical signs (e.g., hyporexia, lethargy, and erythema/crusts of the skin) necessitated treatments every 2–3 weeks. On day 91 the dog was diagnosed with diabetes mellitus and medical management (Vetsulin; 0.32 units/kg administered subcutaneously twice daily) was initiated. All other forms of medical management including trilostane, insulin, ursodiol, zinc/omega-3 fatty acid supplementation, and bathing schedule remained unchanged. The home-prepared diet was well-accepted and the frequency of AAI was maintained (q10–12 weeks) without emergence of SND clinical signs for 520 days (1.4 years). The dog continued to receive AAI typically once every 10– 12 weeks until he was euthanized on day 938 (∼2.5 years) for reasons related to severe, refractory Malassezia skin infections unrelated to SND
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