The third and final treatment focuses on the outdoor environment. This area might not be as important as the home due to the
extreme variations in temperature, humidity or to the pet's environment. If dogs and cats frequent the yard of a home, then
it is advisable to treat these areas monthly with either malathion or diazinon. Newer and safer products also are available
and include biologics, such as a nematode spray. The nematode, Steinernema carpocapsa, preferentially parasitizes flea larvae and other destructive insects, such as cutworms and army worms. The nematodes are
reported to be safe for outdoor use but are effective only in moist-shade and part-shade areas and should be applied every
one month to three months.
With the knowledge of flea reproduction and the proper use of adulticides and environmental treatments, one can deal swiftly
and adequately to control flea infestations and the associated flea allergy in pets. Consistency with treatment is also critical
and will enhance treatment success. Finally, client education is also very important; an adequate flea control program is
not complete without the education of the owner and the monitoring of compliance.
Excessive grooming in the cat to the point of alopecia ranks highly in my most frustrating list of dermatology cases. It was
once thought that all (or most) cats with symmetrical alopecia on the trunk, caudal half of the body and rear limbs were affected
by pyschogenic causes. Many cats were treated with a progesterone-type medication, and some improved. It is now known that
most of those cats probably were affected by an allergy. The response to progesterone-type medications can be non-specific,
but this drug possesses significant anti-inflammatory effects on the skin as well as possessing diabetogenic properties.
Patterns of alopecia associated with this condition usually is confined to the caudal half of the body, flanks, rear limbs
and groin. Some of these cats might have alopecia on the forelimbs, especially near the carpal area. What is most interesting
is most cats lick (or pull hair) to the point of partial alopecia, leaving short hairs without excoriations or evidence of
Cats can be very secretive in their behavior, and some owners fail to observe excessive grooming. Cats are nocturnal, so much
of the grooming occurs at night when owners are asleep. Repeated questioning directed to the owner concerning the behavior
of the cat, including the incidence of hair balls, which should be increased in this condition, can clarify the clinical picture.
Finally, response to corticosteroids (injectable or intermediate strength oral forms are preferred) can be of value in making
a diagnosis. Cats with psychogenic alopecia do not respond to these therapies.
My general approach to these cases is to clearly discern whether the cat is over-grooming and then to pursue diagnostics.
Skin scrapings are recommended as well as performing trichograms. A trichogram is a simple, inexpensive, non-invasive technique
performed by plucking the short hairs in the areas of alopecia and examining the sample on low-power. The hairshafts should
be broken or fractured, thus providing definite proof of self-trauma. It is very important to state that self-trauma might
not be related to allergy or itch. There are actual cases that definitely are related to psychogenic causes.
My four differentials for cases of symmetrical alopecia include demodicosis caused by the contagious demodex mite, Demodex gatoi, flea allergy, food allergy and atopic dermatitis. The demodex mites are relatively easy to find, but fleas can be very difficult
to find and certainly to convince owners of the suspicion of flea infestation, and FAD can be extraordinarily tedious.
Treatment of this type of demodicosis includes weekly sulfur-type dips for four weeks to eight weeks on all cats. We also
recommend treatment of the environment with a commercially available home flea spray. Some cases can be recurrent, so long-term
treatment with periodic sulfur dips might be needed.
Since the most-common diagnoses I have found in these cats is FAD, I have become more skilled in educating clients and instituting
aggressive flea control. Flea control has been described earlier, but there are a few important differences to be noted in
the cat. Initially, I routinely administer corticosteroids in severe cases and advise imidocloprid or fipronil topically applied
to the base of the skull every two weeks. Treatment of all animals with topical products also is recommended. Home treatment
with insect-growth regulators also is advised and should be repeated in two weeks, again in three months, and every three
months to six months thereafter if pets are trafficking in and out of the home.