A diagnostic approach to skin disease in geriatric cats - Veterinary Medicine
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A diagnostic approach to skin disease in geriatric cats
When an older cat develops a skin problem, the presenting complaint will point you to a group of possible diagnoses. From there, a thorough patient history and core diagnostic tests can help you identify the underlying problem.


Thin, fragile skin

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.
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.

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.


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