Connecting the specks: fleas or acne?

The owner of each cat has a different theory about the source of the problem. “I think Tom has fleas on his face,”one says, pointing to the black, pepper-like dandruff on his cat’s chin. “Puss must have gotten into something in the garage,” says another, thinking the debris is dried paint, motor oil, or some other such substance. A third hadn’t noticed and is surprised when I point out the redness, pimples, and hair loss on Kitty’s chin.

Feline chin acne is a fairly common skin disease of unknown cause. It can occur in cats of any age, sex, or breed. Acne is by definition a condition in which hair follicles become clogged with oil and dead skin cells but we don’t know for sure why one cat develops it and another doesn’t. So let’s take our hypothetical kitty, Zitty. The first thing Zitty’s owner notices are little black specks of stuff in the fur on her cat’s chin. Yup, it sure looks like flea dirt — our euphemistic term for flea excrement. You can definitively determine if a black speck has come from the back end of a flea by placing it on a wet piece of white paper towel. Because fleas feed on blood, flea poop will “bleed” a rusty-red ring on a damp towel. With chin acne, the black specks are not flea dirt, so where do they come from?

In the early stages of feline chin acne, material accumulating in abnormal hair follicles produces visible comedones, or blackheads, on the chin, at the corners of the mouth and edges of the lower lip. As bits of discolored debris flake off, the darkening of the fur progresses. The area sometimes becomes a little red. Secondary bacterial infection can lead to more intense crusting, swelling, and redness. Itchiness can cause Zitty to scratch or rub resulting in patches of hair loss. In very severe cases, the entire chin may become thickened or scarred.

If you see those specks on Zitty’s chin, it is a great idea to get a good flea comb and then, well, literally go over him with a fine-toothed comb to check for evidence of fleas elsewhere on his body. The strip of fur down the middle of his back to the base of the tail is often the best place to comb for fleas, though in some cats the little critters like to hang out on the belly, or even the head and neck. Comb everywhere. If you find live fleas or black specks on places other than his chin, you know you need start thorough flea control immediately. Occasionally that is all that is needed to clear up a case of feline chin acne, but often Zitty is flea-free, so we can’t blame his problem on that.

There are many theories about the underlying causes of feline chin acne. Some cases are the result of allergies or hypersensitivity. I always recommend making sure all Zitty’s food and water bowls are made from stainless steel, glass, or other non-reactive material. I have seen a few cats improve dramatically when all plastic bowls were removed, but this does cure the acne in the majority of cases. Zitty may simply have an inherent problem with excessive or abnormal production of sebum (the oily stuff made by the sebaceous glands associated with the hair follicles) just like some people have problems with overly oily skin.

Another theory impugns Zitty’s personal hygiene habits, suggesting that cats with chin acne tend to be poor groomers, allowing the oils to build up on their skin. Like with people, stress and other conditions that weaken the immune system seem to increase the risk of acne. On the other hand, hormonal influences that play such a significant role in human adolescent acne do not seem to be a factor for cats.

So what are we to do about Zitty’s zitty chin? After ruling out fleas and eliminating obvious sources of irritation or contact allergy, there are several other diseases on our differential diagnosis list. Specialists generally recommend a number of tests to check for mange mites and fungal infections like ringworm, and to identify specific types of bacteria or yeast. Biopsies of the area can definitively rule out conditions like eosinophilic granuloma (a syndrome that deserves its own article) but frankly, in most cases, if it walks like a duck and quacks like a duck, it’s a duck. Or a zit.

Treatment depends on the severity of the problem. In some cases it is helpful to clip the fur off Zitty’s chin, making the area easier to clean and treat. Occasionally clipping increases local irritation. A warm compress can help soften the debris and the area can be washed gently with benzoyl peroxide shampoo and treated with 2.5 percent benzoyl peroxide gel. This flushes the hair follicles and inhibits blackhead formation. Some cats get more irritated with this gel, so if the problem worsens, talk with your veterinarian about substituting a different cleansing agent like a salicylic acid wipe. If there is secondary bacterial or yeast infection, your veterinarian may prescribe topical antibiotic or antifungal ointment. In more serious cases, oral medication may be warranted. Deep-seated bacterial infections may require oral antibiotics for as long as six weeks. Zitty may also benefit from omega-3 fatty acid supplements like fish oil. Such products often help with a multitude of skin conditions. Occasionally chin acne can be so bad that oral corticosteroids like prednisone are indicated to reduce swelling and inflammation, or even treatment with retinoids for severe refractory cases, but these situations are uncommon.

Although amenable to treatment, feline chin acne does tend to be recurrent, requiring lifelong care to control it. But the prognosis is good. If the acne is mild, it is primarily a cosmetic problem and unless Zitty is going to the prom soon, it probably doesn’t bother him much or affect his quality of life.