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consultant on call D E R M ATO L O G Y

Hair Loss in Cats

Karen A. Moriello, DVM, Diplomate ACVD,


University of WisconsinMadison

Profile Symmetrical Signalment


Diffuse/generalized hair loss Breed Predilection
Definition - Areas of hair loss can be inflammatory Breed-associated abnormalities of the
Alopecia is defined as loss of hair from or noninflammatory hair coat are spontaneous or the result of
body areas where it is normally found. selective breeding programs.
Hypotrichosis is often used interchange- Genetic Implications Rex cats can have wavy hair coats,
ably with alopecia; also defined as less Hairlessness at birth can occur in any cat downy and shorter than normal hair, and
than normal amount of hair; best breed and is associated with genetic no guard hair.
reserved for congenital hair loss. mutation. Intentional breeding has resulted in hair-
Hair loss is characterized by amount of Litters of hairless kittens often do not less cat breeds, such as sphynx, elf, and
loss, distribution, and presence or survive, suggesting another associated or dwelf.
absence of inflammation. concurrent metabolic defect; hairlessness Congenital hypotrichosis has been
- Loss of individual hairs in an area can may be caused by a recessive gene or reported in Birman, Burmese, Devon rex,
be partial or complete multiple genes. and Siamese breed cats.
- Hair loss can vary in distribution and Other ectodermal defects (eg, disorders Abyssinian cats can have structural
extent: of whiskers, claws, or teeth) can occur in defects of hair shafts that primarily affect
Focal, well-circumscribed areas these cats. whiskers and primary hair.
Multifocal or diffuse patchy areas c o n t i n u e s

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Causes mediated disorder characterized by - Kittens: Dermatophytosis and parasitic


There are 3 general causes of hair loss in focal noninflammatory hair loss. Diag- causes
cats: nosis is via skin biopsy, which shows - Young adults: Allergic diseases and
1. Alopecia due to failure of hair pro- lymphoplasmacytic perifolliculitis/folli- microbial overgrowth
duction culitis. - Older cats: Hyperadrenocorticism, para-
Rare, except when intentionally driven Hair loss may be due to folliculitis neoplastic syndromes, epitheliotropic
by breeding programs (eg, sphinx, associated with dermatophytosis, bac- T-cell lymphoma
Canadian hairless) terial overgrowth, or demodicosis. Breed
Cats are born without primary hairs 3. Alopecia due to self-trauma, sec- - Congenital hypotrichosis: Persian, Bir-
and only a few secondary hairs and ondary to pruritus, or due to psy- man, Burmese, Devon rex, Siamese,
whiskers. chogenic disorders sphinx
Sebaceous glands open directly onto Hair loss associated with self-trauma - Hair shaft abnormalities: Abyssinian
the skin surface, which is oily due to secondary to pruritus is common. - Self-induced alopecia due to behavioral
accumulation of lipids, especially in nail Pure psychogenic hair loss is uncom- causes: Siamese, Abyssinian, Burmese
folds. mon and can be diagnosed only after - Follicular dysplasia: Cornish rex
Cats often do not groom skin and need exclusion of all other causes of pruritic Lifestyle
frequent bathing and lifelong care. and nonpruritic hair loss. - Indooroutdoor, multicat households,
Skin is predisposed to secondary micro- Psychogenic grooming disorders can show cats: Fleas/flea allergy dermatitis,
bial overgrowth (eg, with Malassezia). result from untreated/unresolved pri- contagious parasites, dermatophytosis
2. Alopecia due to loss of existing mary pruritic diseases. - Anxiety/stressful situation: Self-induced
hair alopecia due to behavior
Follicular atrophy may be secondary to Signs Presence of current or previous illness
metabolic disorder; occurs most com- History - Anorexia/vomiting: Pancreatic paraneo-
monly in cats with hyperadrenocorticism. Age plastic alopecia
Hair coat effluvium can be triggered by - Birth: Congenital hypotrichosis or pili torti - Polyuria/polydipsia and abdominal
metabolic stresses, such as gestation
and lactation, surgery, and pyrexia.
- Hair coat effluvium is probably not
uncommon in debilitated young cats
or kittens that acquire severe respira-
tory infections (Figure 1).
- In effluvium, hairs are easily avulsed
with minor traction and rapidly
regrow with recovery.
- Skin biopsy shows normal skin and
hair in anagen phase.
Hair and skin require large amounts
of protein; diseases that result in
protein deficiency or loss (eg, chronic
hepatic or renal disease, malabsorp-
tion/maldigestion) may cause diffuse
hair loss and brittle, dry, easily frac-
tured hairs.
Alopecia mucinosa, a rare disease diag-
nosed by skin biopsy, is a precursor of
cutaneous lymphoma.
1
Alopecia areata is a rare, immune-
Effluvium in a shelter kitten after severe upper respiratory infection Courtesy Dr. Sandra Newbury

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enlargement: Hyperadrenocorticism Physical Examination
- Severe acute illness, especially young General physical examination is neces-
cats with respiratory disease: Effluvium sary in all patients but particularly impor-
- Gastrointestinal signs: May suggest tant in older cats presenting with
food allergy symmetrical or generalized hair loss
Presence of current or past injuries/ because there may be a cutaneous sign
trauma: Cats will often groom painful of systemic illness.
areas (eg, overgrooming of pelvic area in Dermatologic examination should note
cats with fractures) (Figure 2). distribution of hair lossfocal, multifo-
cal, or symmetrical.
- Examination of hair coat should note
whether any hairs are present at sites
of hair loss.
- Broken hairs not easily plucked are
compatible with self-induced hair loss;
pruritus should
be considered.
- Easily epilated hairs or excessive shed-

2 ding are common with folliculitis.


- Large areas that are easily
denuded from mild traction
Symmetrical hair loss over lumbosacral area in cat on hair coat occur with
with fractured pelvis. effluvium.
- Note whether whiskers
Seasonality: Atopy and flea allergy der- are blunted or broken and
matitis can present seasonally. c o n t i n u e s
Evidence of contagious spread is compat-
ible with Demodex gatoi and other
ectoparasites and dermatophytoses. Articles in Clinicians Brief on
Presence or absence of pruritus can be
difficult for owners to assess; just Diagnostic Dermatologic Testing
because the owner does not report pruri-
Using a Wood's Lamp Coming Soon
tus does not mean the cat is nonpuritic.
Hair in feces, constipation, or vomiting Microscopic Examination of Fungal Cultures April 08
due to hair impaction suggests pruritus. Fungal Cultures for Diagnosing Dermatophytosis October 07
Initial distribution of skin lesions and pat- Diagnostic TreeEndocrine-Like Hair Loss Pattern July 07
tern of spread should be determined
Flea Allergy: Best Tests & Prevention August 05
because many causes of hair loss have
recognized patterns of distribution. Obtaining a Skin Biopsy for Histopathologic Evaluation August 05
Response to previous therapies: Diagnostic TreeCanine Skin Eruptions August 05
- Response to steroid therapy suggests Diagnostic TreePruritic Skin Disease February 05
flea allergy and/or atopy. How to Get the Most from Skin Biopsies July 04
- Food allergy responds inconsistently to
Food Allergies in Cats August 03
steroid therapy.
- Response to flea control supports Articles available at cliniciansbrief.com:
parasitic causes. Click on Library and select year of publication under Browse By Date; then select the
- Focal areas of atrophic hair loss can month the article was published.
occur at injection sites.

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whether there is hair loss or comedones


on the chin or lipsthese indicate Differential Diagnosis of Feline Hair Loss
pruritus.
Eyes: Note presence or absence of con- Focal Lesions
junctivitis since this may be present in Alopecia areata
cats with atopy. Bacterial and/or yeast overgrowth
Ears: Preauricular hair loss is normal; Cicatrical alopecia
note any inflammation in and around the Demodicosis
ears. Flea allergy, food allergy, and atopy Dermatophytosis
can manifest with pinnal pruritus. Idiopathic lymphocytic mural folliculitis
Trunk: Palpate skin for small areas of mil- Injection site reaction
iary dermatitis and broken, stubbly hairs; Local glucocorticoid reaction
look for evidence of scalingany of Pinnal alopecia
these may be compatible with folliculitis Pseudopelade
and pruritus. Traction alopecia
Abdomen: Note any follicular plugging
on or around mammae; cytologic exami- Extensive or Symmetrical Alopecia with Pruritus or Overgrooming
nation often reveals bacterial and/or Atopic dermatitis
yeast overgrowth. Bacterial and yeast overgrowth
Nails: Examine for signs of chewing, and Dermatophytosis
inspect the nail beds for debris under the Ectoparasite infestation: Fleas, lice, Otodectes cynotis, Demodex, Cheyletiella, fur mites
nail folds (especially important with Flea infestation/fleabite hypersensitivity
Devon rex cats as they tend to have Food hypersensitivity/food intolerance
Malassezia overgrowth in nail folds).
Malassezia overgrowth is common in Extensive or Symmetrical Alopecia Without Pruritus or Overgrooming
cats with pruritic skin diseases. Alopecia mucinosa
Skin: Note the tone; thin skin is common Cheyletiella infestations
in hyperadrenocorticism. Defluvium/effluvium
Demodicosis
Pain Index Dermatophytosis
Pain is rare in cats with hair loss and sig- Epitheliotropic lymphoma
nals an injury or other illness. Hyperadrenocorticism
Pruritic cats are often twitchy or have Paraneoplastic syndrome
their itchscratch reflex easily triggered. Pseudopelade
Systemic and metabolic causes: Chronic renal disease, chronic liver disease, hypothy-
Diagnosis roidism/hyperthyroidism, diabetes mellitus
Trichorrhexis nodosa
Definitive DiagnosisAcquired Focal
Alopecia If there is no history of topical or injected phytosis
Obtain history, perform physical examina- medications or signs of inflammation 3. Skin cytology or tape preparation to
tion, and determine whether topical or (erythema, scaling, broken stubbly hairs) look for bacterial or yeast overgrowth
injected medications have been used or are present, perform the following tests (in focal alopecia, do this before the
matted hair has been clipped from the in the suggested order: following tests)
site. If medications have been used and 1. Woods lamp examination to screen for 4. Skin scrapings and hair pluckings to
the site is not inflamed, stop medication fluorescent hairs; if found, directly rule out demodicosis
and watch for regrowth of hair (48 examine hairs 5. If above tests are nondiagnostic, per-
weeks). If no regrowth occurs or lesion 2. Fungal culture to rule out dermato- form skin biopsy.
worsens, perform skin biopsy.

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Definitive DiagnosisExtensive or
Symmetrical Alopecia Treatment at a Glance
In cats that present with dramatic or
severe clinical signs (eg, alopecia muci- Treatment depends on a definitive diagnosis Flea Control
nosa, pseudopelade), skin biopsy is the or is part of a series of response-to-treat- 68 weeks of adulticide (eg,
most expedient way to get a diagnosis. ment trials. selamectin); treat all animals in
house
- Additional diagnostics, such as labora-
Follow-Up This is also effective treatment for
tory analysis, imaging, and bone marrow
Otodectes and Cheyletiella mite
cytology, may be needed depending on infestations
the disease. Unless the cause is easily diagnosed at the
- Samples should be sent to a veterinary initial visit, careful patient follow-up is Feline Demodicosis
46 weeks of lime sulfur dips; alter-
dermatopathologist along with digital needed for accurate interpretation of native therapies are not as effica-
photographs. response-to-treatment trials. cious for response-to-treatment
Cats with spontaneous hair loss due to trials
metabolic illnesses (eg, hyperadrenocorti- Relative Cost Lime sulfur is an effective parasiti-
cism, effluvium) usually have historical Cost of diagnosis can vary from $ to $$$$ cidal agent for all common parasites
and physical examination findings that depending on the underlying cause and of cats except fleas
support a cutaneous manifestation of whether the cause is treatable and curable Bacterial & Yeast Overgrowth
systemic illness. or a disease requiring life-long management. 4 weeks of concurrent antibiotics (eg,
- These cats will require additional diag- clavulanated amoxicillin, 22 mg/kg Q
12 H; cefadroxil, 22 mg/kg Q 12 H) and
nostics, such as, but not limited to, Prognosis systemic antifungals (eg, itraconazole,
serum biochemical profile, complete Good unless hair loss is a manifestation of 5 mg/kg Q 24 H or week on/week off)
blood count, thyroid hormone measure- systemic illness (eg, paraneoplastic syn-
drome)
Elimination Diet
ment, diagnostic imaging. 812 weeks of complete and balanced
- Demodex cati, dermatophytosis, and home-cooked diet or limited-protein
bacterial/yeast overgrowth are not commercial diet. Use of antipruritic
uncommon in cats with systemic ill- Cost Key therapy can be used during first 46
nesses. Core diagnostic tests, such as $ = < $100 $$$$ = $500$1000 weeks of diet trial to provide interim
relief:
skin scrapings, skin cytology, and fungal $$ = $100$250 $$$$$ = > $1000
Prednisolone, 0.52.2 mg/kg PO Q
cultures, are still indicated. $$$ = $250$500 24 H for 7 days, then every other
Pruritus/overgrooming is the most com- day; recommended for short-term
mon cause of extensive or symmetrical therapy only
alopecia in cats. Cyclosporine A modified, 5 mg/kg
- Three common causes of pruritus in cats See Aids & Resources, back page, for PO Q 24 H for the first 30 days, then
are parasites, infections, and allergies; references, contacts, and appendices. consider alternate-day dosing
some common causes can be ruled out Article archived on cliniciansbrief.com Antihistamines are of limited useful-
during the initial visit. ness in cats but may be steroid-
sparing:
- If a condition is not diagnosed at the
initial visit, a series of response-to- - Amitriptyline HCl, 510 mg PO
Q 12 H
treatment trials is often the only way to
- Cetirizine HCl, 5 mg PO Q 12 H
make the diagnosis (see Step by Step:
Response to Treatment Trials, page - Chlorpheniramine, 24 mg/kg PO
Q 12 H
12).
- Diphenhydramine HCl, 0.5 mg/kg
PO Q 12 H
- Fexofenadine, 1 mg/kg PO Q 12 H
- Hydroxyzine HCl, 510 mg PO
Q 12 H

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Step by Step: Response to Treatment Trials
Karen A. Moriello, DVM, Diplomate ACVD, University of WisconsinMadison

Initial Visit
Perform fungal culture and skin scrapings, skin cytology, flea combings,
and hair pluckings.
Negative skin scrapings and flea combings may not identify an
ectoparasite but do not necessarily rule it out. Note that skin
scrapings are easier to do in cats by using a skin scraping spatula
(Figure 1).
Skin cytology is done more easily by using clear acetate tape in cats
(Figure 2); response-to-treatment test at future visit may be needed
because bacterial and yeast infections can be subtle in cats (see
Follow-Up Visit 2).
Pending fungal culture, initiate aggressive flea control program (eg, 1
monthly spot-on treatment) for 6 to 8 weeks to rule out fleas, lice,
and Cheyletiella infestations. Skin-scraping spatula: Highly recommended over scalpel blade because
Complete blood count may show peripheral eosinophilia in cats risk for injury is minimized.

with fleas/flea allergy.

Follow-Up Visit 1
The above treatment plan eliminates ectoparasites and flea allergy
dermatitis from the differential diagnosis list. If there is no response
to flea control, treat for feline demodicosis.

Follow-Up Visit 2
Do 4-week trial therapy for bacterial/yeast overgrowth.
This is a common complication of cats that present with extensive
self-mutilation, miliary dermatitis, or exudative lesions.
Unlike dogs, cats have subtle clinical signs and response-to-treat- 2
ment test is often used to confirm diagnosis.
If there is no response to treatment, ectoparasites and common skin Stained clear acetate preparation: To examine, place sample over drop
infections/overgrowth have been eliminated from differential diagnosis of immersion oil on glass microscope slide. Bacteria and yeast on cat
list. skin require oil immersion magnification to be seen clearly.

Follow-Up Visit 3
Initiate strict elimination diet for 8 to 12 weeks, followed by provocative diet challenge.
Food hypersensitivity is confirmed if pruritus and overgrooming cease with diet and condition relapses with provocative diet challenge.
If no change occurs with diet trial and a commercial diet was used for the test, consider repeating diet trial using a home-cooked diet.
Diet trials should be initiated only after parasitic and infectious causes of pruritus have been eliminated.

Follow-Up Visit 4
Remaining differential diagnoses include atopy, psychogenic alopecia, or unknown cause.
Consider allergy testing for atopy, which is strongly recommended before treating cats for psychogenic alopecia.
Response to glucocorticoid therapy supports allergic skin disease.
Lack of response to glucocorticoids or cyclosporine A modified is not compatible with a diagnosis of allergic skin disease and suggests
psychogenic alopecia.
Rule out other causes of alopecia with skin biopsy.

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