Page 1096 - Problem-Based Feline Medicine

1088 PART 13 CAT WITH SKIN PROBLEMS

search for foreign bodies. Treatment course should be Indolent ulceration presents as a progressive erosion
prolonged for 3–4 months. on the upper lip and/or nasal philtrum region.
Botryomycosis: En bloc excision combined with long
duration anti-staphylococcal antimicrobials (e.g. Diagnosis
cephalexins 22 mg/kg twice daily).
Diagnosis is based on clinical and histological appear-
Plague: aminoglycosides, tetracyclines and trimetho- ance.
prim-sulfur are effective, but penicillins are not.
Histopathology of eosinophilic plaque shows severe
L forms: are exquisitely sensitive to tetracyclines (e.g. spongioisis, and intense neutrophilic and eosinophilic
doxycycline 5 mg/kg/day). dermal infiltration. Peripheral blood eosinophilia is
often present.
Prognosis
Indolent ulceration has a very characteristic clinical
Prognosis varies from fair to good depending on the appearance. Histopathology is non-specific but rules
practicality of surgical excision, and presence or out neoplasia. Blood eosinophilia is absent.
absence of dissemination.
It is important to note that indolent ulcer and
eosinophilic plaque are clinical symptoms, and are
Prevention
not a diagnosis. The underlying allergy needs to be
For plague, strict flea control in endemic areas is indi- determined.
cated. ● Allergy investigation involves a flea elimination
trial, a food allergy trial using a novel protein for
Zoonotic potential 6–12 weeks, and intradermal skin testing for atopy.

Plague (Yersinia pestis) is an important zoonotic
organism, and great care should be taken so that
Differential diagnoses
human infection does not occur from suspect cats. The
relevant authorities should be notified. Differential diagnoses which should be considered for
eosinophilic plaque include pyoderma, lymphoma and
mast cell tumor.
FELINE EOSINOPHILIC GRANULOMA
COMPLEX *** The differential diagnosis to consider for indolent
ulcer is neoplasia.
Classical signs
● Glistening, erythemic plaque (eosinophilic Treatment
plaque).
Specific treatment involves treating the underlying
● Ulceration of the upper lip adjacent the
cause using flea control, dietary allergen avoidance or
philtrum (indolent ulcer).
hyposensitization for aeroallergies.
Non-specific treatment to reduce inflammation
Pathogenesis
involves use of corticosteroids (2–4 mg/kg daily) until
Eosinophilic plaque and indolent ulceration are cuta- signs are controlled, and then reducing dose to low-
neous reaction patterns in cats associated with allergic dose alternative day therapy.
skin disease. ● Chlorambucil, aurothioglucose and progesta-
gens may be indicated if specific therapy and corti-
costeroids are not effective. Use of progestagens is
Clinical signs
discouraged because of the high incidence of drug-
Eosinophilic plaque presents as variably sized, induced complications.
alopecic, glistening, red plaques most commonly found ● Cyclosporin 5 mg/kg/d (not registered for use in
on the ventral abdomen and medial thighs. cats).