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Miliary Dermatitis

By: Dr. Mark Thompson

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Miliary dermatitis is a papular, crusting skin disease accompanied by varying degrees of pruritis. Cats with miliary dermatitis have multiple, small bumps on their skin that are usually associated with hair loss (alopecia). On closer examination, these bumps are raised, red swellings topped with a crust. Most commonly the bumps and hair loss are found on the cat's rump, neck, and chin.

Miliary dermatitis indicates an underlying skin problem; almost always, the skin problem is a pruritic (itchy) skin disease. The itching causes the cat to scratch, chew or groom excessively leading to the typical bumps with scales. Flea allergy is by far the most common cause of this skin pattern. Other allergies, bacterial skin infection, parasites and ringworm fungus are among other causes. Less commonly, a more severe disease that suppresses the immune system and allows bacteria or other infections to become established may cause this symptom.

The health impact on the cat depends on the severity of the itching or any other effects of the underlying cause.

What to Watch For

  • Scratching or excessive grooming
  • Hair loss
  • Small, red bumps topped with a crust

    Diagnosis

  • A complete history and physical exam are essential to diagnosis of the cause of miliary dermatitis. It is important to try and establish if the cat is itchy or if the cat is sick. A flea comb may be used to look for fleas, flea dirt, or evidence of other parasites.

  • A skin scrape is done to rule out mites and other skin parasites.

  • A fungal culture is done to rule out dermatophytes (ringworm fungi).

  • A special diet may be prescribed to see if the cat has a food allergy.

  • Allergy testing (skin testing or blood testing) may be necessary if above tests do not yield a diagnosis.

  • A skin biopsy may be required to help categorize the type of skin disease that is present.

  • A blood chemistry profile and CBC may be needed to assess the patient's general health.Tests for feline leukemia virus and feline immunodeficiency virus (feline AIDS virus) may also be done.

    Treatment

  • Long-term, successful treatment always depends on identifying and treating the underlying cause.

  • Strict flea control is essential since flea allergy is the most common cause. Many cats respond to flea avoidance alone. Even if fleas are not the primary cause, they always make the skin condition worse.

  • Corticosteroids are often used to stop the itch and consequently, the self-mutilation. Short-acting oral steroids are safer and easier to control, although long acting injections are sometimes used so that owners do not have to administer pills.

  • Antihistamines are sometimes successful in controlling itching. Although they have far fewer side effects than steroids, they are also far less reliable.

  • Moisturizing and soothing shampoos such as colloidal oatmeal shampoos may be helpful.

  • Fatty acid supplements may help to reduce itching.

  • A broad-spectrum dewormer may be used to help improve the general health of the cat.

    Home Care

    Give all medications as prescribed. Follow-up as directed to make sure that the condition resolves completely. Work with your veterinarian to establish a complete flea control program.

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