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Cat itchy on neck.

Species: Cat
Breed: part Manx I think --
Age: 5-8 years
Recently my cat has been scratching in the area just below her neck at the top of her back. She has scratched away the hair. The vet gave me a topical cream called neo-methylpred .25%. The first little patch of lost hair was about the size of a nickel and when I applied the cream, she stopped scratching right away and it healed within a few days.

But then another patch started 2 days ago below and became much bigger. I went to the vet on Wednesday and they advised to keep using the cream and to also give her an antihisthamine 2 times a day (1/2 of 5mg tablet twice a day) So I started Wednesday night. She seemed to be itching less yesterday but then this past night she's been scratching more again throughout the night and the wound is getting worse. The fur is all gone and the skin is getting rawer and rawer as she scratches.

She also has had some kidney problems since she was kitten and has been on K/D prescription diet since then. It's under control but she has always drunk lot of water and since the past few days she's been drinking even more and eating less. Although she's eating less, she's still eating and is actually more active than usual.

The vet says a biopsy is the only option to check what it is but I'm wondering if a swab or just a scraping of the skin would be helpful? They also said that steroids would help but in case we do the biopsy, they don't want to give them to her yet because it'll prevent the biopsy from working.

I'd like to avoid the biopsy if possible becuase of the invasiveness and the cost. But I realize it's important to diagnose before treating it.

So here are my questions,
1. Should I keep using the cream in the meantime and giving the anti-histamine?
2. Should I do the biopsy or is there another way to diagnose, perhaps a less definitive way? The vet said that even a biopsy may not give definitive results.
3. Is there some topical steroid cream that may help better in the meantime?
4. Do you think this is going to be a life time problem for her? The first and last time she had this was just a little spot when we were living in Japan and again I applied ointment and it healed right away. That was about 4 years ago.

I'm so upset seeing her suffering and I'd appreciate any help you could give.

Thank you,

Corinne


Online vet, Dr. Marie

Dr. Marie replied:

Oh, I am sorry to hear that you and Bubelah are having such a frustrating time.

I have seen cats with similar lesions to this and they can be frustrating. It sounds like your vet is concerned about some type of an allergy. Quite often when we see skin lesions in this area it is related to allergy and often we simply cannot find out what the cause is. If this is a mild allergy then steroid creams and antihistamines can help. However, many times we need something stronger.

Most likely a steroid injection will make this go away. (I can't say for sure without seeing your girl). However, steroid injections sometimes come with risks. These risks include developing diabetes or kidney disease. Both of these are quite uncommon, but do happen sometimes. With your cat's history of a recent increase in thirst I would not do a steroid injection without some bloodwork to make sure that everything is ok first.

Unfortunately your vet is right that a biopsy is the only way to determine what this is. And, if we have given steroids then a biopsy may be inconclusive. However, if I have clients that do not want to biopsy (i.e. due to cost) then I will often do a steroid injection presumptively assuming that it will work. But in Bubelah's case I would definitely want to do some blood tests before I did this.

A skin scraping or swab is very unlikely to be helpful.

There is a good chance that this is a one time problem and once it is resolved she will be ok. I do have some cats that will get a thing like this once a year or so and we do a steroid shot and it goes away.

Here are a few other thoughts that I have that you can discuss with your vet:
  • Ask your vet if there is any chance that this is a skin infection in which case antibiotics would help.

  • Has she had any flea prevention recently? Although this is not likely to be due to fleas, some cats are so allergic to fleas that one bite can set them off. I would definitely advise a treatment of Revolution or Advantage.



If she is drinking more I do think it would be a good idea to go back to your vet again and have some tests done. We want to be sure that everything is ok with her kidneys. Cats generally don't have an increase in thirst unless there is a medical problem.

Until then, definitely keep up with the cream.

I hope things look up 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. AskAVetQuestion.com 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 will try the flea bite treatment you suggested, Revolution or Advantage.

I forgot to mention that the vet thought it might be eosinophilic plaque and she said it was an auto-immune thing.

I would go for the steroid shot but now that you say it could cause kidney disease makes me very worried because she already has kidney problems. She was already drinking over 3 cups of water a day before this started.

I'm sure that if bloodwork were done, it would show, like it has before, that her kidneys are problematic.

So here are my questions:

Does it sound like this eosinophilic plaque?

If she has a steroid shot, considering she already has kidney problems, would it make them worse?

If so, if the biopsy comes out that she needs steroids, is there no other option than steroids?

Do you think it could be a skin infection? Can't these be diagnosed by a scraping? When I had a skin irritation in Japan, they took a scraping and put it under the microscope and diagnosed it right away.

Is the neo-mehylpred a steroid cream? If not, can you suggest a steroid cream I could try?


A little Background:

This problem started the day after I took her to the vet for a physical. She's always been nervous about going go the vet but this last time she had a traumatic time. I let her off the examination table because I thought we were finished. We were not so she hid under the chairs. To get her back on the table they used a blanket to throw on her and she freaked out started screaming and then peed in the vet's arms. She'd never had an episode like that before.

The next day the patch was there so I'm wondering if it was triggered by nerves. However that one healed and now a much bigger one is there.

Thank you again.

Corinne


Online vet, Dr. Marie

Dr. Marie replied:

This definitely sounds like it could be an eosinophilic plaque. We don't know why these occur, but yes, they do tend to be related to the immune system. However, it doesn't mean that she has a deficient immune system.

We really can't diagnose skin infection with a scraping. If there are pustules present then we can sometimes put a needle in a pustule and get a diagnosis of infection, but a skin scraping is usually done to rule out certain types of mange parasites. This really doesn't sound like mange to me.

The methylpred is indeed a steroid cream. Unfortunately if it is not working then she may need either oral steroids or an injection. If it turns out that she has kidney issues your vet may talk to you about a medicine called cyclosporin. This medicine is much safer for the kidneys but can be a little pricey.

I'm sorry to hear about her stressful situation at the vet's office. Unfortunately this is quite common. We often have to get out the towel for scaredy cats! While I don't think the lesion has anything to do with the previous visit it may be that it was "lurking" and as you suggested, the stress of the visit prompted the condition to surface.

So, I really think the first step is to get her kidneys assessed and then your vet can help you decide whether steroids are ok for her.

I hope she does ok!

Dr. Marie.



Customer reply:

Hi Dr. Marie,

Thanks again for your reply. Just to clarify, if there is no other choice than the oral or injected steroid, then why bother doing the kidney blood test? If there is no other option, then it sounds like the cyclosporin is the way to go, no?

Before going for the oral or injected steroid, is there maybe a stronger steroid cream we could try first?

She sometimes licks at the cream I put on her wound. Is that bad for her? I guess there's no choice though. Is it more effective if I put it on more than 3 times a day especially if she's licking some of it off?

And finally, do you think I should continue with the anti-histamine? It doesn't seem to be helping.

Sorry for so many questions. Your help is much appreciated. I haven't been able to sleep and your input is very helpful.

Sincerely,
Corinne


Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome!

The blood work really still is a good idea. If everything is ok, then we know that she should be safe to go with steroids (which are the quickest and least expensive option). However, if there are significant problems then depending on how high the levels are your vet can talk to you about using a low dose of oral steroids, or an alternative such as cyclosporin.

Additionally, if the blood work shows that there is something serious going on, this could actually be an explanation as to why the wounds are not healing. It may be that her immune system is dealing with something else. So, if we can get the "something else" dealt with then the wound will heal faster.

Most creams that we dispense for cats are safe for ingestion, but it would be a good idea to ask your vet about this. Regarding the frequency of meds this is something your vet would have to advise you on. Unfortunately I can't legally advise on medication dosages and frequencies online.

You can also ask your vet about the antihistamine. However, in my experience cats generally don't get a great benefit from antihistamines.

Hope that helps!

Dr. Marie.



Customer reply:

Okay, I understand about the blood tests. I guess that will be my next step.

Thanks for all your help. This is a great service.

Take care,
Corinne



Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome! All the best!

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.

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