If you've been told your cat has miliary dermatitis, don't worry, they haven't enlisted in the army without your knowledge! Misunderstanding me as saying their cat had "that military dermatitis" ranks right up there with those pesky "biblical hernias" (umbilical)!

Miliary dermatitis is a skin condition that has many, many causes. Its name is derived from the millet seed like lesions it produces on a cat's skin. So in reality, miliary dermatitis is not in itself a specific diagnosis but rather a description of the skin. Here's a list of some conditions that produce miliary dermatitis; don't freak out on me, it's a long list: bacteria, fungus, ringworm, yeast, GI parasites, chiggers, scabies, mites, ear mites, lice, flea bite hypersensitivity, inhalant allergies, food allergies, atopy, drug hypersensitivity, eosinophilic granuloma complex, vitamin deficiencies, fatty acid deficiencies, immune mediated problems, and the bane of any doctor with a "just-tell-me-what-it-is" client, idiopathic (meaning we don't know what it is). Can I quit typing yet? Want to know where to start? Read on.

The first thing we do is to ask some questions. How long has there been a problem? Is it constant or intermittent? Itching or not itching? Any hair loss? What has worked and what has not worked? Any fleas? What type of flea control do you use? Indoor or outdoor kitty? (Everyone answer "indoor", please). What type of food are you feeding? What type of shampoo do you use? Are there any siblings and do they have any skin problems? Do you have other cats/dogs and do they have any skin conditions? Do YOU have any skin conditions? Where do you live and how long have you been there? What we are trying to do is narrow that long list down by ruling out some of the conditions.

Next comes the examination. We focus on the entire kitty and not just the skin. Remember, some conditions may be much more involved and just show up as a skin condition initially so we make sure we perform a nose-to-tail physical exam. Now we can concentrate on the skin. We want to check the hairs and the type of lesions using a magnifying glass with a strong light source. Are there lesions, crusts, scales, papules, pimples, ulcers, or vesicles? Is the underlying skin inflamed, thickened, thin and friable, hyperpigmented? Are the hairs being pulled out, are they being chewed off, or are they being destroyed mid-shaft? Is there evidence of fleas? All these clues can help guide us to a diagnosis and a cure.

Based on the findings of our interrogation and examination we may want to run some tests. Fecal exams, skin scrapings, and fungal cultures are usually recommend as a start. If we think there is an underlying systemic disease, we'll order complete blood cell counts, blood chemistries and a urinalysis to get us rolling. Severe and non-responsive infections should be cultured to try and find not only what bacteria are causing the problem but also what is the best antibiotic to use. Biopsies may be needed and are one of my personal favorites as a starting test. The reason is they can help point us in the right direction--be it a hormonal/endocrine problem, infectious, parasitic, allergic, autoimmune or fungal problem. All these conditions create distinct changes in the skin and although not 100% conclusive (Is anything 100% conclusive?), they are invaluable. Getting a biopsy may help us decide which tests to run and which ones not to so in the long run they can save us time and money.

Once we know the cause, we can treat it. Often though, we're forced to treat on a hunch so I'll mention a few general treatments. First, eliminate all fleas. Many noted dermatologists recommend using both oral flea pills Program and the topical solutions Frontline or Advantage. Next correct any dietary problems; go to a premium diet such as Iams or Hills and supplement with a fatty acid supplement. We use cold water fish-oils at triple the recommended dose; in allergic skin disease they are effective in about 50% of the cases. Medicated shampoos can alleviate some of the itching and irritation, some are used to rehydrate the skin and some are used to strip away the top layer of scaly skin; others contain topical anesthetics and oatmeal to relieve itching. Antibiotics or antifungals may be prescribed for fungal or bacterial infections.

One of the mainstays in treating miliary dermatitis is cortisone. Cats are slightly more tolerant of cortisone than dogs. We want to make sure that we are not dealing with ringworm or scabies before we start cortisone; they can make the condition worse and more difficult to treat properly. If your cat has allergies, atopy, immune mediated disease, or eosinophilic granuloma complex you will probably be using cortisone at one time or another. Make sure you also use nutrition, antihistamines, fatty acids, shampoos etc as these agents act together to reduce the amount of cortisone needed to control the condition.

If these don't work we sometimes we try hormones such as megestrol acetate but they have some side effects. If we think the problem is behavioral (called psychogenic alopecia) we may prescribe anti-anxiety drugs or try some behavior modifying therapy (no, we don't have a couch for your cat).

Even with a diagnosis, treatment can be more art than science. Actually, the whole of practicing medicine is more art than science. You need to be patient and cooperative and communicate with your veterinarian. Feedback is good stuff.

Dr. Katherine Dodds, primarily a feline practitioner, practices and owns Hammocks Veterinary Hospital in Kendall (Miami), Florida. She is a graduate of the University of Florida and an affiliate of the American Association of Feline Practitioners. She can be reached at (305) 388-0880.