Saggy Skin in Cats

A cat with excess skin may suffer from an extremely rare and serious medical condition called cutaneous asthenia, dermatosparaxis, or Ehlers–Danlos Syndrome. This hereditary condition results in a deficiency of collagen of the skin. Collagen is a protein that is one of the three main building blocks of the skin. When collagen is deficient, the skin lacks structure and integrity; it sags or hangs. This condition is serious because this collagen deficiency results in skin that not only sags, but that is easily torn and which has difficulty healing. A cat with Ehlers-Danlos Syndrome is likely in a great deal of pain. If you are concerned that your cat may be suffering from cutaneous asthenia it is important that your cat be examined by a veterinarian immediately. This will allow for the vet to make an expert diagnosis of your cat’s condition and to prescribe treatments or protective measures for your cat.

There are differing levels and causes of “sagginess” in the skin of cats, some of which are natural and harmless, others that are very serious and painful. Some cats, much like some human beings and other animals, simply have more skin than others, although it might be best to allow a veterinarian to make this determination. In addition, a cat that has lost a significant amount of weight in a short amount of time will likely have saggy skin, and in extreme cases may benefit from excess skin removal surgery. It is also exceedingly common that cats have a belly of thick skin that hangs down below them as they walk, at times even swaying. This thick flabby skin is referred to as the primordial pouch and is believed to be an evolutionary adaptation that allows the cat to stretch as it runs, to expand its stomach to gorge on food in times of scarcity, and that protects its internal organs in a fight. Not all cases of saggy skin in cats, however, are harmless.

Some cats have a natural, harmless “sagginess” to their skin that is the result of a small amount of excess skin, the common primordial pouch, or stretched skin that is the result of significant weight loss. If any of these conditions are of concern to the pet owner, a veterinarian should be consulted. In contrast to these harmless instances of saggy skin in cats, the following symptoms may be evidence of Ehlers–Danlos Syndrome, a very serious and painful hereditary condition that requires immediate veterinary attention and medical intervention.

• Hyperelasticity of skin
• Frequent skin wounds
• Skin ulcers, tears, and lesions
• Delayed healing of wounds
• Thin, papery skin that tears easily
• Hair loss
• Loss of appetite
• Dehydration 
• Vomiting
• Weight Loss
• Lethargy
• Weakness
• Jaundice
• Joint laxity

Ehlers–Danlos Syndrome is a congenital condition that is, in some cases, the result of a recessive gene that is passed on to the offspring by one parent, and in other cases the result of a dominant gene, which is passed on to the offspring by both parents. The only reliable way to prevent this condition is by preventing any cat from a biological line that has produced a cat with Ehlers-Danlos Syndrome from breeding. This is difficult, however, because cats can be carriers of this gene even if they do not show the symptoms of Ehlers-Danlos Syndrome.

While this condition is extremely rare, there are numerous tools available to veterinarians for diagnosing Ehlers-Danlos Syndrome in cats. If you and your veterinarian are concerned that your cat may suffer from this condition, your vet will likely utilize the following protocol for making a diagnosis:

• Thorough physical examination
• Blood tests to rule out other underlying conditions
• Urinalysis to rule out other underlying conditions
• Skin biopsies 
• Areas of skin will be stretched to their maximum point and measured. These measurements are compared to the skin extensibility index (SEI), which is a scale that shows normal and abnormal ranges of skin extensibility in cats.
• Skin scrapings and hair samples may be examined under a microscope to rule out parasites.
• Skin scrapings may be examined under a microscope in order to observe any collagen abnormalities.

There is no cure for Ehlers-Danlos Syndrome and the options for treatment are few. While some isolated studies have shown mild improvement through prolonged supplementation of vitamin C, zinc, vitamin E, and collagen, the pet owner will likely have to decide between long term management of the condition or euthanasia, depending upon the veterinarian’s advice and the severity of the condition in a particular cat. As difficult as the decision can be, the most humane option for a cat with a serious case of Ehlers-Danlos Syndrome that does not respond to prolonged attempts at treatment, may be euthanasia as to avoid chronic pain and a low quality of life. In cases which the cat’s condition will be managed, depending upon what symptoms your cat has displayed, the vet may provide intravenous hydration, steroids, and antibiotics to help wounds to heal. 

At the present time, full recovery from Ehlers-Danlos Syndrome is not possible. If the veterinarian and pet owner decide that it is a humane option to manage a particular case of Ehlers-Danlos Syndrome, the cat will likely need to be declawed to prevent unintentional self-injury when scratching. The cat will also need to be isolated from other pets as well as small children to prevent injury. Any sharp corners on furniture will need to be padded, and the pet owner will need to examine the cat for tears in the skin on a regular basis. A cat with Ehlers–Danlos Syndrome must never be allowed to breed. It is also likely that the cat will need to be examined by a veterinarian on a regular basis and any wounds treated to prevent infection, substantial blood loss, and damage to subcutaneous tissue.