For my cat, Godric, it started with a little redness around his eyes. Within a few days, his entire face looked inflamed, and I noticed him constantly rubbing his face with his paws. It wasn’t long before I realized he was suffering from a common kitty conundrum: facial pruritis, or itchiness of the face and head.
Godric’s symptoms were pretty typical; redness of the skin around the eyes and ears. Sometimes these cats will develop ear infections as well. In a severe case or if the symptoms are not treated early, a scabby rash will develop on the cat’s face, chin and neck.
I see facial pruritis from time to time in my office, and it can have a few different underlying causes. The most common, especially in older, indoor cats, is allergic dermatitis, although some cats can have an infection with a non-contagious mite called demodex.
For newly acquired cats or cats that spend time outside, particularly in the company of other outdoor cats, the pruritis could be a reaction to external parasites, such as fleas or earmites. Facial itchiness can also be related to the use of methimazole, the oral medication used to treat hyperthyroidism.
Where the pruritis is caused by allergies, often (but not always) the rest of the cat’s body will remain symptom-free. Allergies can either be seasonal, such as allergies to pollens and mold, or year-round, which is more typical of food-related allergies. Early in the course of this condition it is difficult to differentiate food allergies from seasonal allergies without specific allergy testing (which can become costly without the aid of pet insurance). Parasitic causes of facial itchiness can be ruled out through a careful physical exam – checking for fleas and earmites and doing skin scrapes to look for demodex are all part of the work up for a cat with an itchy face.
Godric was parasite-free and does not take any medication, so in his case, allergies are the most likely cause of his itchiness. Because he has never shown any allergic tendencies before this, I am keeping my fingers crossed that he has seasonal allergies, rather than food-related allergies.
For seasonal allergies, facial pruritis can usually be treated with intermittent steroids and antihistamines. In more severe cases, veterinarians will often recommend a more aggressive treatment, with long-term oral cyclosporine. Food allergies require diet trials to determine what the cat is allergic to, and then strict adherence to a diet that avoids those ingredients.
Luckily, Godric responded well to a short course of oral steroids (and he did not mind being pilled), and he is now back to normal. Experience has taught me that this condition typically becomes chronic and recurrent, so I will watch him closely for any more signs of scratching.