safety of cortisone

[opus88]

last year my cat broke out in facial sores that later proved to be essinoplic plaque.
he had i  depo medrol 40mg injection and a food change to a hypo allergenic dry food.

It broke out again in March 09..injection repeated
broke out again in April 29/09...injection repeated

Now almost 5 months later it is surfacing once again.
Why would this stay clear for so long than break out again?

How often is it safe to use the cortisone?
I know in humans its only recommended to get 3x a year.

I am trying to treat the 2 small spots with fuciderm gel however he rubs and now the spots are getting larger and raw.

what can you suggest?

[Jennifer Mathis, D.V.M.]

I don't feel comfortable repeating the injection of Depo more often than every three months. I explained this to a client years ago and gave them other options, but due to inability to give pills by mouth, they chose the injection and the patient developed diabetes soon later.

What hypoallergenic food are you using?  Some work better than others.

Eosinophilic granuloma complex is a recurring problem that is related to allergies.  Allergies work on a threshold, so when something he is sensitive too exceeds his threshold, he breaks out.

Atopica (cyclosporine) is a much safer alternative option to steroids.  It's not without side effects, but the side effects are like gum thickening in the mouth or something which often goes away when the meds are stopped and are rare to happen at all.

Also be sure you're using an excellent flea preventative every month year around FROM YOUR VETERINARIAN.  (There are a few good ones, but my personal preference is Revolution.)

Read more about it at:
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=656

[opus88]

thank you so much for the time to reply, I still have more questions for you.

first of all the food that I am using is MEDI-CAL Hypoattergenic gastro
with a duck and potato base.

did you mean that cortisone in pill form is safer than the injections(diabetes) or what Pill are you referring too?

flea medication...once a month every month or always everyday permanent?
my cat has no indication of fleas and other one in the house either....should I still use?

website says that cyclosporine not yet approved for use in cats...has this since changed? I am from Canada is it avail here?

again thank you so much for he help

[Kimberly Coyner, D.V.M., DACVD]

I agree with Dr. Mathis, the increasing frequency of the steroid injection is a concern, and ideally these long acting steroid injections should only be given an infrequently as possible, ideally 3-4 times/yr or less. I have seen diabetes occur after only one injection, so every patient is unique. Eosinophilic plaques are a symptom of an underlying allergic disease (food allergy, skin parasites, or pollen/dust allergies). If the symptoms are recurring despite good flea control and a strict hypoallergenic diet with no other foods or treats, then the underlying allergy is likely to pollen/dust. Options are to either treat the symptoms for the rest of his life with immunosuppressive medications such as steroids or Atopica (cyclosporin), or to perform allergy testing and desensitization injections (just like allergy shots in kids) to identify and treat the cause of the disease and try to reduce the need for other medications. Ideally, allergy testing is performed by a veterinary dermatologist (www.acvd.org).
Good luck,
Kimberly Coyner, DVM DACVD
www.dermvetvegas.com

[opus88]

thanks for the reply
I am really considering a homemade food for allergy control
any advice on that?

also my vet and I have decided we will use prednisone tablets rather than the steroid injections....IS THE ORAL FORM SAFER????

thank you

[Kimberly Coyner, D.V.M., DACVD]

A homemade diet is fine for 6-8 weeks, but is difficult to balance with adequate vitamins and minerals for maintenance. Your veterinarian can consult with a veterinary nutritionist (www.balanceit.com) to get a balanced home cooked diet recipe for your cat.
Steroid tablets can be relatively safer compared to the long acting injectable steroids, provided that the steroid dose can eventually be reduced to every 2-3 days, or the lowest possible dose to control symptoms. Labwork still needs to be performed every 6 months to screen for side effects such as diabetes, kidney infections, etc. If oral steroids have to be given daily at high doses longterm to control symptoms, then they are no safer than injectable steroids. Additionally, predniSONE is not a good choice for cats due to their unique metabolism, so oral predniSOLONE or methylpredniSOLONE would be better choices, as the slight chemical difference in these drugs enable cats to metabolize them more effectively.

Good luck, Kimberly Coyner, DVM DACVD
www.dermvetvegas.com

[opus88]

sorry I clicked the wrong button there, yes this was very helpful to me.
unfortunately came to late, Sami has now just finished a 3 week course of prednisone tablets...and he broke out again even while ON the meds.
So that leaves me with no other course than to try the the 3 cortisone injections in a 3 week period as was written up for 'resistant' cases.
and I am so worried to do that to him, but every time he breaks out its become worse, now he has these small scabs all around his eyes and a few he has scratched open and they are very raw and sore.

[Kimberly Coyner, D.V.M., DACVD]

Unfortunately, resistance to steroids occurs commonly in cats that are treated chronically with steroids. Additionally, cats on chronic steroids can develop opportunstic skin infections with bacteria, fungal infection (ringworm), and feline demodex mites, all of which can make a rash flare while still on steroids, and I recommend that your cat be rechecked and screened for these infections. If no infections are found, then I recommend talking to your veterinarian about oral Atopica/cyclosporin as a non-steroid way to control your cat's symptoms, or get a referral to a veterinary dermatologist (www.acvd.org). Three steroid shots in 3 weeks may make the issue go away temporarily, but then the symptoms will recur once again when the steroid shots wear off. If you decide to forge ahead with this treatment, then I would recommend having your cat's blood sugar tested weekly before the injections to screen for steroid-induced diabetes.
Kimberly Coyner, DVM DACVD

[opus88]

again I thank you all this advice is valuable to me.
I know Sami should be seen by a Vet dermatologist and I wish I could take him to one.
there is a distance issue and financial issue for me I'm afraid.
I'm disabled and live on a small pension. My vet told me Atopica treatment is very expensive.
thats why I spend hours trying to come up with alternatives.
Last week I also introduced a fragrance free/chemical free litter. And yesterday EFA's and Primrose oil
I will continue with his hypoallergenic diet..he isn't eating the 'raw diet' so that was a waste, maybe will try again next week.
I brought in a stool sample to my vet yesterday to test for parasites.
I just don't know what to do.
I read somewhere that if ringworm is present that 'althletes foot cream' will treat very well, some of his sores as they heal after he's rubbed do look like a ringworm...but may also just be the healing pattern?
again I thank you so much Dr Coyner

[Kimberly Coyner, D.V.M., DACVD]

It is true that Atopica is more expensive than prednisone, but the potential expense of treating steroid induced diabetes needs to be kept in mind as well. The typical cat dose for Atopica is one 25mg capsule per day, and the cost is about $1.25 - 2.00 per capsule, depending on where you obtain it; sometimes online distributors can be found which charge lower prices. I require bloodwork and toxoplasmosis titers prior to starting Atopica, since it is an immunosuppressive medication (just as steroids are), and then I check bloodwork 1-2 times yearly, just like I do when cats are on chronic steroids, to ensure there are no side effects. You can also ask your veterinarian to perform a ringworm (fungal culture) to ensure that a new problem is not developing; if ringworm is present, then it is treated with oral and topical antifungal medications for several months/until negative fungal culture.
Good luck,
Kimberly Coyner DVM DACVD

[opus88]

thanks again, I will wait another week to see if some of these natural therapies are going to help..the sores do look much better today but that may just be coincidence...if I don't continue to see improvements I will take him back to his Vet again next week and will talk to him more abt Atopica, I am in Canada so I'm sure it will be even more expensive here. But you are so right the cost of treating diabetes would also be high and this of course a better alternative.
I thank you very much once again, I maybe back!!

[opus88]

HI I have more questions.
he broke out in such bad raw sores I again spoke to my vet abt Atopica.

he said we'd treat the sores first to find out what they are with BIOCLAV 62.5mg tablets 2x day fir 2 weeks.
THAN do a biopsy to confirm the original dx that was done with a swab test only.
If confirmed we would go ahead with ATOPICA treatment.

Also again changed his diet from medi-cal hypoallergenic 'duck' to(wasn't eating)
medi-cal sensitivity VR.venison...he absolutely wouldn't eat this either, he was starving himself.
So last resort recommended to go to a FISH based diet because it was something he had never been exposed to before...this had to be bought from zellers and not a vet clinic..as they didn't carry and we had to get him eating.

well he is sure eating now and the scabs and open sores have completely disappeared...probably due to the antibiotics more so than food(?).....
so it looks as tho he did have a secondary skin infection(?)

NOw my vet said NOT to do the biopsy unless the scabs recur. and to continue with the FISH and see if he breaks out again....
In your opinion are we following the correct procedure, again if I could afford a dermatologist I would certainly take him, my vet is very patient and doing his own research trying to understand this better...

I like other opinions than what he finds....
are we following the correct route???

thanks so much again for your time.





before the 2 weeks were up

[Kimberly Coyner, D.V.M., DACVD]

I agree, the good response to antibiotic indicates secondary bacterial infection was certainly present. I would concur with your veterinarian, continue the current diet and see what happens; if he breaks out again, then proceed with the plan as outlined.
Good luck,
Kimberly Coyner, DVM DACVD

[opus88]

THANK YOU SO MUCH!