"Feline symmetric alopecia," we call it. It happens when hair loss occurs in a characteristic pattern that’s just about even on both sides of the body (bilaterally symmetrical). But while the condition is well-described by its moniker, there’s almost nothing straightforward about diagnosing or fixing it.

One especially interesting aspect of this kind of common feline skin disease is that while many of these cats’ owners notice excessive grooming behavior, itching and scratching, per se, do not seem to qualify as descriptors. In other words, asking the owner if kitty is itchy will usually elicit a response in the negative.

Yet itchiness in cats — as for so many other feline conditions — is a covert enterprise best described as subtle over-grooming behavior. Scratching and biting is for dogs. A three hour-long grooming session is for cats. (Mostly, anyway. The intense itchiness of ear mites and mange are a big exception to this feline rule of thumb.)

Indeed, the obsessiveness, 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. (By the way, my personal experience supports this in spades.)

OK, so onto the nitty-gritty: 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 testing may immediately be in order. Skin scrapes for mites, flea-combing for fleas (and their droppings), fungal cultures to rule out ringworm, and maybe even skin cultures or biopsy.

My preference, however, is to go easy on the bacterial cultures and biopsies (the former cast too wide a net at this point, and the latter is invasive). I prefer to go for empirical treatment, meaning I’ll give a relatively benign therapy a trial run. Here’s my plan:

  1. I dip for demodicosis. Demodectic mange has been identified as a mite that sometimes likes to leave this pattern of itchy hair loss behind. Because it’s often hard to find under the microscope after a scraping, using a benign (if stinky) lime-sulfur dip once a week for a few weeks is never a bad approach.
  2. I always treat for fleas in these cats. ALWAYS. Regardless of whether I find fleas or not. Revolution is my go-to topical for this but Frontline and Advantage are close seconds. I will often add in a Capstar pill (an oral treatment that lasts 24 hours) every three days for the first three months to ensure I’m getting as good a trial as possible for flea allergies.
  3. 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.

OK, 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 (atopy). Should the food trial result in a negative finding and the symptoms doggedly persist, the dreaded skin or serologic allergy test will be in order. (Dreaded mostly for their expense, btw.)

So you see? Not so straightforward. Though more often than you might expect, the initial treatments are immediately fruitful.

And for those of you who think this is WAY too much ado over a silly little loss of hair ... well ... you might be right. But I'd rather not take my chances when it comes to my own patients' comfort. After all, how itchy would YOU have to be to lick all your hair clean off your body?

Dr. Patty Khuly

Pic of the day: "Grooming" by Miss Claeson