Treatment and outcomes of dogs with hepatocutaneous syndrome or hepatocutaneous‐associated hepatopathy

BACKGROUND: Superficial necrolytic dermatitis (SND) in dogs is a rare disorder most commonly associated with hepatocutaneous syndrome. Although often reported as fatal, sporadically reported long‐term remissions might be more common than previously believed and linked to treatment regimens. HYPOTHESIS/OBJECTIVES: Evaluate treatments and associated outcomes in dogs with hepatocutaneous‐associated hepatopathy (HCH) with or without SND, designated collectively aminoaciduric canine hypoaminoacidemic hepatopathy syndrome (ACHES). ANIMALS: Forty‐one dogs of various breeds and ages diagnosed with ACHES. METHODS: Retrospective study. Electronic surveys, medical records (2014‐2019), and communication with veterinarians provided data. Three treatment categories were each dichotomized: IV amino acid (IV‐AA) infusions (≥2 vs <2), supplements including S‐adenosylmethionine (SAMe), arginine with ornithine, glutathione, lysine, proline, omega‐3 fatty acids, or zinc (≥3 vs <3), and diet type (home‐cooked vs commercial). Optimal treatment was defined as receiving ≥2 IV‐AA treatments, ≥3 nutritional supplements, and a home‐cooked diet. RESULTS: Most dogs (29/41, 71%) received IV‐AA infusions (23/29, ≥2 infusions). Twenty‐one dogs (51%) were fed commercial diets; 17/41 (41%) were fed home‐cooked diets. Most dogs received SAMe (32/41, 78%) and a median of 3 supplements. In 4 dogs, HCH remission occurred. Overall all‐cause median survival time (MST) was 359 days, and disease‐specific MST was 557 days (range, 1‐1783 days). Optimally treated dogs (n = 9) lived significantly longer (MST, >1783 days, P = .02) than variably treated dogs (MST, 214 days). CONCLUSIONS AND CLINICAL IMPORTANCE: Optimized ACHES management can resolve SND and HCH and confer long‐term survival.