Untitled Quiz

Overview

• Feline acne is an inflammatory skin condition that affects the chin and lips of cats.
• Symptoms can occur repeatedly or persist for long periods of time.

Causes & Risk Factors

• The exact cause of feline acne is unknown.
• Common associations include allergies, abnormal keratinization, poor grooming, excessive oil production, suppressed immune system, viral infections, and stress.

Signs

• Cats may experience a single episode, recurrent issues throughout their life, or constant symptoms.
• The frequency and severity of each occurrence varies between individuals.
• Symptoms can range from mild to severe including:
  • Comedones
  • Red papules
  • Serous crusts
  • Dark keratin debris on the chin and lips
  • Chin swelling
  • Nodules
  • Hemorrhagic crusts
  • Pustules
  • Cysts
  • Fistulae
  • Intense redness (erythema)
  • Hair loss (alopecia)
  • Pain
  • Bacterial furunculosis frequently causes pain.

Diagnosis

• Skin scrapings are used to diagnose demodicosis.
• Bacterial cultures are used to identify resistant infections.
• Fungal cultures are used to diagnose dermatophytosis.
• Cytology is used to detect bacteria and Malassezia.
• Biopsies are rarely required and used to characterize changes such as cystic follicles, differentiate acne from other conditions including demodicosis, infections (bacterial, yeast, or fungus), and diagnose neoplasia.

Treatment

• Initial treatment includes:
  • Gently clipping hair.
  • Soaking the affected areas to soften crusts.
• Food elimination diets can be beneficial.
• Intradermal allergy testing.
• Topical therapies include:
  • Shampoos (antiseborrheic)
  • Cleansing agents
  • Medicated wipes
  • Antibiotic ointments
  • Other topicals
  • Combination topicals
  • Topical retinoids
• Systemic therapies include:
  • Antibiotics
  • Prednisolone
  • Isotretinoin
  • Cyclosporine

Follow-Up

• Treatment should continue until all lesions have resolved and tapered over 2-3 weeks.
• Monitor for relapses.
• Maintenance cleansing programs minimize relapses; affected cats may develop comedones throughout their lives, which are often cosmetic, and treatment may not be required.
• Recurrent episodes: once the recurrence rate is established, develop an appropriate maintenance protocol for each affected cat.
• Continual episodes: life-long maintenance treatment is necessary.

Medications

• Shampoos:
  • Sulfur-salicylic acid
  • Benzoyl peroxide
  • Ethyl lactate
• Cleansing agents:
  • Benzoyl peroxide
  • Salicylic acid
  • Chlorhexidine
  • Phytosphingosine
• Antibiotic ointment:
  • Mupirocin 2%
• Other topicals:
  • Clindamycin
  • Erythromycin solution or ointment.
• Combination topicals:
  • Benzoyl peroxide-antibiotic gels
• Topical retinoids:
  • Tretinoin (e.g., Retin-A® 0.01%)
• Systemic antibiotics:
  • Amoxicillin with clavulanate
  • Cephalosporins
  • Fluoroquinolones

Pregnancy, Fertility, and Breeding

• Systemic isotretinoin should not be used in breeding animals.

Contraindications/Possible Interactions

• Benzoyl peroxide and salicylic acids: can be irritating.
• Some wipes contain alcohols: can be irritating.
• Systemic isotretinoin:
  • Use with caution if the animal will not allow topical medications.
  • Potential side effects on humans (drug interactions and potential teratogenicity).
  • The container should be labeled for animal use only to avoid accidental use. It should also be kept separate from human medications.
  • Currently difficult to obtain for animal patients.

Miscellaneous

• Suggested Reading:
  • Jazic E, Coyner KS, Loeffler DG, Lewis TP. An evaluation of the clinical, cytological, infectious and histopathological features of feline acne. Vet Dermatol 2006, 17(2):134–140.
  • Miller WH, Griffin CE, Campbell KL. Acne. In: Muller & Kirk’s Small Animal Dermatology, 7th ed. St.Louis, MO: Elsevier, 2013, pp. 640–642.
  • Rosencrantz WS. The pathogenesis, diagnosis, and management of feline acne. Vet Med 1993, 5:504–512.
  • Werner AH, Power HT. Retinoids in veterinary dermatology. Clin Dermatol 1994, 12(4):579–586.
  • White SD. Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96). Vet Dermatol 1997, 8:157.
• Author: David D. Duclos
• Consulting Editor: Alexander H. Werner, Resnick