Thin, fragile skin
Thin, fragile skin, sometimes called hyperfragility or feline fragile skin syndrome, is a rare dermatologic finding. It is characterized by very thin skin that leads to spontaneous nonhemorrhagic and nonpainful
tearing (Figure 3). An underlying cause is not always found but should always be aggressively sought. Possible causes include spontaneous hyperadrenocorticism
(rare), iatrogenic hyperadrenocorticism from excessive use of corticosteroids, diabetes mellitus, hepatic lipidosis, use of
progestational drugs (megestrol acetate), a progesterone-secreting adrenal tumor,7 and cholangiocarcinoma.
3. A cat with a wound secondary to feline fragile skin syndrome. The dorsal neck is often affected because of self-trauma
or handling or scruffing.
Cutaneous asthenia is another cause of fragile, easily torn skin, but it is a congenital disease of collagen or elastin and
typically shows up in very young cats. However, severe metabolic disorders could exacerbate a subclinical case of cutaneous
asthenia, causing the new clinical sign of hyperfragility in an older cat.8,9
Fragile skin syndrome is often diagnosed based on clinical signs alone, since the presenting signs are pathognomonic for the
disorder. The search for the underlying cause includes a complete blood count, a serum chemistry profile, a urinalysis, and
specific tests such as an ACTH stimulation test, a low-dose dexamethasone suppression test, or abdominal ultrasonography.
Skin biopsies show marked dermal and epidermal atrophy. It is difficult, however, to perform a skin biopsy on these patients
because skin can tear and the dermis may easily separate from the underlying adipose tissue.10
Without any underlying disease to treat, these patients can be difficult to manage. The skin wounds can be sutured, but skin
will continue to tear easily unless the primary disease is identified and treated.