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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 27416
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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I have a manx cat, about years old. She has never had a

Customer Question

I have a manx cat, about years old. She has never had a reaction to flea bites that I'm aware of, but she has always been indoors. Lately the weather being nice, she ventures outside to get some sun, and now I'm noticing her rump (the base of where her tail would be) is red raw from chewing, and she has little crusty spots around her collar and the top of her head. Is this fleas? Haven't seen a live one, but you mentioned in another chat that the cat may "eat the evidence." Also, she has always been sensitive to anyone touching her spine especially towards her rump, and nips if we pet her there. Any ideas of what to do?
JA: I'm sorry to hear that. Using the wrong medication for fleas can be dangerous. You should definitely talk to the veterinarian. What is the cat's name and age?
Customer: Delilah is 10 years old.
JA: Is there anything else important you think the veterinarian should know about Delilah?
Customer: She hisses at our dog, so I guess she might be stressed over that.
Submitted: 6 months ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 6 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 6 months ago.

Yes, the affected areas on her body are pathognomonic (particularly indicative) of a flea saliva allergy. I also need to consider atopy and food intolerance but neither are as likely as a flea saliva allergy. I'm going to post my entire synopsis of such a patient for you but pay particular attention to the section concerning fleas...

Pruritic (itchy) cats are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmentals such as pollens, molds, dust and dust mites, and foods should be considered. In rare 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, preferably, one of the newer prescription products available from Delilah'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 Delilah'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 because it removes the possibility of my patient being intolerant to even a novel 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.

Customer: replied 6 months ago.
Delilah has always been and excessive over-groomer. Maybe it is really just her reaction to allergens after all. Would you recommend trying the diet change first to see if that makes a difference, before assuming its a flea saliva allergy? Or the other way around? Or do both at the same time? She's been eating Meow Mix dry. Doesn't like canned or moist food.
Expert:  Dr. Michael Salkin replied 6 months ago.

I would treat the most likely etiology first - a flea saliva allergy. Food intolerance represents less than 20% of these cats. I suspect that a steroid such as prednisolone and one of the new flea products (the over the counter Seresto collar, prescription Activyl, Cheristen, Comfortis, or Vectra) will work like magic. Please continue our conversation if you wish.

Customer: replied 6 months ago.
Delilah has always been and excessive over-groomer. Maybe it is really just her reaction to allergens after all. Would you recommend trying the diet change first to see if that makes a difference, before assuming its a flea saliva allergy? Or the other way around? Or do both at the same time? She's been eating Meow Mix dry. Doesn't like canned or moist food.So I need to get a steroid from the local vet?
Expert:  Dr. Michael Salkin replied 6 months ago.

Yes, the steroids are prescription drugs. The only over the counter product I listed was the Seresto flea collar. It could potentially suffice but a steroid will hasten resolution of her pruritis and skin changes.

Customer: replied 6 months ago.
Delilah has always been and excessive over-groomer. Maybe it is really just her reaction to allergens after all. Would you recommend trying the diet change first to see if that makes a difference, before assuming its a flea saliva allergy? Or the other way around? Or do both at the same time? She's been eating Meow Mix dry. Doesn't like canned or moist food.So I need to get a steroid from the local vet?OK thank you.
Expert:  Dr. Michael Salkin replied 6 months ago.

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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