The dilemma in Alfie's situation is that the presence of the pimples tell us that we have secondary infection here. This means that while something made Alfie scratch the area initially -- be it allergies (ie to flea saliva, pollens, dust mites, carpet powder, etc) or even due to ear disease (ie ear mites, infection, cysts, etc) -- we also have a bacterial infection on his neck and back that will also be making him itchy. Therefore, the first step to addressing Alfie's skin would be to settle the bacterial infection and then address the underlying cause.
In regards XXXXX XXXXX these bacterial pustules, your approach will depend on how diffuse they are. If there are just a few, you can consider salt water bathing (1 tbsp salt to a pint warm water) the area to dry out and address the infection. Creams are often not helpful in cats (not only do they dislike them but they are often licked off before they can do any good) and therefore would not be advisable here. And if the pustules are numerous, then he may need oral antibiotics to settle this (a means of treating the infection without stressing the cat or owner and something the cat cannot just lick off).
Further to both of these, you do need to take steps to keep him from scratching the area so that it can heal. This can include via keeping his back nails short (to limit damage), covering his feet with baby socks or using Soft Paws (http://www.softpaws.com/), or even putting a baby t-shirt on to protect his back while it is healing. A buster collar could also be an option but from your description I do think that would be of limited use for your lad at this stage.
Once the bacterial infection is in hand, you need to start considering the underlying causes. If his ears smell or full of discharge, then this would given us a hint that ear disease was our likely trigger and this would require a visit to the vet for appropriate treatment. If the ears are clear, then we'd need to consider other differentials for his itching. And that case, we'd need to start thinking about allergies. Now if there has been no change to his diet (including no "new recipe" or flavor to his Go-Cat), we can put this lower on our list of concerns. Furthermore, since we are seeing this issue along the top of his back, contact allergies would be less likely. Therefore, we'd have to consider the possibility of pollen based, environmental (in the house), and flea saliva based allergies.
Now I do want to note, since I see you are using Frontline, we have been seeing some resistance to this treatment here in the UK. That means that it is possible that even with monthly treatment, Alfie could be at risk of a stray flea giving him a nip and setting off an allergic skin disease for him. Therefore, since we are seeing flea resistance to this and since you have noted a very characteristic flea allergy dermatitis area/pattern on his skin, I would strongly advise considering changing flea products to make sure that this isn't the reason triggering his signs. Good quality alternatives would include Advantage II, Advocate, or Activyl. So, if you have not flea'd him in the past fortnight, then consider doing so with one of these alternatives to make address and/or rule out this as a basis of his initial itchiness.
Otherwise, we also need to address the allergy portion of his skin flare-up to stop his itching. To do so, we can give use antihistamines. 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 his skin the chance it needs to settle, it can make kitties drowsy. Therefore, we always keep the dose low and if he were to be drowsy on this, then we'd reduce the dose to once daily for him. 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 him with this and he doesn't settle or his irritation is very severe, then he may require a short course of a stronger treatment like steroids.
Overall, if Alfie has pimples along his neck and back, then we do have to appreciate that he has a bacterial pyoderma and this will be causing itching for him. That said, I would be concerned that this is a secondary issue and that there is also a more subtle reason that started him itching in the first place. With this in mind, we do have to approach his skin in two ways. The first is to address the bacterial infection. If mild, salt water bathing may be all you need but if severe then oral antibiotics would be indicated. Once that is in hand, the next step is to look at the cause for his itching. That is where you want to check his ears (to make sure they are not to blame) but also consider addressing allergies (retreating for fleas and antihistamines). If you can take a step-by-step approach, then you should be able to settle his skin with the above. But if you are struggling or this is already severe for him, then we'd want to consider having his vet examine him and dispense a course of antibiotics and a short steroid course to clear the infection and allay the allergic reaction triggering his itchiness.
I hope this information is helpful.
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