Managing feline atopic dermatitis

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Diagnosing and managing feline atopic dermatitis (FAD) can be difficult for clients, and can even be a challenge for veterinary professionals can diagnose due to the complexities the causes can create. Also, despite some conceptions, cats are not small dogs so their treatment can require more of a tailored approach.

During her lecture at the 2024 Fetch Long Beach conference in Long Beach, California, Ashley Bourgeois, DVM, DACVD, shared with the audience how to approach these itchy feline patients in your practice, and what tools veterinary teams can utilize to get to the bottom of these dermatological conditions and improve patients quality of life.

Difficulty diagnosing

“So why is feline dermatology unique? Well, it's not as common, right? We see lots of days where we just see allergic dogs coming in the doors. There's really not too many days they that are just cats. Though I could have days that are cat heavy but don't have days where it's just cats. I definitely have days where it's just dogs,” explained Bourgeois.

“Why is that? I think a lot of it is that maybe there's a genetic component, but a lot of it is recognition, right? When the pandemic happened, all the owners who had allergic dogs were all of a sudden working from home and spending all of their time with them, called us right? Because all of a sudden they could notice the chocolate lab was slurping their paws next to them, because they were much more obvious with their symptoms, where cats are more isolated. So a lot of times what happens is that they are over grooming or itching. They go away, right? So they do it in the closet, they do it under the bed, and owners don't usually see it,” she continued.

Bourgeois also explained that another reason that makes feline dermatology unique an challenging is because cats are natural groomers. So if they are suffering from FAD, their owners could chalk it up as to them just cleaning themselves and that is normal. Another cause could potentially be resistance to oral medications or veterinary visits from clients. However, Bourgeois explained that it might not always be due to a lack of trying. She shared with the audience a client who had tried multiple times to get his kitten in the carrier and was unsuccessful.

For feline patients that come into general practice, there are occurrences during wellness they will ask the clients if their cat is itchy and they will say no and then during the wellness exam, discover there is no fur on the patients stomach. Clients would then say that the pet has obsessive-compulsive disorder. However, she also shared that she wanted all attendees to know that when it comes to psychogenic alopecia, this is an extremely rare diagnosis.

“One thing I really want you guys to recognize, psychogenic alopecia is exceedingly rare. So I'll see that done as behavioral thing, like they're more behavioral, and will be thrown on behavioral medications. One of my really good friends is actually on his way here now and speaking tomorrow and Sunday, [Christopher Pachel, DVM, DACVB, CABC] is a phenomenal behavioral behaviorist in Portland, and we do a lot of lecturing together. W hen we lecture together, he basically says, You got an over grooming cat kick it to derm before they see us, because it's not that common that we actually see psychogenic alopecia,” she explained.

Options for treatment

When there is an itchy cat in the clinic, the quality of life for both that pet and the client suffers because that pet is in pain and the owner wants to help. Bourgeois explained that although the choices to treat these pets does feel limited, putting everything in your corner to use is crucial for managing these cats. She explained that flea control is a must, despite if the cat is ‘indoor only’ or not. The flea control can help combat symptoms that are caused by fleas or if there is a flea allergy and something else, it can also help with symptoms to lead veterinary teams on the path to helping the pet.

Diet trials are also a useful tool for teams, despite their difficult when it comes to feline patients.

“If we're doing diet and talking about food, it's really important to know how to perform diet trial. And this can sound so simple, but it is often not that simple for our clients to really understand what a diet trial means. So obviously, we want to ditch the itch, as we talked about, don't start a diet with a cat who looks like the one I just showed you, and say, bye, bye. See you in 8 weeks, you're going to lose trust in you as a veterinarian. You know they're going to look for other sources, because the food is not going to act that quickly. We do have a slowly transition for a couple of reasons, not only for [gastrointestinal] tolerance, right? We don't want to sleep closely.

“But what are cats really good about avoiding things if it's different, right? So if almost you switch to the food, there's like, and then they go on hunger strike. We don't have that grace with cats, right? Dogs can kind of be like you do hunger strike for a while, like I never planned on doing a diet trial and causing hepatic lipidosis. It's not on my list of things to do for that day, so I really want to make sure you transition slowly,” she explained to attendees.

In conclusion

When working with clients with an itchy cat, talking to them can help teams also better understand how to help improve the quality of life for both pet and owner. Bourgeois shared as she concluded her lecture about a patient she had where the patient would get car sick and it made it hard for the client to bring the pet in. Bourgeois suggest they try something for the car sickness and gave the cat Cerenia and sent them on their way. She shared the client called her in tears when they returned home saying no one would listen to her about her pet but Bourgeois.

Clients want to help their pets, and by providing options on treatment, advise on diet trials, and explaining what to look out for, they can help some cats less itchy and scratchy.

Reference

1. Bourgeois A. The Itchy and Scratchy Cat: How to Provide Relief When Options Seem Limited. Presented at: Fetch dvm360 Conference; Long Beach, CA. December 6-8, 2024.