Hi Cindy, sorry to hear your kitty is feeling so itchy!! When I see or hear about a cat who is so pruritic or itchy that there is the development of hair loss and inflammation, my very first thought is ALWAYS EAR MITES!!!
Ear mites live within the ear canal, but can also inhabit the face and brow areas of cats. They are extremely irritating and cats will often scratch relentlessly, shake their heads, vocalize while scratching, and rub their face on furniture/carpet, etc. Ear mites are contagious from animal to animal and can live off a host for almost 3 days!!
IF you can take a Q tip and gently swipe the inside of the ear canal, you might see some really dark material within the ear canal. It can vary from chopped up Oreo cookie like material to very light and crusty like material. The mites themselves are very tiny (barely visible to the naked eye) and usually must be confirmed via otoscopy by your vet or via microscopic examination. The debris they leave behind is their fecal excrement, digested blood, etc. If you see this type of material in the ears, than several different treatment options are available to you. My favorite treatment is REVOLUTION by Pfizer. This product is used one time a month for 3 months and works systemically to kill and eradicate the mite. It also prevents heartworm, kills fleas, ticks, scabies, and kills roundworms and hookworms with each treatment for 30 days!!Revolution is available by your veterinarian. I truly do not like any of the topical over the counter "ear mite treatments" available at drugstores and petstores. Why? Because the chemicals that are put into the ears are pesticides that can be very irritating to the inner ear canal and if there is any chance of a ruptured eardrum, they can be ototoxic to your pet, causing seizures and possible hearing loss.
As vets, we also have other products available that JUST treat the mites. One is ACAREXX which consists of 2 tubes of medication instilled in the ears every 3 weeks for several treatments. Tresaderm is another liquid suspension available for mites, but it must be used DAILY!
I can tell you that cats with sore, painful ears do NOT appreciate having them manipulated!! Any medication that you can deliver with minimal stress to your pet is a great option!!
NOW, if mites are NOT the issue, than another very likely cause of extreme facial itching is allergic dermatitis secondary to FLEAS. If you have seen ANY fleas on your pet than they should be treated safely and effectively with a long acting topical medication dispensed by your veterinarian. Once again, Revolution is a great product, but I also recommend Frontline Plus & Advantage. Frontline is my favorite for fleas and flea allergy patients because typically a flea cannot even bite your pet once it comes in contact with the skin and the frontline!! Since pets are allergic to flea saliva, than preventing the bite, prevents the allergic reaction !!
Symptomatic relief of mite and flea associated dermatitis involves the usage of antihistamines and if your vet feels it is indicated , steroids.
There is absolutely NO topical flea product spot on product that you can buy over the counter that I would ever recommend my clients buy. Cats are EXTREMELY sensitive to pesticides!!! Products like Hartz, Sargent's, Zodiac and the like are pure pesticides (permethrin/pyrethrin based) and this makes the possibility of systemic toxicity very likely in your pet!! Toxicity can cause severe seizures and even DEATH in cats that use these products!!
Your best bet is to pick up some Revolution from your vet!! IT will kill both fleas and mites! Use it monthly for the next 3 months. IF fleas are an issue, than you can also use Perimeter Flea Sprays from VetKem, Zodiac, etc. to treat any areas where your pet may sleep, rest, lie alot (rugs, blankets, etc.). One female flea can lay 500 eggs each day, so your environment could be contaminated!!
A vet exam is of course my number one suggestion, so you can know For Sure what you may be dealing with, but you can try home treatment first if you wish. IF symptoms Worsen, or do not improve, than a trip to your vet's will likely be needed!!
Other possibilities for hair loss and itchy skin on the face would include the SCABIES mite which is contagious to humans and the fungal parasite, ringworm. Scabies can be successfully be treated with monthly Frontline treatments. Seeing the vet will help you differentiate which parasite may be causing your kitty's problems!!
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Best wishes!! Dr. Smith