Idiopathic Ulcerative Dermatitis

Feline idiopathic ulcerative dermatitis is a rare skin disease characterized by a nonhealing ulcerative lesion on the dorsal neck or between the scapulae caused by unremitting self trauma. Prognosis is poor because the lesions do not respond to medical treatment and are often too extensive for surgical resection. After an extensive medical and dermatological evaluation, idiopathic ulcerative dermatitis was diagnosed in a cat (2 years of age). In this case report, a diagnosis of neuropathic pain was made and the cat underwent unsuccessful treatment with gabapentin, pregabalin, and phenobarbital. The cat did respond to topiramate (5 mg/kg PO q12h); improvement was seen within 2 weeks, and the lesion was in remission by the end of 4 weeks. Remission continued for 30 months as of study publication; withdrawal from the drug resulted in relapse within 24 hours both times it was attempted.

Commentary

This rare condition is a diagnosis of exclusion. In almost all cases referred to me, an underlying cause (eg, allergies, bacterial or fungal infection, Demodex gatoi, neoplasia) is found. Although skin biopsy findings cannot confirm the diagnosis, it is important for ruling out other differential diagnoses. Currently, the underlying cause is believed to be neuropathic pain, thus the relatively rapid response to topiramate. Neuropathic pain is poorly understood and hard to explain to clients; however, they might understand the example of post-amputation pain reported in humans.—Karen A. Moriello, DVM, DACVD

Source

Topiramate in the management of feline idiopathic ulcerative dermatitis in a two-year-old cat. Grant D, Rusbridge C. VET DERMATOL 25:226-e60, 2014.