Vet School 101 Kitty acne and other unsightlies: Eosinophilic ulcers and plaques in cats
One of our technicians brought in her unhappy kitty named Gizmo last week. Gizzie had been pawing and scratching his chin raw. Beyond the common chin acne some cats can get, this feline patient sported an abundance of bleeding pustules beyond the pallor of the standard blackheads and pimples we often see secondary to ingrown hairs (all that chin rubbing sometimes takes its toll).
Though not quite akin to the adolescent acne humans often suffer through, cats can still manage a passing imitation of a pimply-chinned teenager—at all life stages.
Sometimes it’s the result of sensitivity to plastic food bowls—but more commonly it’s from rubbing their chins along every surface that makes itself available to convey their pheromonic presence.
And then there are cats like Gizmo, whose level of inflammation on their chins and other parts rivals that of any seriously afflicted human adolescent’s—and in many cases looks much worse.
Though these occur most typically on chins, lips and noses, they can also occur anywhere on their skin in crusty, reddish, plaque-like lesions. Alternatively, they can look like chronically ulcerated spots. The latter variety can look so angry and ugly they’re commonly mistaken for bite wounds—until they fail to go away, even after weeks of antibiotic therapy.
Here's one variety we call a "rodent ulcer":
Here's a plaque on a paw:
And yet another on a nose:
One lowly bit of equipment, however, can lay all doubts to rest: the handy microscope slide. In this simple test, the plaque, crust or ulcer is smeared with the slide to rub cells off its surface. The slide is then stained and the cells are viewed under the microscope.
Nine out of ten times, feline lesions that look this nasty will shed cells that look like bursting raspberries: eosinophils, they’re called. Here's a pic:
Eosinophils are white blood cells that occur naturally in the blood in tiny percentages. More often implicated in allergic reactions, they aren’t commonly seen in most wounds when subjected to the impression smear test described above. Hence, when we do see these cells we know we’ve got a very characteristic condition on our hands: the eosinophilic granuloma complex.
Veterinary dermatologists will tell you that these lesions obnoxiously defy reason. We don’t understand why some cats get them and others don’t. We don’t know how to make them go away once and for all (though they do respond amazingly well to the strong immunosuppressive action of corticosteroids like prednisone). And we have no idea what brings them on, though stress seems to play a role in these cats’ eosinophilic flare-ups.
Gizmo’s impression smear confirmed his diagnosis: an eosinophilic plaque leading to deep furunculosis, a kind of skin infection with nasty draining tracts of pus. A week of prednisone and one shot of Convenia (a one-dose antibiotic) later, the wound is barely there.
It’s kind of amazing, actually, that a sore so serious could have received the heave-ho so quickly. Nonetheless, it’s likely to return. And then Gizmo’s owner will have to decide: How many shots and pills will she have to give over his lifetime to keep his chin happy?
I wish there was a better way. But when it comes to eosinophilic plaques and ulcers it always seems to come down to the complex calculus of steroid side-effects versus basic comfort. Maybe one day we'll look back and marvel at our medical stupidity when it comes to treating these lesions. In the meantime, steroids and antibiotics it is...
October 1st, 2008
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Add Comment13 Comments
Eos are so prettttttty...
Megan October 1st, 2008 10:32:00 AM
My boy Spider has a flare up of this eosinophilic granuloma thingy at the mo (on his bottom lip though).
He had it first many years ago, and I think it was due to my painting the flat back then. Funny enough, I just had the outside of my house painted, which makes me think that this is the cause of the recurrence - whether it´s just the fumes or he came in contact with the paint, I don´t know, but it´s the same unsightly "fat lip" that looks like an ulcer/large white-yellow spot on his lower lip. Like you said, some say it could be stress - of course there was the stress of the painters being in and out and around the house for a few days, and the noise - things that throws kitties´ usual routine out the window....
The first time Spider had it (and he had one recurrence after that, until this week) I was worried that it was malignant and the vets did a biopsy which turned out normal (relief!), and the lesion eventually disappeared again after a few weeks without any treatment. I will of course watch him closely with this again, but so far it hasn´t got any worse (or any better yet) - at least he doesn´t appear in pain, which is a good thing....
Barbarella Buchner October 1st, 2008 11:41:00 AM
I agree...there's not one cell I can point to that's as aesthetically pleasing as an eosinophil. Can you?
Dr. Patty Khuly October 1st, 2008 11:44:00 AM
My late lamented tuxedo kitty, Kuttatoa, fought this for about a decade.
A particular treatment would work for several years, then stop working, and we'd be back to grasping for something else. We toggled between various forms of steroid.
The apex came when he jumped into my lap one day and I felt multiple large "tumors" all over his belly that had not been there the day before.
His nipples were crusty and reddened.
Rushed to the vet, vet squeezed a "tumor," and out squirted -- MILK.
Neutered male cat, folks.
Vet looked at me, agape, and asked "Well what do you think is causing THAT?!"
Holy shit -- how am I supposed to know?! Isn't that what I pay YOU for?
The vets finally decided that a recent change in medication had confused the crap out of his adrenal glands, which decided it was time to get some lactatin' on.
It did go away; I was seriously considering getting him some foster kittens for a while there.
Anyway, we called it the Liprosy, and it sucked. Stank, too, literally. And clearly itched.
I hope somebody figures it out someday. Nobody should have to go through what that sweet, tolerant cat had to endure.
H Houlahan October 1st, 2008 11:53:00 AM
I feel pretty lucky that none of my cats had that mess!! That looks scary and painful.
Dr. K. is the drug Atopica a possibility for felines? So many dog people (different breeds) have called it a savior for skin disease.
And how about when eosinophils are found in interior "body cavity" tumors or necrotic tissues, etc. What is the significance of that in the way of disease process or cancer? Curious.
Barbara A. Albright/New Hampshire October 1st, 2008 08:19:00 PM
My poor pooky has recurrent rodent ulcers, and I just can't do the Depomedrol thing to her anymore.
A couple things that have helped her, despite their being totally alternative and not at all scientifically proven, are the homeopathic remedy Lachesis mutus (suggested by an Israeli vet who's had good success with EGC and certain homeopathics), and adrenal glandulars. Her ulcers aren't cured, but she sure is a lot better off than when she was smacked with repeated rounds of Depo.
Darned persistent ailment, it is. Grr. And so individual. My kitty doesn't respond at all to any traditional therapies besides the Depo. Hope someone figures this one out someday.
LaShelle October 1st, 2008 09:59:00 PM
Yikes, totally didn't mean to plagiarize H Houlahan with my last line. Musta been stuck in my head while I was writing. Anyway... what she said!
LaShelle October 1st, 2008 10:02:00 PM
I have 3 littermates that suffer with EGC and for what it's worth this is what I have had success using(Dr. Khuly pipe in any time) Sebastian had a rodent ulcer since the Hurricane Katrina evacuation, tried sever rounds of Depo with temoporary success. I used homeopathic Kali Bich. and it started to reduce in size. During this treatment I found the EGC plaque on his inner thigh that I hadn't noted previously. I started applying Bee Propolis and calendula lotion at least one a day and saw a little improvement but ended up having to put an e-collar on him to stop the licking. I was seeing slow improvement so I put the propolis and calendula on the ulcer. Both cleared up after a couple of weeks and haven't returned in almost a year.
Steinway only had the EGC on his thigh so with the same topical application and an e-collar his dried up and started growing hair in a week. Don't know if the fact that this was the first time he had shown any sign of EGC contributed to the fast recover or not. He also has not had a reoccurance in almost a year.
Yoshi is still a work in progress with only the rodent ulcer.
Sorry for the lengthy post
Patty P October 2nd, 2008 06:58:00 AM
On the use of cyclosporine (Atopica): I haven't had much luck with it with EGCs, though most derms seem to think it's worth a try for the severe cases that don't respond completely to steroids and seem everpresent.
Dr. Patty Khuly October 2nd, 2008 08:21:00 AM
Thanks for the new ideas Patty P, I will have to try the calendula and propolis! :)
LaShelle October 3rd, 2008 12:47:00 AM
We have a cat who for 17 months has chewed his back paws to pretty much mush, he has been through every treatment there is including cortizone, prednisone, anti-fungals, antibiotics, treatment for ringworm, allergy shots, and changes in food and environment. Our vet found out about Atopica for felines and our cat has been on this treatment for nine weeks, 10mg once a day and his situation has completely resolved. Check with your vet to see if you can try Atopica. Our cat has had no adverse affects, his paws are healed and his hair is growing back, we are thrilled.
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