Evaluating Feline Pruritus -

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PetsLivingLonger.com

Keith A Hnilica DVM, MS, MBADiplomate ACVD

[email protected](865) 405-4203

Evaluating Feline Pruritus

What's the problem?Cats are not small dogs…Differentials for feline pruritusDifferentials for feline pruritus.A dermatologists approach…

CookbookMethodical


Distinct Clinical Syndromes?Miliary DermatitisAllergic Alopecia - PruritusAllergic Alopecia PruritusEosinophilic Granuloma Complex"Head and Neck Pruritus"

All have similar etiologiesSimilar diagnostic strategySimilar therapeutics

Evaluating Feline PruritusFleas

Fleas Fleas

Food allergyAtopyContact DermatitisPyodermaMalasseziaMites

Demodex gatoiOtodectesCheyletiellaNotoedres

Insect HypersensitivityMosquitoesMoth, CockroachFlies

MalasseziaDermatophytosisDrug ReactionParaneoplasticPemphigusMycosis FungoidesPsychogenicHerpes VirusFeLV/FIVPapilloma virus

Miliary Dermatitis

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Managing Feline Pruritus

Cats only eat what THEY want.Cats are in touch with the inner barbarianbarbarian.Cats don't like pills.Cats don't like elixirs.Cats don't like water.Cat's remember!


Miliary dermatitis Allergic Alopecia Eosinophilic Granuloma

Miliary Dermatitis Feline Pruritic Syndrome

Allergic Alopecia Eosinophilic Granuloma Complex

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Eosinophilic Dermatoses Eosinophilic Dermatoses

Feline Idiopathic Ulcerative Dermatosis Plasma Cell Pododermatitis

Feline Idiopathic Ulcerative Dermatosis Evaluating Feline Pruritus

FleasFleas

Fleas

Food allergyAtopyContact DermatitisPyodermaMalasseziaMites

Demodex gatoiOtodectesCheyletiellaNotoedres

Insect HypersensitivityMosquitoesMoth, CockroachFlies

MalasseziaDermatophytosisDrug ReactionParaneoplasticPemphigusMycosis FungoidesPsychogenicHerpes VirusFeLV/FIVPapilloma virus

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Dogs follow the rules What to do?

Dr. Depo approach Evaluating Feline Pruritus

5 days post Depomedrol

When Steroids Go Bad - CatsDiabetesCorticoid-associated Congestive Heart Failure in 29 Cats. Smith SA, et al.

271 cats with CHF

29 with steroid administration in previous 90 days (11%)

VIN searchapx >30 cats with CHF after steroid administration

What to do?

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Cat Dermatitis: Easy or NOT

1. Eliminate fleasCapstar qod for 30 days

2. Ring worm

3 Eliminate mites3. Eliminate mitesRevolutionLime sulfur

4. Food trial

5. Cyclosporine

Hnilica itchnot.com

Managing Feline PruritusGo with the odds

FleasFleasFleasDemodexDemodexInsects/MitesFood

What to do? Eosinophilic Dermatoses


Ciba AH Novartis

http://www.cymedica.com

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The Life CycleWhat are MY dogs on??

Hnilica itchnot.com

What to do??

Identify what can be killed.

Evaluating Feline PruritusDTM Fungal Culture

Pruritus is variableDramatically different therapeutic planLi bilit f Z ti diLiability for Zoonotic disease

Bactilabs 1-800-227-7300

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What to do??? Evil Evil Creatures

Hartz Mountain

AVEHO

www.radil.missouri.edu

Novartis


Skin ScrapesTape prepFlea combFlea combVacuum

Feline Demodex

Demodex catiImmunosuppressionFeLV or FIV or steroids"Traditional Demodicosis"

Demodex gatoiContagiousPruriticSuperficial dweller

Demodex Gatoi

Feline Demodex gatoiClusters >> "Hot spots"Multiple cats in a homeCan be difficult to findon scrapesEasily treated

Lime sulfar dipsWeekly for 6-10 weeksAll cats in home

Demodex Gatoi

Lym Dyp trialTreat with 3 weekly dipsIf improved keep going for 6-10 p p g gtotalIf not improved pursue allergies

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Demodex Gatoi

MitesLime sulfar dipWeekly for 6-10 weeksSarcoptiform mitesDemodex gatoi


The FecalyzerR


Feline Demodex gatoiClusters >> "Hot spots"Multiple cats in a homeCan be difficult to findon scrapesEasily treated

Lime sulfur dipsDip Trial – weekly for 3 weeksWeekly for 6-10 weeksAll cats in home

What to do????


Feline allergic Dermatitis70% flea allergic17% food allergic17% food allergic

Variable response to steroids

13% atopic Good response to steroids

Chalmer s, Medleau L. Recognizing the signs of feline allergic dermatoses. Vet Med 1989.


Feline Food AllergyYear round pruritusAny of the 3 patternsAny of the 3 patternsVariable response to steroids10-30% with concurrent GI symptomsCommon offending proteins

Dairy, fish, beef, pork, chicken, rabbit, horse, lamb, eggs, clams, "commercial diets"

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Managing Feline PruritusDiagnosing food allergy

10 week food trialHome cooked

Cooked meatCooked meatPotato/rice

Canned foodInnovative Veterinary Diets (IVD)Green pea & duck/rabbitHills ZD???

No hunting!

Managing Feline PruritusFood

CannedBlend it

Rabbit/duckPotato

Real meat

Cats can commit foodacide.

What to do?????Cat Dermatitis: Easy or NOT

1. Eliminate fleasCapstar qod for 30 days

2. Ring worm

3 Eliminate mites3. Eliminate mitesRevolutionLime sulfur

4. Food trial

5. Cyclosporine

Hnilica itchnot.com

CyclosporineTacrolimus

Idiopathic Pruritus - Cyclosporine

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Eosinophilic Granuloma Stomatitis

D. Mawby

What to do?????

Eosinophilic Dermatoses Eosinophilic Dermatoses

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BiopsiesAt least 3 samplesSent to a dermatopathologistSent to a dermatopathologist

www.UTSkinVet.org

AllergicEosinophilsMast cells Autoimmune

AcantholysisNeoplasia

" Mr. Boo"

11 year old, MC, domestic short hairHypertension w/ II/VI systolic murmur

AmlodipineAmlodipineAtenolol

2 weeks durationAlopeciaIntense pruritus

" Mr. Boo" " Mr. Boo"

" Mr. Boo" " Mr. Boo"

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" Mr. Boo"Ultrasound revealed multiple nodules in the liver and spleen.

Cytology of aspirates: carcinoma

Owner elected euthanasia.

" Mr. Boo"Learning issue

Time reveals all.

If the world didn't suck we would all fall off.

jb

PetsLivingLonger.com

Keith A Hnilica DVM, MS, MBADiplomate ACVD

[email protected](865) 405-4203

"Daisy"3 year old, FS, domestic short hair2 year history of progressive alopecia

Licks all the timeLicks all the timePoor response to DepoMedrol

"Daisy" "Daisy"Cyclosporine

25mg/day on empty stomach6-8 weeks then taper

Macrolactam immunomodulators for topical treatment of inflammatory skin diseases.Bornhovd E et al. JAAD 2001.

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"Daisy"Learning issue

Never give up.

Evaluating Feline Pruritus -

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