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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 24357
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My cat had demadite mites when he found us. We gave m a bath

Customer Question

Customer: My cat had demadite mites when he found us. We gave him a bath once a week for a year with a couple of things recommended from our vet, plus we gave him a dose of flea med between his shoulder blades every 3 weeks for that same year. It seemed he infected our oldest cat as well who was dealing with his own health issues and had a lowered immune system.
After the year was up, ***** ***** had most of his hair back (I should've mentioned that when he found us, he was small and bald, except for a strip of fur on his back & his head fur). It looked like he had a mohawk!
After the first year he was cleared of mites, so we stopped with all the procedures. He gradually started scratching, grooming & biting/pulling his fur out in patches again.
Benny, our elderly feline family member, also continues to do the same, but at a much lower level.
JA: Thanks. Can you give me any more details about your issue?
Customer: Oops...so sorry, I'm Myra. ***** ***** is my big ole lovable cat who walked in to the school kitchen I worked at one day over 3 years ago & let out a pitiful yelp!
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Customer: Sure...I do have an appt at 1:30 CST, but I'll hold on!
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Submitted: 1 year ago.
Category: Cat Veterinary
Customer: replied 1 year ago.
My question is about Elmer's skin & current itching, scratching, over grooming & biting/pulling out patches of fur, sometimes to the point of causing sores that bleed. When I'm trying to pet him (which he loves since he's very lovable) it's hard to not hit a place that seems to send him into a "that drives me crazy" reaction & then a foot comes up to scratch.I have nerve pain & I know what it feels like to have a sensation that bothers you, but you just can't stop it. As a human, I have medications, ice packs...knowledge on what to do. I don't, however, have knowledge on what to do to help my cat. Our vet is wonderful, but he's at a loss. We've also tried antihistamines, feramon collar & prednisone. Food doesn't seem to help him either.
I can pet across him & feel all this bumpy spots. Some turn out to be scabs & other's look like hard dry lumps of skin.I found this site by looking up bag balm & if it was safe for cats. I've started to give him a bath again once a week with an oatmeal moisturizer & though he's not "happy" about it, I can tell that when the water hits his skin, it seems to give him some relief. I've been told by others that lavender oil would be good. I've used coconut oil a couple of times, but I worry about him ingesting it.Any ideas, suggestions or better yet...solutions??Thanks,
Myra
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the thorough history you provided. By the principle of Occam's Razor, we need to consider a recrudescence (relapse without cure in between events) of D. gatoi - the mite of feline demodicosis which appears to be contagious between adult cats. D. gatoi may be difficult to find on microscopsy but respond well to lime sulfur dips. 2-4% lime sulfur dips applied every 3-7 day for 4-8 weeks is indicated. Clinical improvement is often observed within 3- 4 weeks but therapy should be continued for a total of 6-8 weeks to resolve the infection. Both of your cats should be treated to prevent reinfection.

I'm going to post my complete synopsis of the pruritic cat for you but it appears that you've already ruled out most of the possible etiologies of Elmer's dermatopathy...

I'm sorry to hear of this with Elmer. Pruritic (itchy) cats are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmental allergens such as pollens, molds, dust and dust mites, and foods should be considered. In rarer instances the mange mite Demodex might be responsible.

Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage or a fipronil-containing product such as Frontline or one of the newer prescription products available from Elmer's vet even if fleas aren't seen. Cats can be such effective groomers so as to eliminate all evidence of flea infestation. Indoor cats can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. Turning on the heater or As the weather warms at this time of year then hatches the eggs. Flea saliva allergy is usually most evident on the saddle area – the area between the edge of the rib cage and tail. In severe cases, an anti-allergenic prescription corticosteroid such as prednisolone will work wonders for cats allergic to the saliva of the flea. Your other pets may not be allergic to the saliva of the flea.

Environmental allergies are usually addressed with prednisolone as well. In some cats an over the counter antihistamine such as chlorpheniramine (Chlor-Trimeton) dosed at 2mg/cat daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily may be effective.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Elmer's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. There are many prescription novel protein diets and the prototypical hydrolyzed protein diet is Hill’s Prescription Diet z/d ultra (I prefer a hydrolyzed protein diet). We usually see a positive response to these foods within a few weeks if we’ve eliminated the offending food allergen. A food intolerance can appear at any age and even if our cats have been eating the same food for quite some time.

We used to diagnose these cats with psychogenic alopecia - a neurotic over-grooming - but have come to realize that most of these cats truly are allergic cats. Feline psychogenic alopecia is overdiagnosed but does exist. Excessive and out-of-context grooming is thought to be an obsessive-compulsive behavior that's triggered by environmental stresses and anxiety. The condition is uncommon in cats, with purebred cats that have high-strung nervous temperaments being possibly predisposed. This type of alopecia may occur anywhere on the body where the cat can lick but it most commonly involves the medial forelegs, inner thighs, perineum, and ventral abdomen. Hair loss is often bilaterally symmetrical but remaining hairs don't epilate easily. The top differentials are flea allergy dermatitis, food allergy, dermatophytosis (fungal infection), other ectoparasites (mange) and atopy (allergies to environmental allergens such as pollens, molds, dust, and dust mites, etc.).

The underlying cause of the psychological stress (e.g., separation from owner, moved to a new house, animal companion died, new pet in household, formerly outdoor cat denied access to outdoors) must be identified and appropriate environmental modifications made, if possible. A good flea control program should be instituted to prevent fleas from aggravating the symptoms. Use of a mechanical barrier (e.g. Elizabethan collar, T-shirt) for 1-2 months to prevent grooming may help break the habit. Behavior-modifying drugs may help stop the abnormal grooming behavior. In some cases, treatment may be discontinued after 30-60 days of therapy; in others, lifelong therapy is required for control. Drugs that may be effective include the following: amitriptyline, clomipramine, buspirone, phenobarbital, diazepam, and naloxone.

Please respond with further questions or concerns if you wish.

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