Compulsive Disorders in Cats

Compulsive Disorders in Cats – An Overview

  • Repetitive, relatively constant, exaggerated behavior patterns (often derived from normal behavior, but taken to extreme) with no apparent reason or function; performed to the exclusion of other normal behaviors or to the detriment of the cat
  • Behaviors such as psychological hair loss in which the cat grooms excessively (known as “psychogenic alopecia”), frequently repeated meowing or vocalizing (known as “repetitive vocalization”), compulsive pacing, fabric chewing, or wool sucking may be considered compulsive disorders, when other reasons for the behavior cannot be identified

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Siamese and Burmese, other Asian breeds and crosses are more likely than other cat breeds to demonstrate repetitive vocalization, fabric chewing, and wool sucking

Mean Age and Range

  • Age of onset approximately 24 months (range, 12–49 months)

Predominant Sex

  • Both males and females are affected equally

Signs/Observed Changes in the Pet

  • Signs or observed changes are determined by the abnormal behavior itself. A cat may demonstrate one or more abnormal behaviors
  • Psychogenic alopecia—localized, symmetrical hair loss; most commonly involving the skin of the groin, lower abdomen, and inner thigh or back of thighs; appearance of the skin may be normal or may be abnormal, with redness or abrasions from excessive grooming
  • Compulsive pacing
  • Repeated meowing or vocalizing (repetitive vocalization)
  • Fabric chewing and wool sucking—secondary gastrointestinal signs, such as vomiting, may develop
  • These behaviors may quickly increase in frequency if they are reinforced with feeding or attention by the owner

Causes

  • Unknown
  • Organic or physical causes for the abnormal behavior should be ruled-out before a psychological basis is presumed

Risk Factors

  • Changes in surroundings may lead to abnormal behaviors
  • More commonly reported in indoor cats; may be an artifact of the higher level of attention such pets receive or may be related to the stress of confinement or social isolation

Treatment

Health Care

  • Reduce environmental stress—increase the predictability of household events by establishing a consistent schedule for feeding, playing, exercise, and social time; eliminate unpredictable events as much as possible; avoid confinement
  • Identify and remove triggers (triggers are situations or things to which the cat reacts, leading to compulsive behavior) for the behavior, if applicable
  • Ignore the behavior as much as possible; distract the cat and initiate acceptable behavior
  • Do not reward the behavior
  • Note details of the time, place, and social environment so that an alternative positive behavior (such as play or feeding) may be scheduled
  • Any punishment for an unwanted behavior associated with the owner’s voice, movement, and touch may increase the unpredictability of the cat’s environment, may increase the cat’s fear or aggressive behavior, and may disrupt the human-animal bond

Activity

  • Playing or exercise on a consistent schedule
  • Increase opportunities for social interactions

Diet

  • Depends on compulsive behavior exhibited and individual pet

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Anticompulsive drugs may be helpful
  • No drugs are approved by the federal Food and Drug Administration (FDA) for the treatment of these disorders in cats; your veterinarian will discuss the risks and benefits of using these drugs
  • Goal—use drugs until control is achieved for 2 months; then attempt gradual decrease in dosage; treatment should be resumed at first sign of relapse
  • Tricyclic antidepressant (TCA)—amitriptyline or clomipramine
  • Selective serotonin reuptake inhibitor (SSRI)—fluoxetine or paroxetine
  • Buspirone
  • Phenobarbital
  • Deprenyl (seligeline), if signs related to cognitive dysfunction (changes in behavior and awareness related to aging of the brain)
  • L-tryptophan

Follow-Up Care

Patient Monitoring

  • Before initiating treatment, record the frequency of abnormal behavior that occurs each week so that progress can be monitored
  • Successful treatment requires a schedule of follow-up examinations
  • Environmental modification program and/or psychologically active medications must be adjusted according to the cat’s response
  • If a medication is not effective after dosage adjustment, another drug may be prescribed

Preventions and Avoidance

  • Create an enriched environment for the cat
  • Do not reward the behavior
  • Ignore the behavior as much as possible

Possible Complications

  • Treatment failure
  • Fabric chewing/wool sucking—gastrointestinal problems, such as vomiting or blockage
  • Irritation or frustration of people in household

Expected Course and Prognosis

  • Realistic expectations must be understood; changing a behavior that has become a habit is very challenging
  • With treatment, prognosis for improvement is good; estimated that two-thirds of pets respond to the client’s satisfaction
  • Immediate treatment improves the prognosis, since the outcome is impacted negatively by prolonged problem duration
  • Immediate control of a long-standing problem is unlikely

Key Points

  • Any cat may develop repetitive, exaggerated behavior patterns that apparently have no reason or function
  • Ignore the behavior as much as possible and avoid rewarding the behavior
  • Abnormal behavior should be evaluated by your veterinarian as soon as possible to determine if a physical cause exists
  • Treatment may include behavioral modification and psychologically active drugs, if no physical cause is identified
  • Realistic expectations must be understood; changing a behavior that has become a habit is very challenging
  • Immediate treatment improves the prognosis, since the outcome is impacted negatively by prolonged problem duration

Aggression In Cats

Aggression In Cats – An Overview

  • Aggression can be a normal and appropriate behavior in certain situations, such as allowing the cat to protect itself, or it may be abnormal, with serious consequences for the cat’s physical and emotional well-being
  • “Aggressivity” describes both mood and temperamental traits that relate to the likelihood to show aggression when environmental circumstances dictate it might be used
  • Numerous types of aggression have been identified in cats, including the following:
  • Play aggression (toward people)
  • Typically refers to a cat that scratches and bites the owners during play
  • Not true aggression; overzealous play without proper impulse control due to lack of training or proper social feedback
  • The cat’s intent is not to harm the person
  • Behavior encouraged and rewarded by owners through rough play when younger (that is, a kitten); as cat grew and became stronger, overzealous play perceived as aggression
  • Predatory aggression (toward people or other animals)
  • Cats have an innate drive to “hunt” or show predatory behavior, which induces “stalk, hide, and pounce”
  • Predatory behavior is not a direct function of hunger
  • Typically stimulated by fast movements and can progress to the cat hiding and waiting for a person or animal to walk by
  • Play is a common way for young cats to perfect hunting (predation) skills; play aggression and predatory aggression may overlap
  • Redirected aggression (toward people or other animals)
  • Cat sees, hears, or smells a trigger (triggers are situations or things to which the cat reacts, leading to aggressive behaviors) and directs aggressive behavior toward the closest innocent bystander (a person or another animal)
  • In some cases, one person or animal in the home becomes the designated victim, and the cat may bypass a nearby individual and look for the preferred victim
  • Some cats may stay aroused for 24–72 hours after a triggered event
  • A common trigger inciting redirected aggression is the cat seeing another cat or wildlife outside the homeCat in wayne nj stalking prey
  • Fearful or fear-induced aggression/defensive aggression (toward people or other animals)
  • Cat will show body postures indicating fear and/or anxiety; cat may hiss, spit, arch the back, and hair may stand up (known as “piloerection”); turn away; run away; cower; roll on its back and paw (a defensive position and not a submissive position) if cornered
  • Territorial aggression (toward people or other animals)
  • Some cats, particularly male cats, show territorial behaviors in domestic home settings due to the size and presence of more resources (such as people, food, resting areas, feeding areas, litter box areas); the territorial behavior is designed to defend the cat’s domain
  • Turf may be delineated by various territorial behaviors, such as patrolling the area, chin rubbing, spraying, non-spraying marking, scratching; threats and/or fights may occur if a perceived offender enters the area
  • In severe cases, the aggressive cat may seek out other individuals (people or other animals) and attack
  • Body posture with territorial aggression is assertive and confident
  • Pain aggression (toward people and animals)
  • Cats in pain may show aggression (hissing, growling, scratching, biting) when they are physically handled or prior to or after movements, such as jumping onto or off a piece of furniture
  • Maternal aggression
  • May occur during the period surrounding the birth of kittens (known as the “periparturient period”)
  • Protection—mother cats (known as “queens”) may guard nesting areas and kittens by showing aggressive behaviors toward individuals approaching the kittens
  • Contact-induced/petting aggression (toward people)
  • Cat shows early signs of aversion when people pet or stroke him/her; ears go back, tail swishes
  • If physical contact or petting continues, cat typically will bite
  • Owners often miss early warning signs
  • When cats groom one another, they typically limit grooming to head area
  • Some cats do not want to be petted or stroked along their backs, which is commonly done by people
  • Cat-to-cat (intercat) aggression within a home
  • Fifty percent of cat owners report fighting (scratching and biting) after introduction of a new cat into the home
  • The number of cats, sex, and age are not significant factors in predicting which cats will show cat-to-cat aggression

Signalment/Description of Pet

  • Any breed of cat
  • Some types of aggression appear at onset of social maturity (2–4 years)
  • Males more likely to show aggression to other cats than females
  • Abyssinian, Russian blue, Somali, Siamese, and Chinchilla breeds showed more aggression than other cat breeds
  • Maine coon, ragdoll, and Scottish fold breeds showed the least aggressiveness

Signs/Observed Changes in the Pet

  • Aggressive behavior (such as staring, biting, hissing, and growling)
  • Physical examination findings are generally secondary to aggression, such as injuries, lacerations, or damage to teeth or claws
  • Continuous anxiety—decreased or increased grooming; anxious behavior (such as “meatloaf position” and averting gaze)

Causes

  • Underlying medical issues can cause aggression
  • Temperament/behavior is influenced by genetics, rearing, socialization, environment in which the cat lives, and types of interactions the cat has with people and other animals

Risk Factors

  • Poor socialization
  • Abuse—cat may learn aggression as a preemptive strategy to protect itself
  • Administration of steroids or other medications may induce aggression or remove normal inhibition for aggressive behavior
  • Underlying painful conditions

Treatment

Health Care

  • Never use physical correction or punishment, as it may escalate the aggression
  • Avoid known triggers (triggers are situations or things to which the cat reacts, leading to aggressive behaviors)
  • Identify triggers and desensitize and counter-condition cat to the triggers
  • Implement safety measures (for example, use of Soft Claws®, wearing long pants/long sleeves to protect people, keep flattened cardboard boxes around the home to place between the person and cat)
  • Behavior modifications to redirect the cat and reduce arousal
  • Train cat to respond to commands, such as “sit” or “go to” a certain place in the home
  • Implement environmental enrichment for the cat

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

  • No drugs are approved by the federal Food and Drug Administration (FDA) for the treatment of aggression in cats; your veterinarian will discuss the risks and benefits of medical treatment
  • Anti-anxiety medications that increase levels of serotonin in the central nervous system, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs)
  • Amitriptyline (TCA)
  • Benzodiazepines: oxazepam
  • Buspirone; may make some cats more assertive; thus may work well for the victim in anxiety-associated aggression
  • Clomipramine (TCA)
  • Fluoxetine or paroxetine (SSRI)

Follow-Up Care

Patient Monitoring

  • Owners should consult with the cat’s veterinarian every 1–2 weeks for the first 2 months after a treatment plan has been recommended to evaluate response
  • If the cat is receiving medications, the dose should be evaluated every 3–4 weeks
  • Frequency of follow-up will be determined by the severity of the aggressive behavior
  • Blood work (including complete blood count [CBC], serum chemistry, and thyroid [T4] levels) should be obtained prior to beginning medications; 2–3 weeks after starting medication, blood work for liver and kidney tests should be obtained; thereafter, blood work should be rechecked annually in young, healthy pets and semiannually in older pets or at the interval recommended by your pet’s veterinarian
  • Physical examinations should be repeated semiannually in older pets as painful conditions may start to contribute to the aggressive behavior or make it worse

Preventions and Avoidance

  • Ensure appropriate socialization of kittens with people and other cats
  • Avoid provocation of the cat
  • Observe signs of aggression (such as tail flicking, ears flat, pupils dilated, head hunched, claws possibly unsheathed, stillness or tenseness, low growl) and safely interrupt the behavior; leave cat alone and refuse to interact until appropriate behavior is displayed
  • Avoid direct physical correction or punishment; may intensify aggression
  • Remember that a cat displaying aggressive or predatory behavior can bite or scratch any person or another animal—always be careful to ensure that you do not get injured; the best approach in some situations is to leave the cat alone in a quiet area until it calms down

Possible Complications

  • Human injuries; surrender of cat to animal control or animal shelter; euthanasia of cat

Expected Course and Prognosis

  • Ultimately depends on the specific kind of aggression and the ability of the owner to carry out the suggested treatment
  • Some types of aggression can improve or resolve within a few weeks, while other types may take several months or longer
  • Some forms of aggression have a poor prognosis

Key Points

  • Most cases of aggression need a combination of behavioral modification, environmental modification, training, and, when necessary, medication to maximize chances of improving the cat’s behavior
  • Behavioral medicine is concerned with recognizing and identifying abnormal or inappropriate aggressive behavior
  • Numerous types of aggression have been identified in cats

Pemphigus

Pemphigus

BASICS-Overview

  • A group of diseases in which the immune system attacks the skin (known as “auto-immune dermatoses”); auto-immune diseases are ones in which the body produces antibodies against its own tissue; an “antibody” is a protein that is produced by the immune system in response to a specific antigen (a substance that induces an immune response)—when the body is exposed to the antigen (in the case of pemphigus, the antigen is some part of the skin), the antibody responds, resulting in signs of disease.
  • The pemphigus group of diseases is characterized by varying degrees of loss of tissue on the surface of the skin, frequently with inflammation (known as “ulceration”); dried discharge on the surface of a skin lesion (known as a “crust”); and formation of small, raised skin lesions containing pus (known as “pustules”) and blisters or small, circumscribed elevation of the outer layer of the skin filled with clear fluid (known as “vesicles”)
  • Affects the skin and sometimes the moist tissues of the body (known as “mucous membranes”)
  • Forms identified in animals include pemphigus foliaceous, pemphigus erythematosus, pemphigus vulgaris, panepidermal pustular pemphigus/vegetans, canine benign familial chronic pemphigus (Hailey-Hailey disease), and paraneoplastic pemphigus; type of pemphigus based on location of skin lesions and microscopic appearance of skin lesions

Genetics

  • Benign familial chronic pemphigus (Hailey-Hailey disease)—may be a genetic disease

Signalment/Description of Pet

Species

  • Pemphigus foliaceus, erythematosus, and vulgaris—dogs and cats
  • Panepidermal pustular pemphigus—dogs

Breed Predilections

  • Pemphigus foliaceus—Akitas, bearded collies, chow chows, dachshunds, Doberman pinschers, Finnish spitzes, Newfoundlands, and schipperkes
  • Pemphigus erythematosus—collies, German shepherd dogs, and Shetland sheepdogs

Signs/Observed Changes in the Pet

Pemphigus Foliaceus

  • Scales (accumulations of surface skin cells, such as seen in dandruff); crusts (dried discharge on the surface of skin lesions); pustules (raised skin lesions containing pus); superficial loss of skin tissue (known as “erosions”); reddened skin (known as “erythema”); hair loss (known as “alopecia”); circular patterns of hair loss (alopecia) bordered by scales or surface peeling of the skin (pattern is known as an “epidermal collarette”); and thickening of the skin (known as “hyperkeratosis”) of the footpads with furrows or slits (known as “fissures”)
  • Occasional blisters (vesicles) are transient
  • Common involvement—head, ears, and footpads; often becomes generalized
  • Lesions involving the moist tissues of the body (mucous membranes) and areas where the moist tissues of the body contact the skin, such as the lips (areas known as “mucocutaneous junctions”) are uncommon
  • Cats—nipple and nailbed involvement are common
  • Sometimes enlarged lymph nodes (known as “lymphadenopathy”), fluid buildup in the skin (known as “edema”), depression, fever, and lameness (if footpads involved) may be present; however, pets are often in good health
  • Variable pain and itchiness (known as “pruritus”)
  • Secondary bacterial infection is possible

Pemphigus Erythematosus

  • Same signs as for pemphigus foliaceus
  • Lesions usually confined to head, face, and footpads
  • Loss of pigment of the moist tissues (mucous membranes) and skin (known as “mucocutaneous depigmentation”) more common than with other forms of pemphigus; loss of pigment may precede crusting

Pemphigus Vulgaris

  • Pemphigus; loss of pigment may precede crusting
  • Ulcers of the mouth are frequent, and may precede skin lesions
  • Ulcerative lesions; superficial loss of skin tissue (erosions); circular patterns of hair loss (alopecia) bordered by scales or surface peeling of the skin (pattern is called epidermal collarettes), blisters, and crusts (dried discharge on the surface of skin lesions)
  • More severe than pemphigus foliaceus and pemphigus erythematosus
  • Affects moist tissues of the body (mucous membranes), areas where the moist tissues of the body contact the skin, such as the lips (mucocutaneous junctions), and skin; may become generalized
  • Area under the front legs and between the rear legs (known as the “axillae and groin”) often involved
  • Positive Nikolsky sign (new or extended erosive lesion created when lateral pressure is applied to the skin near an existing lesion)
  • Variable itchiness (pruritus) and pain
  • Lack of appetite (known as “anorexia”), depression, and fever
  • Secondary bacterial infections are common

Panepidermal Pustular Pemphigus

  • Pustule (raised skin lesion containing pus) groups become masses that ooze
  • Involvement of the mouth has not been seen
  • No systemic illness

Causes

  • Undetermined—genetics and a possible triggering event (such as a viral infection or medication)

Risk Factors

  • Undetermined

Treatment

Health Care

  • Initial inpatient supportive therapy for severely affected pets
  • Outpatient treatment with initial frequent hospital visits (every 1–3 weeks); taper to every 1–3 months when remission is achieved and the pet is on a maintenance medical regimen
  • Severely affected pets may require antibiotics and hydrotherapy/soaks

Diet

  • Low-fat—to avoid inflammation of the pancreas (known as “pancreatitis”), which can be a side effect of steroids and (possibly) azathioprine therapy

Surgery

  • Surgical biopsy of the skin lesion and the skin surrounding the lesions

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

Pemphigus Foliaceus and Pemphigus Vulgaris

  • Steroids—prednisone or prednisolone
  • Chemotherapeutic drugs and other drugs to decrease the immune response—more than half of pets require medications other than steroids to decrease the immune response; these drugs generally work in conjunction with prednisone, allowing reduction in dose and side effects of the steroid; examples include azathioprine, chlorambucil, cyclophosphamide, cyclosporine, and dapsone
  • Gold-salt treatment or chrysotherapy—gold salts are used to decrease inflammation and the immune response; often used in conjunction with prednisone; such as auranofin

Pemphigus Erythematosus and Panepidermal Pustular Pemphigus

  • Steroids—prednisone or prednisolone administered by mouth
  • Steroids administered by application directly to the skin (known as “topical steroids) may be sufficient in mild cases

Alternative Steroids

  • Use instead of prednisone, if undesirable side effects to prednisone or poor response occur
  • Methylprednisolone—for pets that tolerate prednisone poorly
  • Triamcinolone
  • Steroid pulse therapy—methylprednisolone sodium succinate administered intravenously for 3 consecutive days to induce remission; limited application

Topical Steroids (Administered to the Skin Directly)

  • Hydrocortisone cream
  • More potent topical steroids—0.1% betamethasone, fluocinolone, or 0.1% triamcinonide

Miscellaneous Medications

  • Tetracycline and niacinamide

Follow-Up Care

  • Monitor response to therapy

Monitor for medication side effects—routine bloodwork (complete blood count [CBC] and serum biochemistry), especially pets on high doses of steroids, chemotherapeutic drugs, or gold-salt treatment; check every 1–3 weeks, then every 1–3 months when in remission

Prevention and Avoidance

  • Pet should avoid the sun, because ultraviolet (UV) light may worsen the lesions

Possible Complications

  • Depend on type of pemphigus
  • Secondary infections
  • Side effects of medications may affect quality of life
  • Pemphigus foliaceus and pemphigus vulgaris may be fatal, if untreated (especially pemphigus vulgaris)

Expected Course and Prognosis

  • Treatment with steroids and chemotherapeutic drugs and medications to decrease the immune response is needed
  • Pets may require medication for life
  • Monitoring is necessary
  • Side effects of medications may affect quality of life
  • May be fatal, if untreated (especially pemphigus vulgaris)
  • Secondary infections cause morbidity and possible mortality (especially pemphigus vulgaris)

Pemphigus Erythematosus and Panepidermal Pustular Pemphigus

  • Relatively benign and self-limiting
  • Steroids administered by mouth eventually may be tapered to low maintenance doses; may be stopped in some pets (as directed by your pet’s veterinarian)
  • Skin disorder (known as “dermatosis”) develops, if untreated; generalized (systemic) signs are rare
  • Prognosis fair

Key Points

  • A group of diseases in which the immune system attacks the skin (known as “auto-immune dermatoses”)
  • Pet should avoid the sun, because ultraviolet (UV) light may worsen lesions

Pigment Loss

Loss of Pigment in Dogs & Cats

Overview

  • Disease or cosmetic condition involving loss of pigmentation of the skin and/or hair coat either by lack of pigmentation or by melanocyte damage; “melanocytes” are cells that produce pigment in the skin or hair
  • Normal pigment in the skin and hair coat is melanin
  • “Leukotrichia” is the medical term of whitening of the hair, without indication of location of the whitened hairs
  • “Poliosis” is the medical term of whitening of the hair on the head and/or face
  • “Leukoderma” is the medical term of whitening of the skin

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Mucocutaneous pyoderma (bacterial skin infection involving areas of the lips, eyelids, nostrils)—German shepherd dogs
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs) and discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)—collies, Shetland sheepdogs, German shepherd dogs
  • Pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus)—chow chows, Akitas
  • Uveodermatologic syndrome (a rare syndrome in which the pet has inflammation in the front part of the eye, including the iris [condition known as “anterior uveitis”] and coexistent inflammation of the skin [known as “dermatitis”], characterized by loss of pigment in the skin of the nose and lips)—Akitas, Samoyeds, Siberian huskies
  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose) in dogs—Belgian Tervuren, German shepherd dogs, Doberman pinschers, rottweilers, German shorthaired pointer, Old English sheepdog, and dachshund
  • Seasonal nasal hypopigmentation (loss of pigment in the tough, hairless skin of the nose [known as the “nasal planum”] that occurs seasonally)—Siberian huskies, Alaskan malamutes, yellow Labrador retrievers, and golden retrievers
  • Proliferative arteritis of the nasal philtrum (inflammation of the arteries of the nasal philtrum, the juncture between the sides of the upper lip extending to the nose)—Saint Bernards, giant schnauzers
  • Vitiligo in cats–Siamese
  • Periocular leukotrichia (whitening of the hair coat around the eyes) in cats–Siamese
  • Chediak-Higashi syndrome (an inherited disorder that affects many tissues in the body; causes lack of pigment in the skin and eyes)–Persian

Mean Age and Range

  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose) in dogs—usually less than 3 years of age
  • Epitholiotropic lymphoma (a type of skin cancer; also known as “mycosis fungoides”)—typically dogs over 10 years of age

Predominant Sex

  • Discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)—may occur more often in females than in males
  • Vitiligo in Siamese cats—females

Signs/Observed Changes in the Pet

  • White hair (known as “leukotrichia”)
  • Partial or total lack of pigment in the skin (known as “leukoderma”)
  • Lightening of the pigment in the skin, often seen as a “graying” or “browning” of previously pigmented areas
  • Reddening of the skin (known as “erythema”)
  • Loss of the top surface of the skin (known as “erosion” or “ulceration,” based on depth of tissue loss)

Causes

  • Mucocutaneous pyoderma (bacterial skin infection involving areas of the lips, eyelids, nostrils)
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)
  • Discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face)
  • Pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus)
  • Pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Uveodermatologic syndrome (a rare syndrome in which the pet has inflammation in the front part of the eye, including the iris [anterior uveitis] and coexistent inflammation of the skin [dermatitis], characterized by loss of pigment in the skin of the nose and lips)
  • Contact hypersensitivity (increased sensitivity or reaction in the skin to the presence of a foreign agent that comes in contact with the skin)
  • Vitiligo (condition characterized by symmetrical lack of pigment in the skin and white hair coat, especially involving the face and nose)
  • Seasonal nasal depigmentation (loss of pigment in the tough, hairless skin of the nose [known as the “nasal planum”] that occurs seasonally)
  • Albinism (inherited disorders characterized by lack of pigment in the skin, hair, and/or eyes, due to abnormal production of melanin)
  • Schnauzer gliding syndrom (young, gray miniature schnauzers develop golden hair color, primarily in the body)
  • Hormonal disorders
  • Drug reaction
  • Erythema multiforme (skin disorder caused by reaction of medications, infections, or other diseases)
  • Proliferative arteritis of the nasal philtrum (inflammation of the arteries of the nasal philtrum, the juncture between the sides of the upper lip extending to the nose)
  • Loss of pigment in the skin and/or hair following skin inflammation
  • Dermatophytosis (fungal infection on the surface of the skin)

Risk Factors

  • Sun exposure—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face), and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Treatment

Health Care

  • Outpatient, except for systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), erythema multiforme (skin disorder caused by reaction to medications, infections, or other diseases), and lymphoma of the skin (a type of skin cancer), when severe multiple organ dysfunction is present
  • Reduce exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Replace plastic or rubber dishes—particularly if roughened edges cause abrasions
  • Application of water-resistant sun-block ointments or gels (with a SPF UVA and UVB greater than 30) to depigmented areas
  • Vitiligo and nasal depigmentation–no treatment

Activity

  • Restrict outdoor activity to minimize exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Surgery

  • Skin biopsy

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Vary based on underlying cause
  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)—immunosuppressive therapy with steroids (such as prednisolone or dexamethasone) and chemotherapy drugs (such as azathioprine [dogs] or chlorambucil [cats])
  • Tetracycline and niacinamide—to treat pemphigus erythematosis (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus) and discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) in dogs
  • Medications to decrease the immune response (known as “immunosuppressive therapy”)—to treat systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), pemphigus foliaceous (auto-immune disease involving the skin, characterized by inflammation with crusting and lesions containing pus), pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)
  • Cyclosporine to decrease the immune response in auto-immune disorders
  • Steroids applied to the skin directly (known as “topical steroids”)
  • Tacrolimus, 0.1% gel or pimecrolimus 1% cream applied daily to lesions in combination with or to replace steroids
  • Imiquimod 5% cream for actinic keratosis (a precancerous skin condition caused by sun exposure)
  • Antibiotics–trimethoprim-sulfadiazine, cephalexin, or amoxicillin-clavulanate; effective in some cats
  • Antibiotics for bacterial skin infection (known as “pyoderma”)
  • Chlorambucil, a chemoterapeutic drug
  • Medications to treat fungal infections (known as “antifungal drugs”) to treat dermatophytosis (fungal infection on the surface of the skin)

Follow-Up Care

Patient Monitoring

  • Varies with specific disease and treatment prescribed

Preventions and Avoidance

  • Restrict outdoor activity to minimize exposure to sunlight—systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs), discoid lupus erythematosus (auto-immune disease involving the skin only, usually the face) and pemphigus erythematosus (auto-immune disease involving the skin of the face and ears, characterized by reddening of the skin [erythema] and lesions containing pus)

Possible Complications

  • Systemic lupus erythematosus (auto-immune disease in which the body attacks its own skin and other organs)—scarring
  • Squamous cell carcinoma ( a type of skin cancer) in cases of sun-damage to the skin, with resulting loss of skin pigment

Expected Course and Prognosis

  • Vary with specific disease

Itchiness in Dogs & Cats

Itchiness in Dogs & Cats – An Overview

  • “Pruritus” is the medical term for itching or itchiness; it is the itching sensation that provokes the desire to scratch, rub, chew or lick
  • Pruritus is an indicator of inflamed skin
  • The term is not a diagnosis but rather is a description of a clinical sign

Species

  • Dogs
  • Cats

Signs/Observed Changes in the Pet

  • Scratching
  • Licking
  • Biting
  • Rubbing
  • Chewing
  • Self-trauma
  • Inflammation of the skin (known as “dermatitis”)
  • Hair loss (known as “alopecia”); hair loss without inflammation may be the only sign in some cats
  • Other signs determined by underlying cause

Causes

  • Parasites—fleas; mites (canine scabies [Sarcoptes], Demodex, ear mites [Otodectes], feline scabies [Notoedres], “walking dandruff” [Cheyletiella], harvest mite or red bud [Trombicula]); lice; rhabditic dermatitis (Pelodera strongyloides); or migration of internal parasites
  • Allergies—parasite allergy; atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems); food allergy; contact allergy; drug allergy; allergy to skin bacteria (known as “bacterial hypersensitivity”); allergy to Malassezia (a yeast found on the skin)
  • Bacterial or fungal infections—Staphylococcus (a bacteria) and Malassezia pachydermatis (a yeast or fungus); rarely a dermatophyte (fungus living on the skin, hair, or nails); however, Trichophyton is a dermatophyte that tends to cause more itchy skin disease than the other dermatophytes
  • Miscellaneous—excessive scaling of the skin (known as “seborrhea”); calcium deposits in the skin (known as “calcinosis cutis”); skin tumors or cancer
  • Immune-mediated skin diseases and hormonal skin diseases can be variably itchy
  • Psychological skin diseases may be associated with itchiness

Risk Factors

  • Exposure to other animals with parasites

Treatment

Health Care

  • More than one disease can contribute to itching
  • The use of mechanical restraint (such as an Elizabeth collar) can be a helpful option, but is seldom feasible in long-term treatment
  • Treat for secondary infections, which are common

Diet

  • Depends on underlying cause
  • Usually no change in diet needed, unless suspected food allergey

Medication

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

Medications Applied to the Skin Directly (Known as “Topical Therapy”)

  • Topical therapy is helpful in mildly itchy pets
  • For localized areas of itchiness or skin inflammation, sprays, lotions and creams are most appropriate
  • If the itching involves many areas or widespread areas, shampoos are the preferred means of application
  • Antibacterial shampoos help control bacterial infections that cause itching; however, some antibacterial shampoos (such as those containing benzoyl peroxide or iodine) can cause increased itching
  • Colloidal oatmeal is common in all forms of topical therapy; its duration of effect usually is less than two days
  • Topical antihistamines may be found alone or in combination with other ingredients; they may not have a beneficial effect
  • Topical anesthetics may offer only a very short duration of effect
  • Antimicrobial shampoos help control bacterial infections that cause itching; however, some contain ingredients (such as benzoyl peroxide or iodine) that can increase itchiness through excessive drying
  • Lime sulfur (which has a bad odor and can stain) can decrease itching, while also having anti-parasitic, antibacterial, and antifungal properties
  • Topical steroids probably are the most useful topical medications; hydrocortisone is the mildest and most common topical steroid; stronger steroids (such as betamethasone) may be more effective and are more expensive; a triamcinolone-containing prescription spray (Genesis® Topical Spray, Virbac) is effective in decreasing itchiness (pruritus)
  • Some topical steroid medications also contain ingredients (such as alcohol), which can aggravate already irritated skin
  • In some pets, the application of any substance, including water (especially warm water), can result in an increased level of itchiness; however, cool water often is soothing

Medications Administered by Mouth or by Injection (Systemic Therapy)

  • Steroids to decrease inflammation and itchiness of the skin
  • Cyclosporine to decrease the immune response
  • For pets affected with airborne allergies for more than a few months out of the year, “allergy shots” (known as “allergen specific immunotherapy”) are appropriate, frequently beneficial, and may lead to a cure (in some cases)
  • Antihistamines (such as hydroxyzine, diphenhydramine, and chlorpheniramine) to prevent inflammation and itching
  • Fatty acids are available in powders, liquids, and capsules; they help block pathways that lead to inflammation, but may require 6–8 weeks of use until maximum effect is observed; fatty acids work better as preventive medications, rather than stopping the inflammation once it has become a problem; they also help reduce dry or flaky skin, which can cause itching
  • Medications to relieve anxiety or depression (known as “psychogenic drugs”) can be helpful in controlling itchiness; include such drugs as amitriptyline, fluoxetine, and diazepam
  • In rare cases, alternative medications to decrease the immune response (known as “immunosuppressive drugs,” such as azathioprine) may be utilized; however, they should be reserved for instances when all other treatments have failed

Follow-Up Care

Patient Monitoring

  • Patient monitoring is imperative; pets should be examined periodically to evaluate response to treatment
  • Pets receiving long-term (chronic) medications should be evaluated every 3–12 months for potential side effects as well as occurrence of new contributing factors

Preventions and Avoidance

  • Prevent infestation with parasites (such as fleas and mites)
  • Avoid foods identified as causing food allergy for your pet

Possible Complications

  • Owner frustration is common
  • Complications (such as increased thirst [known as “polydipsia”] and increased urination [known as “polyuria”]) are common with long-term (chronic) steroid use

Expected Course and Prognosis

  • Depend on underlying cause
  • Many causes of itchiness in pets are extremely frustrating to control

Key Points

  • Many different unrelated diseases may contribute to itchiness (pruritus), and control of one disease does not mean that other causes cannot be contributing to itchiness or cannot occur later
  • Multiple causes (such as flea allergy, inhalant allergy, and bacterial skin infection [known as “pyoderma”]) commonly are present in a single patient
  • Elimination of bacterial skin infection (pyoderma) and flea-associated disease may not be enough to significantly reduce itchiness
  • Food-allergy and inhalant-allergic pets may do well during the winter season with a hypoallergenic diet, only to become itchy during the warmer months in association with inhalant allergies

Flea Bite Hypersensitivity & Flea Control

Flea Bite Hypersensitivity & Flea Control – Overview

  • “Hypersensitivity” is an increased sensitivity or reaction in the skin due to the presence of a foreign substance; in flea-bite hypersensitivity, the foreign substance is found in flea saliva; the reaction is immune based and would be considered to be an “allergic” reaction
  • “Dermatitis” is the medical term for inflammation of the skin
  • “Antigens” are substances that induce sensitivity or immune response
  • “Flea-bite hypersensitivity”—hypersensitivity or allergic reaction to antigens in flea saliva, with or without evidence of fleas and flea dirt
  • “Flea-bite dermatitis”—inflammation of the skin due to the flea bite itself; it is not an allergic or hypersensitivity reaction, but rather an irritant response to flea bites

Genetics

  • Flea-bite hypersensitivity—unknown inheritance pattern; more common in breeds with atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Mean Age and Range

  • Flea-bite hypersensitivity—rare in pets less than 6 months of age; average age range, 3–6 years, but may be seen at any age

Signs/Observed Changes in the Pet

  • Determined by the severity of the reaction and the degree of exposure to fleas (that is, seasonal or year-round)
  • Itchiness (known as “pruritus”)
  • Compulsive biting
  • Chewing (“corncob nibbling”)
  • Licking, primarily in the back half of the body, but may include the areas
  • Signs of fleas and flea dirt; finding fleas and flea dirt is beneficial, although not essential, for the diagnosis of flea-bite hypersinsitivity
  • Sensitive pets require a low exposure to fleas to have an immune response and they tend to over groom, removingt evidence of flea infestation, and making identification of parasites difficult
  • Hair loss (known as “alopecia”)
  • Small, raised skin lesions (known as “papules”)
  • Darkened skin (known as “hyperpigmentation”) in dogs
  • Thickening and hardening of the skin, usually associated with hyperpigmentation (known as “lichenification”) in dogs
  • “Hot spots” in dogs
  • Miliary dermatitis (skin inflammation characterized by numerous, small, crusty bumps) in cats)

Causes

  • Fleas
  • Immune response to flea saliva (flea-bite hypersensitivity or flea-allergy dermatitis)

Risk Factors

  • Flea-bite hypersensitivity—intermittent exposure to fleas increases likelihood of development; commonly seen in conjunction with atopy (disease in which the pet is sensitized [or “allergic”] to substances found in the environment [such as pollen] that normally would not cause any health problems)

Treatment

Health Care

  • Outpatient treatment

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Steroids—to decrease inflammation in the skin for symptomatic relief, while instituting flea control
  • Antihistamines–symptomatic relief
  • Flea control on the pet; examples include dinotefuran/pyriproxyfen (monthly spot treatment; rapid acting; two products—one for cats and one for dogs; dog product contains high dose of the insecticide, permethrin, and should NOT be used on cats); fipronil (monthly spot treatment for dogs and cats and spray treatment for dogs); imidacloprid (monthly spot treatment for cats and dogs); metaflumizone (monthly spot treatment for dogs or cats; product for dogs contains another active ingredient [amitraz] and should not be used on cats)
  • Flea control using medications given by mouth (known as “oral medications”)—nitenpyram (rapid action, but short-acting; kills over 95% of adult fleas on dogs and cats within 4–6 hours of administration, lasts for 48–72 hours); spinosad (monthly oral treatment for dogs only)
  • Other flea control for pets (such as flea sprays and other topical treatments)—usually contain pyrethrins and pyrethroids (synthetic pyrethrins) with an insect-growth regulator or synergist; generally effective for less than 48–72 hours
  • Environmental/indoor treatment—professional exterminator or home-use fogs and premises sprays; products usually contain organophosphates, pyrethrins, and/or insect-growth regulators; apply according to manufacturer’s directions; treat all areas of the house
  • Environmental/indoor treatment using inert substances—boric acid, diatomaceous earth, and silica aerogel; treat every 6–12 months; follow manufacturer’s recommendations
  • Environmental/outdoor treatment—concentrate outdoor treatment in shaded areas; sprays usually contain pyrethroids or organophosphates and an insect-growth regulator; a product containing nematodes (Steinerma carpocapsae) is chemical-free
  • Other products for use include flea powders, dips, sprays, and foams
  • NOTE: Always read all label instructions and follow the manufacturer’s directions when using any flea-control product; ensure that the product is labeled for use on the species (dog or cat) or location (indoors or outdoors) for which you intend to apply it—for example, some products that are safe for dogs are very toxic to cats and should not be used on cats

Follow-Up Care

Patient Monitoring

  • Itchiness (pruritus)—a decrease in itchiness indicates the flea infestation and/or flea-bite hypersensitivity is being controlled
  • Fleas and flea dirt—absence is not always a reliable indicator of successful treatment in very sensitive pets

Preventions and Avoidance

  • Year-round warm climates—year-round flea control is required
  • Seasonally warm climates–begin flea control in May or June, as directed by your pet’s veterinarian

Possible Complications

  • Secondary bacterial infections
  • Sudden (acute) moist dermatitis, also known as “hot spots”
  • Acral lick dermatitis (inflammation of the skin characterized by a firm, ulcerated lesion on a leg, caused by consistant licking)

Expected Course and Prognosis

  • Prognosis is good, if strict flea control is instituted

Key Points

  • Flea control is important for dogs and cats
  • No cure exists for flea-bite hypersensitivity
  • Flea-allergic pets often become more sensitive to flea bites as they age
  • Controlling exposure to fleas is currently the only means of controlling signs; “allergy shots” (known as “hyposensitization”) for flea-bite hypersensitivity are not effective

Bacterial Skin Infections

Bacterial Skin Infections (Pyoderma) – An Overview

  • “Pyoderma” is the medical term for bacterial infection of the skin
  • Skin lesions are characterized by the presence of pus
  • “Superficial pyoderma”—involves the top surface of the skin (known as the “epidermis”) and the hair follicles
  • “Deep pyoderma”—involves the lower layers of the skin (known as the “dermis”) and possibly the tissues under the skin (known as the “subcutis”)

Breed Predilections

  • Dogs—sporting breeds, hounds, working breeds, and mixed-breed dogs (greater than 12 kg [26 lbs] of body weight)

Mean Age and Range

  • Dogs—common in young and old dogs; range, 1 month–15 years; many cases in puppies less than 1 year of age

Risk Factors

  • Contact of animals that have not been vaccinated or have not responded to vaccinations with animals that are infected with canine distemper virus (dogs or wild carnivores)

Signs/Observed Changes in the Pet

  • Cough
  • Fever
  • Labored breathing
  • Exercise intolerance
  • Lack of appetite (known as “anorexia”) and weight loss
  • Sluggishness (lethargy)
  • Nasal discharge
  • Difficult or rapid breathing
  • Abnormal breath sounds on listening to the lungs with a stethoscope (known as “auscultation”)—increased intensity or breath sounds over the bronchi; short, rough snapping sounds (known as “crackles”); and squeaking or whistling sounds (known as “wheezes”)
  • Dehydration

Causes

Dogs

  • Most common primary disease-causing organisms of the respiratory tract— Bordetella bronchiseptica and Mycoplasma.
  • Most common gram-positive bacteria—Staphylococcus, Streptococcus, and Enterococcus; gram staining is a technique in which slides with potential bacteria on them are stained in a sequential manner; gram-positive bacteria stain dark purple while gram-negative bacteria stain pink; gram staining allows differentiation of bacteria into groups (that is, gram-positive or gram-negative).
  • Most common gram-negative bacteria— Escherichia coli, Klebsiella, Pseudomonas, Pasteurella
  • Anaerobic bacteria (bacteria that can live and grow in the absence of oxygen)—found in lung abscesses and various types of pneumonia (particularly with aspiration or foreign bodies); approximately 20% of pets with bacterial pneumonia have anaerobic bacterial infections.

Cats

  • Bacteria—Bordetella bronchiseptica, Pasteurella, and Moraxella most frequently reported; Mycoplasma considered a primary disease-causing microorganism (known as a “pathogen”) in the lower respiratory tract.
  • Carrier state—may exist; periods of shedding Bordetella bronchiseptica after stress; infected female cats (queens) may not shed the organism during pregnancy (prepartum) but begin shedding it after delivering the kittens (postpartum), serving as a source of infection for kittens.

Risk Factors

  • Preexisting viral infection.
  • Regurgitation (return of food or other contents from the esophagus or stomach back up through the mouth), dysphagia (difficulty swallowing), or vomiting (forceful ejection of stomach contents up through the esophagus and mouth).
  • Functional or structural (anatomic) defects—paralysis of the voice box or larynx (known as “laryngeal paralysis”); enlarged esophagus (known as “megaesophagus”); cleft palate; inherited disorder in which the normal secretion clearance mechanism of the lungs is defective (known as “primary ciliary dyskinesia”).
  • Reduced level of consciousness—stupor, coma, or anesthesia.
  • Foreign body in the bronchi (part of the airway).
  • Long-term (chronic) dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (known as “bronchiectasis”).
  • Drugs to decrease the immune response (known as “immunosuppressive drugs”)—such as chemotherapeutic drugs and steroids.
  • Severe metabolic disorders—excess levels of urea and other nitrogenous waste products in the blood (known as “uremia” or “azotemia”); sugar diabetes (diabetes mellitus); excessive production of steroids by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”).
  • Presence of pus-forming bacteria and their poisons in the blood or tissues (known as “sepsis”).
  • Age—very young more susceptible to fatal infections.
  • Vaccination status.
  • Environment—housing, sanitation, ventilation.
  • Abnormal function of cells that normally remove bacteria and foreign materials from the body (known as “phagocyte dysfunction”)—feline leukemia virus (FeLV) infection and diabetes mellitus.
  • Complement (a protein substance in the blood that contributes to the destruction and removal of bacteria from the body) deficiency—rare.
  • Selective immunoglobulin A (IgA) deficiency; immunoglobulin A is an immune protein, found in the intestines; it functions as a protective barrier to prevent limit antigens (substance to which the immune system is responding and producing antibodies) and disease-causing microorganisms from entering the body through the intestines—rare.
  • Combined T-cell and B-cell dysfunction—rare; a lymphocyte is a type of white blood cell, formed in lymphatic tissue throughout the body; lymphocytes are further divided into T lymphocytes (which are involved in cell-mediated immunity), so-called “T-cells” and B lymphocytes (which produce antibodies as part of the immune process), so-called “B-cells”—rare.

Treatment

Health Care

  • Inpatient—recommended with signs involving multiple body systems (such as lack of appetite [anorexia], high fever, weight loss, and sluggishness [lethargy]).
  • Maintain normal hydration—important to aid the normal secretion clearance mechanism of the lungs; use a balanced electrolyte solution.
  • Administration of medication in a fine spray (known as “nebulization”) with saline aerosol—results in more rapid resolution, if used with physiotherapy and antibiotics.
  • Physiotherapy—efforts to dislodge secretions in the lungs and to induce coughing (known as “coupage”); windpipe manipulation to stimulate mild cough; and postural drainage; may enhance clearance of secretions; always do immediately after nebulization; avoid allowing the pet to lie in one position for a prolonged time.
  • Oxygen therapy—for pets with low levels of oxygen in their blood (known as “hypoxemia”) and signs of severe breathing difficulties (known as “respiratory distress”).

Activity

  • Restrict during treatment (inpatient or outpatient), except as part of physiotherapy after administration of medication in a fine spray (nebulization).

Diet

  • Ensure normal intake of food, with foods high in protein and calorie or energy density.
  • Feeding directly into the intestinal tract (known as “enteral feeding”) or through the veins (known as “parenteral nutrition”)—indicated in severely ill pets.
  • Use caution in feeding pets with an enlarged esophagus (megaesophagus); lack of normal function of the voice box or larynx (known as “laryngeal dysfunction”) or surgery on the voice box or larynx; disease of the throat or pharynx (known as “pharyngeal disease”), and pets that are unable to get up (they are recumbent).

Surgery

  • Surgical removal of a lung lobe (known as “lung lobectomy”)—may be indicated with lung abscesses or foreign body in the bronchus with secondary pneumonia; may be indicated if the pet is unresponsive to conventional treatment and disease is limited to one or two lobes of the lung(s).

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Antibiotics

  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing from transtracheal wash (a technique in which samples from the lower airways are obtained for bacterial culture and/or for evaluation through a microscope) or other diagnostic techniques.
  • Reasonable initial antibiotic choices pending culture results include amoxicillin–clavulanic acid, cephalexin, enrofloxacin, or trimethoprim-sulfonamide.
  • Gram-positive cocci—ampicillin, ampicillin-sulbactam; amoxicillin; amoxicillin–clavulanic acid; azithromycin; chloramphenicol, erythromycin; gentamicin; trimethoprim-sulfonamide; first-generation cephalosporins.
  • Gram-negative rods—enrofloxacin; chloramphenicol; gentamicin; trimethoprim-sulfonamide; amikacin; marbofloxacin; carboxypenicillins.
  • Bordetella—doxycycline; chloramphenicol; enrofloxacin; azithromycin.
  • Mycoplasma—doxycycline, enrofloxacin, marbofloxacin, chloramphenicol.
  • Anaerobes (bacteria that can live and grow in the absence of oxygen)—amoxicillin–clavulanic acid; chloramphenicol; metronidazole; clindamycin; ticarcillin-clavulanic acid.
  • Administration of gentamicin in a fine spray (known as “gentamicin nebulization”) for Bordetella—typically used in conjunction with antibiotics given by mouth or injection.
  • Continue treatment for at least 10 days beyond clinical resolution and/or 1–2 weeks following resolution of x-ray (radiograph) evidence of pneumonia.

Antibiotics

  • Recommended by some veterinarians; no objective evidence that they increase movement of mucus or mobilization of secretions.

Bronchodilators

  • Recommended by some veterinarians; used to decrease spasm of the bronchi; bronchodilators are medications that enlarge the bronchi and bronchioles in the lungs.

Follow-Up Care

Patient Monitoring

  • Monitor breathing rate and effort.
  • Complete blood count (CBC) should be performed periodically; CBC should return to normal as the pet responds to treatment.
  • Arterial blood gases, to monitor levels of oxygen and carbon dioxide in the blood—most sensitive monitor of progress.
  • Monitor pulse oximetry; : “pulse oximetry” is a means of measuring oxygen levels in blood.
  • Listen to the pet’s lungs (auscultate) frequently.
  • Chest x-rays (radiographs)—improve more slowly than the clinical signs.

Preventions and Avoidance

  • Vaccination—against upper respiratory viruses; against Bordetella bronchiseptica, if dog is boarded or exposed to large number of other dogs.
  • Catteries—environmental strategies to lower the number of cats or the close proximity in which they are housed (known as “population density”) and improve hygiene help control outbreaks of bordetellosis (infection caused by Bordetella).

Possible Complications

  • Presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Expected Course and Prognosis

  • Prognosis—good with aggressive anti-bacterial and supportive therapy; more guarded in young pets, pets with decreased ability to develop a normal immune response (immunodeficiency), and pets that are debilitated or have severe underlying disease.
  • Prolonged infection—potential for long-term (chronic) inflammation of the bronchi (bronchitis) or chronic dilation of bronchi or bronchioles, as a consequence of inflammation or blockage of the airway (bronchiectasis) in any pet.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Key Points

  • Inflammation in the lung as a response to disease-causing bacteria, characterized by accumulation of inflammatory cells and fluid in the lung, conducting airways (bronchi and bronchioles), and alveoli (the terminal portion of the airways, in which oxygen and carbon dioxide are exchanged).
  • More common in dogs than in cats.
  • Antibiotics are best selected based on results of bacterial culture and susceptibility testing.
  • High death rates are associated with severely low levels of oxygen in the blood (hypoxemia) and presence of pus-forming bacteria and their poisons in the blood or tissues (sepsis).

Pet Dermatology

Common Skin Conditions Seen In Dogs & Cats

Here, we have listed some of the most common skin conditions and provided you with the typical symptoms, and possible treatment. In some instances (when possible), we’ve included information about treatment that can be done with readily available at-home remedies. However, we would like to remind you that most skin conditions can be difficult to treat and will require veterinary assistance.

  • Mange
  • Bacterial Skin Infections (Pyoderma)
  • Inflamed Skin & Allergies
  • Eosinophilic Granuloma In Dogs & Cats
  • Loss of Pigment in Dogs & Cats
  • Flea Bite Hypersensitivity & Flea Control
  • Tick & Tick Control
  • Hair Loss In Cats (Feline Alopecia)
  • Hair Loss In Dogs (Canine Alopecia)
  • Hair Loss Without Inflammation of The Skin In Dogs
  • Nail & Nailbed Disorders
  • Itchiness in Dogs & Cats
  • Inflammation of the Outer & Middle Ear (Otitis Externa)
  • Pemphigus
  • Bumps On Skin (Papulonodular Dermatoses)
  • Skin Disorders Caused by Reactions to Food
  • Pododermatitis (Inflammation of Skin of the Paws)
  • Blisters & Pustules (Vesiculopustular Dermatoses)
  • Sterile Nodular Granulomatous Skin Diseases
  • Ulcers of the Skin
  • Skin Disorders of the Nose in Dogs (Canine Nasal Dermatoses)

We will work closely with you to diagnose, treat and monitor any skin, ear, nail or foot problem your pet may have. We are here to help your pet with problems such as diseases of the skin, dog or cat ear infections or immune-mediated problems.

Dermatology-Immune Related Skin Disorders

Your pet’s immune system plays a large role in many of the dermatology problems in both dogs and cats that we see at Tri-County Animal Hospital. Just like humans who can inherit allergies in the “gene lottery”, our canine & feline counterparts can have this unfortunate trait passed down to them. Pet’s often show allergic reactions to certain grasses, plants, and even certain types of food. While humans generally show allergies through sneezing, dogs and cats usually show through their skin.

In dogs, susceptibility to demodectic mange is another example of an immune related skin problem. This is a skin issue caused my microscopic mites, and can be relatively common in puppies. Diagnosis is determined through a simple skin scraping. Our veterinarians will look under the microscope to see if these mites are the cause of your dog’s skin condition, and recommend the appropriate treatment.

Environmental Related Skin Disorders (Sometimes Physical / Self Inflicted)

Environmental skin disorders are another common problem that we see at our animal hospital. The majority of these conditions are caused by excessive licking or chewing of the skin. In order to solve this challenge, our veterinarian not only treats the visible skin problem, but also determines the underlying problem that is causing your dog or cat to chew on themselves.

Lick granulomas are an example of this type of skin condition. Oftentimes, dogs will lick themselves so excessively that an open wound is left behind. While there could be numerous reasons for this type of self-destructive behavior, it is usually the result of a psychological issue (boredom, stress, anxiety). Our Staff will work to pinpoint the cause and help eliminate the harmful behavior.

Infectious Skin Disorders

Infectious skin diseases occur in both cats and dogs, and can be both contagious or non-contagious. The contagious infections fall under a broad range of viral, parasitic, fungal and bacterial diseases. Ringworm is one common example of this type of skin disorder. This fungal skin infection is contagious to dogs, cats and even humans. Diagnosis is determined through a culture, during which time, Dr. Silberman will advise treatment for your pet accordingly.

Another example of an infectious skin disorder is a staph infection. Staph infection is caused by bacteria belonging to genus Staphylococcus, and usually presents on the skin as scales or severe redness. In these cases, Dr. Silberman will examine your pet and often take cotton swab culture samples and perform cytologic evaluation under the microscope.

Secondary Conditions Caused By Internal Diseases

Sometimes, skin conditions are simply the manifestation of larger, underlying illnesses in your dog or cat. Many hormonal abnormalities have the ability to affect the quality of your pet’s skin and coat. In dogs, thyroid disease and Cushing’s Disease (hyperadrenocorticism), causing skin issues are probably the most common. Among cats, hyperthyroidism and diabetes may cause a dull coat, very matted fur, and in some cases, lose patches of hair from over-grooming. Dr. Silberman will determine which treatment is best for your pet, and discuss all available options with you.

Tooth Fractures

Tooth Fractures – An Overview

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Classified as “uncomplicated” if the fracture does not enter the internal part of the tooth containing the blood vessels and nerves (known as the “pulp”) and “complicated” if the fracture enters the pulp.
  • Both dogs and cats can fracture their teeth, although this is slightly more common in dogs.

Signs/Observed Changes in the Pet

Crown Fractures (Involving the Portion of the Tooth above the Gum Line)

  • Clinical loss of tooth-crown substance; may affect enamel only, or enamel and dentin; the enamel is the hard, shiny white material covering the crown of the tooth; the dentin makes up the bulk of the tooth structure.
  • Uncomplicated fractures with the fracture line close to the pulp (the internal part of the tooth, containing the blood vessels and nerves)—pale pink pulp is visible through the dentin; gentle exploring will not allow the explorer into the pulp cavity.
  • The recent or fresh complicated fracture is associated with bleeding from the pulp.
  • Older fractures may exhibit a dead pulp; clinically the pulp chamber is filled with dark material, and the tooth is often discolored.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • May occur at any point along the root surface; often in combination with fracture of the crown, although root fractures can occur without fracture of the crown.
  • Root segments may remain aligned or may be displaced.
  • Clinical signs indicating a possible root fracture include pain on closure of the mouth or during open-mouth breathing.
  • Abnormal horizontal or vertical mobility of a tooth may raise suspicion of a root fracture.

Causes

  • Generally the result of a traumatic incident (such as a road traffic accident, blunt blow to the face, chewing on hard objects).

Treatment

Dental Care

Uncomplicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line without Entering the Pulp)

  • Dental procedure by the veterinarian in which sharp edges are removed with a bur and the exposed dentin tubules are sealed with a suitable liner or restorative material.

Complicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line with Entering the Pulp)

  • Require treatment of the internal part of the tooth containing the blood vessels and nerves, known as the “pulp”; such treatment is known as “endodontic therapy” and includes root canals and pulpotomy—if the tooth is to be maintained; otherwise, extraction is preferable to no treatment at all.

Mature Tooth

  • Recent fracture in the mature tooth with the pulp still alive (vital)—two options exist, partial pulpectomy and direct pulp capping (vital pulpotomy) followed by restoration or conventional root-canal therapy and restoration.
  • For partial pulpectomy and direct pulp capping to succeed, the procedure should be carried out within hours of the injury; the initial procedure may not be the final treatment—the tooth may require standard root-canal treatment later, if the pulp tissue dies.
  • When the pulp already is inflamed chronically or is dead (known as “necrotic tissue”), standard root-canal therapy and restoration are the treatments of choice, if the tooth is periodontally sound.

Immature Tooth

  • A living (vital) pulp is required for continued root development; as long as the pulp is alive (vital), the treatment of choice is partial pulpectomy and direct pulp capping, followed by restoration.
  • If the pulp tissue is dead (necrotic), no further root development will occur; necrotic immature teeth need endodontic treatment to be maintained; remove the dead tissue and pack the root canal with calcium hydroxide paste; some continued root development and closure of the apex can be stimulated if this procedure is performed; change the calcium hydroxide every 6 months until the apex is closed at which time a standard root canal is performed.
  • Immature teeth may be present in the mature pet, if trauma to the developing teeth caused death of the pulp; such teeth should be treated as “immature teeth”.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • Treatment of crown and root fractures depends on how far below the gum line the fracture line extends.
  • If the fracture line does not involve the pulp (the internal part of the tooth, including the blood vessels and nerves) and does not extend more than 4–5 mm below the gum, restorative dentistry can be performed; if the fracture extends more than 5 mm below the gum and involves the pulp, the tooth usually should be extracted.
  • In some cases, the fractured tooth root may heal, if the tooth can be stabilized; in other cases, extraction of the tooth may be necessary.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • A broad-spectrum antibiotic drug for 5–7 days may be indicated; for example, when long-standing infection is present.

Follow-Up Care

Patient Monitoring

  • Check a partial pulpectomy and direct pulp-capping procedure with dental x-rays (radiographs) 6 and 12 months post-operatively, or at intervals determined by clinical signs, to detect death of the internal tissues of the tooth, including the blood vessels and nerves (pulp) and subsequent changes in the bone around the tips of the root, indicating the need for root-canal treatment.
  • Check the outcome of conventional root-canal therapy by dental x-rays (radiographs) 6–12 months post-operatively; evidence of changes in the bone around the tips of the root at this time indicates the need for further treatment or extraction of the tooth; further treatment consists of redoing the root canal, often using surgical techniques.
  • Check root fractures with dental x-rays (radiographs) 6–12 months post-operatively.
  • Check uncomplicated fractures with dental x-rays (radiographs) at 4–6 months post-operatively.

Preventions and Avoidance

  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Possible Complications

  • Untreated pulpal exposure invariably leads to inflammation of the pulp (known as “pulpitis”) and eventual death of the pulp tissue and subsequent changes in the bone around the tips of the root.
  • Immature teeth stop developing.

Expected Course and Prognosis

  • Vary with vitality of the pulp (the internal structure of the tooth, including the blood vessels and nerves), location of the fracture, and whether the tooth is mature or immature.

Key Points

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Periodontal Disease

Periodontal Disease – An Overview

  • Inflammation of the tissues around and supporting the tooth; the tooth support structures include the gum tissue (known as “gingiva”); the cementum and periodontal ligament (the cementum and periodontal ligament attach the tooth to the bone); and the alveolar bone (the bone that surrounds the roots of the tooth); periodontitis (inflammation/infection of the tissues around and supporting the tooth) indicates some degree of periodontal attachment tissue loss (that is, some loss of the structures [cementum, periodontal ligament, alveolar bone] that attach the tooth to the bone).
  • Both dogs and cats get periodontal disease

Signs/Observed Changes in the Pet

  • Swelling of the gum tissue (known as “gingival tissue”)
  • Bad breath (known as “halitosis”)
  • Redness or fluid build-up (edema) of the gums
  • Variable amounts of plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface)
  • Gum surfaces bleed easily on contact (for example, during play or physical examination)
  • Loose teeth, missing teeth, and exposure of roots of the teeth

Causes

  • Plaque bacteria (bacteria found in the thin, “sticky” film that builds up on the teeth)

Treatment

Dental Care

  • Professional cleaning.
  • Periodontal surgery.
  • The ultimate goal of periodontal therapy is to control plaque and prevent attachment loss; a willing pet and a client who can provide home care are important considerations in creating a treatment plan.

Diet

  • Dry food or hard, biscuit-type foods are preferable to soft, sticky foods.
  • Dental diets, such as Hill’s Prescription Diet t/d—specifically indicated to control plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface) in dogs and cats.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Antibiotics—clindamycin and amoxicillin/clavulanic acid are approved for periodontal disease
  • Tetracycline

Follow-Up Care

Patient Monitoring

  • The degree of periodontal disease determines recall interval; some pets are checked monthly, while others can be evaluated every 3–6 months.

Preventions and Avoidance

  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Your pet’s veterinarian will discuss home care and available products and will provide instructions for their use.

Possible Complications

  • Loss of teeth; loss of bone structure in lower jaw (mandible), leading to shortened lower jaw; tongue protruding from mouth.
  • Generalized infection in the body.
  • Possible heart, liver and/or kidney disease.

Expected Course and Prognosis

  • The response of the individual pet and the expected course and prognosis are highly variable.
  • Early diagnosis and appropriate treatment can minimize the destructive effects of this disease.

Key Points

  • Periodontal disease is the most common infectious disease in dogs and cats.
  • Periodontal disease can lead to infection in other areas of the body and may cause heart, liver, and or kidney disease.
  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Our staff will discuss home care and available products and will provide instructions for their use.