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Feline Dermatology Updates

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Feline Dermatology Updates FELINE DERMATOLOGY Karen L. Campbell, DVM, MS, DACVIM, DACVD Professor Emerita, University of Illinois Clinical Professor of Dermatology, University of Missouri Evaluation of the Pruritic Cat Itching is a PAIN • Parasites • Allergies • Inflammation • Neurogenic Parastic causes of feline itching • FLEAS • Demodex gatoi • Demodex cati • Notedres • Cheyletiella • Otodectes • Mosquitoes • Ticks Fleas • May be difficult to find on cats • Check fecal – fleas or tapeworms present? • Manifestations include pruritus, symmetrical hair loss, miliary dermatitis, eosinophilic granuloma complex • Treatment trials • Serum IgE to flea saliva • IDT flea reactivity Feline Demodicosis • Demodex cati • Demodex gatoi Demodex gatoi • Short bodied • Found in the stratum corneum • Contagious • Pruritic • May find mites on skin scrapings or fecal flotation Demodex gatoi • Distribution • Head, neck, elbows • Ventral abdomen • Clinical signs • Alopecia • Scale, erythema • Excessive grooming Demodex gatoi Therapy • Stop any glucocorticoid or progesterone tx • Treat all in-contact animals • Lime sulfur is tradional treatment of choice • improve in 3 weeks • treat for 4-6 weeks minimum • Bravecto for cats: one treatment may be curative • Ivermectin: 300 mcg/kg once weekly, variable response • Advantage Multi (q 7-14 days, variable response) • Amitraz: 125 ppm (1/2 normal strength) Demodex cati Localized follicular demodicosis • Rare condition • Eyelids, periocular, head, neck • Differential for feline acne • Usually responsive to lime sulfur or other mild parasiticides • Often self-limiting Demodex cati Generalized follicular demodicosis • Very rare • Siamese and Burmese at risk • Usually have an underlying condition • FIV, FeLV, Diabetes Mellitus, Bowen’s disease Demodex cati Treatment: generally much easier than K9 • Manage pyoderma • Lime sulfur dip weekly • Ivermectin 300 mcg/kg wkly + Lime sulfur dips • Bravecto for cats should be curative • Amitraz at 125 ppm (1/2 strength) Cheyletiella: “Walking Dandruff” • Large, surface dwelling mite • Highly contagious, poorly host specific (zoonotic) • 3 species • C. yasguri Dogs • C. blakei Cats • C. parasitivorax Rabbits Cheyletiella - Pathogenesis • Non-burrowing mite, lives on skin surface and occasionally pierces skin to feed • Entire life cycle (21 days) takes place on one host • Females may survive in environment for 10 days • Disease prevalence decreasing due to increased use of flea preventatives Cheyletiella – Clinical Signs • Dorsal distribution • Scale • Variable pruritus (possible hypersensitivity in severely pruritic animals) • Exfoliative erythema • Miliary dermatitis or “fur mowing” in cats Cheyletiella - Diagnosis • Visualization of parasite: • Larger than sarcoptes • Prominent mouth hooks • Visualization of eggs: • Small and attached to hair by fine strands (vs large louse nits firmly cemented to hairs) Cheyletiella Cheyletiella - Diagnosis • Methods of parasite visualization: • Direct examination of “walking dandruff” (naked eye or hand lens) • Superficial skin scrape • Acetate tape preparation • Fecal floatation • Flea combing • Vacuum test Cheyletiella • Treatment • All in-contact animals • Minimum of 6 weeks (ideally 2-4 weeks past clinical cure) • Treat environment (pyrethrin spray) • Keratolytic shampoo Treatment • Lime Sulfur: • Dip weekly for 6 weeks • Fipronil: • 0.25% spray: 1-2 pumps/lb q 2 weeks for 3-4 treatments • 10% spot on: apply 1-2 times/month for 3 treatments • Selamectin: • Apply once q 2 to 4 weeks for 3 treatments Otodectes cynotis – “Ear Mites” • Highly contagious, especially in young animals • Not species specific • Cause of >50% of all feline ear disease • 5% of canine ear disease • Asymptomatic carriers are common Otodectes cynotis Complete 3 week life-cycle on a single host Feed/breed in canal • Irritates tissues • Increased cerumen • Mechanical damage • “Coffee ground” debris Migrate all over body • tail base pruritus • miliary dermatitis Otodectes cynotis Diagnosis • Visualization of mites (otoscopy) • Mineral oil prep of debris • Diff-Quick prep of debris for concurrent infections • Response to therapy Otodectes cynotis - Treatment • Treat all in contact animals • Ear Cleaner • Topical or systemic parasiticide Parasites as causes of scaling • Lynxacarus radovsky = cat fur mite • Sarcoptes scabiei var canis • Notoedres cati • Felicola subrostratus Feline Scabies • Notoedres cati • Transient infestation of other animals (foxes, dogs, rabbits, humans) • Highly contagious Feline Scabies • Large numbers of mites are present (easily found on skin scraping) • Die rapidly off host • Smaller than S. scabiei with a dorsal anus (vs terminal anus in S. scabiei) Notoedres: Clinical Signs • Intense pruritus • Distribution: • Medial pinna • Upper ear, face, eyelids, neck • Feet and perineum • Lesions: • Erythematous papule (early) • Thickened, folded skin with extensive yellow crust (chronic) • Excoriations Notoedres - Diagnosis • Clinical signs are strongly suggestive • DDX: Pemphigus, Otodectes, Sarcoptes, Cheyletiella, dermatophytosis, atopy, food, lupus, drug eruption. • Positive skin scrape is diagnostic, mites are easily recovered Notoedres – Topical Treatment • Clip hair NOTE: Permethrin is toxic to cats!! • Keratolytic shampoo • Lime sulfur dip • Weekly for 6-8 weeks • Amitraz: • Increased toxicity in cats Notoedres – Systemic Treatment • Ivermectin: • 200-300 ug/kg SQ every 2 weeks for 3 treatments • Advantage Multi or Selamectin: • Q 2 weeks for three treatments • Bravecto • One dose should be effective Mosquito Bite Hypersensitivity • Erythema, edema, • Keep cats indoors crusting, hair loss, especially at dusk and depigmentation dawn • Antibiotic ointment or oral • Lesions may be pruritic • Topical/oral steroids and/or painful • May affect nose, ear pinnae, chin, eyelids, and/or footpads • Primarily affects outdoor cats during summer months From Clinicians Brief Allergies in cats TYPES OF ALLERGIES • Parasitic • Food • Environmental • “Atopic dermatitis” • Contact • Drug Allergies in Cats • Manifestations include • Pruritus • Feline Miliary Dermatitis • Eosinophilic Granuloma Complex • Feline Symmetrical Alopecia Facial Pruritus • Prior to diagnosis of allergies rule out • Otodectes • Demodicosis • Notedres • Viral/mycoplasma infections • Facial pruritus is most commonly associated with food allergies Feline Miliary dermatitis • Lesions • Variably Pruritic • Papulo-Crustous Eruptions • Location • Dorsum • Neck Feline Miliary Dermatitis Feline Miliary Dermatitis • Etiologies • Ectoparasites • Allergies (often flea allergy, also food allergies and environmental allergies) • Bacterial (usually 2o) • Dermatophytes (rare presentation) • Autoimmune (pemphigus) • Nutritional deficiency? Feline Miliary Dermatitis • Diagnostic workup • Examine for parasites • Woods light exam • DTM culture • Cytology (organisms? acantholytic cells? • Treatment trial • Flea control • if responds continue flea control • Evaluate for allergies • Diet trials • Intradermal allergy testing • Biopsy lesions Eosinophilic Granuloma Complex Three Syndromes Seen • Indolent Ulcers • Eosinophilic Plaques • Linear Granulomas Common Features • Chronic • Circumscribed • Inflammatory Lesions Eosinophilic Granuloma Complex • Diagnosis of underlying cause • History • Physical exam • Response to flea control • Restrictive diet trial • Intradermal allergy test • Skin Biopsies (rule out infections and neoplasia) Indolent Ulcer Indolent Ulcer • More common in females between 5-6 years • Lesion • Ulcer on upper lip • Often bilateral • May have oral ulcers Indolent Ulcers Indolent Ulcer • Histopath • hyperplastic ulcerative dermatitis with PMN, plasma cell, mononuclear cell infiltration • Differential Diagnosis • Squamous Cell Carcinoma • Fibrosarcoma Indolent Ulcer • Treatment • Identify and treat underlying cause • Flea control for flea allergies • Change diet • Environmental allergy control • Desensitization treatment • Antibiotics • Convenia or Clavamox • Systemic corticosteroids • Prednisolone 1mg/kg/day • DepoMedrol 5mg/kg/IM • Cyclosporine • 7 mg/kg/day Indolent Ulcer • Refractory/Recurrent • Tacrolimus topically • CO2 laser • Radiation treatment • Cryosurgery Eosinophilic Plaques Eosinophilic Plaque • More Common in Females • Mean Age 3 Years • Lesion • well-circumscribed • raised • ulcerative plaque Eosinophilic Plaque • Locations • abdomen • back • legs • head • neck Eosinophilic Plaque • Histopath • Eosinophilic and Mast cell infiltration Eosinophilic Plaque • Diagnostic W/U for EGC • Flea control • Restrictive diet trial • Intradermal allergy test • Biopsy Eosinophilic Plaque • Treatment • Identify and treat underlying cause • Flea control • Diet change • Environmental allergy control • Desensitization • Elizabethan collar or sweater (to stop self-trauma) • Antibiotics • Corticosteroid trial • Cyclosporine and/or tacrolimus Linear Granuloma • Either Sex • 1-5 years in age • Lesion • Linear plaque on the posterior aspect of hind legs • Less often found on chin or in mouth • Histopath • necrobiosis of collagen with histiocytic and multinuclear giant cell infiltration with or without eosinophils • Usually secondary to allergies, however must rule out inflammatory/infectious/neoplastic diseases Linear Granuloma Linear Granulomas Linear Granuloma • Treatment • Observation • Identify and treat underlying cause • Flea control • Diet change • Environmental allergy control • Desensitization • Antibiotics • Corticosteroid trial • Tacrolimus or cyclosporine Allergies in Cats • Common manifestations include •
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