Now I am glad to hear that the hair loss pattern doesn’t look like round sporadic lesions, as that would suggest ringworm. Furthermore, it is good that we are not seeing any gross changes to the skin as severe itchiness with ulceration could indicate mites/mange. And a lack of pustules tells us that we don't have bacteria complicating things.
Now when we have such extensive hair loss over the back, tail base, tail, and inner thighs; this suggests we have an issue with overgrooming even if we aren’t seeing her scratch excessively. Now as I am sure you can appreciate overgrooming can be due to a range of issues. When we consider these triggers, we tend to be able to divide them into two categories: allergy/irritative causes for overgrooming and stress/anxiety reasons for overgrooming.
Now based on your history and the distribution of her hair loss, I would be highly suspicious of a low grade allergy driving this situation as opposed to stress based overgrooming. Of course, a lack of seeing her groom excessively is common with stress overgrooming but those cats typically will target the belly, flank, back legs, and not bother with their back. So, we’d want to keep stress based overgrooming in the back or our minds but focus on addressing irritative skin issues first.
Therefore, if our top concerns for your gal will be potential allergies or topical irritants playing a role here, then we have a range to consider. Allergies can literally be from anything she is in contact with. This includes allergens like food proteins, pollens, flea saliva, laundry powders, and dust mites. Again we can see them react to literally anything, so we do need to be aware of this. And in the case of a cat that is spending more time outside, flea saliva allergies and pollens are going to be the top of our list.
Just to note, milk protein would be a potential consideration, but isn’t an overly common one with skin allergies (we are more likely to see diarrhea). Furthermore, food allergy cats tend to be itchy everywhere and therefore will target easy to reach places (ie belly, flanks, thighs, and end of the tail). That said, for the sake of making sure she isn’t a rare milk allergy kitty, it’d be worth stopping this for the next 6 weeks to just make sure it isn’t playing a role here.
Otherwise, in regards ***** ***** her situation, the first step is to make sure we rule out fleas properly. Ideally, as she will be due for treatment next week, we would want to use a good quality flea treatment (ie Advocate, Advantage II, Activyl, etc). If we wanted to just rule out mites at the same time, Advocate would be the one to use here (since it does flea, lice, and mites).
Further to this, since flea allergy can literally be caused by a single bite (even if the cat is on treatment and the flea dies afterwards) and to also rule out/address pollen allergies, it’d be worth considering a trial with an anti-histamine. Anti-histamines can settle allergic skin reactions in early stages or mild cases since the skin irritation is an allergic response. Typically in these cases, we will use Piriton for these wee ones (ie 1-2mg or 1/4 – 1/2 tablet of a 4mg Piriton tablet up to twice daily). Do note that while anti-histamines will break that itchiness cycle and give her skin the chance it needs to settle, it can make kitties drowsy. Therefore, we always keep the dose low and if she were to be drowsy on this, then we'd reduce the dose to once daily for her. And of course, this medication shouldn't be used if your kitty has any pre-existing conditions or are on any other medication without speaking to your vet. That all said, if you treat her with this and she doesn't settle or her irritation is very severe (which doesn’t sound the case), then she may require a long acting injection of a steroids to allay the allergic skin response and associated itchiness. But if we have mild signs of allergic overgrooming, this can help settle the drive to groom and give her skin and coat the peace it needs to regrow her coat.
Overall, her signs suggest a focal irritation of her skin as opposed to a stress based overgrooming or diffuse food allergy. Therefore, your approach here needs to be to settle the irritation for her. So, we would want to consider using antihistamines and a good quality flea treatment (ideally that will do mites and lice too) at this stage. If we can allay the grooming she is doing with this, then we should see her hair regrow for us.
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