3-5-15
NMVMA listserve Tip #3

Jeff Nichol, DVM
Behavior resident in private practice training
Veterinary Emergency and Specialty Centers

Albuquerque and Santa Fe

Feline psychogenic alopecia (over-grooming), has long been linked to hyperesthesia syndrome. Rippling of the skin or sudden intense licking can be comorbid with behavioral problems like house soiling, spraying, or sparring with other household cats. These kitties are highly stressed but the underlying cause in most cases (76% in one study) is skin disease, not behavioral pathology.

A careful skin evaluation is advised before prescribing anti-anxiety medication. Even indoor cats living with asymptomatic feline housemates should be scraped for mange and evaluated for ringworm. Dermatology and behavior specialists are on the same page: even negative scrapings don’t entirely rule out sarcoptes. Eliminating every differential is the best diagnostic approach for this miserable and, and for many cats, lifelong problem.

Empirical treatment with ivermectin or Advantage Multi is almost always indicated. These parasiticides are safe and effective. Microscopic examination of hairs and impression smears plus fungal cultures are also worth our clients’ investment. A chemistry profile, CBC, and T4 are recommended to screen for hyperthyroidism and other endocrinopathies.

Among the most common medical causes for feline pruritus are atopy and food sensitivity/allergy. A limited antigen diet trial is advised in many cases, as well as a course of antihistamines + fish oil.

While less common, pain, neurologic and seizure disorders should also be considered. Empirical treatment for elusive pain can be prudent but don’t assume that a reduction of signs of over-grooming is proof of a painful etiology. Drugs like tramadol and buprenorphine can have positive behavioral effects. A drug trial with an anxiolytic like amitriptyline or clomipramine, with their antihistamine effects, can help but may also mask the truth.

The end game, of course, is to not just reduce suffering but to make an accurate diagnosis to enable a cure, or at the very least, to effect improved long term management. In a couple of weeks I’ll share insights into behavioral treatment for cats who are at war with their own skin.

All the best,
Jeff Nichol, DVM
505.792.5131