Feline Alopecia: What to Do When Bad Hair Happens To Good Cats

Dr. Patty Khuly

Got an itchy kitty? It could be feline alopecia. To be more specific, symmetric feline alopecia. It happens when hair loss in a cat occurs in a characteristic pattern that’s pretty much identical on both sides of the body (bilaterally symmetrical). But while the condition is well-described by its nome de guerre, there’s almost nothing straightforward about diagnosing or fixing it.

One especially interesting aspect of this common feline skin disease is that it tends to fly under the radar for many cat owners. While many of these cats’ owners notice excessive grooming behavior, itching and scratching isn’t what they observe. In other words, asking the owner, “is kitty itchy?” will usually elicit a response in the negative.

Yet itchiness in cats — as with so many other feline conditions — is a covert enterprise best described as a subtle over-grooming behavior. These are the cats who simply seem “overly fastidious” or are described as “OCD about grooming.”

Indeed, the fixated approach, intense focus, and near-fervor with which cats seem to attack this assiduous grooming experience has led many veterinarians to assume this pathology might be more a brain-slash-behavioral condition than a primary skin disease.

Recent research, however, seems to show that true "psychogenic alopecia," as we term the psychological version of events, is actually quite rare. (My personal experience supports this too.) Something organically amiss with the skin, it would seem, is the likelier cause.

Which brings us to the bottom line: Let’s say your cat starts to look like a male pattern baldness sufferer, with pink skin poking through on both sides of her butt, flanks, and/or limbs (or maybe on her back and/or belly).

Off to the veterinarian you go, where a history and physical examination will reveal some information, but where some degree of testing will invariably be in order:

  • Skin scrapes for mites,
  • tape preps to look for yeast and bacteria,
  • flea-combing for fleas (and their droppings),
  • fungal cultures to rule out ringworm, and
  • maybe even skin cultures or biopsy.

But despite the decisiveness of our science, sometimes skin conditions’ sources remain elusive. In these cases, we’ll sometimes try “empirical” therapy. Which means we try something and see if it works. In itchy kitty cases, here’s my typical plan:

#1 Dip it

I dip to kill mange mites. Demodectic mange mites have been identified as a mite that sometimes leaves this pattern of itchy hair loss behind. Because it’s often hard to find under the microscope after a scraping, using a benign (but stinky!) lime-sulfur dip once a week for a few weeks is never a bad approach.

#2 Flea treat

I always treat for fleas in these cats. ALWAYS. Regardless of whether I find fleas or not. Comfortis and Capstar are my faves, but they’re oral and that can be tough for cats to swallow. And Comfortis can have some GI side effects. Which is why topicals (those little tubes) are sometimes better. Revolution is my go-to topical for this but Frontline and Advantage are close seconds.

#3 Antibiotics and/or antifungals

Depending on the case’s unique physical findings (redness, odor, crusts, a positive fungal culture), I’ll definitely add in some antibiotic and/or antifungal medication. Evidence of yeast and/or bacteria, however, doesn’t mean these creatures caused the problem. Indeed, they’re usually secondary to an allergy, given this clinical picture.

Okay, so let’s say I’ve tried all of this and gotten absolutely nowhere. Or not too far, anyway. The next step is always allergy testing. But, before you balk, consider that allergy testing doesn’t always have to involve dermatologists and expensive skin or blood tests. A simple injection of long-acting steroids will often suffice.

And yes, I’ll often fast-forward to the "steroid shot" (or a short course of oral prednisone, for example) if I’ve got enough reason to believe my patient’s condition is allergic above all else. Problem is, corticosteroids can have an adverse impact on several of the above-mentioned diseases. They can also induce serious side effects. It’s for that reason that I prefer to consider these drugs only after I’ve absolutely eliminated some of the above possibilities.

If I do get a positive response to these drugs, and fleas have already been eliminated as a confounding factor, I’ll then proceed with a food trial to distinguish the possibility of a food allergy from that of an environmental or seasonal allergy (called “atopy”). Should the food trial result in a negative finding and the symptoms doggedly persist, the skin or serologic allergy test will be in order.

So you see? Not so straightforward. And for those of you who think this is WAY too much ado over a silly little loss of hair ... well ... you probably never felt itchy enough to lick the hair clean off the whole side of your body, now, did you?

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