Diagnostic approach to the pruritic cat

Managing cats with pruritic skin diseases can be challenging. The diagnosis can be extremely difficult, unless a cat is presented with a heavy flea burden! Some owners, further more, do not believe that their cats are pruritic and they may present them to the practice for apparently spontaneous lesions, such as eosinophilic plaques, and alopecia. As with all pruritic animals (Figure 1), it is imperative to use a systematic approach to diagnosis. This uses the history and clinical signs to give the differential diagnosis. The appropriate tests can then be used to rule out certain conditions and confirm the diagnosis.

History taking is very important as it can help to establish some important points. Table 1 outlines some of the questions to ask. These will help formulate a differential diagnosis list.

It is also useful at the first consultation to use a scale to map how pruritic the owner perceives the cat to be, if at all. This can then be asked at every appointment to see whether the pruritus is getting better or not. The scale outlined in Figure 2 (modified from Peter Hill and colleagues) can be used: