Approach to feline inflammatory skin disease

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Inflammatory skin disease in cats can pose many difficulties owing to varied presentations. In particular, with hypersensitivity type skin disease (feline atopic skin syndrome, FASS), cats present with different clinical signs compared with dogs, respond differently to treatment, and may not tolerate many of our therapies aimed at improving the skin barrier. This presentation reviews the most common clinical presentations of FASS are reviewed (miliary dermatitis, eosinophilic dermatoses, self-induced alopecia and head and neck pruritus), and explains how to form a logical approach to these challenging cases. Reaction patterns provide information of a likely inflammatory/hypersensitivity condition, but they do not help guide in terms of the underlying reason for the inflammation. For this reason, other causes of inflammation and/or pruritus such as parasites (fleas/demodex), infectious organisms (dermatophytosis, bacterial, yeast or more rarely viral infections), behavioural or drug reactions should be investigated and excluded. In rare cases, other causes of inflammation such as neoplasia or a paraneoplastic condition may also be considered – however, these unusual cases will have distinct features or characteristics. Other causes of a potential hypersensitivity such as fleabite, cutaneous adverse food reaction and mosquito-bite must also be excluded before a diagnosis of FASS can be made. This presentation provides a clear and logical workflow to investigate feline inflammatory skin disease focusing on history, clinical exam and diagnostic investigations.

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