I have a cat scratching itself raw. What is the cause and treatment?

Original Question: For the past 2 months my indoor only cat Dexter has been licking and scratching himself more than normal. The amount of licking and scratching has increased throughout this time to the point where he's doing so every 15 seconds. The apparent itching / discomfort appears to mostly be around the neck and shoulder areas, and he's developed small scabs around the back of the neck and shoulders from where he's clawed himself. I'm concerned about possible infection, and his obvious discomfort. My vet's only advice was to get a flea collar, despite my mention that he's an indoor cat, my wife is allergic to fleas and has experienced no bites, and we have never seen a single flea when inspecting his coat and/or brushing over white paper looking for flea poop. We now don't know if the reason for his itching is: dust mites, a food allergy, mold or dust from forced air, cat litter allergy, stress, or maybe even arthritis. We did move around 4 months ago, so I suppose stress could be a factor, yet we've moved many times before and have never experienced this. I don't know what to do. I'm not a fan of using toxic chemicals / flea collars, especially since that doesn't seem to be the culprit. Diet changes can take many weeks to notice changes, and I don't even know what food to use. I'm not a fan of the Hills Science allergy foods because they have a lot of artificial ingredients and my old cat's fur went from shiny to dingy when on that. I also don't want to use Atopica (which almost killed my last cat Phoenix, who also experienced chronic itching). Phoenix experienced strokes and one of his pupils became massively dilated when on that drug. He was then put on steroids for the last two years of his life, which helped with the itching but probably contributed to his death. Since my cat is a very picky eater, I'm not sure what food changes to try, especially when he needs a mix of soft and dry (soft for moisture, and dry for when we're not home). I've read that dust mites are a very common problem, yet I'm not sure how to rule that out. We try our best to keep the floors clean and things washed, but it seems impossible to clean every surface. Regarding cat litters, I've always suspected the dust or fragrances could cause issues. We get the 99% dust free no fragrance brand. The non-stone litters are very messy or way too expensive, so not really sure what to do with that. Any help would be greatly appreciated. My vet requires me to bring in Dexter for advice, yet that only contributes to his stress. I'm not sure how to narrow down the culprit of his issue. The last thing I want to do is put him on toxic medications that will probably cause further complications / stomach upset / etc. I also worry that his scratching will cause an infection and having to put him on antibiotics can cause problems as well. Please help! I'm willing to reciprocate for your advice. I'm a graphic designer and could offer my time in exchange for your knowledge. Thank you kindly. Any help would be greatly appreciated. I don't want to take him back to the vet again, only to stress him out even further. Thanks. - Derek

Dec 27, 2018

Hi Derek,

Thanks for submitting your question. Sorry to hear that you’re dealing with this but I think I can help.

The most important thing here is to stop guessing. We need to start determining what’s going on. The first thing I want you to do is to visit your veterinarian and have a skin scraping performed. This is a quick inexpensive test where they scrape the top layer of the affected skin and look at it under a microscope. This is then evaluated for bacteria, yeast and ectoparasites. During this test, your cat’s coat should be examined for evidence of fleas or flea dirt. If they are present then some evidence should be easy to find. If we perform tests then we can eliminate the guesswork. This needs to be done before any discussion of allergies or diet is entered into.

Make sure you speak to your veterinarian about a reliable treatment plan for any of the infectious agents found on the skin scraping. Keep in mind that an underlying disease could be present with one of these infectious agents as a concurrent condition. If treatment for the cause is unsuccessful, then I would investigate the possibility of an underlying disease that allowed the infectious agent to become a secondary issue.

I recommend you perform blood work and urine testing to make sure there are no underlying health issues that could interfere with the body’s ability to fight an infection. If this is negative as well, then you could consider a skin biopsy as the next step. Many cats will have skin lesions due to complicated immune conditions that biopsies could diagnose. You have to remember that a diagnosis of allergies is really something that should occur after all other causes are eliminated since there is no confirmatory test for it. As a side note, you could always consider requesting a referral to a veterinary dermatologist. They deal with complicated dermatological cases such as these that have been difficult to diagnose and that have not responded to recommended treatments.

You’ll notice in my answer so far I have not mentioned diet at all. I recommend you stop thinking about diet as a treatment at this point until you achieve a diagnosis. The diet typically comes into play if we’re dealing with allergies. You cannot be certain about allergies in any way at this point until the infections are identified and eliminated. So I recommend everyone stop guessing, perform the tests, confirm the diagnosis, and implement the correct treatment. Otherwise, this problem may persist and cause further cost and distress to you and discomfort to your cat.

If you perform these tests and don’t achieve a diagnosis, only then would I consider allergies. I would recommend that you look at our resources about allergies. We have videos and articles that discuss it in depth from diagnosis to treatment.