EosinophilicGranuloma,Diabetic Cat Care

The information contained in this sticky is provided for educational purposes only and is not intended to replace veterinary advice. The intention of this sticky is to open doors to understanding about the specific medical condition and allow for educated and on-going discussion with your vet.

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Eosinophilic Granuloma 101

Many of our cats contract eosinophilic granuloma complex (aka Rodent Granuloma, Indolent Ulcer, and Eosinophilic Plaque). Traditional vet treatment for granuloma includes the use of antibiotics and steroids. Unless the granuloma is severe and causing stress to our cat (affecting their ability to eat or breathe for example), according to Cornell Vet most antibiotics rarely work. The most frequent vet treatment protocol is to use traditional steroid shots which are NOT appropriate for FD kitties and should be used as a last resort only!

What is Granuloma?

The term eosinophilic granuloma complex (EGC) refers to a group of skin diseases that share clinical similarities and respond to similar treatments. Eosinophils (pronounced ee-oh-sin-oh-fills) are a type of white blood cell. When the body is responding to a parasitic condition, such as a flea or mosquito bite, or develops an allergy to something (food for example), the number of eosinophils in the blood tends to increase. The most common allergies in cats are flea allergy, food allergy, and inhalant allergy (also called atopy). Underlying allergies and the resulting increase in eosinophils are thought to play a role in the development of EGC, possibly through a problem in the body’s ability to control the levels and activity of eosinophils. EGC may have a genetic link in some cats, but in some cases, the precise cause is unknown. Cats of any age can be affected, but most are young to middle-aged.

Eosinophilic granulomas are areas of skin inflammation that traditionally can take three forms: the most common chin form often referred to as "chin acne" usually appears around the chin or exterior lip area; the linear form usually appears on the body, typically on the stomach, leg or the foot pads, and the more severe form Nodular pharyngeal granulomas can appear as firm, raised lesions in the mouth (usually on the tongue, the palate or the back of the throat).

Granuloma (particularly in the chin form) is generally recurring...the sores can last up to six weeks, and typically move around the mouth area, from side to side, and/or top to bottom of the mouth area for example.

Most forms of granuloma are the result of stress, bug bites (fleas or mosquitoes) or the result of a food intolerance/allergy. Granuloma is considered a "virus" and is why most common antibiotics typically don't work. In the case where steroids are used, while they quickly work to resolve the sores, steroids to not resolve the underlying issues causing the granuloma resulting in the repeated use of steroids being necessary to keep it at bay. The overuse of steroids can cause diabetes in cats, particularly those on dry food diets. In some rare case, granuloma can transform to become cancerous leisons, so if treatment does not resolve it, your veterinarian may recommend further testing to check for evidence of this transformation.

For photos of granuloma, click on the website links below;

2010 Vets Blogspot
My Pets Dentist
Moose on Flicker
Veterinary Partner

What Are the Clinical Signs of Eosinophilic Granuloma Complex?

For many cats with EGC, the only clinical signs are the skin lesions themselves. The lesions are not always painful or itchy. However, when multiple forms of the disease occur simultaneously in the same cat, clinical signs will likely reflect that. Depending on which forms of the disease are present, clinical signs may include the following:

•Itching (sometimes severe) or pain
•Drooling, bad breath, and difficulty eating (if the lesions are in the mouth)
•Breathing difficulty (if a lesion in the mouth or throat is obstructing airflow)
•Lameness (if the lesions are on the footpads)

How Is Eosinophilic Granuloma Complex Diagnosed?

Most cases of EGC are diagnosed based on medical history and the physical appearance of the skin lesions. For some lesions, your veterinarian may want to take an impression smear. This involves gently touching the surface of a lesion with a clean, dry microscope slide to collect cells lying on the surface. Examining this slide under a microscope and identifying a large number of eosinophils can increase the suspicion for EGC.

In some cases, your veterinarian may recommend a skin biopsy to confirm the diagnosis or rule out other conditions (like skin cancer) that can look similar.

If allergies are suspected to be the underlying cause, your veterinarian may recommend allergy testing or, if food allergy is suspected, a “hypoallergenic” diet trial. Hypoallergenic prescription foods may contain ingredients unsuitable for FD cats and if so, trying a "novel protein" diet (a protein source that is new to the cat) will likely be a better option. For example a cat that has developed granuloma and is used to eating chicken, if switched to turkey or rabbit may see the EGC resolve over a matter of a month or two.

Additional blood work may also be recommended, such as a complete blood cell count (CBC); this test may show an increase in the number of eosinophils for cats with some forms of EGC. Because other conditions such as fungal infections, immune-mediated diseases, feline leukemia, feline AIDS, and other viral infections can cause lesions similar to those of EGC, your veterinarian may advise specific testing to rule out these conditions.

Treatment and Outcome

In most cases, EGC responds well to treatment with corticosteroids, however the use of steroids in FD cats needs to be carefully considered. Because secondary infection is sometimes a factor, antibiotics may also be prescribed. In some cats, the problem may resolve without treatment, or come and go until an underlying problem can be identified and managed.

Dr. H states that EGC is a basic allergic reaction with a secondary bacterial infection. Her recommendation to treat granuloma, particularly granuloma which occurs around the mouth area, is to use a gentle product such as Cetaphil, or to use Betadyne sparingly; gently applied to the affected area as frequently as possible with a Q-Tip. In addition, after application of the cleanser, covering the area with a small amount of BagBalm also helps with healing. In more severe cases antibiotic ointments can be helpful, and as well Dr. H comments that immune suppressive drugs may be needed for a short time.

Dr. Elizabeth, DVM 08/22/2007

Eosinophilic granuloma (this is a "rodent ulcer" when it occurs on the lip) is a manifestation of allergic skin disease. I like to use oral steroids in non-diabetic cats with eosinophilc granuloma who are being fed wet food only. In a diabetic cat, I'll change the diet to a single ingredient raw, like raw ground rabbit or chicken and either use Cyclosporine or intraleisonal depo steroids (which do not become systemic and do not affect BG levels). For small leisons, laser removal of the lesion can also work. I strongly urge that FD cats NOT get systemic steroids to manage leisons.

Cornell Vet recommends the use of salmon oil (only 2 to 3 drops daily given with food) to help get rid of the complex and to help prevent it from returning. Agaricus mushroom is also very helpful to boost the immune system to the point the granuloma can be prevented from reoccurring.

For cats that don’t respond to corticosteroids and antibiotics, other medications may be successful. However, if the condition does not respond to repeated treatment, your veterinarian may recommend additional diagnostic testing (such as biopsy, viral testing, screening for immune-mediated disease) to investigate the possibility that another condition is causing the skin lesions. In some cases, if no other cause can be found, isolated lesions that are causing discomfort may be treated with alternative therapies, such as radiation therapy, surgical excision, laser therapy, or cryosurgery, but the efficacy of these treatments has not been determined.

For cats with flea allergy or mosquito hypersensitivity, safe and effective long-term control of these parasites is required to help prevent the recurrence of EGC. Your veterinarian can recommend an appropriate product for your cat. As mosquito and flea bites are known causes of granuloma, during months when these insects are present, the use of a bug repellant containing no harmful chemicals which might be ingested with grooming is recommended. Cats being groomers can easily be poisoned if the wrong bug repellents are used, so take great care as one that works very well for dogs could end up causing a severe, even potentially fatal situation for a feline. Please post on open forum to find out what members safely use as bug repellants for their cats.

Switching from plastic to glass or china dishes is recommended for felines to help prevent the development of granuloma.

If an underlying cause for EGC can be identified and managed successfully, the condition can resolve and not recur. For cases that are resistant to treatment, or for cats in which an underlying problem can’t be identified, recurrence is possible.

For more information about eosinophilic granuloma complex (EGC) please visit the following websites:

Cornell Vet
Dr. Becker/Mercola Healthy Pets
Wikipedia