feline miliary dermatitis

Question
My vet said that my young cat has feline miliary dermatitis, and that this is a genetic disorder that cannot be cured, only treated & supressed. Is this true? She has been scratching almost non-stop around the fronts of her ears above the eyes, and under the chin. She has caused much of her fur in these areas to fall out. My vet prescribed cephalexin, medrol, and otomax. Are these good RXs?

Answer
Miliary dermatitis is a non-specific term for the small crusty lesions that cats can get in response to many different conditions. (They feel like little "millet seeds", hence the name.) It is not genetic. Underlying reasons for cats to get miliary dermatitis include flea allergy, environmental allergy, food allergy, bacterial infections, immune-mediated skin diseases such as pemphigus. Food allergies are often manifested as facial itchiness and self-inflicted excoriations. The first thing I suggest is you treat the cat with an effective flea preventative such as Advantage, Frontline or Revolution so the fleas can be ruled out. If it is not fleas, and this is by far the most common cause of miliary dermatitis, then I would recommend a skin biopsy so you can get an answer. Then  your vet will know what they are treating rather than throwing lots of different drugs at her. Once we know what we are treating we can come up with a plan which might include a hypoallergenic diet for a food allergy or immunotherapy for environmental allergies or prednisolone in the case of Pemphigus. If you are not happy with the tests you are being offered for your cat by your vet then I would seek a second opinion elsewhere.
Dr. G.