Feline psychogenic alopecia

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.