皮肤是猫咪健康状况的标志-全身性疾病的皮肤表现（2）

王帆

皮肤是猫咪健康状况的标志

SKIN AS A MARKER OF GENERAL FELINE HEALTH

全身性疾病的皮肤表现

Cutaneous manifestations of systemic disease

作者：Linda J Vogelnest

翻译：何梦婷 校对；王帆

被毛无光泽、粗乱的患猫

The cat with a dull, unkempt haircoat

之前被毛健康的猫突然全身或局部发生被毛质量改变通常反映全身性问题，对其他全身性疾病症状进行筛查。被毛可能变无光泽（失去正常的光泽）（图1）、油性质感多样化、毛发杂乱、成簇打结毛发和皮屑，这些问题都可能反映出一系列全身性问题。

Generalised or regional changes in haircoat quality in a cat with a previously healthy coat frequently reflect systemic problems, and screening for other signs of systemic illness is indicated. Haircoats may be dull (loss of normal sheen) (Figure 1), with variable degrees of oiliness, hair matting, tufts of unshed hair and scaling, reflecting a range of systemic problems.

图1一只被毛粗乱患（无光泽、粗乱、暗淡）。

猫Figure 1 Unkempt (dull, dishevelled and matted) haircoat in a cat

营养不足

Nutritional deficiencies

必需脂肪酸的缺乏会导致猫被毛粗乱有皮屑。日粮储存不当（例如，温度高）、防止日粮腐坏的抗氧化剂不足，或者自制粮和营养不均，会发生日粮性营养不足；某些患猫长期使用商业化控制体重日粮或不符合营养标签要求的商品粮也可能导致营养不足。其他非常罕见的日粮营养不足（例如：蛋白质、维生素[A、E、B2、B6、生物素或矿物质[锌、磷）也可能会导致皮肤或被毛改变。

Essential fatty acid deficiency can lead to a dull scaly haircoat in cats. Dietary deficiency can occur with diets that are poorly stored (eg, high temperatures), have inadequate antioxidants to prevent rancidity, or are homemade and imbalanced; deficiency may also be caused by long-term use of commercial weight management diets in some patients, or commercial diets not meeting their nutritional label claims.Other, very rare dietary deficiencies (eg, protein, vitamin [A, E, B2, B6, biotin] or mineral [zinc, phosphorus]) may result in skin or haircoat changes.

理毛能力下降

Reduced ability to groom

一系列慢性全身性疾病会降低理毛能力，这可能会影像正常的皮肤和被毛外观。肥胖、身体疼痛（关节炎、口腔疾病）以及各种慢性疾病（如心脏、肾脏、肝脏）引起的嗜睡或不适都是需要考虑的因素。

A range of chronic systemic problems can reduce grooming ability, which may impact normal skin and haircoat appearance. Obesity, physical pain (arthritis, oral cavity diseases), and lethargy or malaise from a variety of chronic diseases (eg, cardiac, renal, hepatic) are all considerations.

甲亢

Hyperthyroidism

据报道，虽然30-40%的甲状腺机能亢进的猫会出现皮肤变化，但当出现更明显的症状时，皮肤变化的报道可能被低估。粗乱、无光泽或油腻的毛发是最常见的。也有报告称，由于过度理毛导致的局灶性或大面积脱毛。可能明显见到爪部毛发长。皮肤的变化通常轻微，猫通常表现为全身症状，包括多食但体重减轻、行为改变/多动症、多饮和胃肠道症状（呕吐、腹泻或排便增多）。

Cutaneous changes reportedly occur in 30–40% of cats with hyperthyroidism,although may be under-reported when present along with more prominent signs. An unkempt, matted or greasy haircoat is most common, presumed to reflect reduced grooming activity. Regional or extensive alopecia from excessive grooming is also reported. Prominent claw growth may be apparent.Skin changes are generally subtle, and cats typically present with systemic signs of disease, including weight loss despite polyphagia, behavioural changes/hyperactivity, polydipsia and gastrointestinal signs (vomiting, diarrhoea or voluminous faeces).

疾病可能在猫的日常健康检查/疫苗接种时先被发现。体格检查通常会发现身体状况不佳、被毛粗乱，甲状腺明显肿大（80-90%的病例）和心动过速（48%的病例）

Disease may be first apparent in cats presenting for routine healths screening/vaccination. Physical examination will often reveal poor body condition, an unkempt haircoat, palpably enlarged thyroid glands (80–90% of cases) and tachycardia (48% of cases) .

任何表现被毛粗乱的猫咪都将具有潜在全身性疾病作为重要考虑因素

Any cat presenting with a dull, unkempt haircoat will always have underlying systemic disease as an important consideration.

诊断方法：无光泽、粗乱的被毛 Diagnostics: dull, unkempt haircoat 任何表现被毛无光泽、粗乱的猫咪都要重点考虑存在潜在全身性疾病，要先进行整体健康状况评估。对病史（尤其是年龄、生活方式、整体健康状况和饮食）的评估和完整的体格检查可能会发现异常，为初步诊断提供指导。 Any cat presenting with a dull, unkempt haircoat will always have underlying systemic disease as an important consideration, and initial assessment of general health is a priority. Evaluation of history (especially age, lifestyle, general health and diet) and complete physical examination may reveal abnormalities to guide initial diagnostics. 在高风险因素下（例如：幼龄动物、群养、饲养条件不佳），重点考虑感染性皮肤病，因为外寄生虫（虱子和姬螯螨）和某些皮肤癣菌病可能表现为毛发粗乱。日粮始终是本报告的一个重要考虑因素，特别是对于生活条件较差且日粮摄入不平衡的猫，虽然自制粮更可能出现潜在的营养缺乏，但是商品粮同样可能会出现这种情况。如果无明显感染和营养原因，应进一步评估全身疾病的症状，包括甲状腺疾病。 Consideration of infectious cutaneous diseases is important in higher risk scenarios (eg, younger animals, multiple pets, poor conditions), as external parasites (lice and Cheyletiella species) and some cases of dermatophytosis may manifest as an unkempt coat. Dietary causes are always an important consideration for this presentation, particularly for cats living in poorer conditions and on imbalanced diets; although underlying nutritional deficiency is more likely with homemade diets, it may occur with commercial diets. If infectious and nutritional causes are not apparent, further evaluation for signs of systemic disease, including thyroid status, is indicated. 如果怀疑日粮不均衡，可考虑提供更高质量的均衡日粮和/或额外补充脂肪酸。ω-6脂肪酸、即亚油酸，是角质层屏障功能的重要组成部分，补充脂肪酸可能有益于干性皮屑的皮肤和被毛。月见草油和冷榨葵花籽油或红花子油是富含亚油酸的脂肪酸。虽然没有明确的剂量指南，但据报道，高达约400毫克/公斤的剂量在猫上是安全的。开始补充月见草油，剂量为100 mg/kg，每24h一次或冷榨葵花籽油，剂量为2 ml/kg，每24h一次，可能有效，如果在8周内没有明显的临床改善，可能需要增加剂量。补充脂肪酸所增加的热量/脂肪摄入可能会加重肥胖，以及胰腺、肝脏或胃肠道疾病；因此，在考虑脂肪酸补充之前，应进行仔细的全身评估。 If dietary imbalance is suspected, provision of a higher quality balanced diet and/or additional fatty acid supplementation may be considered. The omega-6 fatty acid, linoleic acid, is an important component of the stratum corneum for barrier function, and supplementation may benefit dry scaly skin and haircoats. Evening primrose oil and cold-pressed sunflower or safflower oils are fatty acids rich in linoleic acid. Although there are no clear guidelines for dosage, up to ~400 mg/kg has been reportedly used safely in cats. Commencing supplementation with evening primrose oil at 100 mg/kg q24h or cold-pressed sunflower oil at 2 ml/kg q24h may be effective, with dosage potentially increased if clinical improvement is not apparent within 8 weeks. Increased caloric/fat intake from fatty acid supplementation may exacerbate obesity, and pancreatic, hepatic or gastrointestinal diseases; thus careful systemic assessment is prudent before considering fatty acid supplementation.

诊断性评估既往病史 <生活方式-室内、其他动物(传染性感染?) <日粮-减肥粮?潜在营养不足? <整体健康状况-目前/最近的问题(如甲状腺机能亢进或慢性疾病?) 体格检查 <皮肤检查-虱子筛检(可见)、毛螨(观察移动的物质) <全身性疾病评估 -行动不便(关节炎、肥胖) -脏器疾病(心脏、肾脏) -甲状腺机能亢进(触诊甲状腺、体况不佳、心动过速) 诊断 <皮肤采样-胶带粘贴、皮肤浅刮；可能需要真菌培养(如果病史显示有传染的可能性) <全身性评估-根据最初的发现 <如无病史或临床异常表现-筛查血液学、生化检查、尿液分析、甲状腺疾病±影像学检查(超声、X光检查)

Diagnostic evaluation of this presentation History < Lifestyle – housing, other animals (contagious infections?) < Diet – weight reduction diet? Potential deficiencies? < General health – current/recent problems (eg, hyperthyroidism or chronic diseases?) Physical examination < Skin examination – screen for lice (visible), fur mites (just visible as moving particles) < Evaluate for systemic disease – Mobility problems (arthritis, obesity) – Organ disease (cardiac, renal) – Hyperthyroidism (palpable thyroid glands, poor body condition, tachycardia) Diagnostics < Skin sampling – tape impressions, surface scrapings; potentially fungal culture (if history reveals potential for contagion) < Systemic evaluation – as indicated by initial findings < If no initial historical or clinical abnormalities apparent – screening haematology, biochemistry, urinalysis, thyroid status ± body imaging (ultrasound, radiography)

甲状腺功能减退

Hypothyroidism

治疗甲亢患猫（手术或放射碘治疗），从而引起患猫甲减的数量增加。自然发生的甲减极为罕见（年轻幼猫先天性侏儒症；一例已报道的成年猫自发性病例）。最常见的症状是嗜睡、食欲下降、体重增加和皮肤轻微变化，包括被毛无光泽、皮屑、毛发打结和过度脱毛。有耳廓、压力点和尾背区域性脱毛的报道。治疗需要补充甲状腺素。

Hypothyroidism is increasingly recognised in cats following treatment for hyperthyroidism (surgical or radioactive iodine). Naturally occurring disease is extremely rare (congenital dwarfism in young kittens; one published spontaneous case in an adult cat). The most common signs are lethargy, reduced appetite, weight gain, and subtle skin changes including dull haircoat with scaling, hair matting and excessive shedding. Regional alopecia affecting pinnae, pressure points and the caudal back is reported. Treatment requires adequate thyroid hormone supplementation.