Question Details
Facial Itching In A Cat
by crowleykatherine - August 8, 2023    View Case Report
I had a 9 month old CM feline that presented 8 months ago for facial pruritus and facial lesions. Bloodwork revealed a HCT of 9.5 with lymphocytosis, FELV/FIV/HW- neg. He responded well to prednisolone and it was slowly tapered over the course of 6 months. Now he has been completely off the red for about 2 months and the facial pruritus and lesions are starting again. The HCT is normal at 36 %.
Pulses were difficult to palpate - he is very shy and crouches into a ball during exams, his tongue is pink/red with mild gingivitis. O states that he is more heat seeking. He is on a diet of kibble and canned food. O has not offered real foods, but is open to adding them.
Please let me know if I should be looking to treat the blood xu, dispel wind and relieve damp and what would be recommended?
Thank you,
by naturevet
August 18, 2023
Hi Katherine,

That was a bizarre initial presentation. At present, if it's just the skin, then given the 'dependency' on pred, the facial inflammation and the use of a processed food, I would target the Spleen and Dampness first. It's Spleen deficiency that leads to vacuities (e.g., of Blood) that allow easy Wind invasion.

To make a stab in that direction, I'd be tempted to try Si Miao San (Four Marvels). Even if it doesn't eradicate the problem, it may greatly reduce the required dose of pred to keep the cat symptom-free. If it does work, then you know that the diet is the culprit

The alternate approach is to use Minor Bupleurum (Xiao Chai Hu Tang) on the assumption that the initial presentation was one of immune mediated disease that included a mitogenc response (i.e., lymphocytosis) and even a blood dyscrasia. Minor Bupleurum treats Shao Yang disharmony. Shao Yang disharmony is associated with excess systemic immune reactions. In Chinese medical terms, it is commonly associated with the entrapment of Yang in the Yang Ming, which can reflect itself in facial inflammation.

One of those two approaches should work. I guess I would be tempted to try Minor Bupleurum first.

Hope this helps!

by crowleykatherine
September 11, 2023
Hi Steve,
I just wanted to give you a quick update. Nacho is doing well !!!! We have been tapering the prednisone down and the owners started him on Four Marvels. They have not introduced real foods, but they are planning to start soon. I will send another update once he is completely off the prednisone.
Thank you and have a great day!!!
by naturevet
September 19, 2023
Great news, Katherine! It's always refreshing to hear when things are going well instead of when there are problems!
Reply to this question.
You must be logged in to reply