Visiting Vet: Feline chin acne

A quirky skin condition that’s typically mild, and easily treated.

A cat with skin conditions around the chin and lips may be treated with topical medications. — Amber Kipp

Minato and Umaki are two sweet but sometimes shy siblings. Born feral, this brother and sister pair were taken in as kittens by a rescue organization, and eventually placed together in a wonderful home here on the Vineyard. The first time I met Minato, his owner mentioned noticing some black flecks along the margins of his lips and on his chin. “It’s probably just feline chin acne,” I said, and sent the owner home with a liquid medication to rub into the area. I also recommended regular flea control, and using stainless steel food and water bowls.

Feline chin acne is a quirky skin condition in which the hair follicles around the chin and lip margins get clogged up and infected, causing lesions some of us will remember none too fondly from our adolescence. Blackheads, whiteheads, and plain old pimples. Sometimes it’s just a few little bumps — not pretty, but not a bother to the cat in question. Other times the entire chin may be involved, becoming thickened, red, crusty, and occasionally painful. The medication I prescribed for Minato contained an antibiotic to address bacterial infection, an antifungal for fungal infection, and an anti-inflammatory, to just calm everything down. Topical medications like this are the usual starting treatment for minor cases.

Minato, however, was not thrilled with my plan. He didn’t like having this medication put on his chin, and started actively avoiding his owner, who soon decided to stop trying to treat this mild case of acne rather than risk ruining their relationship. Later, when his chin flared up a little more, we tried a long-acting injectable antibiotic and oral corticosteroids that could be hidden in his food to reduce inflammation (without making him run away from his owner). That helped a bit, but wasn’t there some permanent cure? Well, no. 

We don’t really understand what causes feline chin acne. It does seem to run in families, in individuals that are related, but also in those that simply share a household. This suggests that both environmental and genetic causes may be implicated. (In fact, Minato’s sibling Umaki has recently been having a problem with chin acne as well.) In many ways, feline chin acne is analogous to human acne. People with acne have excess oil (sebum) production. Their follicles get clogged by oil and dead skin cells. Bacterial infection and inflammation follow. Things known to trigger or worsen outbreaks in people include hormonal changes, certain medications or foods, and stress. 

In cats, theories proposed as to the underlying causes include poor grooming habits, allergies, immune system problems, and inherent abnormalities of the skin and hair follicles on the chin. Adolescence does not factor into feline acne as it does in humans, but triggers may include food or environmental allergies, stress, and possibly contact with substances that may irritate the chin, provoke a hypersensitivity reaction, or simply carry bacteria. This is the reason behind the recommendation to avoid plastic, ceramic, or glazed pottery dishes, and to use stainless steel bowls. Toys, too, might be triggers, depending on their materials. Anything plastic or porous may serve as a reservoir for bacteria. Although no scientific studies have proven an association of chin acne with contact with such items, many of us in the field anecdotally have seen improvement with removing them. 

If Minato’s case had been severe, we would have discussed additional diagnostics to rule out other diseases: skin scrapings for mites, cultures to identify resistant bacterial infections, and fungal cultures for ringworm; even biopsies to identify autoimmune diseases or eosinophilic granuloma complex. Allergy testing is more complicated. For inhalant allergies, we can try blood tests or referral to a dermatologist for skin testing, followed by desensitization injections if indicated. For food allergies, the best diagnostic tool is a 12-week prescription “elimination” diet. The reality is that owners rarely opt to go to these lengths, since the condition is typically mild, localized, and not bothering the cat. The reality is also that in most cases, all these tests will be negative. In other words, we will not find any definitive explanation for that funky chin, nor additional insight in how to treat it. 

Most owners opt for empirical treatment, which is a bit of a trial-and-error proposition. Sometimes it is useful to shave the area so it can be more easily cleaned and medicated. I find this often exacerbates the irritation, and usually avoid shaving unless absolutely necessary. Warm compresses may soften scabs and help get pimples to open and drain. Then we try a variety of antiseptics, antibiotics, antifungals, and anti-inflammatories, hoping to find the one that helps the most while annoying the cat the least. Mupirocin ointment is one prescription medication that is favored by many veterinarians, and has been documented to often be helpful. In certain cases, your veterinarian may prescribe oral antibiotics and/or corticosteroids. What about products like Accutane that are used for severe cases of acne in humans? There is very limited information about the use and safety of drugs like this in cats, so overall the risks outweigh the benefits.

If you have ever struggled with acne (or have friends or children who have), then you understand the chronic and frustrating nature of the disease. Just like people, cats who pay good attention to grooming may be able to better control outbreaks. If Minato or Umaki are not tidy cats and don’t clean themselves well, help them out by toweling off their faces and brushing their fur regularly. If your cat continues to exhibit symptoms consistent with feline chin acne, consult your veterinarian. Your cat may benefit from more aggressive diagnostics or treatment. Your veterinarian can also talk to you about various medicated wipes and cleansers, to be used for maintenance care. On the other hand, for shy kitties like Minato, treatment may be more stressful than helpful. If it’s mild, try not to worry about it too much. I have a pimple on my chin right now. It’s no big deal.