I'm sorry that your question wasn't answered in a timely manner. There's a good chance that her skin condition is related to her inappropriate eliminative behavior. Both are complicated discussions and so I'm going to post my synopsis of both the pruritic cat and marking behavior in cats. Please take your time reading them and then return to our conversation with further questions or concerns.
I'm sorry to hear of this with Naomi. 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 one of the newer prescription products available from Naomi'svet 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 Naomi'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.
I have advanced training in feline behavior and am pleased to discuss Naomi's behavior with you. I must admit that retraining her is going to be a challenge but perhaps after reviewing my notes that I use when lecturing about her behavior you'll have a better idea of how to address it.
Naomi is clearly exhibiting marking behavior. She is not likely to be eliminating inappropriately due to litterbox aversion or a medical disorder. Marking on a horizontal surface (the floor and, particularly, the bed) is marking behavior (a communicative function) caused by the same stimuli that causes spraying. We’re not sure what cats are trying to communicate to us but we do know that wild cats will mark to announce their presence. It’s reasonable to assume then, that Naomi is doing so as well. She’s essentially “taking ownership” over marked areas which then assuages her anxiety. The most common cause is increased cat density - in the home or nearby. Emotional problems, such as a stressful relationship with a family member, separation anxiety, anxiety over her status in the existing hierarchy, fear, owner absence, moving, new furniture, inappropriate punishment, teasing, household changes and remodeling in the home are examples of stimuli that can induce anxiety in our cats. The etiology can be difficult to diagnose, especially if the behavior is only manifested intermittently and because the stimuli for her inappropriate eliminative behavior may be imperceptible to you but readily so to her - another cat roaming outside, e.g. If emotional factors are influencing the housesoiling, you might notice other changes such as avoidance, aggression or an alteration in her general temperament. I would suspect that her discomfort from her skin condition is a major contributor to her marking behavior and so managing her skin should be the first order of business and may obviate the need to treat her marking as follows:
Treatment involves two major considerations: 1) Remove the cause - easier said than done. You might have to be quite the detective to discern the stimuli for her inappropriate eliminative behavior 2) Prevent Naomi from returning to previously soiled areas by confining her to a very small area with the box and only allowed out when she can be supervised 100% of the time. When confined to a relatively small area, most cats seem to prefer to eliminate in the box rather than soiling the floor. It’s then a matter of confining her long enough for a consistent habit to become established. As a rule of thumb, one week of confinement is usually recommended for every month of soiling. She should be removed from the confinement area as much as possible for socialization and play, but never allowed out of sight. Food rewards may help when given after she uses her box. If she refuses to use the litterbox when confined to a small area, the confinement area should be changed to a large cage. The floor should be covered with litter, forcing her to use it for elimination. The litter is gradually removed and replaced with a litterbox. Once she has used the litterbox in a confined area for an appropriate amount of time, she can be allowed to have more freedom in the home. Previously soiled areas can be safeguarded by changing the behavioral function of the area by placing food bowls, cat bedding or toys in the area. The area can also be made unacceptable for her by placing a motion-activated alarm or lemon-scented room deodorant in the area. Plastic carpet runners can be placed upside down with the "feet" facing up. Plastic, foil, or double-stick carpet tape can be used to protect specific areas. Removing urine and stool odor is important. Products such as Nature's Miracle which are specifically formulated to work on these types of odors are recommended.
Some cats are extremely sensitive to changes in their environment. They may mark in response to the most minor of alterations. You must strive to keep the home environment as constant as possible. When situations exist that are likely to upset her, you might want to consider confinement, closer supervision and the use of anxiolytic (anti-anxiety) medication such as paroxetine (Paxil) and fluoxetine (Prozac). In fact, most behaviorists feel that without the use of psychotherapeutic drugs our chance of correcting inappropriate marking behavior is near nil. (Personal note: My two cats began marking as kittens. After 6 months of fruitless treatment they became outdoor cats - for 12 years.)
Nobody wants to confine their pet as I've described but her behavior requires desperate measures. My male urinated on my pillow while I slept - an obvious behavior designed to make sure that his sister and I knew who's bed it really was. He apparently was anxious about his status in the hierarchy of my home.
Success in management with psychotherapeutic drugs is measured by a 70% reduction in adverse events. In other words, if my cat urinated on my pillow 10 times monthly prior to drug administration but only 3 times monthly after drug administration, success in treatment is acknowledged. Needless to say, that didn't please me and I certainly hope that you have better "success" than I. Perhaps you will not having another cat in the house.