Acne in Cats

Overview of Feline Acne

Feline acne is a relatively common problem in cats. It is a life-long skin disease limited to the chin and lips. Unlike human acne, it is not limited to puberty.

Feline acne starts at around one year of age and may have periods of remission and periods of exacerbation. It often begins as tiny plugs of dark material, like blackheads, around the hair shafts of the chin and lower lip. These do not bother your cat, although they may progress to red, infected bumps that can be itchy and painful. Hair loss and loss of pigmentation may occur in chronic cases.

The exact cause of feline acne is not known. It is thought to be a disease in which an excessive amount of oil is produced from oil glands that plugs the hair follicles. Since it is seen in both male and female cats, hormones do not seem to play a role.

What to Watch For

The frequency and severity of symptoms vary with each cat.

• Formation of blackheads on the chin and lower lips
• Swelling of the chin
• In severely affected cats:
• Redness
• Hair loss
• Pain\

Diagnosis of Feline Acne

• The diagnosis of feline acne is mostly based on clinical signs. There are, however, other diseases that may look similar to chin acne. Your veterinarian may do deep skin scrapings and fungal cultures to rule out the possibility of mange and fungal infections.

Treatment of Feline Acne

• Some topical products used for human acne have been tried in cats with good success. They include topical retinoids, benzoyl peroxide, topical antibiotics and steroids.
• Many cats develop yeast infections on their chins so topical antifungal creams are commonly recommended. Many of these products are over the counter and include topical miconazole and clotrimazole. These products are very safe in cats and are usually used twice daily for a minimum of two weeks.
• Oral retinoids can be tried in cats with acne. They are quite expensive and take several weeks to work. Assessment of the efficacy is done after the first month. If your pet responds to this therapy life long treatment is usually required. These drugs may induce liver damage and periodic blood work is recommended to monitor liver function. In addition these drugs are teratogenic (they cause malformation in the fetus), thus should not be used in pregnant animals.\

Home Care

• At home, you may be asked to do daily soaks with Epson salts or apply antibacterial and/or antifungal creams on the chin to disinfect the area. Topical therapy may help promoting the drainage of these lesions. It is important that topical therapy is not too aggressive to avoid trauma in the area and excessive scarring. Clipping of the area may increase the efficacy of topical therapy.
• You may be asked to wash the chin with medicated products once or twice weekly to remove the scabs and the excessive sebum from the skin. A contact time of 10 minutes is recommended.
• In severe cases you may be required to administer systemic drugs. They include oral antibiotics, oral antifungal drugs, oral steroids or oral retinoids. The antibiotics are usually given for several weeks. They may cause stomach irritation and nausea causing loss of appetite (anorexia) and diarrhea. Antifungal drugs have the potential of inducing liver disease, thus any loss of appetite should immediately reported to your veterinarian. Other adverse effects include vomiting and diarrhea.
• You should monitor your cat closely and call your veterinarian is necessary.

In-depth Information on Feline Acne

Feline acne is a skin disorder that generally affects the chin and the skin around the mouth (perioral skin). The cause is not known and the exact pathogenesis (development) has not been established, although various factors have been hypothesized to play a role. They include poor grooming habits, seborrhea, stress, and viral infections. Hormones do not seem to play a role, as sex predilection is not observed.

Feline acne is considered a disease of keratinization in which excessive sebum is produced leading to follicular dilation and comedo formation. It appears to have a different clinical behavior from canine acne, as the disease in cats is not limited to puberty. The condition can be cyclical. It starts at less than one year of age and remains in most cases a life-long condition.

Various organisms may be isolated from the skin of affected cats. They include Pasteurella multocida, beta hemolytic Streptococcus, and Staphylococcus. In addition, Malassezia is commonly found on cytological examination of the material extruded from the blackheads.

Comedones (blackheads) are the first lesions noted on the chin. They result from follicular dilation and plugging with excessive keratin formation. Erythema and alopecia may be present in more advanced cases.

A brown/black discharge may be prominent in cats with a secondary Malassezia infection. Papules, pustules, firm nodules and fistulous tracts may develop as a consequence of a bacterial infection (folliculitis and furunculosis). Lesions ulcerate and discharge a purulent exudate.

Swelling of the chin is variable but it could be severe in some cats. Regional lymphadenopathy (swollen lymph nodes) may be prominent and pain and itchiness may be intense in cats with a secondary skin infection. Cysts may develop in chronic cases.

Diagnosis In-depth

Diagnosis of acne is usually based on physical examination findings. Sebaceous (oil) glands are usually enlarged. Differential diagnoses include dermatophytosis (fungal infections), and feline demodicosis (mange). Eosinophilic granuloma may be considered as a differential diagnosis in cats with a swollen chin.

Tests may include:

• Deep skin scrapings to rule out demodicosis, skin cytology to evaluate secondary bacterial and yeast infections and fungal culture to rule out dermatophytosis
• Skin biopsy to reveal follicular dilation and keratosis (comdeones). Folliculitis and furunculosis may be present in animals with a significant bacterial infection. Yeast organisms may be visible inside the follicles. The inflammatory infiltrate is mainly composed of neutrophils and macrophages and is focused on the hair follicles.

Treatment In-depth

In mild cases topical therapy may be sufficient. Topical therapy should be done gently and aggressive scrubbing of the lesions should be avoided to limit scar formation. It could exacerbate the inflammation. Clipping of the area may be helpful to increase the efficacy of topical therapy. Additional treatment may include:

• Soaks with Epsom salts to help promote drainage of the lesions
• Benzoyl peroxide gel (5 percent, Oxydex® gel, Pyoben® gel) may be used daily on affected areas. Benzoyl peroxide combines a good antibacterial action against Staphylococcus with a follicular flushing property, which helps in cases of comedones. Benzoyl peroxide may also be used as a shampoo once or twice weekly. It could be irritating in some animals.
• Antiseborrheic shampoos (e.g. SulfOxyDex®) to remove crusting and excessive sebum from the skin
• Tar should not be used in cats due to its toxicity in this species.
• Another topical product that is effective in feline acne is mupirocin (2 percent ointment, Bactoderm®). The efficacy was evaluated in an open, prospective study and mupirocin was used twice daily for three weeks in 25 cats with acne. Excellent response was reported in 15 out of 25 cats while good response was observed in 9 out of 25 cats. Treatment was discontinued in one case due to local irritation. Resistance may develop with prolonged use.
• Topical clindamycin (Cleocin®) has been reported to be very effective in cases of feline acne is a small preliminary study.
• Topical glucocorticoids (e.g. Synotic®) to decrease the inflammation and the granulomatous infiltration triggered by the keratin.
• Topical vitamin A and topical retinoids
• Topical metronidazole
• Topical preparations effective against Malassezia include miconazole and clotrimazole. They are available as lotions or creams. Topical therapy should be used twice daily for a minimum of two weeks.
• Selenium disulfide is a good antiseborrheic product effective for yeast infection but it should not be used in cats, due to its potential for toxicity in this species.
• Retinoids have been tried and been successful in about 30 percent of the cases of feline acne. They work by normalizing epidermal proliferation and decreasing sebum production.
• Systemic treatment in severe cases
• The duration of the systemic antibiotic therapy depends on the severity and depth of the lesions (average case may require 3 to 4 weeks of antibiotic).
• Antibiotics with activity against Staphylococcus and Pasteurella (e.g. amoxicillin/clavulanic acid)
• If severe inflammation is present systemic glucocorticoids may be needed. A 10 to 14 day course of oral prednisone is usually sufficient to decrease swelling and pain in affected cats.
• In cases complicated by secondary yeast infection, antifungal therapy may be necessary. Depending on the severity and the number of yeast found on cytology either topical or systemic therapy can be used.
• Oral itraconazole is preferred over ketoconazole as it is better tolerated in cats. It should be given for at least two weeks. Itraconazole is available as a solution (Sporonox®), which makes administration to cats easier. Adverse effects of itraconazole therapy include anorexia, vomiting, and diarrhea. Griseofulvin is not an effective treatment for yeast infection.
• Clinical response is usually seen within 30 days. Oral isotretinoin (Accutane®) is the one most commonly used. Animals that respond to this therapy may require it as a life long treatment.