Hot spot?

Every couple months, Sebastien rips all the hair out of his shoulders ("withers") and scratches himself until he's bleeding. Sometimes actually he will go for longer in between episodes, but it occurs regularly. Doesn't matter where I live, what he eats, how often I groom him, etc. I'm at my wit's end. Vet and I have been treating him with drops (antibiotic steroid drops) and by putting soft paws on his back toes so he can't scratch. Vet sometimes gives him an injection as well to kickstart the healing process.

He's on a grain and dairy free diet. The protein is turkey. No flea/tick drops. He's a strictly indoor cat. He's a nervous kitty by nature. Sneezes send him to the other room or under the couch.

Is this a hot spot? Any of your kitties get them? Any advice to try and make his episodes less frequent? I attached a photo of what he's been doing to himself.
Currently giving him belly scratches while he drools and looks at me adoringly.

Well, technically I guess you could call that a hot spot.  Normally they lick or chew a hot spot, but due to the position of it, he can't very well do that, but since he is causing it over and over again, I would say that's what it is. 

What are the drops he's getting?  Do you administer them orally?   I'm guessing the shots to kick-start the healing are maybe cortisone directly into the spot?  Do you apply any sort of topical spray or cream onto the spot?  Have you tried Vetericyn Wound and Skin Care? 

It's possible he needs to be on something besides turkey as his protein....rabbit?  OR, it's possible he needs to be on something for his anxiety, since he's a nervous cat by nature.  Do these outbreaks coincide with any specific things that happen that are extra frightening to him? 

The drops are called Tresaderm, and I apply them directly to the spot. And yes he usually gets a shot of cortisone. I don't think they coincide with anything significant to me, but who knows with his cat brain? He did the current spot all while I was at work, just over the course of a few hours. I spray ComfortZone but I need a new refill for my diffuser. It seems to help him a little.

Have you and your Vet ever discussed using Atopica?  Just a thought.  Not sure if it's appropriate, but it might be.  I think many people use it for skin issues/allergies, that type of thing.  Here's a thread on it, that discusses the good and bad of it:  http://www.thecatsite.com/t/239900/anyone-using-atopica.  And then, there are anti-anxiety MEDS, as a last resort.  But first, I would absolutely refill that Comfort Zone diffuser.  Is ONE enough, or do you need one for each room?  I know with Feliway, the diffusers only cover XX amount of square footage. 

So does your guy usually do this while you're at work?  I guess something could happen while you're away to cause him anxiety...someone comes to the door, a neighbor makes a lot of noise, whatever.  Or maybe he just gets bored?  Hard to know.