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*Examination of the skin
 
*Examination of the skin
 
*Microscopical analysis of hair shafts
 
*Microscopical analysis of hair shafts
*Rule out of other potential causes and underlying actors (e.g. ectoparasites)
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*Exclusion of other potential causes and underlying factors (e.g. ectoparasites)
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In true [[Alopecia and Hypotrichosis|alopecia]], hairs are easily epilated in the areas of hair loss, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the remaining hairs remain firmly attached but will feel '''spiky''' and '''sharp''' because the tips have been removed. Microscopic examination of a hair pluck will confirm the state of the hair tips. '''Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue'''. These signs are an immediate indication that the cat is not suffering from a true alopecia. Parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as [[Feline Scabies|sarcoptic mange]] may also be causes of overgrooming that progresses into self-harm.
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n true [[Alopecia and Hypotrichosis|alopecia]], hairs are easily epilated in the areas of hair loss, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the remaining hairs remain firmly attached but will feel '''spiky''' and '''sharp''' because the tips have been removed. Microscopic examination of a hair pluck will confirm the state of the hair tips. '''Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue'''. These signs are an immediate indication that the cat is not suffering from a true alopecia. Parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as [[Feline Scabies|Notoedric mange]] may also causes of overgrooming that progresses into self-harm.
   
Feline idiopathic cystitis (FIC) has recently been found to account for a substantial proportion of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area, leading a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. [[Feline Hyperaesthesia Syndrome|Feline hyperaesthesia]] can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.
 
Feline idiopathic cystitis (FIC) has recently been found to account for a substantial proportion of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area, leading a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. [[Feline Hyperaesthesia Syndrome|Feline hyperaesthesia]] can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.
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===Feline Orofacial Pain Syndrome (FOPS)===
 
===Feline Orofacial Pain Syndrome (FOPS)===
Although not a problem of over grooming, FOPS may be presented by owners as a grooming problem. The clinical signs are characterised by '''exaggerated licking and chewing movements, with pawing at the mouth'''. Typically the discomfort is '''unilateral''' or worse on one side and can be episodic or continuous. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. Episodes of FOPS are often triggered by mouth movements during eating or grooming, indicating a problem of allodynia. As a result, cats will often become anorexic or stop grooming. Self-mutilation may be very severe, involving partial removal of the tongue.The aetiology and genetic basis of this condition are under investigation. Two groups of FOPS cases are observed; those with continuous symptoms, and those with intermittent bouts of symptoms. FOPS can begin at any age, but in most cases seen in older animals there may have been a history of a brief episode of facial pawing earlier on in life, even if that did not lead to tongue damage. This implies that there is a lifelong sensitivity issue that is exacerbated by certain medical problems. Oral health plays a significant role, with FOPS being associated with dental disease (such as [[Periodontal Disease|periodontal disease]] and [[Feline Odontoclastic Resorptive Lesions|dental resorptive lesions]]), dental eruption and mouth ulcers. It is also common for FOPS to become symptomatic after dental work, particularly removal of tartar or teeth, when either dental neck lesions are exposed or tooth roots are not completely removed. Treatment involves resolution of the underlying problem, such as ulcers or dental problems, combined with the use of analgesic drugs, including those typically used for treating epilepsy or neuropathic pain.In a recent study some cases with [[gingivitis]] appeared to respond to antibiotics, although spontaneous remission could not be ruled out. [[NSAIDs]] provided effective analgesia for some mildly affected cases. [[Opioids]] proved to be very useful for hospitalised cases; but anti-epileptic drugs (diazepam or phenobarbitone) gave more sustained and consistent relief. Occasionally life-long therapy is required. Some cases, especially those with chronic dental disease, responded to [[Steroids|steroid]] therapy.
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Although not a problem of over grooming, FOPS may be presented by owners as a grooming problem. The clinical signs are characterised by '''exaggerated licking and chewing movements, with pawing at the mouth'''. Typically the discomfort is '''unilateral''' or worse on one side and can be '''episodic''' or '''continuous'''. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. Episodes of FOPS are often triggered by mouth movements during eating or grooming, indicating a problem of allodynia. As a result, cats will often become anorexic or stop grooming. Self-mutilation may be very severe, involving partial removal of the tongue. The aetiology and genetic basis of this condition are under investigation.  
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'''Two groups of FOPS cases are observed'''; those with '''continuous symptoms''', and those with '''intermittent bouts of symptoms'''. FOPS can begin at any age, but in most cases is seen in older animals and there may have been a history of a brief episode of facial pawing earlier on in life, even if that did not lead to tongue damage. This implies that there is a lifelong sensitivity issue that is exacerbated by certain medical problems. Oral health plays a significant role, with FOPS being associated with dental disease (such as [[Periodontal Disease|periodontal disease]] and [[Feline Odontoclastic Resorptive Lesions|dental resorptive lesions]]), dental eruption and mouth ulcers. It is also common for FOPS to become symptomatic after dental work, particularly removal of tartar or teeth, when either dental neck lesions are exposed or tooth roots are not completely removed. Treatment involves resolution of the underlying problem, such as ulcers or dental problems, combined with the use of analgesic drugs, including those typically used for treating epilepsy or neuropathic pain. In a recent study some cases with [[gingivitis]] appeared to respond to antibiotics, although spontaneous remission could not be ruled out. [[NSAIDs]] provided effective analgesia for some mildly affected cases. [[Opioids]] proved to be very useful for hospitalised cases; but anti-epileptic drugs (diazepam or phenobarbitone) gave more sustained and consistent relief. Occasionally life-long therapy is required. Some cases, especially those with chronic dental disease, responded to [[Steroids|steroid]] therapy.
    
==Treatment==
 
==Treatment==