Professional Documents
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enlargement: Hyperadrenocorticism Physical Examination
- Severe acute illness, especially young General physical examination is neces-
cats with respiratory disease: Effluvium sary in all patients but particularly impor-
- Gastrointestinal signs: May suggest tant in older cats presenting with
food allergy symmetrical or generalized hair loss
Presence of current or past injuries/ because there may be a cutaneous sign
trauma: Cats will often groom painful of systemic illness.
areas (eg, overgrooming of pelvic area in Dermatologic examination should note
cats with fractures) (Figure 2). distribution of hair lossfocal, multifo-
cal, or symmetrical.
- Examination of hair coat should note
whether any hairs are present at sites
of hair loss.
- Broken hairs not easily plucked are
compatible with self-induced hair loss;
pruritus should
be considered.
- Easily epilated hairs or excessive shed-
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Definitive DiagnosisExtensive or
Symmetrical Alopecia Treatment at a Glance
In cats that present with dramatic or
severe clinical signs (eg, alopecia muci- Treatment depends on a definitive diagnosis Flea Control
nosa, pseudopelade), skin biopsy is the or is part of a series of response-to-treat- 68 weeks of adulticide (eg,
most expedient way to get a diagnosis. ment trials. selamectin); treat all animals in
house
- Additional diagnostics, such as labora-
Follow-Up This is also effective treatment for
tory analysis, imaging, and bone marrow
Otodectes and Cheyletiella mite
cytology, may be needed depending on infestations
the disease. Unless the cause is easily diagnosed at the
- Samples should be sent to a veterinary initial visit, careful patient follow-up is Feline Demodicosis
46 weeks of lime sulfur dips; alter-
dermatopathologist along with digital needed for accurate interpretation of native therapies are not as effica-
photographs. response-to-treatment trials. cious for response-to-treatment
Cats with spontaneous hair loss due to trials
metabolic illnesses (eg, hyperadrenocorti- Relative Cost Lime sulfur is an effective parasiti-
cism, effluvium) usually have historical Cost of diagnosis can vary from $ to $$$$ cidal agent for all common parasites
and physical examination findings that depending on the underlying cause and of cats except fleas
support a cutaneous manifestation of whether the cause is treatable and curable Bacterial & Yeast Overgrowth
systemic illness. or a disease requiring life-long management. 4 weeks of concurrent antibiotics (eg,
- These cats will require additional diag- clavulanated amoxicillin, 22 mg/kg Q
12 H; cefadroxil, 22 mg/kg Q 12 H) and
nostics, such as, but not limited to, Prognosis systemic antifungals (eg, itraconazole,
serum biochemical profile, complete Good unless hair loss is a manifestation of 5 mg/kg Q 24 H or week on/week off)
blood count, thyroid hormone measure- systemic illness (eg, paraneoplastic syn-
drome)
Elimination Diet
ment, diagnostic imaging. 812 weeks of complete and balanced
- Demodex cati, dermatophytosis, and home-cooked diet or limited-protein
bacterial/yeast overgrowth are not commercial diet. Use of antipruritic
uncommon in cats with systemic ill- Cost Key therapy can be used during first 46
nesses. Core diagnostic tests, such as $ = < $100 $$$$ = $500$1000 weeks of diet trial to provide interim
relief:
skin scrapings, skin cytology, and fungal $$ = $100$250 $$$$$ = > $1000
Prednisolone, 0.52.2 mg/kg PO Q
cultures, are still indicated. $$$ = $250$500 24 H for 7 days, then every other
Pruritus/overgrooming is the most com- day; recommended for short-term
mon cause of extensive or symmetrical therapy only
alopecia in cats. Cyclosporine A modified, 5 mg/kg
- Three common causes of pruritus in cats See Aids & Resources, back page, for PO Q 24 H for the first 30 days, then
are parasites, infections, and allergies; references, contacts, and appendices. consider alternate-day dosing
some common causes can be ruled out Article archived on cliniciansbrief.com Antihistamines are of limited useful-
during the initial visit. ness in cats but may be steroid-
sparing:
- If a condition is not diagnosed at the
initial visit, a series of response-to- - Amitriptyline HCl, 510 mg PO
Q 12 H
treatment trials is often the only way to
- Cetirizine HCl, 5 mg PO Q 12 H
make the diagnosis (see Step by Step:
Response to Treatment Trials, page - Chlorpheniramine, 24 mg/kg PO
Q 12 H
12).
- Diphenhydramine HCl, 0.5 mg/kg
PO Q 12 H
- Fexofenadine, 1 mg/kg PO Q 12 H
- Hydroxyzine HCl, 510 mg PO
Q 12 H
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Step by Step: Response to Treatment Trials
Karen A. Moriello, DVM, Diplomate ACVD, University of WisconsinMadison
Initial Visit
Perform fungal culture and skin scrapings, skin cytology, flea combings,
and hair pluckings.
Negative skin scrapings and flea combings may not identify an
ectoparasite but do not necessarily rule it out. Note that skin
scrapings are easier to do in cats by using a skin scraping spatula
(Figure 1).
Skin cytology is done more easily by using clear acetate tape in cats
(Figure 2); response-to-treatment test at future visit may be needed
because bacterial and yeast infections can be subtle in cats (see
Follow-Up Visit 2).
Pending fungal culture, initiate aggressive flea control program (eg, 1
monthly spot-on treatment) for 6 to 8 weeks to rule out fleas, lice,
and Cheyletiella infestations. Skin-scraping spatula: Highly recommended over scalpel blade because
Complete blood count may show peripheral eosinophilia in cats risk for injury is minimized.
Follow-Up Visit 1
The above treatment plan eliminates ectoparasites and flea allergy
dermatitis from the differential diagnosis list. If there is no response
to flea control, treat for feline demodicosis.
Follow-Up Visit 2
Do 4-week trial therapy for bacterial/yeast overgrowth.
This is a common complication of cats that present with extensive
self-mutilation, miliary dermatitis, or exudative lesions.
Unlike dogs, cats have subtle clinical signs and response-to-treat- 2
ment test is often used to confirm diagnosis.
If there is no response to treatment, ectoparasites and common skin Stained clear acetate preparation: To examine, place sample over drop
infections/overgrowth have been eliminated from differential diagnosis of immersion oil on glass microscope slide. Bacteria and yeast on cat
list. skin require oil immersion magnification to be seen clearly.
Follow-Up Visit 3
Initiate strict elimination diet for 8 to 12 weeks, followed by provocative diet challenge.
Food hypersensitivity is confirmed if pruritus and overgrooming cease with diet and condition relapses with provocative diet challenge.
If no change occurs with diet trial and a commercial diet was used for the test, consider repeating diet trial using a home-cooked diet.
Diet trials should be initiated only after parasitic and infectious causes of pruritus have been eliminated.
Follow-Up Visit 4
Remaining differential diagnoses include atopy, psychogenic alopecia, or unknown cause.
Consider allergy testing for atopy, which is strongly recommended before treating cats for psychogenic alopecia.
Response to glucocorticoid therapy supports allergic skin disease.
Lack of response to glucocorticoids or cyclosporine A modified is not compatible with a diagnosis of allergic skin disease and suggests
psychogenic alopecia.
Rule out other causes of alopecia with skin biopsy.
This page may be downloaded from cliniciansbrief.com and printed for use in your clinic.
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