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Itchy Skin With Mild Erythema And Seborrhea Oleosa In A Cat

by Diewertje - September 30, 2019 View Case Report

Signalment
Age: 12 years
Sex: female spayed
Breed: DSH
Species: cat

Disease Notes
Certainty: confirmed
Comments: Hello,

Maybe you can help me with this case.
A 12 year old female spayed DSH.
Loves to be with the owners. Very social to humans, grumpy to the two other cats and sometimes also hissing to the dogs when they are to pushy.
Purrs really loud and makes some breathing noises during sleep(Damp)
Good appetite. She gets raw meat
She hunts a lot
Has one eye. the other one is removed 5 years ago because it looked like there where some melanomas in it.
Drinking increased the last two months
No information on her bowel movements and urine behaviour because she urinates anf defecates outside.
Episodes of vomiting slimy mucus with grass and hair.
She likes to lie in the sun.
Normal weight

Problem
Itchy skin started in spring this year. bloody crusts around the ears and in the neck. the itch got worse over time together with the processionary caterpillar plague.
In July the itch got worse and also her skin problems. It began with a small wet spot on her belly and it grew bigger and bigger. It now looks like a wet eosinofilic plaque.(wet, red pusteles )
She now is very busy with licking, scratching and biting her tummy, her hind paws and her head.
Her back looks fine.

TCM exam:
Pulse: full, wiry
Tongue: pale, wet and swollen. Underside looks purple.
Very grumpy, hates to be touched at her hindpaws, belly and hips. Skin: Wet and alopecia spots at her tummy(GV and stomach meridian), the inside of her hindpaws(spleen merdian). Crust around her ears, chin and neck. the spots on her tummy are red, hot and look like pustules.
Active points: GB34, GB41, SP4, Bl23 I tried to massage them because needling is not an option.I wasn't sure in the beginning about the active GB points so that's why I tried other formulas first.

TCM diagnosis: Spleen Qi def., damp heat in the skin, Shao Yang Disharmony

First I treated her with Chu Shi Wei Ling Tang because Of the pale tongue and the underlying SP deficiency. That did nothing.
After that with San Ren Tan because of the heat signs and the wet skin problems got worse. That didn't change a thing either.
Then I tried Qing Jing Tang because of the active galbladder points and progressed damp heat into blood heat. Only the tongue doesn’t fit the diagnose.
The itch got worse and she became more grumpy.
So Maybe not damp heat but a Shao Yang Disharmony?She is now on XCHT for almost 2, 5 weeks and it still looks the same. Also some new bloody crust and she is still licking and biting excessively. Still very crumpy.
I don't know what to do now. I thought about Bu Zhong Yi Qi Tang but I am not sure if that fits the symptoms. ( especially the increased thirst).
Can you help me?

by naturevet

October 4, 2019

Hi Diewertje

When I'm struggling with a skin case, it's worth trying the animal on a real food diet (no kibble, no canned, low starch) diet for a couple of weeks. If you see even partial improvements that are significant, you know it is a Damp Heat case. If they get worse or fail to improve at all, they are an immune case. Since this cat eats raw, if there is no kibble or canned food in the diet, we can be pretty sure it is an immune issue. if that is the case, then feeding the diet that the cat has done the best on in the past (even if it is not a real food diet) is a good idea while you are getting control of the problem.

The redness on the belly, chin and neck suggests Heat in the Yang Ming, and the ear involvement suggests Shao Yang, so I agree that XCHT was the place to start. Usually, to have the formula work, I have to combine it with a Blood tonic like Si Wu Tang, approximately 2 parts XCHT to 1 part SWT. Generally, Heat in the Yang Ming creates dryness which keeps the Heat going. It often needs to be moisturized (the damp appearance of the lesions notwithstanding). SWT addresses that.

One of our vets in Canada recently tried Chai Hu Qing Gan San for a stubborn Shao Yang case and had it worked. This formula has Blood and Yin tonics in it, plus additional Heat clearing and Wind Heat dispersing herbs. This may be an option for you.

If this is a XCHT case, you're battling the time of year (for this is when they often get worse). A higher dose may help of whatever you are using. Particularly if you are using the Kan products, the dose recommended on the label is far too low. You can obtain dosing guidelines here

Lastly, it is my belief that the gut and gut flora play a major role in Shao Yang cases in propagating the immune reaction. Making sure there is soluble fiber in the diet and also probiotics can undermine the gut flora issue that is priming the immune system. This is particularly true for animals being fed raw.

Hopefully these ideas help you out. I know how challenging these cases can be!

Steve

by Diewertje

December 14, 2019

Hai Steve,

Sorry for the late response but I have been very busy and occupied with this case.
I tried the Chai Hu Qing Gan San but it only resolved the big spot on the belly and the intense thirst. The scratching at the neck and head became worse. She was scratching so hard that it became bloody ulcerated crusts in the end.
Finally I put her on antibiotic because I was thinking of a stap. aureus infection. The antibiotics worked well on the infection but there was still the intense itch.
So I tried SWXFY in combination with Jin Qiao San. That worked a bit but she became more irritated again and the snoring and breathing sounds got worse.
Now I am trying your modified Wen Dan Tang and it seems that this is working for her. There is now one spot near Galbladder 21 which she licks and scratches but it is less often.
I also put her on probiotics.
Thanks for your help and your ideas.

by naturevet

December 16, 2019

Wow! Good for you for persevering! Did you mean Modifed Wei Ling Tang? Or are you using Wen Dan Tang (which I think of more for hyperthyroidism)?

S

by Diewertje

December 17, 2019

Hai Steve, it’s your modified Wen Dan Tang for hyperthyroidism. Because There was stil the wiry pulse and the skin spots on the gallbladder and stomach meridians, I was looking for a formula which adres both. So with the damp problems I thought of using the modified Wen Dan Tang. The cat has no hyperthyroidism but with the TCVM symptoms and diagnosis it was worth the try.

by naturevet

December 17, 2019

That's fascinating! Thanks for sharing your experience!

Steve

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