Help with feline dermatology case

Re: Help with feline dermatology case

Busybee — Tue, 15 Jul 2014 19:15:20 GMT

Another quick update - cat has been on RC hypoallergenic food and regular Comfortis treatment (as have all animals in the house) for 7 weeks now and is doing great!

Re: Help with feline dermatology case

Anthony Todd — Mon, 12 May 2014 15:22:58 GMT

[quote user="Kate Richardson"]

[quote user="Busybee"]The last thing I want to do is induce a diabetic state in this cat as I know the owners will find it difficult to manage, hence why I'm trying to avoid giving steroids again and again. [/quote]

If you do end up using corticosteroids long term (having ruled out causes other than an allergy) and they can manage oral medication, use prednisolone rather than depomedrone injections and wean cat down to the lowest effective dose to prevent flare ups and emphasise the need to use the medication continuously with possible intermittent increases in dose according to clinical signs. Cats are fairly tolerant of prednisolone but obviously you need to discuss the risks with the owner and see if those risks outweigh the benefits to the cat.

[/quote]

Used sensibly and only on recurrence steroids or megestrol [Ovarid] never caused diabetes in my experience; diabetes induction seemed to be associated with prolonged overdose, certainly with prolonged usage.

I was always concerned with making the cat comfortable, rather than the possible risk of diabetes. And Elizabethan collars are just plain cruel in intense irritation.

Trouble with pred is it is daily dosage [owner compliance?] and it never seemed "strong" enough to prevent massive excoriation in a matter of hours; the irritation must be severe!

Depomed works well but, by the time the owner has got to the surgery for the jab the lesion is nicely back to square one.....

I disagree that the dose of any steroid should be "continuous" [and this is where the risk of diabetes may be raised] far better to use an "effective" dose, repeated as necessary, rather than the common and, in my experience, ineffective continuous low doseage.

Re: Help with feline dermatology case

Anthony Todd — Mon, 12 May 2014 15:10:34 GMT

[quote user="Busybee"]

Thanks for all the ideas!

So the options are:

depo/ovarid at flare ups
FIV/FeLV testing
Food trial
?Apoquel
Atopica
Analgesia in case FOPS-like syndrome
Ringworm testing
Referral!

The cat is part of a multi-animal household (I lose track of how many animals they have!) so unfortunately, a food trial would be very difficult for the owners to police. Also, we must make sure flea control is top-notch! FeLV/FIV and ringworm testing is certainly possible. Similarly, will be happy to trial analgesia. Atopica and referral will likely be financially out of reach. I will have to speak to Zoetis about Apoquel.

The last thing I want to do is induce a diabetic state in this cat as I know the owners will find it difficult to manage, hence why I'm trying to avoid giving steroids again and again.

[/quote]

With a multi-animal household fleas have got to be at the top of the diagnostic list with food allergy second, but I'd still back fleas every time until you can definitely eliminate them which, in a multi animal household, is near impossible and a food trial similarly.

I can't see that FIV;FeLV testing is going to improve the diagnosis and certainly not the treatment or well-being of the patient.

Never used Apoquel or Atopica so can't comment.

Never seen ringworm cause much irritation, if any,certainly not the lesions described,

Antibiotics in these make no difference at all, and if infection was a factor steroids would make the lesions worse, surely?

All I can say again is that Ovarid or Depomed [but it's an injection] gives total relief and you can explore the other diagnoses while the cat is comfortable which should always be a factor, at least as far as I was concerned.

Get the owner to give it at the first sign of recurrence and continually until the lesions have completely, or nearly, disappeared or they are self generating.

Re: Help with feline dermatology case

Kate Richardson — Mon, 12 May 2014 13:49:21 GMT

Re: Help with feline dermatology case

Stephen Courtney — Mon, 12 May 2014 12:27:43 GMT

We had the technical vet from zoetis in to talk about apoquel, and we asked about using it in cats. they have no plans to extend the license due to the cost of doing the trials. So I guess they are waiting for someone brave or desperate enough to try it off label.

Check the online price of Atopica, it may well be within the owner's means.

and if they can afford to keep seeing you for flare ups they can certainly afford Atopica - once the animal is on EOD dose rate the price halves!

Re: Help with feline dermatology case

Busybee — Mon, 12 May 2014 12:02:22 GMT

Thanks for all the ideas!

So the options are:

depo/ovarid at flare ups
FIV/FeLV testing
Food trial
?Apoquel
Atopica
Analgesia in case FOPS-like syndrome
Ringworm testing
Referral!

The last thing I want to do is induce a diabetic state in this cat as I know the owners will find it difficult to manage, hence why I'm trying to avoid giving steroids again and again.

Re: Help with feline dermatology case

Adrienne McPartland — Sun, 11 May 2014 12:36:56 GMT

+1 for food trial.. I have many of these sorts of cases respond very well to elimination diets.

Also have you cultured for dermatophytosis? I had a similar case that marginally responded to antibiotics and steroids, pruritus, erythema and excoriations around head, positive culture and was cured with a period of Itrafungol.

Re: Help with feline dermatology case

Thomas Johnson — Sun, 11 May 2014 09:06:26 GMT

[quote user="Evelyn Barbour-Hill"]

Just idly musing here...... no, not like classic Feline Orofacial Pain syndrome at all. But in people, mysterious trigeminal pain, neuralgia, call it what you like, can be a big problem, and we have no way of knowing if such things can occur in cats or dogs. For the cat in question, maybe a trial course of analgesic? Meloxicam, opiate, acupuncture.

Just a thought, in rainy Saturday afternoon mode.

[/quote]

And following on from that thought, if it is nerve pain would it be worth considering Gabapentin?

Re: Help with feline dermatology case

Evelyn Barbour-Hill — Sat, 10 May 2014 16:08:53 GMT

[quote user="Rob Davis"]

[quote user="Busybee"] Could it be FOPS? Any other ideas?? [/quote]

Doesn't sound like FOPS, lesions in wrong place, not Burmese.

[/quote]

Just a thought, in rainy Saturday afternoon mode.

Re: Help with feline dermatology case

Stephen Courtney — Fri, 09 May 2014 22:44:38 GMT

Sounds like an allergic root cause. Suspect atopy, food allergy or flea allergy - they can all present with exactly the same variety of distributions and patterns so presenting signs are next to useless diagnostically.

I would suggest rigid flea control of all animals in the home - i love Seresto collars for this as it takes away all reliance on the owner, assuming the cats don't lose the collars!

I'd also suggest a trial of atopica - i have had some good success with this in cats. I prefer to use the 25mg capsules for dogs, as i have had some cats react violently to the taste of the liquid formulation . If finances are an issue write a prescription, start with a 5ml bottle and if tolerated then let them have the 17ml bottles. As i said, i have less hassle with the capsules, was using them before the liquid became available and the first two cats i prescribed the liquid to went nuts.

It seems this cat doesn't respond terribly well to steroids. This might suggest a food allergy? i find them poorly responsive to sterods . I'd start getting the client ready to consider an exclusion diet, in principle, if nothing else seems to be working - which is quite likely. I would be very apprehensive about using ovarid but accept that it has its place in some circumstances.

And I'd also be quite keen to refer such a case...!

Re: Help with feline dermatology case

Kate Richardson — Fri, 09 May 2014 09:36:49 GMT

+ another 1 for a dietary trial, often present with lesions around the head and neck. Ensure the antibiotics are used continuously for long enough- not just until the lesions are clear, use for 2-3 weeks beyond the point of clinical resolution and used corticosteroids if they help.

Re: Help with feline dermatology case

Rob Davis — Fri, 09 May 2014 09:19:06 GMT

[quote user="Busybee"] Could it be FOPS? Any other ideas?? [/quote]

Doesn't sound like FOPS, lesions in wrong place, not Burmese. I think a food trial sounds sensible, ? allergy testing. If steroids help then this may be the only way forward. Can you use apoquel in cats?

Re: Help with feline dermatology case

Anthony Todd — Fri, 09 May 2014 07:38:23 GMT

[quote user="Michael Woodhouse"]Steroids seem to help. Cats tolerate them well. I'd go with religious flea Tx and either Depomed or Ovarid at the first sign of flare up[/quote]

+1 this sort of scenario was common in the days before FAD was recognised. I never used antibiotics as I believe bacteria are just opportunistic.

If there are other cats in the household or in the flat above or next door fleas are more likely, treating all animals in the house is vital.

Food allergy is possible and should be explored when fleas are eliminated [every 4 weeks might be too long in a heated home and owners idea of "regular" isn't] Name the day! Advantage weekly on, say, a Monday was the best way to get compliance.

Our own cat had sudden head lesions and was allergic to milk......

Essential to give Ovarid at the first sign of irritation, as the lesion becomes the cause of the irritation if you don't; It really is a safe and most effective drug if given only when needed; 5mg is enough.

The owner can medicate at home and really early in the lesion cycle.

Re: Help with feline dermatology case

Kara Gibson — Fri, 09 May 2014 02:45:00 GMT

Just a thought given the difficulties you have had resolving infections, have you checked for FIV/FeLV?

Could be worth doing a food trial as head and neck pruritus in cats can often have food allergies underlying.

Re: Help with feline dermatology case

Michael Woodhouse — Fri, 09 May 2014 00:05:00 GMT

Steroids seem to help. Cats tolerate them well. I'd go with religious flea Tx and either Depomed or Ovarid at the first sign of flare up.

I suspect that will lead to path of least resistance.

[you could try Cortavance, IF systemic steroid really upsets you. I have used it in cats, but if they can lick it off they vomit]