Pancreatic Disease and Skin Lesions in Dogs: Superficial Necrolytic Dermatitis

Based on peer reviewed veterinary research · For educational purposes only · Updated October 2026 · 9 min read

What Is Superficial Necrolytic Dermatitis in Dogs?

Superficial necrolytic dermatitis (SND) is an uncommon, serious skin disease in which the outer layers of the epidermis (the top layer of skin) break down because of a metabolic disorder elsewhere in the body, most often chronic liver disease and less commonly a pancreatic endocrine tumor. The condition is known by several names, including hepatocutaneous syndrome, metabolic epidermal necrosis, and necrolytic migratory erythema, the term used in human medicine for the glucagonoma-associated form (Gross et al., 1993).

SND is a textbook example of the skin acting as a window into internal disease. The lesions themselves are the visible end result, but the real problem is biochemical: affected dogs have profoundly low circulating amino acids, and skin cells, which turn over rapidly and demand a constant supply of protein building blocks, are among the first tissues to fail.

The disease typically affects middle-aged to older dogs, with most cases diagnosed around 10 years of age. Shih Tzus, West Highland White Terriers, Cocker Spaniels, and Scottish Terriers are among the breeds reported more frequently, and a large retrospective series identified 31 affected Shih Tzus at a single referral center (Hall-Fonte et al., 2016). Because the skin signs often appear before any obvious illness, recognizing them early can shorten the path to diagnosis considerably.

How Is Pancreatic Disease Linked to Skin Lesions?

The pancreatic form of SND is driven by a glucagonoma, a tumor of the pancreatic alpha cells that secretes excessive glucagon. Glucagon is a catabolic hormone (one that breaks tissue down): it pushes the liver to convert amino acids into glucose. When glucagon is chronically elevated, circulating amino acids are consumed faster than the diet can replace them, and the epidermis is starved of the proteins it needs to mature normally (Torres et al., 1997).

In dogs, the pancreatic form is the minority presentation. Most cases are associated with a distinctive chronic liver disease, a degenerative vacuolar hepatopathy that produces a honeycomb pattern on ultrasound. The two forms share the same end point, severe hypoaminoacidemia. In a landmark study of 36 dogs with biopsy-confirmed SND, plasma amino acid concentrations averaged approximately 30% of normal values, and the deficiency was consistent regardless of the suspected underlying cause (Outerbridge et al., 2002).

Other contributing factors that have been described include zinc and essential fatty acid deficiency, chronic phenobarbital administration, and mycotoxin exposure. A notable proportion of affected dogs also develop diabetes mellitus, either from glucagon excess directly or from progressive pancreatic and hepatic dysfunction, which adds another layer of impaired wound healing and infection risk. For a broader look at how endocrine disease affects the coat, see Diabetes and Skin Problems in Dogs.

What Do the Skin Lesions Look Like?

SND has a recognizable distribution. Lesions cluster on the footpads, the muzzle and lips, the skin around the eyes, the ears, the genitals and perianal area, and pressure points such as the elbows and hocks. Symmetry is common.

The footpads are frequently the first and most painful site. They become markedly thickened (hyperkeratosis), crusted, and cracked with deep fissures, and many dogs become reluctant to walk or begin limping. On the face and body, owners may see redness, scaling, adherent yellow crusts, erosions, and ulcers that ooze and bleed.

How Do Veterinarians Diagnose Superficial Necrolytic Dermatitis?

Diagnosis rests on two pillars: confirming the skin disease and identifying the internal cause.

Skin biopsy is essential. Samples taken from the edge of early, crusted lesions show the classic "red, white, and blue" pattern under the microscope: a pink layer of parakeratosis (retained nuclei in the outermost skin) at the surface, a pale band of swollen, degenerating keratinocytes in the middle, and a blue-staining layer of hyperplastic basal cells beneath (Gross et al., 1993). Older, heavily infected lesions may lose this pattern, so selecting the right biopsy site matters.

Abdominal ultrasound is the next critical step. In the hepatic form, the liver has a distinctive honeycomb or "Swiss cheese" appearance, with hypoechoic nodules separated by hyperechoic borders. When the liver appears normal, the pancreas should be examined carefully for a mass, and advanced imaging such as CT may be recommended to locate a small glucagonoma or check for metastasis.

Supporting laboratory work often includes a complete blood count, biochemistry panel (elevated liver enzymes and blood glucose are common), plasma amino acid profile, bile acids, and serum glucagon when a pancreatic tumor is suspected. Research in affected dogs has also documented marked aminoaciduria (amino acid loss in urine), which helps explain why dietary protein alone rarely corrects the deficit (Loftus et al., 2017). If you are trying to make sense of crusting lesions on your dog, the Dog Skin Condition Checker can help you organize what you are seeing before the appointment.

Treatment Options for Pancreatic and Hepatic SND

Treatment depends on the underlying cause and has three goals: correct the amino acid deficit, address the source when possible, and control secondary infection and pain.

Pancreatic glucagonoma: Surgical removal of the tumor offers the only potential cure, and resolution of skin lesions within weeks of successful resection has been reported (Torres et al., 1997). Because these tumors frequently metastasize to the liver by the time of diagnosis, surgery is not always possible. Octreotide, a somatostatin analog that suppresses glucagon release, may be used to reduce hormone output when surgery is not an option.

Amino acid replacement: Intravenous infusion of a crystalline amino acid solution, commonly given over 6 to 8 hours and repeated every 7 to 10 days, is the cornerstone of management for the hepatic form and a useful bridge in pancreatic cases. Many dogs show visible improvement in footpad and facial lesions within 1 to 3 weeks. At home, a high-quality, highly digestible protein diet, often supplemented with egg yolks, plus zinc and omega-3 fatty acid supplementation, supports skin repair between infusions.

Secondary infection control: Because damaged skin is rapidly colonized by bacteria and yeast, your veterinarian may prescribe systemic antimicrobials alongside topical therapy. Chlorhexidine Shampoo contains chlorhexidine gluconateand ketoconazole, a combination that disrupts bacterial cell membranes and inhibits ergosterol synthesis in yeast, helping reduce the Staphylococcus and Malassezia burden on crusted, compromised skin. As an FDA-registered OTC veterinary drug listed on DailyMed, it is designed for exactly this kind of supportive topical role, used alongside, never instead of, treatment of the underlying metabolic disease. Gentle bathing also softens and lifts adherent crusts, which improves comfort and allows prescribed topicals to reach the skin surface.

Corticosteroids are generally avoided in SND, because they can worsen the underlying liver disease and precipitate or aggravate diabetes. For more on how liver-driven skin disease is managed, read Hepatocutaneous Syndrome in Dogs: Signs and Management and Liver Disease, Jaundice, and Skin Changes in Dogs. Our overview of bacterial skin infections in dogs explains why secondary pyoderma needs its own treatment plan.

Prognosis and Long-Term Management

SND carries a guarded to poor prognosis, and many dogs with the hepatic form survive months rather than years after diagnosis. Outcomes are better when a resectable pancreatic tumor is found early, and quality of life can be improved substantially even in non-curable cases with consistent supportive care.

Practical long-term management focuses on comfort and on preventing flare-ups of secondary infection:

• Footpad care: Soft bedding, non-slip flooring, and protective booties reduce pain from fissured pads. Keep nails trimmed to improve weight bearing.
• Regular medicated bathing: Follow your veterinarian's schedule, which is often 2 to 3 times weekly during active infection and less frequently once lesions are controlled. Allow 10 minutes of contact time before rinsing.
• Nutrition: Feed a protein-rich, highly digestible diet unless your veterinarian advises otherwise, and do not restrict protein on the assumption that it will protect the liver.
• Blood glucose monitoring: Watch for increased thirst and urination, which can signal emerging diabetes.
• Recheck schedule: Periodic ultrasound, bloodwork, and skin cytology help your veterinarian adjust treatment early.

Owners of older dogs with thickened, painful footpads should not assume the change is simply age-related. Our article on why older dogs get cracked, thin paw pads explains which pad changes are normal and which warrant investigation.

Frequently Asked Questions

Can pancreatic disease cause skin problems in dogs?

Yes. A glucagon-secreting pancreatic tumor (glucagonoma) can cause superficial necrolytic dermatitis, a condition in which excess glucagon depletes blood amino acids and the skin breaks down, producing crusts, ulcers, and cracked footpads.

What does superficial necrolytic dermatitis look like on a dog?

It typically appears as thick, crusted, deeply fissured footpads plus redness, crusting, and erosions on the muzzle, around the eyes, on the ears, genitals, and pressure points. Lesions are often symmetrical and frequently become infected with bacteria and yeast.

How is hepatocutaneous syndrome diagnosed in dogs?

Veterinarians confirm it with a skin biopsy showing a characteristic "red, white, and blue" layered pattern, then use abdominal ultrasound to look for a honeycomb liver or a pancreatic mass. Plasma amino acids, which averaged about 30% of normal in one 36-dog study, support the diagnosis.

Is superficial necrolytic dermatitis curable?

It can be cured only when a pancreatic glucagonoma is found and surgically removed before it spreads. Most cases are liver-associated, and those are managed rather than cured, using intravenous amino acid infusions every 7 to 10 days, high-protein nutrition, and infection control.

Sources

1. Gross TL, Song MD, Havel PJ, Ihrke PJ. Superficial necrolytic dermatitis (necrolytic migratory erythema) in dogs. Veterinary Pathology. 1993;30(1):75-81.
2. Outerbridge CA, Marks SL, Rogers QR. Plasma amino acid concentrations in 36 dogs with histologically confirmed superficial necrolytic dermatitis. Veterinary Dermatology. 2002;13(4):177-186.
3. Torres SM, Johnson K, McKeever P, Hardy R. Superficial necrolytic dermatitis and a pancreatic endocrine tumour in a dog. Journal of Small Animal Practice. 1997;38(6):246-250.
4. Hall-Fonte DL, Center SA, McDonough SP, et al. Hepatocutaneous syndrome in Shih Tzus: 31 cases (1996-2014). Journal of the American Veterinary Medical Association. 2016;248(7):802-813.
5. Loftus JP, Center SA, Lucy JM, et al. Characterization of aminoaciduria and hypoaminoacidemia in dogs with hepatocutaneous syndrome. American Journal of Veterinary Research. 2017;78(6):735-744.
6. Miller WH, Griffin CE, Campbell KL. Muller and Kirk's Small Animal Dermatology. 7th ed. St. Louis: Elsevier; 2013.

Related Reading

• Hepatocutaneous Syndrome in Dogs: Signs and Management
• Liver Disease, Jaundice, and Skin Changes in Dogs: What Yellow Skin Means
• Zinc Responsive Dermatosis in Dogs: Breed Guide

E. Maddens

Founder of Vetified. Develops topical antifungal and antimicrobial formulations for companion animals. Vetified products are listed on DailyMed and manufactured through FDA-registered facilities in the United States.

Research basis: All Vetified content references peer reviewed research published in journals including Veterinary Dermatology, JAVMA, and Journal of Small Animal Practice.