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Feline psychogenic alopecia

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01 June 2016, at 1:00am

David Grant continues his series looking at dermatological conditions.

PSYCHOGENIC ALOPECIA IS CAUSED BY EXCESSIVE GROOMING OR LICKING (Miller and others, 2013). Most veterinary dermatological texts describe the condition in cats as uncommon, although feline behaviourists believe that psychogenic aspects may also be a factor in some chronic pruritic conditions.

There are many potential causes of feline stress and a very careful analysis of the history is important along with a consideration of other causes listed under the differential diagnosis. 

In one study evaluating 21 cats referred to a behaviourist, only two satis ed the diagnostic criteria for psychogenic alopecia (Waisglass and others, 2006).

Grooming is a normal reaction of cats to a stressful incident and it may result in the release of endorphins, which exert a calming effect. Continued excessive stress could be expected to result in over-grooming.

Clinical features

  • The problem has been described more often in multicat households and in indoor cats (Waisglass and others, 2006). 
  • Siamese and other oriental breeds may be predisposed. 
  • Affected cats may exhibit severe anxiety during the clinical examination and appear to be generally nervous.
  • Alopecia without inflammation of the skin is characteristic. However, with severe over-grooming eosinophilic plaques and secondary pyoderma may develop. Primary psychogenic alopecia does not normally produce skin lesions other than alopecia.
  • Hairs may be pulled out entirely or be broken off near to the skin surface. Good illumination and magnification is important.
  • Commonly affected areas include the caudal abdomen, medial thighs, inguinal region and dorso-lumbar regions. Areas not frequently associated with the more common pruritic skin diseases may also be affected, such as the forelimbs, raising clinical suspicion for psychogenic alopecia. 

Differential diagnosis

(From Paterson, S., 2008) 

  • Ectoparasites (Fleas, Cheyletiella, Otodectes, lice, Demodex). 
  • Allergic dermatitis (flea, food, atopy). 
  • Dermatophytosis.
  • Demodicosis. 
  • Telogen defluxion. 
  • Hyperadrenocorticism. 
  • Paraneoplastic alopecia.

Diagnosis

  • History and physical examination.
  • Trichoscopy. This simple test will demonstrate hairs in both anagen and telogen. Trauma-inducing broken-off tips are easily visible under the low power of the microscope.
  • Rule out differential diagnosis diseases. Due to the large number of possible differential diagnoses, the investigation is potentially extensive and may involve (from Miller and others, 2013): 
  • Multiple skin scrapings.
  • Fungal culture from a large area using the toothbrush technique.
  • Complete blood count – eosinophilia suggest allergy.
  • Trial elimination diet for at least eight weeks with the cat confined indoors. 
  • Trial ectoparasitic therapy for eight weeks while the cat is confined indoors.
  • The above investigations will leave atopy as the main differential. 

Further investigation would be:

  • Trial use of glucocorticoids for two weeks. Cats with psychogenic alopecia will not respond to anti- inflammatory doses of glucocorticoids, whereas atopic cats usually will.

Clinical management 

  • Identify any stressors and eliminate them if possible.
  • Spend more time with the cat and enrich the environment. Consultation with a feline behaviourist to identify ways to reduce stress and build confidence is invariably rewarding. 
  • Various psychogenic medications have been proposed. The most commonly cited of these is clomipramine (Swanepoel and others, 1998), for example. 
  • This author prefers behavioural modi cation and confidence-boosting strategies, whenever possible. 
  • True psychogenic alopecia does not produce lick-cycle skin lesions. Therefore, adequate time can be taken to allow stress-reducing strategies to take effect.

References and further reading

  1. Miller, W. H., Grif n, C. G. and Campbell, K. L. In: Muller and Kirk’s Small Animal Dermatology, 7th edition, pp654-657. 
  2. Elsevier, 2013. Paterson, S. In: Manual of Skin Diseases of the Dog and Cat, 2nd edition, pp 227-228. Blackwell Publishing, 2008.
  3. Swanepoel, N., Lee, E. and Stein, D. J. (1998) Psychogenic alopecia in a cat: response to clomipramine. J S Afr Vet Assoc 69 (1): 22.
  4. Waisglass, S. E., Landsberg, G. M., Yager, J. A. et al (2006) Underlying conditions in cats with presumptive psychogenic alopecia. J Am Vet Med Assoc 226 (11): 1,705-1,709.