The challenges of diagnosing feline atopic skin syndrome
It is more difficult to diagnose a cat with feline atopic skin syndrome than it is to diagnose a dog with atopic dermatitis, but why?
In this interview taken during the 2025 WVC Annual Conference, Sandra Koch, DVM, MS, DACVD, professor at the University of Minnesota College of Veterinary Medicine and director of the school’s Veterinary Medical Center Dermatology Service, talks about challenges associated with diagnosing feline atopic skin syndrome (FASS). As Koch explains, the 4 reaction patterns associated with the syndrome—self-inflicted alopecia, miliary dermatitis, head and neck pruritis, and eosinophilic granuloma complex—are not unique to FASS.1 As such, many conditions, including parasitic diseases, neoplasia, ear mites, and more, can mimic the disease. In the interview, Koch also talks about the importance of ruling out flea and food allergies. She also goes into what the diagnostic process entails.
Below is a partial transcript which has been edited for clarity:
Sandra Koch, DVM, MS, DACVD: The diagnosis of FASS or feline atopic skin syndrome is a challenge because the clinical presentation, or the reaction patterns, the 4 reaction patterns that we talked about, they are not pathognomonic of the disease—they're not specific [to] this condition and there's not a set criteria exclusive for feline atopic skin syndrome, for diagnosis.
So many other diseases can mimic this condition, can have the same patterns. So, it'd be wonderful, right, if you had like, ‘okay, these are the criteria, if you have this, you have the diagnosis.’ [But] it comes down to the fact that feline atopic skin syndrome is a diagnosis of exclusion, just like canine atopic dermatitis. So you need to think about your history, your clinical presentation, and then you start doing diagnostic tests according to your main differential diagnosis, to rule out certain things, including parasitic diseases like Demodex gatoi…very commonly causes pruritus and it leads to clinical symptoms or signs similar to feline atopic skin syndrome.
Neoplasia [as well] in the case of eosinophilic granuloma complex, especially there's huge masses on the tongue. And you can also see, sometimes ear mites can be a differential for cases of atopic skin syndrome that has that have otitis externa.
References
- Bautista-Alejandre A, Koch S. Clinical presentations of feline atopic skin syndrome. dvm360. March 6, 2025. Accessed March 7, 2025. https://www.dvm360.com/view/clinical-presentations-of-feline-atopic-skin-syndrome
