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Crusty scab on cat.

Species: Cat
Breed: tabi
Age: 5-8 years
Last week I noticed a bare patch of skin on the back of my cat's neck about the size of a nickel. Over the week I was using neo-methylpred and the size stayed the same size with no skin damage. But on Thursday when I used the topical anti-biotic, hibitane, it seemed to almost double in size and I saw that she had scratched a bit of skin off.

The same thing happened about 2 months ago, starting off as a small bare skin patch but as she kept scratching the wound got very bad. The vet took a biopsy and she was diagnosed with "neutrophilic crusting dermatitis with scarring". I treated it with oral steroids. At first it didn't work but in the end it started to heal slowly after I tapered off the steroid use, which was at its highest dose used for 5 days. The fur grew back and everything was fine until last week.

When I noticed a patch of bare skin last week, I called my vet and she prescribed cyclosporin but I asked her for a topic anti-biotic instead because it seemed less invasive. I started it (hibitane) last Thursday. As I mentioned above, by Saturday(yesterday), the bare skin patch seemed to grow about half or double so I stopped using it yesterday and today I started using the topical steroid neo-methylpred again. Neverthelss, the scratching is escalating and she has scatched off more of the skin since this morning.

What should I do? Should I start to use the cyclosporin or keep using the topical steroid or what? It's exactly the same situation as when it happened 2 months ago except this time it's taken longer the excelerate so I was hoping it was going to heal before it got worse but then after I used the hibitane it seemed to cause it to excelerate. Do you think the hibitane caused it to excelerate? Maybe I shouldn't have used it at all.

I really hope it doesn't escalate to the point it got to 2 months ago where she had scratched off all the skin raw. At that time, it only stopped when I used the oral steroid but then as I mentioned it didn't start healing until several weeks later.

My vet told me there is still no consensus on how to treat this neutrophilic illness but oral steroid is not recommended.

Any advice would be appreciated.

Thank you,


Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that you are dealing with this frustrating problem with Bubelah.

It sounds like your vet is doing all of the right things. Sometimes skin problems in cats can be very frustrating.

A diagnosis of "neutrophilic crusting dermatitis" doesn't always tell us a lot. Sometimes that can just mean that there is scabbing or scarring present because the cat has been scratching at the area. It doesn't necessarily tell us what the cause is.

Usually when we have an area of skin that is affected like this we need something stronger than a cream. (Sometimes if we catch things early we can use a cream but I find that most cats with a large itchy area need something stronger.)

If your vet has prescribed cyclosporin then I would highly advise using it. Cyclosporin is not an antibiotic but it is a medication that tells the immune system to stop over reacting. It works in a similar way to steroids but doesn't tend to have the side effects that steroids do. But, as you have likely found out, it can be expensive.

It can sometimes take a while for the cyclosporin to start to be effective so your vet may advise that you continue with the methylpred cream for a while. This is something you will need to have the advice of your vet on though as I can't make decisions on medications for you online.

There are several ways you can go from here. You may want to ask your vet if there is a veterinary dermatologist in your area. A dermatologist sees all of the "unusual" things.

You may unfortunately have to consider another biopsy. Sometimes a second biopsy can give us more complete results.

You may want to ask your vet about the possibility of this being pemphigus. If it is, then you may need to stay on the cyclosporin.

You can also ask your vet if they feel that you should be trying a hypoallergenic food. And, if not already done, I would advise a flea treatment even if there are no obvious fleas.

Finally, has your vet done a fungal culture to look for ringworm? This is a possibility as well.

I wish I could give you more hopeful advice. I have had cases like this that are frustrating! I hope things are improving soon!

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you so much for your reply.

I think I've found a veterinary dermatologist and I've already made an appointment for this Wednesday.

In the meantime, should I start her on the cylcosporin because her scratching is escalating?

Her doctor hasn't said anything about pemphigus and I looked up the symptoms which seem quite different from what she has, so I don't think that's the cause.

We did a fungal culture last time she had this and it came out negative.

I guess I should do the flea treatment even though there are no visible fleas to rule that out.

It is very frustrating and I thank you for your help.



Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome Corinne. I sympathize with you as this is really a frustrating problem! I am really happy that you have an appointment with the dermatologist. This is really the best thing you can do!

I don't think there will be any benefit to starting the cyclosporin now, if you have an appointment tomorrow. The drug will take a few days to even a couple of weeks to really start to be effective so it's probably best to wait for your dermatologist to advise you on what to do.

I would love to be updated after your dermatology consult. I hope everything goes ok!

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.