Zoom Recap: Skin Issues in Cats—Call #12

Fur loss, scabs, itchy, redness, etc. All of these indicate your cat might be having a skin issue. A cat with itchy skin can even be lethargic or lose her appetite because they're so uncomfortable. What causes things like this? How is it treated? What makes this problem so frustrating? Indiana small animal veterinarian Dr. Leslie Brooks tackles the complexity of skin issues in cats during this Zoom call. Fostering and behavioral specialist Liz Italia co-hosted the call and discussed the many skin issues she's seen with her foster cats over the years.

Recorded: September 7th, 2020.

Disclaimer: The opinions expressed in this call are those of the guest(s) and/or host(s) and may or may not reflect the views or opinions of My Lovely Feline.

The Nature of Skin Issues

If you notice fur loss or scabs, schedule an appointment with your vet to review the most likely causes of the problems. Getting on a treatment plan is crucial. Skin issues that go on for too long without treatment can get to the point that it’s hard to turn it around.

The fur may never grow back. One crucial thing to note: There are no quick fixes unless it’s an abscess that’s easily treatable with antibiotics. Skin issues are often reoccurring, coming and going, and diagnosing plus treating can be expensive.

Most Common Skin Issues

Allergies

Miliary dermatitis is when a cat has red bumpy skin, most often from one of the three types of allergies:

• Fleas - Some cats are allergic to flea saliva, and one bite can cause an allergic reaction. They’ll get bumps all over their skin and lose fur.
• Food - Cats can develop a food allergy at any time, even if they’ve been on the same food their whole life. More often than not, it’s an allergy to the main protein in the food, commonly chicken or pork. Although less common, they can have a reaction to the carbohydrate, like rice or potato.
• Seasonal/Environmental - Cats can be allergic to anything outside or inside, like pollen, grass, dust, mold, human skin, or even themselves!

To treat allergies, most vets will suggest a multi-step approach. Even if fleas aren’t visible, they’ll recommend flea treatment for three months because it’s a very simple solution and a great way to eliminate variables that could cause a skin issue. If a cat looks like they have a secondary bacterial infection, your vet may give a shot of antibiotics, called Convenia, which lasts on the cat’s system for two weeks. Oral antibiotics are also an option.

To control the itch and calm down the inflammation, vets will suggest antihistamines (Zyrtec, Benadryl, etc.) or steroids, which can be injected if you prefer that over oral meds. However, if the cat has an underlying heart condition, the steroid injection could send them into heart failure.

If they have kidney issues, the injection could make them worse. And lastly, because steroids decrease the body’s immune response, a cat with underlying infection, FIV (feline immunodeficiency virus), or FeLV (feline leukemia) will get worse.

If you’re using oral steroids to control inflammation, you’ll typically taper the steroids until the cat doesn’t take them at all. DO NOT taper the steroids until all of the redness is gone, or the cat will likely flare up again, and you’ll have to start over with the steroid cycle.

Liz mentioned she’s seen this happen multiple times because steroids come with a rigid schedule. She stressed the importance of making sure the inflammation is gone before tapering.

A newer medication for itching is Apoquel. It comes in a tiny pill that’s more expensive than steroids or antihistamines, but it’s safe and can work well.

After ruling out a flea allergy, your vet may then recommend a food trial, which must run 6-8 weeks with a food that contains a protein they’ve never been exposed to before. The cat can’t eat anything other than that food (not even a treat) during this time.

Your vet will likely recommend a prescription food. If you decide not to go with prescription food, you will need to be diligent and read the entire ingredients list.

For example, if you’re removing chicken from your cat’s diet, the food may be advertised as a tuna flavor but contain chicken by-product or chicken by-product meal. Read the entire list and make sure it doesn’t have any ingredients related to the protein you’re trying to avoid. Uncommon proteins you could try include duck, rabbit, or venison.

If the cat is still scratching near the end of the trial, then you know it’s environmental allergies.

The next step could be to visit a veterinary dermatologist and get your cat tested for allergies, either by a skin test or blood test. You can get allergy shots or oral drops to administer. Although it’s expensive, the goal is eventually they’ll be desensitized to the allergens, and their reactions when exposed will be less severe, especially if they’re prone to skin infections.

Atopica (cyclosporine) is an expensive allergy medicine used in cats and dogs, but it isn’t always an option for owners because of its hefty price tag.

If allergy shots and the meds mentioned are too expensive, you can try to manage allergies with steroids until the redness is gone, then try an antihistamine, like Zyrtec, to manage the allergies long-term. The cat may still need steroids daily or seasonally to manage flare-ups. Both antihistamines and steroids are very affordable.

There are allergy shampoos, mousses, and spot treaters that you can use to clean the fur and skin. One great brand is Douxo. The idea behind these is you wash the allergens off the fur so the cat doesn’t consume the allergen during grooming. Then, other ingredients will soothe the skin and decrease itchiness.

External Parasites

Fleas - Fleas can cause a cat to scratch and have irritated skin even if they don’t have a flea allergy.

Mites - There are two different types of mites: Demodex mite (not contagious) or scabies (aka mange, contagious). With Demodex, they might be itchy or might just be losing fur. With scabies, they’ll be itchy all over.

Lice - You can see little egg packets on their fur, and they’re sticky. It’s more common in kittens or stray or feral cats. It’s not common for an indoor cat to get them.

Ringworm

Cats, especially long-haired cats, tend to be very good carriers of ringworm, which is not a worm but actually a fungus. It’s very contagious, and on people, it looks like a dry patch of skin.

On cats, ringworm can be hard to spot because it isn’t itchy, but they’ll lose fur and have a little scab. Typically, cats will get ringworm from other cats, so it will more commonly be seen in a shelter or stray cats.

For ringworm, a cat will be put on an oral antifungal. Terbinafine is a commonly prescribed antifungal because it’s extremely cost-effective. It’s given daily for at least three weeks. If you need a med that’s gently on the stomach, Intrafungol liquid is an option. It’s a liquid that’s given every day the 1st, 3rd, and 5tth week (weeks 2 and 4 no meds).

Your vet may ask you to give your cat a lime sulfur dip, which smells like rotten eggs (but has antifungal properties). You can also try a better smelling medicated shampoo.

If you only see one spot, you can spot treat with medicated wipes instead of traumatizing the cat with baths. The difficult part about ringworm is that once it’s in your home, the spores go everywhere. You’ll need to deep clean and vacuum constantly to make sure you’re getting everything.

Stress-Induced

Cats can have stress-induced anxiety that causes them to pull their fur out. You’ll notice the fur on their sides or abdomen is really short. The skin looks fine – no redness or bumps.

The fur will be gone or really short because they overgroom or pull out their fur. It can start as an itch that turns into almost an obsessive-compulsive behavior. They may need to be on pain or anxiety meds.

Ear Issues

Cats that have skin issues often have issues with their ears and ear canal. Kittens and adult cats can get ear mites, but they aren’t very common. They’re easily treatable, typically with certain topical flea meds. Itchy red ears with discharge are allergy-related. An overgrowth of yeast in the ears is common from inflammation.

When cats scratch and itch, it gets worse, leading to a bacterial or yeast infection. A cat will likely be prescribed daily ear drops (possibly Tresaderm) for their ears along with an ear rinse to use every few days to clean out the gunk in the ear (wax, yeast, etc.) and the medicine, which builds up over time.

Emotional Rollercoaster

Liz discussed how difficult it is to treat these problems because every cat is so different, with allergies presenting differently, and the treatments needed being so different. One foster she had presented with scratching one side of her neck. That was it. Another foster scratched his ears and above his eyes, but his neck was fine.

You have to work hard to figure out what’s causing the issue, and then you have to continue to work hard to find what exact maintenance program works for the cat. Plus, during food and medicine trials, you sometimes see the cat scratching, and there isn’t much you can do because you’re waiting to see if the trial will ultimately work. It’s not uncommon to think you have it under control, and then there’s a flare-up, and you feel like you’re starting over.

There is a large expense associated with going to a dermatologist and allergy shots, so Liz mentioned to be honest and not feel guilty if you can’t spend the money on allergy shots. Talk with your vet about other options because there usually are other routes to take.

Q&A

My 15-year-old cat is suddenly having issues with balance? Could she have cerebellar hypoplasia (CH)?

Dr. Brooks: CH is something kittens are born with. It could be an ear infection, which starts in the external ear. The infections can creep down into the inner ear, causing issues with balance and possibly a head tilt. Some cats can also get little polyps inside their ear that you can’t always see, which can cause them to shake their head or lose balance. Have her checked out by your vet.

Liz: I’ve had fosters with ceruminous cysts, which are purplish growths in the ear that are benign but may need to be removed if they grow too big or a cat has too many of them.

Can you share techniques to help owners bathe their cats and give oral medications?

Liz: The easiest thing to do with baths is to make it a two-person operation. Have one person hold the cat in a sink with water, and the other person use a large cup to dump water on them or run them under the faucet.

You may need to scruff them to hold them still. Then follow the directions on the shampoo – the one I most recently used said to let the shampoo sit on the fur for 10 minutes. Other ones may be less.

I wrap the cat in a towel while we wait. Then, rinse them off and make sure you don’t get water in the ear or eyes. Lastly, I use another towel to help dry off excess water.

For kittens, you should fully dry them. I’ll put the hairdryer on low, medium heat, and I move it all over them. You don’t want to hurt them with the heat, so move it constantly and fluff their fur while doing it until they’re dry.

As far as pilling, the easiest way to do it is to hide it in wet food. Some pills can be ground up and mixed in food. You could also make a little meatball of pate and hide the pill in the middle. Pill pockets are another option – I’ve never had success with them, but I know people who have—hiding the pill in squeeze cheese.

I personally prefer pilling by hand by just opening their mouth and putting the pill in the back of their throat. I use a pill shooter sometimes. The one I use has a rubber end where you stick the pill, and there’s a syringe-type back. You open their mouth, and when you pop the syringe part, the pill shoots into the back of their throat.

One of the best times to pill a cat is while they’re eating because they’re distracted, especially in the morning when they’re super hungry from not eating overnight.

As far as liquid, you just have to do it as quickly as possible. You can squat on the ground and position them between your legs with their back facing you and then squirt it in their mouth.

Get a Support System

If your cat has skin issues, it’s important to have a support system and talk to others who have gone through a similar experience. Talk with cat and dog owners, find out what worked for them, and ask for tricks and tips you can use. There will be lots of good days and bad days, and a support system will help you get through it.