Hepatocutaneous Syndrome

Todayโ€™s path rounds are on ๐ก๐ž๐ฉ๐š๐ญ๐จ๐œ๐ฎ๐ญ๐š๐ง๐ž๐จ๐ฎ๐ฌ ๐ฌ๐ฒ๐ง๐๐ซ๐จ๐ฆ๐ž!

๐–๐ก๐š๐ญ ๐ข๐ฌ ๐ข๐ญ?
๐‡๐ž๐ฉ๐š๐ญ๐จ๐œ๐ฎ๐ญ๐š๐ง๐ž๐จ๐ฎ๐ฌ ๐ฌ๐ฒ๐ง๐๐ซ๐จ๐ฆ๐ž is also known as ๐ฌ๐ฎ๐ฉ๐ž๐ซ๐Ÿ๐ข๐œ๐ข๐š๐ฅ ๐ง๐ž๐œ๐ซ๐จ๐ฅ๐ฒ๐ญ๐ข๐œ ๐๐ž๐ซ๐ฆ๐š๐ญ๐ข๐ญ๐ข๐ฌ. Putting both of these names together, you get a liver disease (hepato-) affecting the skin (cutaneous) that causes cell death (necrolytic).

๐–๐ก๐จ ๐ ๐ž๐ญ๐ฌ ๐ข๐ญ?
This syndrome is most commonly seen in dogs!

๐–๐ก๐š๐ญ ๐œ๐š๐ฎ๐ฌ๐ž๐ฌ ๐ข๐ญ?
The actual cause of hepatocutaneous syndrome is unknown, however it gets its name because almost 90% of patients have severe liver disease as well. So, it is thought that liver disease is a contributing factor to developing these skin lesions.

๐–๐ก๐ฒ ๐ข๐ฌ ๐ญ๐ก๐ข๐ฌ ๐š ๐ฉ๐ซ๐จ๐›๐ฅ๐ž๐ฆ?
Hepatocutaneous syndrome attacks the ๐ž๐ฉ๐ข๐๐ž๐ซ๐ฆ๐š๐ฅ (skin) cells, causing cell death. Affected areas of skin slough off easily, leaving crusty, bleeding areas that are extremely painful. The foot pads also become ๐ก๐ฒ๐ฉ๐ž๐ซ๐ค๐ž๐ซ๐š๐ญ๐จ๐ญ๐ข๐œ, or crusted, due to the increased number of dead cells.

๐‡๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐๐ข๐š๐ ๐ง๐จ๐ฌ๐ž๐?
Diagnosis is made through skin biopsy! Hepatocutaneous syndrome produces a classic appearance under the microscope of a โ€œred, white and blueโ€ epidermis. What the pathologist is really seeing is red from ๐ค๐ž๐ซ๐š๐ญ๐ข๐ง (the protective layer of the skin), white from swollen and dying skin cells, and blue from ๐›๐š๐ฌ๐š๐ฅ ๐œ๐ž๐ฅ๐ฅ๐ฌ, which are the reproducing cells that make new skin cells.

๐‡๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐ญ๐ซ๐ž๐š๐ญ๐ž๐?
Unfortunately, there is no specific treatment for this condition. Supportive care, such as increasing amino acids needed for skin health and treating underlying liver disease are helpful. Many patients are euthanized due to a poor prognosis.

๐๐ก๐จ๐ญ๐จ๐ฌ
1-2) Examples of hepatocutaneous syndrome on the skin!
3) A very sad looking liver from a dog with hepatocutaneous syndrome.
4) The classic โ€œred, white and blueโ€ appearance under the microscope!

๐’๐จ๐ฎ๐ซ๐œ๐ž๐ฌ
Maxie, G. Jubb, Kennedy and Palmerโ€™s Pathology of Domestic Animals, Volume 1. Sixth Edition.

Photos 1-4 ยฉ Noahโ€™s Arkive contributor Schelling, Jakowski, Latimer and Rakich, Werner licensed under CC BY-SA 4.0.

Leave a Reply