Bowen's Disease

[Black&White]

Hi Babiemom! Thank you for your message, I don't seem to have received a notification for that, so I am just seeing it now, so sorry to have missed that... but I did receive a notification for AlexB.just now.
Thank you for the update and suggestions, we have not been able to find anyone who does cryotherapy, I do not know why that would not be more available in Canada.
It was found that Kitty is also anemic, and has stage 2 kidney disease. Since her surgery, in the last week or so I noticed she was drinking a lot more water than usual, and just 2 days ago I discovered that she had been urinating in a corner of the house - quite alot! So she is now using a litter box, and has another blood test/urinalysis next week. I am guessing the aldera has agravated her kidney disease? Otherwise she seems to be her usual self...

 

[Black&White]

Hello Alex, make sure to cut the fur away from the lesion, and I use a shaving razor to take it right to the skin. Use some warm water and a cloth to exfoliate the scab off as much as possible, dry with tissue, before applying the cream. Use as little as possible, I use a pen that has a roundish end, where you press it, to apply the cream. Just dab it on and around the edges of the lesion area. For a larger area I would use a latex glove.
If there is any area where she can lick, you need to cover that. Apply every two days, and perhaps rub off with a cloth using warm water the days between.
I have a large pillow that I put on my lap, and I lay her on her side and turn her as needed.
New lesion should disappear after 3-6 applications, some could take longer, even months, but if there is no response then you want to keep them at bay with the aldera until you can have laser, cryotherapy, or surgery.

 

[AlexaB]

Hi Black&White,



Thank you so much for your answer and for the advice! I am following almost everything you said already. When I went with her to the dermatologist, he identified the problem, took a biopsy (from 2 different lesions) and we decided to trim all of her hair just to see how many lesions she has because she is a black and white cat and the black lesions were hard to see under the fur. We discovered she had a loooot – I think at least 50 – her neck and back are covered in black spots. Now that I know where the larger lesions are, I trim her hair off with very small and sharp scissors. I cannot use a razor because of the crusts she has. I started with the neck area because those were the ugliest and 1 sachet of Aldara was not enough to cover all of them. I am using a very thin film and a latex glove because I have a very large area to cover. Now that part of the crusts fell off I can cover a larger area and in the last 2 weeks, I managed to apply it on almost her whole back. The vet told me that this dissipates through the skin and generates an immune response that will act at a distance too, so also on lesions where I do not apply cream. Also, he said I need to use it daily, which I do. I have no clue which lesions are new and which I maybe just notice now because I keep stressing her and looking through her fur all the time. I saw one on her front paw a few days ago but I don’t know if it’s new or I just saw it now because I saw her licking that area. I started doing the wet cloth thing today, let’s see if the crusts fall off easier and do not come back.

She is not licking the cream off because I usually apply it just before we go to bed and she sleeps near me under the cover after. I watch TV for a 2-3 hours until I fall asleep so I can stop her if she tries to do something

I am sorry I write so much but I try to figure things out and the most frustrating thing is that I am not sure the treatment works because I cannot see a very clear improvement. Maybe some little ones but it’s not something easy noticeable. We have our next appointment on the 15th of December, so I will see what the vet says but I am pretty stressed

 

[Black&White]

The black spots are not necessarily lesions, my cat also has them even after the lesion has cleared up.

 

[AlexaB]

Hmm, so you say only those scabs are dangerous? I was expecting the black skin to go away too. That actually sounds very encouraging because in that case, something is happening. This is how it looks today but it used to look a whole lot worse.

 

[Black&White]

Yes, just the scabby center is the lesion, that looks similar to my cat although that is a very large area of black spot.I think you could shave around the lesion a little more with a razor if you use the hot water and cloth. The razor will also take some of the scabby surface off, lightly scrape, then use the water and cloth.Scab and fur will prevent the aldera from penetrating deeper.

 

[babiesmom5]

Welcome to the Bowen's Disease club...but sorry you and your cat are in it. Black & White and I have been here for a while and I read what she said and echo it. Bowen's Disease usually goes undiagnosed for a year or more, as it did with my kitty. Regular vets rarely see cases (my vet only saw one in her entire career), so vets try this and that and only when it doesn't work, is a Dermatologist brought in. By the time Bowen's was finally diagnosed with my cat, she had an ulcer on her head which required surgery.

We have been dealing with Bowen's now going on 4 years. As you can read from my previous posts, we tried Imiquimod (Aldera), but she had a reaction to it and we switched over to Cyrotheraphy which has worked very well in keeping the lesions at bay.

Initially, the lesions/scabs are crusty and dark grey or black. Aldera causes them to become lighter grey and less prominent in size. If the lesion is small to begin with, it will turn pink like normal skin. But the larger lesions never really turn pink. This does not mean the Bowen's is still active though. I have seen grey lesions, slightly crusty which I thought were still active, but upon close examination by the Dermatologist under a light, she says they are resolved.

I'd say your cats lesions were fairly extensive and widespread, so I would not expect immediate results. You may see some improvement, (lesser area, lighter grey, less crusting) in 6 weeks, but in my opinion, it may take a few months to reach the point of stabilization. It did for me.

If you are able to get laser treatment, or Cyrotheraphy, after stabilization, I would go for it as it has the potential to hold these lesions at bay longer than Aldera cream. These things never fully go away it seems as the papilloma virus remains in the body, but you can at least prevent it from going sub-dermal.

Try to get the Aldera directly onto clean, uncrusted, hairless skin so it makes the most direct contact. Keep the area clean with a washcloth, shaved and exposed, and keep at it. Don't get discouraged. Fortunately this is a slow growing type of cancer, so one can stay ahead of it.

Please keep us updated on how your cat is doing. We welcome any and all questions too. Remember, we're all in this battle together for our dear fur babies! You can prevail, so hang in there!

 

[Black&White]

We found a vet on the island who does cryotherapy (they call it cryo-surgery), in Nanaimo of all places, which is about a 2-3 hour drive for us. They said it is a small pen and they have only used it for very small skin issues, so they are not sure if it would be suitable for our needs. I am going to try and do a remote consult over zoom to see, I think that with some photos should be enough to determine whether they can manage it or not.
I was informed that it is possible to buy a disposable cryopen on the net, so I wonder why more vets dont buy one...

 

[AlexaB]

Hello ladies,

So, I have an update. We went to the vet on the 21st of December and the dermatologist said he is very pleased with how the lesions look, he said all of them look much better and we have our next appointment at the end of January to see where we go from there. I was soooo happy with the news, you cannot even imagine. I want to thank you both again for answering my questions and for the encouragement and advice, it really helped a lot.
We talked a bit about laser and cryptherapy again. He said that cryotherapy is not an option for her because it's a bit more agressive than the laser and the hair does not grow back where you use it and since she has large areas that need to be treated, he does not recommend it. Laser would be best option for us and we will see in January. She lost some weight (the assumption is that it's a side effect from the Aldera) so I switched her on wet food to be able to control how much she eats a bit better (I have 2 other cats so I can never figure out how much she eats). I noticed she was eating a bit less then she was supposed to but she started eating better and better because I always run around her with a bowl full of food, like a crazy person ). We went from a bit less than a can to 1 1/2 cans a day so I am hoping she will gain some weight soon. She, of course, has some days when she does not want to eat that much but I am less worried now because she does not vomit or anything, it's just her appetite that it's a bit decreased probably. Also, she had some swollen lymph-nodes. I panicked a bit at first because as you know this could be a sign of malignancy but the doctor said we should wait and see because he thinks it's a side effect from Aldera. I noticed them right after I started her treatment, at the beginning of November. He checked them now and said they did not grow at all, they actually are a bit smaller so it was almost for sure a side effect but we will keep watching that. He scraped some of the crusts away and checked them under a microscope and said she has some bacterial infection but did not give her any antibiotics, just some wipes with clorehxidine that I should use daily. She did not have any fever or other signs of infection so we will see what happens. Otherwise, she is doing pretty good, she even runs to the kitchen where we keep the wet food. She never was a very energetic cat, she mostly seeks the company of humans and wants to sit on our lap so the fact that she runs to get food is the most action we get from her It's usually a sign that she is feeling well.

Happy holidays to you and your families! I hope your fur babies are doing good and that we will all share good news in all our next posts

 

[babiesmom5]

We found a vet on the island who does cryotherapy (they call it cryo-surgery), in Nanaimo of all places, which is about a 2-3 hour drive for us. They said it is a small pen and they have only used it for very small skin issues, so they are not sure if it would be suitable for our needs. I am going to try and do a remote consult over zoom to see, I think that with some photos should be enough to determine whether they can manage it or not.
I was informed that it is possible to buy a disposable cryopen on the net, so I wonder why more vets dont buy one...

That is wonderful that you have found a vet on the island who does cryotherapy in Nanaimo! Great news!
Yes, the cryotherapy pen is a very small one, but there are different size pens used depending upon the size and scope of the lesion. My cat has had the 2-4mm, the 3-5mm and the 5-8mm pens used. There may be others as well. The 2-4mm pen was used on small, delicate lesions near over her eye and ears. I have not heard of the disposable cryopen, but thanks for informing us. Do you have a scheduled vet appointment for the cryotherapy? I think a remote consult over Zoom beforehand is a great idea. I wish you and your cat all the best. Please keep us updated...and Happy Holidays to all!

 

[babiesmom5]

Hello ladies,

So, I have an update. We went to the vet on the 21st of December and the dermatologist said he is very pleased with how the lesions look, he said all of them look much better and we have our next appointment at the end of January to see where we go from there. I was soooo happy with the news, you cannot even imagine. I want to thank you both again for answering my questions and for the encouragement and advice, it really helped a lot.
We talked a bit about laser and cryptherapy again. He said that cryotherapy is not an option for her because it's a bit more agressive than the laser and the hair does not grow back where you use it and since she has large areas that need to be treated, he does not recommend it. Laser would be best option for us and we will see in January. She lost some weight (the assumption is that it's a side effect from the Aldera) so I switched her on wet food to be able to control how much she eats a bit better (I have 2 other cats so I can never figure out how much she eats). I noticed she was eating a bit less then she was supposed to but she started eating better and better because I always run around her with a bowl full of food, like a crazy person ). We went from a bit less than a can to 1 1/2 cans a day so I am hoping she will gain some weight soon. She, of course, has some days when she does not want to eat that much but I am less worried now because she does not vomit or anything, it's just her appetite that it's a bit decreased probably. Also, she had some swollen lymph-nodes. I panicked a bit at first because as you know this could be a sign of malignancy but the doctor said we should wait and see because he thinks it's a side effect from Aldera. I noticed them right after I started her treatment, at the beginning of November. He checked them now and said they did not grow at all, they actually are a bit smaller so it was almost for sure a side effect but we will keep watching that. He scraped some of the crusts away and checked them under a microscope and said she has some bacterial infection but did not give her any antibiotics, just some wipes with clorehxidine that I should use daily. She did not have any fever or other signs of infection so we will see what happens. Otherwise, she is doing pretty good, she even runs to the kitchen where we keep the wet food. She never was a very energetic cat, she mostly seeks the company of humans and wants to sit on our lap so the fact that she runs to get food is the most action we get from her It's usually a sign that she is feeling well.

Happy holidays to you and your families! I hope your fur babies are doing good and that we will all share good news in all our next posts

Thank you for the update. That is great news! I can truly understand your joy. I do think the reduced appetite may have been caused by the Aldera. That happened with my cat; reason we had to switch to the Cryotherapy. My cat has other issues, so appetite decrease could be problematic in her case. Since your cat has more extensive lesions, your vet was right in that the laser would be a better option. Cryotherapy is mainly used for smaller lesions and those in more sensitive areas around the face. It is good your vet checked under the crusts with a microscope and she did not need antibiotics. My cat had to be on antibiotics for a while for the main lesion on the head which had become ulcerated prior to treatment. Now I too use those chorhexidine wipes for a bacterial area between the toes, but she hates it, so the vet gave me this spray which works well. It seems your cats is stabilized now and feeling better. So continue what you are doing, monitor carefully between now and January appointment. She should be ok between now and then. Please keep us posted and Happy Holidays to all!

 

[AlexaB]

Hi Babiesmom,

You said your vet gave you a spray to use instead of the wipes so I searched if we have something in my country too and I found one (from VetExpert). It contains NanoSilver, Chlorhexidine, Panthenol and Lanolin so I bought it because I too think it easier for her to tolerate it. She started being pretty pissed when I do stuff to her so it seemed like a better option. I wanted to ask you what the spray you are using contains, if you could tell me it would be great. I did not ask the vet if I can use it yet and am a bit worried that it might contain something that is not ok for her disease (don't think so but I would be more at peace if I knew what you are using).

 

[babiesmom5]

This spray is "Douxo Chlorhexidine Micro-emulsion Spray" (200 ml, or 6.8 fl. oz.). The active ingredients are Chlorhexidine gluconate 3%, Phytosphingosine salicylate 0.05%.There are some inactive ingredients also like water, Hexyl laureate glycerin, Centeryl Alcohol, Centereath-20, Centeareth-12, Glyceryl Stearate, PCA Ethyl Cocoyl Arginate,Potassium sorbate, Sodium Hydroxide.

The main antibacterial ingredient we both have in these sprays is Chlorhexidine. If you got yours from a veterinary supply place as it appears you did, I would think ingredients would be safe for a pet. Nanosilver is sometimes used on fungus areas. Panthenol and Lanolin I know are used for skin issues. Just from my perspective, it doesn't appear to contain anything harmful, but to be completely at peace you could always run the ingredients past your vet.

I do think the spray is better tolerated than the pads as you are not "messing" with their feet. Cats hate that as we both know!. Good luck with your kitty.

 

[Black&White]

Hi Babiemom, i wanted to share a couple of photos of a new lesion that formed shortly after her surgery. It is unlike any other I have seen, it started small, then just when I think it has cleared up, it moves outwards. About a month of treating it almost every day now, and it has progressed from the small to the large in the pics.

One observation is that the long 'C' shape is similar to the incision made to remove the old lesion that was next to it, almost like it is mimicking the incision...

How does it look to you?

 

[babiesmom5]

This does not appear to be a progression of Bowens as it would be dark, grey color. To me it looks like possibly inflammation, possibly even infection being red like this and getting larger. I mean after surgery on my girls head lesion, the area was pinkish for a while,but did not get larger. Is this area sensitive to her? Does she scratch it? This redness and enlargement merits a look by your vet in my opinion. Please let me know how you make out with this.

 

[Black&White]

Thank you, I also thought it might not be Bowen's, she does scratch and lick at it but she wears a collar. I will stop applying the aldera and see what happens, and let our vet know.

 

[AlexaB]

Hello ladies,

just wanted to give an update. We took a very big stept back and it was touch and go for a few days. My cat started having neurological issues (she seemed dizzy and struggled to keep her balance - she did not fall over but for a minute or so, she was balancing from one side to the other) so I rushed her to the vet. They took some labs, said there are a number of things that might cause it but they told me to stop the Aldara immediately and talk to the dermatologist afterwards. Her labs came back and her liver enzymes were very elevated. She was on iv treatment for a couple of days and I honestly thought she was going to die. But she got better and she is a different cat now, I swear. She eats a lot better, she does not shake anymore, she is more alert and happy. She gained 150 grams in less than 1 week. I went to the dermatologist with her a few days later and he was very disappointied I took her off the Aldara (to put it mildly) because he did not think that was the cause and I basically stopped the only treatment she had for her disease. He said I should exclude other causes first and then we'll see but he did not seem to want to get involved anymore, or at least that is how I felt. Anyway, she had an abdominal echo, a full cardio workup and everything came back clean (except signs of renal disease but that we knew, she has treatment for that since the end of 2019 and it's managed pretty well - her labs are normal). It's pretty clear now that the toxicity of the Aldara caused that whole episode and I don't really want to put her back on it. So now I have no clue what to do, I have to search for laser options, seems it's the only thing that's left. The dermatologist gave me the name of a doctor in Austria so I will write them an email on Monday and we'll see if they will accept her as a patient.

 

[fionasmom]

I am glad to read that you were able to pull her back from the brink!

Use of imiquimod 5% cream (Aldara) in cats with multicentric squamous cell carcinoma in situ: 12 cases (2002-2005) - PubMed.
I don't have any direct experience with Aldara but the article does list some side effects that you seem to have had. The fact that the dermatologist seemed less interested once you stopped it is probably not unexpected.

I had good luck years ago with laser on a dog's feet which were seriously abraded from the loss of the use of the rear legs, so hopefully there is a laser treatment which might help your cat.

 

[babiesmom5]

Hello ladies,

just wanted to give an update. We took a very big stept back and it was touch and go for a few days. My cat started having neurological issues (she seemed dizzy and struggled to keep her balance - she did not fall over but for a minute or so, she was balancing from one side to the other) so I rushed her to the vet. They took some labs, said there are a number of things that might cause it but they told me to stop the Aldara immediately and talk to the dermatologist afterwards. Her labs came back and her liver enzymes were very elevated. She was on iv treatment for a couple of days and I honestly thought she was going to die. But she got better and she is a different cat now, I swear. She eats a lot better, she does not shake anymore, she is more alert and happy. She gained 150 grams in less than 1 week. I went to the dermatologist with her a few days later and he was very disappointied I took her off the Aldara (to put it mildly) because he did not think that was the cause and I basically stopped the only treatment she had for her disease. He said I should exclude other causes first and then we'll see but he did not seem to want to get involved anymore, or at least that is how I felt. Anyway, she had an abdominal echo, a full cardio workup and everything came back clean (except signs of renal disease but that we knew, she has treatment for that since the end of 2019 and it's managed pretty well - her labs are normal). It's pretty clear now that the toxicity of the Aldara caused that whole episode and I don't really want to put her back on it. So now I have no clue what to do, I have to search for laser options, seems it's the only thing that's left. The dermatologist gave me the name of a doctor in Austria so I will write them an email on Monday and we'll see if they will accept her as a patient.

Oh, I am so sorry about your kitty. I have pulled my cat back from the brink and know how scary this is. Thank goodness she has improved and is stable now, except for the Bowens and renal disease. I definitely think it was wise to discontinue the Aldera. This cream has to be processed through the kidneys (already compromised) and can affect the liver as you just saw. The fact that she is doing much better since discontinuing tells you something also.
Obviously the dermatologist you were seeing can suggest no other alternatives, therefore you were wise to seek out a new one who could provide other options. Do look into a Dermatologist who could use Cyrotherapy which uses extreme cold to freeze and remove the lesions. My cat has used this for the past 2 years very successfully. It is not the same as laser, but does use a fine tip pen. When you write the doctor in Austria, be sure to ask about Cyrotherapy along with laser therapy. Please keep us updated; and as always, we wish you and your kitty the very best.

 

[Black&White]

The rash on Kitty's chest disappeared after I stopped the aldera...but the incision where she had surgery is quite itchy, it is quite a long incision across her chest, but it is several months since the surgery, is this indicative of anything?