Himalayan cat idopathic facial dermatitis

Question
Dr. Gotthelf, I have been asking you privately about this problem. Now I will post so that others can read. I have a young whole male Himalayan that has a type of idiopathic facial dermatitis problem on his chin and check fold area. The vet felt it was a food allergy but I have discovered that it's not. I had another high expensive bill with another cat and can't keep spending money and have no results. I see holistic vets and will never get steroids for something like this it's risky with side effects. It looks black waxy crusty and greasy but his body is not the slightest bit greasy. I think this is an inherited breed problem. Feeding single protein food has not improved this like the dermatologist said. I took away the dry food for three weeks and he had drastic weight loss with no improvement. I worry about the cat getting Lipodosis/fatty liver.  I told him I had already ruled out the food but he wanted me to try again. He said he would not give me the Atopica or tacolomus without the food trial. I know they are specialized but going on now four appointments? This is crazy. I have gone to them three times now. I was given cleansers and topical antibiotic cream and advised to give Zenequin for three weeks because there were bacteria's in the skin. This has not changed it one bit. I told them I wanted to try the Atopica or tacrolimus cream and you had also suggested this. I want to find a pet home for this cat but not pass on this problem I want to solve it. I am a breeder and it is cost me a lot of money to date and will never get the expenses back. This dermatologist has been the only one up till now and he has not got the best public relations reputation with clients. I heard this from one of my veterinians. I totally agree and wanted a referral to a different one for future. I hate going to spend money only to be treated rudely and not listened to.  There is a better one that has a better way with people. The poor cat is hating me now because I clean and shave his chin to try to keep it clean. Our conversation was so upsetting to the cat that the cat urinated on him. I think the cat felt the upset. He is sensitive. He did this at another vet's office. Poor boy. I wonder if neutering him can help improve his skin. Deb

Answer
Idiopathic means that we have no idea what this is.  If there is chin acne, there could be yeasts, demodex mites, or a bacterial infection. Have they done a biopsy, cytology, or cultured these lesions?  With facial dermatitis, food allergy is a common culprit.  I always try Hill's z/d diet for cats with food allergy because they love it and it is easy to do.  Atopica is now available for cats in a liquid form and it will not hurt the cat.  It can be used concurrently with a 6 week food trial and when the 6 weeks is up, if the cat is better, then you can withdraw the special diet food and go back to regular food.  By that time, the Atopica dose should be reduced to twice weekly. If the facial lesions come back with the new food, then it is a food allergy.