Wow! What big words you have! All the better to make you feel like your cat has as complicated a problem as you suspect she does.

Psychogenic alopecia is a term we use to describe both cause and effect of this itchy kitty syndrome. Psychogenic refers to the origin: the brain. Alopecia refers to the effect: hair loss. Everything in between, as you may have already guessed, is a mystery wrapped in a riddle surrounding an enigma.

Life is tough for these kitties. We don’t know quite what causes this problem and its very existence (rather, how common it is) is hotly debated in veterinary dermatologic circles (yes, even skin geeks actually get riled up from time to time).

As I mentioned in Part 1 of the Itchy Kitty series, this disease manifests primarily as over-grooming with subsequent hair thinning, hair loss, and sometimes, even as angry, red, raw patches. The most common sites are the backs of the legs, lower belly and lower back, often distributed in a symmetrical pattern.

These kitties will often respond to a dose of steroids but their symptoms almost never completely subside — or if they do they come back mighty quick. Nonetheless, a complete dermatologic workup along with allergy screening (described in Part 1) should not be skipped as treatment for concurrent allergic disease seems to be a basic for treating this problem.

The most recent research (a very thorough study) concluded that only about 15 percent of kitties with itchy kitty syndrome have a true, purely psychogenic problem. This means that these kitties itch and lick (is it really itchiness, we wonder?) for purely psychological reasons. (The rest of these kitties may suffer some elements of psychological disease but still suffer the true allergic skin issue.)

As with OCD in people (hair pulling, hand-washing, etc.) and anxiety disorders, these cats often respond to psychotropic or anti-anxiety drugs. Behavior modification (training and conditioning) is largely considered ineffective. Environmental sprays (aromatherapy) have been found to be of some benefit. Lavender, Feliway (a feline pheromone spray or diffuser), and others have been tried to some effect. More effective, though, are the BuSpar (buspirone), Elavil (amitryptilline), Paxil (parexetine) and Prozac (fluoxetine) alternatives.

What does my cat have to be anxious about? (Um … who knows?) Maybe this is a purely organic disease of brain chemistry. Perhaps it’s a real manifestation of environmental anxiety. Who knows? But it does seem that these kitties get worse when their home environment gets tampered with (new litterbox, new kitty, new baby, etc.).

In terms of stress, inter-cat issues seem to be the biggest offenders so these cats are often best placed in stable, regimented households with few (or no) other cats.

But before you reach for the Prozac, consider (1) the allergy issue; and (2) the environment. If your kitty is stressed and truly itchy no amount of drug is likely to help very much. Drugs are always your last choice, introduced only as a means of trying to arrive at a diagnosis by way of trial and error.

In spite of all our attempts to treat these cats, very few recover completely. Unfortunately, our medicine seems to only reach so far into their bodies and their brains. Perhaps some day well have an answer but as long as the spit continues to fly among the skin geeks you can rest assured there will be no complete solution to the itchy kitty syndrome.

Image: got an itch by Janet 59