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  • Lip Ulcers in Cats

    Dear Boo:

    Anna is a 2 1/2 year old calico that is prone to lip ulcers – upper and lower lip and sometimes on her face. We have never seen any inside her mouth. Her littermate has never had one. We noticed when we got them from the mother at about 6 weeks of age that the mother’s lower lip was terribly swollen and we simply thought it was from being a good mother and licking her kittens a lot. The vet tells us that this is a hereditary condition but, as I said, her sister Kelly as never had one.

    We have eliminated all plastics, put her on special diets and we have to give her steroid shots whenever these ulcers crop up. Is there anything in cat science that has been developed to either understand or treat these ulcers? Poor Anna is on a low fat food, but weighs 16 lbs! Her littermate only weighs 8 or 9 lbs.

    Marty

    Dear Marty:

    The lip ulcers that you describe sound very consistent with a condition known as eosinophilic granuloma complex. This is an allergy based condition that results in skin lesions. These lesions tend to come and go, sometimes seasonally. These lesions present in three general ways.

    1. Eosinophilic lip ulcers, also called rodent ulcers, are ulcerated swellings usually seen on the lips of cats.
    2. Eosinophilic plaques are raised orange to yellow plaques seen typically on the abdomen or inner thighs.
    3. Eosiniphilic granulomas are thickened raised lesions that can occur anywhere, most typically in the mouth and down the back legs. Eosinophilic granulomas can also be seen as a puffy chin or puffy foot pads.

    The allergens that are at the root of this syndrome vary from cat to cat. Flea allergy dermatitis is very common, but we also see food allergies, environmental allergies, and contact allergies causing this syndrome. A diagnosis is often made by taking into account history, clinical signs and presentation of lesions. We also may need to test for and rule out other skin diseases that can present in similar ways. Sometimes a biopsy is taken to confirm the diagnosis.

    Treatment options are numerous and vary from cat to cat: flea treatment and prevention, antihistamines and essential fatty acids supplements, hypoallergenic or novel protein diets trials (see Food Allergy article in the Cat Hospital of Chicago library for more information), corticosteroids (topical, oral, or injectable), antibiotics, hyposensitization injections (allergy shots – blood and/or skin allergy testing must be done first to identify the allergens), and several other possible treatments. Many times we go through several different treatments before we find one that works. Generally we start with the least aggressive treatment options (because they have the fewest potential side effects), but if the lesions are severe or the cat seems very uncomfortable, we may have to be more aggressive with treatment options initially.

    Although most lip ulcers in cats are not as severe as is the one pictured here, they can become very large, disfiguring, and a source of discomfort for the cat.  This kitty, a handsome Abyssinian named ‘Oscar’, is on multiple medications, incuding pain medication, anti-inflammatories, and has been on multiple diet trials in an effort to resolve his ulcer ‘flare-up’.

    In response to your other comment about her weight issue, I have a few recommendations to consider. In cats that are predisposed to weight gain, the key to attaining a more ideal body condition is food restriction. You can try all the low fat diets you want, but if the amount she is offered is unrestricted, she is likely to continue to overeat. Food restriction can be more difficult with multiple cats, but can be done with a little effort and sometimes creativity. Start by separating your cats to feed them. Many people will feed their small cat on a countertop or the top of a dresser, etc and their overweight kitty on the floor. You can also feed them in different rooms. Consult your veterinarian for recommendations on feeding amounts for each cat. If your cats are used to free choice eating (grazing all day), start transitioning them to meal feeding by picking up the food for several hours each day, extending the time the food is picked up over several weeks. The cats will slowly begin to learn that the food won’t just always be there and in many cases will start to eat the food when it is put down.

    I generally recommend 2 to 3 meals per day once you transition to the meal feeding system. If you have a situation in which the small cat won’t transition to meal feeding and feeding her on an elevated surface doesn’t work you can buy or make a Kitty Caf© – basically a large cardboard box with a hole cut in it that allows only the small cat to enter and eat her food as she pleases. If food restriction alone doesn’t work, your cat may need a prescription weight loss diet from your veterinarian. These come in two major varieties: low-fat/high fiber and high protein/low carbohydrate. Your veterinarian can recommend which one might work best for your cat. And any time we put a cat on a diet, we need to monitor her weight very closely. It can be dangerous for cats to lose more than one percent of their body weight per week. We recommend taking your cat into the vet for weight checks every 2 to 4 weeks, or consider buying a baby scale or other scale that measures to the ounce and checking her weight at home. By closely monitoring the cat’s progress, we can make adjustments in a timely fashion and get to an ideal body condition in a safe and timely fashion.

    Good Luck!

    Boo

    (Whew! That was a long answer! I may need to take next month off!)

    If you have a question for the Ask Boo column, please feel free to e-mail us at askboo @ cathospitalofchicago.com. Boo will do his best to answer questions submitted.


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