Accepted Answer

Hi,
I would agree that hepatocutaneous syndrome is very rare. I have never diagnosed it in my 15 years, although I may have missed it, too. From what I understand, if the liver disease (or cancer) has progressed so far that the skin is affected, there isn't much more that can be done.

Here is a bit more info that I found (the stuff in the parantheses is mine):

Hepatocutaneous Syndrome

(AKA superficial necrolytic dermatitis, necrolytic migratory erythema, metabolic epidermal necrosis) This disorder is an inflammatory, necrolytic dermatitis associated with hepatic disease, diabetes mellitus, and glucagonomas. Clinical features include erythema (redness of the skin), alopecia (hairloss), and crusts around the eyes, muzzle, external genitalia, and extremities. Foot pad changes include hyperkeratosis (thickening), erythema, and severe crusting. The feet are often painful and animals are frequently presented for failure to walk on sore feet.

Diagnosis is made by identifying the underlying systemic disease and identifying the cutaneous syndrome. A CBC, serum biochemical profile, urinalysis, and serum bile acid concentrations are recommended when the condition is suspected. Liver biopsy may be indicated to assist in identifying the hepatopathy causing the underlying metabolic problem. The cutaneous component of this condition is confirmed by skin biopsy of the affected skin and food pads. Classical histologic findings of the skin include diffuse, parakeratotic hyperkeratosis, epidermal necrosis, ballooning superficial epidermal degeneration and necrosis, intercellular and intracellular edema of the upper third of the epidermis, and epidermal hyperplasia. This creates a "red, white, and blue" pattern. Ultrasound exam may demonstrate a pancreatic tumor or a honeycomb or Swiss cheese appearance to the liver.

The most common pathologic association is liver disease, although pancreatic tumors have also been reported. The pathogenesis is not completely understood. It is believed that deficiencies in certain nutrients (e.g., amino acids, biotin, essential fatty acids, zinc) probably cause keratinocyte degeneration. Affected animals may have hypoalbuminemia (low albumin), extremely low plasma amino acid concentrations, and elevated serum glucagon concentrations (these last 2 aren't tested in routine bloodwork).

Treatment is primarily directed at controlling the underlying systemic disease. Therapy includes zinc and amino acid supplementation. Amino acid supplementation can be given IV (slow drip) weekly or orally. Some dermatologists have used the IV amino acid supplementation successfully to improve the quality of life of these patients.

Paraneoplastic Alopecia

Paraneoplastic syndromes consist of clinical signs associated with malignancies but not directly related to tumor invasion. Cutaneous paraneoplastic syndromes have been described in humans for years. However, there are only rare reports of their presence in dogs and cats. In 1997, a report of 4 cases of an unusual skin condition associated with internal neoplasia was reported in the literature. Since then, more cases have been seen and reported. The syndrome, seen in primarily older cats develops rather acutely (suddenly). It usually begins with alopecia on the ventrum (stomach) which progresses to include the limbs. The skin is reported to "glisten" probably due to exfoliation of the stratum corneum. Most of these cats come into the clinic with a history of anorexia (not eating), weight loss and in some cases pruritus(scratching). The hair epilates easily (pulls out) and affected cats are sometimes painful when manipulated. Blood work is often within normal limits but abdominal ultrasound often reveals neoplasia. The tumors reported to date include liver and pancreatic carcinomas and bile duct carcinomas. Histopathology shows severe follicular and adnexal atrophy. Affected hair follicles often have miniature hair bulbs. The prognosis is grave unless the tumor can be resected.

If your vet is experienced in doing ultrasounds, then I would think his US evalution would have picked up a liver or pancreas problem. Your vet may be able to send the x-rays and a video of the ultrasound to a radiology specialist for review prior to sending you for a referral. I would also ask about Care Credit--a credit card for health care that might make it easier to pay for the referral. One thing to keep in mind, you can always just go for a physical exam and review of what has already been done. The specialist will then discuss possibilities, further testing, etc and you can decide then how far (if at all) you want to proceed. So you don't need to commit to a $2000 estimate (or whatever) immediately.

Prednisolone is a prescription drug--your vet will need to dispense it to you.
If the hydrocortisone spray is helping, I would continue to use it. You might want to put an e-collar (the "lampshade") on your cat if that will help stop him from scratching. You might start Quincy on a fatty acid supplement, too--you can probably find one at your local pet store this weekend.

Expert:	Dr. Scarlett
Pos. Feedback:	100.0 %
Accepts:
Answered:	9/20/2009

Cat Veterinarian

I am a practicing small animal veterinarian with 13 years experience.