Reactive Skin

I'm in quite a dilemma with my big, 15 pound, boy Sushi. I took him into the vet 2.5 months ago for a skin issue. He had some thickened rashy skin on the back of his neck. Assuming it was a dermititis the vet sent me home with 2 weeks of clavaseptin (antibiotics) and Isaderm (topical antibiotic cream). After not much progress and much stress with pilling a cat we tried one more week of antibiotics. At this point the skin was not getting better and kitty was scratching with back claws a bit and with no hair protecting the area he started cutting himself. A round of venactyl (steroid and antihistamine) to help inflammation and itch still no better. I continued to use the isaderm cream and tried as much as I could to keep a shirt or bandage around him to cover the affected area but Sushi manages to get out of the shirts.

Three days ago I took him back to the vet and now I'm told he needs to have surgery to remove the skin! I'm thinking of getting a second opinion but Sushi is scratching SO SO much. Several times a day I have to clean bleeding and broken skin. I'm heartbroken over it and feel helpless.

The vet doesn't even seem to know what this is....he keeps calling it reactive skin and that the best way to describe it is the skin tissues aren't behaving the way they're supposed to.

So I guess I'm wondering if anyone else has dealt with this before? Would you just automatically jump and have your cat get surgery on something that the vet doesn't even know what it is? Would you get a second opinion? I'll pay the $1500 for the surgery if it's absolutely necessary but with no tests having been done I feel like operating on something unknown seems irresponsible.

If you've experienced this and have gotten out onto the other side successfully I would sure appreciate hearing your story! HELP!!!

And if you have any creative ideas on how to cover a wound on the back of a cat's neck I'm all ears! Tried a dog shirt which was ill-fitting and didn't actually cover the wound. He manages to squirm his way out of the baby shirt. I've tried an ace bandage but he can squirm his way out of that too and I'm worried it's too tight around his neck. Now there's the issue that he has sores on the infected skin and I can imagine how uncomfortable a shirt rubbing against it would be. My vet has offered me no help or support in this regard other than "make sure he wears the shirt as much as possible".

See pictures for most recent photos of skin and wounds.

Oh my goodness!  Your poor boy!

I think it's definitely worth getting a second opinion from another vet.  That's a drastic step to take.

One possibly very obvious question - are you sure he doesn't have fleas?  Some cats are VERY allergic.

He is a completely indoor cat. I've never once seen a flea on him or myself ever. The only times he's ever been out of the house is in the carrier on the way to the vet or when I've moved a few times. If it's fleas damn they can hide

Do you apply any topical flea meds on him?  What do you feed him? It could very well be food allergy or even a litter allergy.

He's an indoor cat and has never been treated for fleas.

I feed him various flavours of a soft food called performatrin. And science diet oral care hard food. I switched to those foods in december from a super shite brand from the grocery store and started noticing the skin stuff about 5 months later. The vet suggested awhile back that it could be a food allergy but then never revisited that option and went straight to surgery. I dont' have the first clue on how or what to eliminate when trying to find a food allergy. I feel like the vet should have provided guidance on that no?