Question: Dear Dr. Richards,
I love your site and refer to it constantly. I have a spayed pug bought from a reputable breeder born July 18, 1998. When she was approximately 10 months old she developed bumps around her right eye. They were biopsyed and there was nothing except lots of demodex mites. Unfortunately it became generalized and she had some secondary infections going on as well. Although she didn't fit the profile the dermatologist vet thought she had juvenile cellulitis also so she was put on 15mg of prednisone (very risky with generalized demodex), 11.5mg of milbemycin (interceptor) and 75mg of antirobe. That combination worked and she got better after two months and a bit. I recently weaned her off of everything. She did not tolerate the interceptor (lots of vomiting and aspirating) once she was off the prednisone so even though we wanted to keep her on that we've stopped all meds. Then just one week after stopping her medications she has developed a lump around her eye again and her pads of her paws are reddish. My vet did a scraping and plucking and there was no evidence of demodex so we put her back on 75mg of antirobe and it is starting to get better. My question is I know that all of these problems are probably a result of t-cell deficiency and low immune system but how can I find out for sure exactly what she has. What kinds of tests can be done? I don't have insurance but I do want to do what's necessary to keep my pug in a happy state. Another question is how come prednisone helps dogs get better when it suppress the immune system of an already compromised dog? She also has a weak stomach and vomits quite readily and my vet wants to do an endoscopy to see if she has eosophilic enteritis as he suspects. Any thoughts? Thanks.
Answer: Marlo-
I would be careful about the possibility of a recurrence of demodecosis. It would be worth checking a scraping again, or even a couple more times, if this problem doesn't respond well to antibiotics.
Itching around the feet is sometimes associated with food allergies and these allergies can show up in young dogs. This is also a source of chronic vomiting and sometimes diarrhea, as well. So it might be worth checking into this. An elimination dietary trial, in which a protein source that your pup has not been exposed to is used as the sole protein source for 3 to 8 weeks, is the usual method of trying to rule out food allergies. Foods like salmon/rice, rabbit/potato, egg/rice or the newer hydrolyzed diets are all possible diets to try to rule out food allergies. Our experience has been that we test for food allergies about 30 times for every time we find it, but for the dogs we can diagnose with this condition, there is a great deal of relief in just controlling their diet.
Sometimes immune system diseases occur because the immune system is working hard -- but not doing the right job and actually causing harm. When this is the case, corticosteroids are necessary to prevent the immune system from causing damage. This is what happens in juvenile cellulitis. Other times, there is true immune suppression or immune compromise and in those diseases, when the immune system isn't working properly because of weakness, corticosteroids can cause terrible problems because they further weaken an already weak immune system. Choosing when to use cortisones and when not to can be very difficult. It was a difficult choice to make to treat a dog with demodecosis with corticosteroids, but they are necessary when juvenile cellulitis is present --- this would have been a really tough choice to make and I am glad to hear it worked out well.
There are some disorders that just occur in eyelids, such as infections of the glands that produce the mucous for tears, along the lid margins. These are aggravating but are not especially serious. So there is some chance that this is just an ordinary problem with bad timing, since you do have to take it seriously with the past history.
I hope that things are improving. I am sorry for the delay in responding. I am just getting over an unexpected trip to the hospital where they really didn't want me to bring my laptop.
Mike Richards, DVM 11/15/2000
Demodex - should you treat or wait
Question: Dr. Mike, Hi, I have a 5 month old puppy who has been diagnosed with generalized Demodex mites. I have read the letters written to you on this subject and I have several questions. Here's his history. His litter and mother had Sarcopti mites when they were first born. I am not sure if the mother had them when she was pregnant or not, I think that she did. The mother and puppies were misdiagnosed as having allergies three times before my parents finally took my puppy away from the litter and he was diagnosed with the Sarcopti mange. He and the other puppies were treated with the Iver-mectin shots and some kind of dip and he cleared up, grew his hair back and put on weight. He looked awful, poor guy had super pink skin and almost no hair but never acted sick in any way and never lost his appitite. Okay that's Chapter one. About four weeks ago I gave him a bath and noticed that he had spots of allopecia (right word for dogs?) along his body. I took him to the vet and he did a scraping and sure enough tons of Demodex. Now, I have read all of the stuff about immune deficiencies and at this point I think that I have to assume that my puppy has some type of immunocompromise. My question is where do I go from here? If it is genetic is it a recessive gene? The father is my family dog who I know has no problem and from as far as I know the mother has no outward signs of immune problems either. Could this problem have happened during gestation if the mother had Sarcopti during pregnancy and nursing? His littermate was just diagnosed with Demodex as well. They are both healthy acting, full of energy, super smart (of coarse) and growing like weeds. My puppy (Indy) has doubled his weight to over 40 pounds in the last two months. He has also had alot of exposure to many other dogs (after all of his shots), the wilderness and people and has had no other problems. Indy is currently getting a Iver-mectin shot and a dip every two weeks. My husband and I love this puppy like the child that I can't have right now because I am in medical school. We don't have much money but we are both ready and willing to do whatever it takes to get him as healthy as possible. I want to do the most aggressive preventative and diagnostic treatments I can possibly do. We live in the LA area and I am sure that there are lots of specialists out there. Should I go find out exactly where his deficiency is ? Is finding out sooner better so that we can get him some sort of immunoglobin replacement therapy early while he is still developing? Would that make any difference? Is there any chance that his condition won't be lifelong? I know that in people it takes some pretty bad deficiency for normal flora to become an "infection" and he just doesn't seem that sick and like I said he has had alot of exposure. Like I said, I am willing to go just about to the ends of the earth to help this dog and I want to be sure that I am doing the best thing right now and not find out later that I should have done something earlier. My parents will help us with money issues if neccessary. Also, any ideas on the best food out there? Please help! I am feeling so helpless just treating the symptom and not the underlying cause! Thanks, Tawnya
Answer: Tawnya-
It is a bummer to have a puppy who had sarcoptic mange and then developed demodectic mange but there is probably no link between these events.
Sarcoptic mange (scabies) is a highly contagious mange that does not require any sort of immune suppression to infect dogs and can affect dogs of any age. It is relatively easy to treat and most dogs can readily be cleared of this mite infection.
Demodectic mange is also contagious, in that most dogs acquire the infection from their mother. The mite usually lives in relative harmony with the dog and it is assumed that most dogs have Demodex canis mites on their body. If the dog's immune system is competent the mites are suppressed and never achieve large enough numbers to cause damage. Sometimes, local areas of the skin are affected by hair loss (alopecia) and secondary bacterial infections are common. When there are a number of spots, or the spots have spread over large areas of the body and when these spots do not clear up without treatment in four to eight weeks, the dog is said to have generalized demodectic mange. Localized demodectic mange is thought to occur due to transient stress or a decrease in local immune function at the affected sites. Generalized demodectic mange is thought to be due to a specific deficiency in T-cells that suppress these mites. This is thought to be a hereditary condition but if the exact mechanism by which inheritance occurs is known, I am not aware of it.
The best way to tell if the condition is severe enough to warrant the assumption that it can be passed on to future generations is to wait and see if it clears up on its own. For this reason, we try not to treat demodectic mange until it is evident that it will not get better on its own. At least 80% of dogs will outgrow this condition. The dogs that do not get better and require treatment can usually be cured, or at least managed and controlled, in about 80% of cases -- so the risk of this being a life long infection is not so high that you should worry excessively about it at this time.
I am not aware of any evidence that there are benefits to immune system therapy, probably because this does appear to be a pretty specific defect in the immune system. The odds are very good that this will all turn out OK. If you intend to breed Indy, it is much better not to treat, in order to be sure of whether the problem is generalized demodectic mange. If you do not intend to breed Indy, it probably doesn't matter if you treat at the localized stage but amitraz dip, the only approved medication for demodecosis, has serious side effects, including causing death in up to 3% of patients treated with it. Considering that waiting to see what happens is successful therapy in 80% of dogs, taking this risk prematurely does not seem justified, to me.
I know that many people disagree, but I think that the major brand name dog foods are all reasonable choices for most dogs. I am not aware of any major benefits or problems with treatment or occurrence of demodecosis that have been linked to diet.
Hope this helps in your decision making.
Mike Richards, DVM 9/8/2000
Demodex as inherited problem in Mastiff
Question: I just subscribed to your site...do not want to wait to ask you a question, I hope my question is answered here..... Purchased 8 week old mastiff bitch $1500.00. (specif for breeding! She eats her food, pedigree puppy and can food fine now. Noticed some very slight It comes and goes. She plays pretty rough with our 2yr old mastiff, who is over 200pnds and figured this could all be play injuries. Before she did scraping the vet pre Then she said the swelling is from her body trying to fight off the mites. The vet said the first scraping showed 5 or 6 adult mites (with that small number I would think you could remember exactly how many) and the second scraping she couldnt get a good scraping because the areas are new and it showed no mites But that she feels that it is clinically safe to ASSUME I explained that a assumption in diagnosing this is not o.k I can clearly see that the hereditary factor is a pure assumption that most vet's quote as a fact. ba humbug. Are we looking at a potential serious problem here I'm in a very irritating dilemma.
Answer: Y-
I don't think that your message forwarded in its entirety, but I think I get the gist of it.
There is no question that the predisposition to develop generalized demodecic mange is hereditary in many dog breeds and it is presumed to be in the ones in which it has not been proven yet.
So the question is this, does your mastiff have generalized demodectic mange or localized demodectic mange?
I am not sure based on the loss of some of the information in the note what the exact situation is, so this is the information on the differences.
There are a lot of definitions of localized versus generalized demodectic mange. At this point I prefer to think of this as "likely to be inherited" or "not likely to be inherited". My interpretation of the situation is this --- if the dog can clear the disease on its own, without the use of a medication to kill the mites, such as amitraz or ivermectin, then it probably did not have an inherited deficit in specific T-cells which leads to generalized demodecosis. I think this is true even it takes several months for the dog to get over the demodecosis.
Localized demodectic mange is usually confined to the head region but sometimes there are a few lesions on the body, as well. Most dogs with localized demodecosis will have less than five lesions but sometimes there are more and a dog will clear the infection on its own. Having only adult mites is a pretty good sign that the dog is winning the battle against the Demodex mites on its own.
Generalized demodecosis occurs when there are multiple spots, when there are all stages of life of the mite (eggs, juveniles, adults) present. Some cases of generalized demodex so obviously need care that it is not possible to wait and see if they will get better on their own. If this occurs, it should be assumed that the dog has a high probability of passing this tendency on and it should not be bred. If the infestation is present when the dog reaches a year of age or possibly a few months beyond that time it should be considered to be potentially heritable and the dog should not be bred.
Dogs that are intended to be used for breeding should not be treated for demodecosis until it becomes obvious that they must be treated or until they are one year of age or older. If they get better on their own, it is reasonable to assume that they do not have the specific T-cell deficiency problem that is thought to be inherited and it is reasonable to breed these dogs.
If this is not enough information, I will try to find answers to specific questions that you have.
Mike Richards, DVM 8/27/2000
Demodex - Mitaban is serious medicine
Question: Thank you for your reply. Today I took the pup in for a second opinion First off, I do like this lady. Here is what she said.
The pup has a minor case of generalized demodex. So....we now have localized, minor generalized and generalized. What ever. She did one scraping off her side, a nice deep one I'd say, and she came back in and said "nasty critter's, it's demodex". She sat on the floor and explained the program to me. She stated that the pup has few spots, and normally would only treat with a ointment and antibiotics. But because she has some spots on her trunk, she recommends dipping and antibiotics.
I came home with $100.00 of medication:
Cephelexin 500 mg - 14 days , 2x a day. Virbac Pyoben - Shampoo dog night before dipping. leave on 5min then rinse Now the nasty stuff!!! mitaban dip concentrate amiytaz - mix 5.3 ml w/ 1 gallon water sponge on dry dog. Refills -0- Flammable (are we kidding!!)
I opted to go ahead with the medicine due to the fact it breaks my heart to return this puppy to the breeder. The vet said she thought this should clear up after two dippings and see her again in 5 weeks for a new scraping. Here is what I wonder...and think: 1. Antibiotics - I figure this should help her out 2. Dip - I question. Normally I dont put anything on myself or my animals that is flammable. Geez this stuff sounds like SERIOUS poison. 3. I understand your idea of the wait and see approach. Very difficult when you think of your dog possible losing more fur, maybe getting worse. It's a concern. It's it easier to nip it in the bud, than to fight it full blown? But then of course, how do you know. This vet felt that if it is cleared after the second dipping then she should be fine to breed. If after the second dipping, she still has mites, then we have a problem. What do you think? oh, one more question: If I go through with the dip. The puppy plays daily with my older mastiff. After she has been dipped and for the two weeks to the next dip, is my older mastiff in danger of getting any poison in his mouth from playing with her. Or even if one of my other dogs licks her? Is this poison the fur also or it somehow is only the skin...how does this work...
Answer: Y-
If you choose to use amitraz (Mitaban Rx) to treat the demodectic mange at this stage you will have eliminated the possibility of determining if the mange would have cleared up on her own, unless the amitraz doesn' t work. I do not believe that you can use the ease of treatment as a gauge to determine whether or not a case of demodecosis would have resolved on its own. There is probably room to argue this point but I think it is better to be sure of this situation prior to choosing to breed a dog with demodecosis.
Amitraz (Mitaban Rx) is a very toxic medication. This is the other thing that makes me reluctant to treat a patient for a demodecosis prior to the time it is obviously necessary to do so. In order to understand how a medication this toxic ever got approved, you have to understand the whole situation. Prior to the time that amitraz was available most dogs that developed generalized demodectic mange died from the disease. When I was in veterinary school this was a serious threat to affected dogs, as there was no effective treatment at the time. So when amitraz killed 3 out of the 1100 test dogs and caused other dogs to have adverse reactions, including, incoordination, severe lethargy and seizures, this was an acceptable risk -- compared to the high likelihood of death from the demodecosis. However, this risk is not as easily justified when looking at the population of dogs who will get over the mange all by themselves, which is approximately 80% of the dogs affected by demodecosis. I am opposed to putting my patients and their owners at risk for severe side effects when there may be no reason to do so.
Unless there is new information that I am unaware of, the percentage of the amitraz which is applied to the dog's skin that is then absorbed into the dog's system is unknown. Amitraz is more toxic if it is ingested than when applied to in a pour-on or "dip" solution. I do not think that the other dog is at significant risk after the puppy is dry since it would be hard to ingest a significant amount of the amitraz orally from the puppy's hair after that time.
I know that it is very tempting for both veterinarians and their clients to treat demodecosis early on but I think it is better to wait and see what happens in most cases but especially in dogs that may be used for breeding in the future. Obviously, your veterinarians disagree with me and you have to consider that in your decision making.
Mike Richards, DVM 8/29/2000
Question: Hi Dr. Mike, We adopted our beagle mix from the Humane Society 2 months ago, when she was 6 months old. She had a vomiting problem (which I had written you about) which is now cleared, but now has been diagnosed with localized demodetic mange. She has 2 tiny spots--one on her right cheek/neck and another on her right calf. Both spots looked like little scrapes but we decided to have them checked out to be on the safe side. Our vet did the scrapings and confirmed mites in both places. He has placed her on Primor 240 mg once a day and an ointment which he was out of that we will get tomorrow. She has an app't again in 2 weeks. I have read all that is in your archives about this mange and am worried. Our vet seems to think it will clear up and I know you said up to 80% of localized mange does, but I am wondering why this happened 2 months after we got her and have given her the best of care possible after having a rocky start (she was a starving stray) and if there is anything else we can do at this point or if there is any type of preventative medicine or booster to the immune system that would help in her healing and her remaining symptom-free. She itches more than is normal, although nothing is red or oozing or infected and if you didn't look carefully for these 2 little spots, you wouldn't notice them and if you did, wouldn't think they were anything. We really expected the vet to say she just scraped herself playing as she seems so healthy now and playful. Is there ANYTHING we can do to help her get better and not get an outbreak again (assuming this is going to clear up). We love this dog like a child and want her to get the best treatment available. Why is sarcoptic mange so much easier to treat and cure than this? Should Belle have any bloodwork done to see if anything else is wrong with her system? If I understand correctly, her immune system is not doing its job well enough and we are concerned as to the cause of this, esp. since she has had a pretty good life with us the last 2 months. She is just over 16 lbs and the vet says this is an ideal weight for her as she will remain a small beagle mix. She appears to be in good health in every other respect--her ear infections when we got her have all cleared up (after steroid drops--could that have triggered a suppressed immune system??) and her vomiting stopped after she was de-wormed again (even though her tests were negative, she must have had something). Please tell us what else we can do to give her as good a life as possible. We are not rich by any means, but we love her deeply and want to do everything possible.
Thank you, Linda
Answer: Linda-
It is hard to figure out why localized demodectic mange occurs in a particular dog. Hormonal changes as puppies age may have some effect. Local skin conditions may favor the mite, giving it a chance to reproduce excessively until the dog's immune system is stimulated to respond. Localized demodectic mange is a minor problem and it is not indicative of an overall immune system deficiency. There does seem to be evidence that controlling secondary bacterial infections is helpful so that is probably the reason that your vet chose to use an antibiotic. The ointment most commonly used for localized demodecosis is Goodwinol's Ointment (tm) but I think of this mostly as a placebo since localized demodecosis will clear up without any treatment in most cases. Some vets use other gels, such as benzoyl peroxide.
There is a growing trend among vets to go ahead and treat localized demodecosis cases with amitraz (Mitaban Rx) or ivermectin (Ivomec Rx) but I really believe it is better to wait and see whether the mange will clear up on its own. I think it is better for the dog if medications do not have to be used and it also allows an assessment of the severity of the problem and the likelihood of a recurrence later in life. Waiting and doing nothing is really hard for many of my clients but I truly believe it is the best approach. Obviously, there are many vets that disagree with this assessment since treatment for localized demodecosis is fairly commonly attempted now.
It is unlikely that you will find a problem by doing blood testing in a dog that appears to be healthy and is in her age range but there is no reason not to check the blood chemistry and cbc values if it makes you more comfortable.
Some dogs do absorb enough corticosteroid when eye or ear drops are used to cause some degree of immune suppression but there doesn't seem to be a strong correlation in our practice between the use of corticosteroid containing ear medications and later occurrences of demodectic mange. In general, this effect is slight enough that it doesn't cause problems.
I really don't know why sarcoptic mange mites are so much easier to kill and so much more contagious. They are an entirely different species, though.
It sounds to me like you are providing a good life for Belle and that you don't need to make any major changes right now to ensure that will continue to be the case.
Mike Richards, DVM 7/9/2000
Question: Hi Dr Mike
I have two dogs (mixed breeds) who stay outside our house most of the day. 1 dog, Ginger had a rawish rash at her mouth and started to limp so I took her to the vet. They did skin scrapes and skin tests and told me that she had the beginnings of demodetic mange at the mouth and eye area, and a fungal infection in between he hind foot toenails. I now have to apply an amitraz solution to the mange areas once a week and I have to give her baths in Ketaconazole Shampoo (that's usually for fungal dandruff here) 2x a week. But shes worrying at her foot and is starting to bite it raw. What I did was clean the wound with hydrogen peroxide and betadine, and I let her wear a satellite-dishlike thing on her head so she doesn't bite or see her foot. Is there anyway to prevent itching? I bought a "hotspot itch reliever" at the vet and its made of camomile, and tea tree oil but I am not sure if I should use it because it might make the situation worse. Is there anything else I can ask my vet about re: the mange and the fungus? I think Kinky, my other dog - who's always with her - is starting to limp as well.
Please advise as Im worried about them and would like to prevent any further injury / pain.
Thanks. Mia
Answer: Mia-
How old is Ginger? Demodectic mange in a puppy is a lot different than demodectic mange in an older adult dog, so it would help to know which is the case.
In either case, we find that using antibiotics in dogs that itch when they have demodectic mange is very helpful in relieving this syndrome. The demodectic mange itself is not usually very itchy so most itchiness comes from secondary infections. Fungal infections can itch, so that is also a possible cause -- but our experience is that the itchiness is most often bacterial in demodectic mange cases.
We usually use 4% chlorhexidine shampoo when we try to treat skin yeast infections as has worked a little better for us than ketaconazole shampoo. In some cases it is necessary to use systemic (oral) medications for the yeast infections, though.
If there are Demodex mites in scrapings from the mouth and the feet it would probably be better to treat the whole body by following the directions on the package insert. If that doesn't work, there are alternative treatments that might.
It is important not to use cortisone products in a dog with demodecosis and since these are anti-itch and available over the counter, they do sometimes get used. I know of no problems with tea tree oil or camomile in conjunction with demodecosis, though.
There is a lot of information on the site about demodecosis but if you have questions about it and especially if Ginger is an older dog, please write back.
Mike Richards, DVM 7/3/2000
Dr Mike - Ginger is 2.5 yrs old.
Answer: Mia-
In this situation it is important to try to look for an underlying cause for the demodecosis. Most dogs with immune system disorders that allow demodecosis to occur develop it at a younger age, usually less than one year of age. In dogs in which demodecosis occurs later, there is often something causing significant compromise of the immune system. Cushing's disease, liver disease, diabetes, high doses of prednisone or other cortisones, cancer and other strong suppressors of immune function can lead to adult onset demodecosis. It is worthwhile to put a good effort into eliminating as many of these causes as is possible through lab work and physical exam. This is a situation in which asking for referral to a veterinary dermatologist can be a good idea, too.
I missed the part about Kinky limping. Demodex mites can be spread from one dog to another but it takes an immune system deficiency for the mites to cause problems, so demodecosis is not considered to be a contagious disease. If there is a disease or environmental problem stressing both dogs at once it is conceivable that they might both develop demodecosis but this is really unlikely. On the other hand, allergies leading to interdigital (between the toes) skin infections is a pretty common problem in dogs and something like this could be affecting both of them, with the demodecosis being secondary to damaged skin in Ginger. There are an awful lot of causes of lameness so it is actually more likely that they have different problems, though.
Hope this helps some.
Mike Richards, DVM 7/4/2000
Demodecosis and other problems
Q: Hi...It's me again! I am the one that wrote you several weeks ago about my 7 month old Boxer that had the Small Intestinal Bacterial Overgrowth, well, now she also has demodectoc mange. Could this be the reason for the bacterial overgrowth or the intusseception(oops.spelling?)? We are so upset, because it has been one thing after another with this poor dog and we don't know where to draw the line...Please help! Thanks,
Mindy
A: Mindy-
It is unlikely that the demodecosis and the intestinal problems are directly related but multiple problems like this do tend to make me wonder about underlying genetic disturbances or immune system problems that will lead to continual problems. We have seen puppies who just barely made it to a year old turn into healthy adults and have seen very healthy puppies develop chronic health problems later, so it is possible that some day your problems will slow down. I hope so.
Mike Richards, DVM
Q: Dr. Richards, We have a labrador retriever who is 1 year old. She was recently diagonosed with mites. She was given antibotics and the situation appeared to be cleared up and "regrowing" the fur that she had lost. We recently saw the same bald spots on her paws and are wondering if the situtation has come back. Is this possible that we didn't get rid of it all the first time? The images of these diseases helps identify what may be happening to our dogs. As you know, vet bills can be expensive and having this great tool helps. Thanks. This website is priceless!!!!
Sharon
A: Sharon-
Unfortunately, it is not unusual for demodecosis to persist or to appear to recur. Sometimes sarcoptic mange will do this, too, especially if there is a source of the mite (like a neighboring dog) that is still there after the dog is treated the first time. So the best thing to do is have skin scrapings done of the new areas of hairloss and then make a treatment plan based on the results of the skin scrapings.
Mike Richards, DVM
Q: I need Help. I have a yorkie terrier, which is having a demodex illness. I am in Bangkok,Thailand. I check with the veterian for MITABAN. But they don't have in Bangkok. Is their any alternative on curing my dog. Thanks David
A: David-
You may be able to find amitraz, the active ingredient of Mitaban (Rx) in other formulations. It is sold as a peach orchard spray in the United States and veterinarians used that prior to FDA approval of Mitaban in some instances. Also, ivermectin may be available as it is a commonly used deworming medication for agricultural purposes and it can be used in high dosages with some success. Lastly, milbemycin, a once-monthly heartworm preventative medication, will also kill Demodex mites if given daily for about eight weeks. These are the only other alternatives that I am aware of.
Mike Richards, DVM
Q: Dear Dr. Mike,
I have a 2.5 year old male Great Dane, Ike, who was born in Australia in a farm. No need to say he is very important for me. I work with an American women's group in Istanbul to help stray dogs. 3 months ago I adopted 2 puppies from different litters. One was very healthy and the other was about to die when I found him and his siblings which we couldn't save. The puppy was diagnosed with distemper and parvo and he also had mange. Thanks to our vet's efforts he recovered after a long treatment. His mange treatment started after his recovery from both diseases as the vet didn't prefer to put too much work on his immune system. Once the vaccinactions of the other puppy were completed, I had to bring him home and we tried to keep him seperated from my Great Dane and the puppy. Unfortunately they both contracted mange from him. The healthy puppy had localized demodectic mange with only one patch on her front leg and the other one had generalized demodicosis with several patches all over his body. They had ivomec injections and mitaban dips whilst Ike who wheighs 55 kgs was orally given 3cc ivomec daily and had two mitaban dips every two weeks. I had two mitaban bottles shipped by a petshop in New York for $ 100- a bottle which I found very expensive. Then I had Ectodex (equivalent of Mitaban) shipped from Germany which has a reasonable price. Ike had only two small patches on his body and the hair started to grow soon after we started the treatment, but his back and his neck area are full of small buttons which look like insect bites. Some of these look red like a rash and some look like pimples which become scabs and sores. He started to lose hair and although his skin doesn't have any hairless patches, his coat looks awful when looked in the opposite direction of hair growth in the sunlight. After four weeks treatment with Ivomec and Mitaban, I gave him an Ectodex dip in the morning which has to be repeated every week according to its prescription. In the evening I gave him 3 cc Ivomec orally along with vitamin E and EFA capsules. He was also on Tavegil to prevent him from scratching (2 pills daily). It is a medication from Bayer which causes drowsiness in humans. Half an hour later he vomited and then had somefood and water. I took him out for some fresh air and when we returned home he leaned towards the wall and collapsed with his eyes rolled. He stood up in 10 seconds but he seemed very dizzy and couldn't walk straight. I couldn't find the vet and I didn't want to take him to the emergency service of an animal hospital as I do not trust the knowledge and skills of most vets in Turkey. I spent the night at his bed side and he went to his food bowl many times, but I stopped him with fear of bloat. I called the vet first thing in the morning. He asked me to stop the treatment. I always suspected Ivomec to cause appetite loss and white gums and tongue at Ike, but the vet insisted that it is safe. He believes that amitraz is the reason for his fainting. He had had his blood checked the previous morning for liver and it was OK. Yesterday, he also had carried out a urine test and said Ike has bladder infection (pH level is 8). Now he is on antibiotics. He switched his diet from Lamb and Rice to Response Formula from Eukanuba. Ike is also very red and itchy between the webbing on his paws an toe nail rims. He prescribed a daily antiseptic bath for his paws, but it didn't seem to work after 3 days. His eye lids were very swollen and bleeding because of extreme scratching (I try to stop him, but he scratches at night). Iapplied tea compression and put Terramycin ointment and it seemd to work well. His eyes look a lot brighter now. I am exceptionally worried for him and ready to do anything to make him recover. Please let me know if the teratment was correct so far, should I continue the treatment, what would cause him to collapse? The vet says we have to continue Ectodex dips every two months even after he recovers. Is this correct? I am desperate for an answer. Many thanks.
Engin
A: Engin-
Unless demodicosis is caused by a different strain of the mite in Turkey I have a hard time accepting that it is contagious. Demodecosis is not considered to be a contagious illness here in the United States. Dogs affected by generalized demodex have an immune deficiency that allows this normal inhabitant of canine skin to cause serious disease. Since almost all dogs have Demodex mites somewhere on their body but only a few have clinical signs of demodecosis the theory is that dogs don't have to be infected with the organism because they probably already have it. The necessary key for disease to occur is immune suppression or immune incompetence.
It is possible that sarcoptic mange could cause the symptoms you are seeing but it is very susceptible to both amitraz (Mitaban Rx) and ivermectin (Ivomec Rx) and is almost always possible to cure with one or the other of these medications.
Therefore, I think that it would be a really good idea to look for other causes of the symptoms seen unless a really positive confirmation of demodecosis is made. If demodecosis has occurred in your older dog, with no previous history, then it is necessary to look very hard for some factor that is decreasing his immune competence, such as a systemic illness (liver disease, cancer, etc).
Both ivermectin and amitraz can cause depression, weakness and neurologic signs, so it would be hard to tell which one is the problem. This happens more often with amitraz than with ivermectin but you are using a pretty high dose of ivermectin, making a problem from it more likely. I would be suspicious of the sedative as well if I read the email you sent correctly, since it was given prior to the appearance of the signs.
If it is possible to get a good second opinion, I would advocate doing this. If that is not possible, at least ask your vet about the possibility that something else could be going on. Antibiotic therapy may be necessary to combat a secondary skin infection, there may be a fungal illness or a systemic disease with skin manifestations. Unfortunately, to try to help more it would be necessary to examine Ike.
If demodecosis is the problem it is very likely that lifelong maintenance therapy will be necessary given the difficulty you have had in clearing up the problem with the treatments already underway.
Mike Richards, DVM
Q: Dr., My Lab/Dane mix has obtained a skin condition in which his skin becomes inflamed, red, and eventually bleeds. He has this all over his stomach, bottom of his head, and most of all, his paws. He leaves blood everywhere he sits, lies down or walks. We've tried everything. Just so you know, he had puppy mange when he was 3-5 mths old (he;s now 10mths) and the vet treated him with shots and dips, making him more irritated. The real; problem started with his puppy shots, he has a bad immune system. His brother lives 2 doors down and has no problems at all. Our other dog doesn't either. What should we do? He's a wonderful dog and we need to do something about this problem. Our vet treated him homeopathically and it didn't work. He was on a medicine called RHUS TOXICODENDRUM and it seemed to get worse. What can we do? We're running out of answers and money on him. Please help us in figuring out what this poor animal has.
Thank You,
Adi
A: Adi-
I would be really worried about the possibility that your puppy continues to be infected with Demodex mites based on the symptoms and history in your note.
Skin scrapings to determine if the mites are still present would be a good first step. In some cases it is necessary to do skin biopsies to confirm mites when the skin damage has been chronic and severe.
If amitraz (Mitaban Rx) dip causes problems for your puppy there are other treatment options. Our website has information on these. Search using "demodex" or "demodecosis".
It is expensive to treat demodecosis in some cases but usually it can be cured. There are other possible problems, such as food allergies and immune system disease but the first thing to do is to determine if there are still Demodex mites present causing disease.
Mike Richards, DVM
Q: Our Pit Bull puppy, who is currently 18 weeks old, was diagnosed with Demodicosis mange around April 10th. On that visit, our vet showed us under the microscope the mite and told us that she needed to be dipped with Mitaban. He aslo gave her a steriod shot of cortisone and prescribed two medications (Cephalexin 250mg & Hydroxine). Two days later, we noticed that she was scratching her self raw on the chest and seemed to be itchy all over.
We took her to an emergency clinic and the vet we saw said that she was going to get a lot worse than before she starts to get better.
We have just taken our puppy in for her second dipping and our vet said that she still has the same number of mites as when we first brought her in. Two days later, she started scratching herself raw on her chest again and seems to be itching all over...is this normal? Our vet also gave us a higher dosage of Cephalexin 500mg...do you think this will help? Is there anything we can possibly do at home to help; like an ointment or lotion? We are very concerned because she seems to be getting a lot worse.
Something else I am wondering is, if she is having an allergic reation to the Cephalexin, were can I look for a rash if she has mange? We noticed that she has small bumps, like pimples on her chest. Could this be a possible allergic reaction?
Any help or information you can provide will be greatly appreciated.
Thank you,
David & Linda
A: David and Linda-
It sometimes takes three or four dips with Mitaban to see a lot of improvement and it takes at least six or eight dips to cure the condition in most dogs. It is usually not considered to be a good idea to use cortisones in a dog with demodecosis because they suppress the immune response to the mites even further than it is naturally suppressed in dogs susceptible to this problem. I don't know how much effect that has on resistance to treatment but it may have some. In general antibiotics will control the itching within a few days as it is usually from the presence of a bacterial skin infection. If this is not the case by now, it would be a good idea to ask your vet about referral to a veterinary dermatologist for a second opinion on the case. It is not likely that your vet is wrong about the demodectic mange but it is entirely possible that there are two problems present at the same time.
Just in case there is some confusion it is usually considered to be OK to use corticosteroids to control the intense itching when treating for sarcoptic mange, which is a completely different problem than demodecosis.
A soothing bath, such as an oatmeal shampoo bath or a tar and sulfer shampoo bath might help with the itching. Antihistamines help a few dogs and aspirin is even helpful in some cases. Let your vet know the itching continues and if it is severe, definitely consider asking about referral to a veterinary dermatologist if that is possible in the area in which you live.
Mike Richards, DVM
Extreme itchiness - Demodex or Allergy
Q: Dear Dr. Mike,
I have an adorable female Boston Terrier "Ruthie", who at around 5 months of age, was diagnosed with demodex mites. Her ears smelled bad and she was scratching and biting her ears and legs to the point of bleeding. The vet (vet #1) suggested mitaban dips which seemed to not be very successful. Several scrapings were done thereafter and the mite was never found again, however she continued to itch. Eventually sores occurred on her belly and became infected and smelled awful. He put her on antibiotics and again, the dips. Again, there was a very temporary period when she seemed to not itch so badly, however the itching did come back. I had read about a treatment called "milbemycin" and he tried that for 4 weeks, but there was no improvement. He said that the condition was probably made worse by allergies and eventually gave her an injection of steroids. Finally, there really seemed to be an immediate improvement...... for about a week or two, then back to the itching. In the meantime, we moved about 50 miles away and changed vets. By this time, the dog was almost 1 year old. The new vet (vet #2) said that she should stay on antibiotics, take steroid pills and discontinue the dips since they had not proved to be very beneficial. She still itched. He also said, emphatically, that the demodex mites would not cause the terrible itching that she was experiencing and that more than likely she was having allergies. When I saw no improvement, I called a friend and she recommended her vet highly, so I called him. He (vet #3) considered all that had been done to her and did four scrapings and did not detect demodex. He told me that the best approach to treatment of allergies was to do some testing similar to that which is used in humans. She would have to have a large area shaved and have the allergens injected, however, she would have to be off of the steroids for at least 30 days to do this test. He said that there was a blood test that could be done to identify allergies, but he felt that the first test he mentioned was much better. We tried to wean her off of the steroids (Prednisolone 5mg.) and when we would get down to 1/2 pill every day, she would begin to itch. I would add Children's chewable Benadryl, 1 pill two or three times a day. If we could get her down to 1/2 pill of Pred every other day, or less, she would scratch herself bloody. It looks like we will never be able to keep her off of the "Pred" for the needed 30 days to perform the prescribed test. I was also giving her a liquid antiobiotic (it looked very much like the stuff I used to give my children). By mistake, the antibiotic was left down in Florida while we were down there on vacation, and I didn't get anymore when we returned. That was my oversight. She didn't get any better, it was the same old story. I called the vets office, and expressed my concern to his office girl and asked of the vet wanted to see Ruthie. She said the doctor wasn't in that day but she would tell his associate (vet #4) about my concerns, when she returned to the phone, she said that the vet said that the demodex could indeed cause extreme itching and that I should start the mitaban dips again. I continued the steroids, benadryl, and gave her 4 dips (one every other week)....no real improvement. Again, when I would try to wean her off the steroids, she would start to itch. Now vet #3 is trying the treatment for sarcoptic mange. He gave her a shot and gave her a lime sulphur dip. Should I ask for more antibiotics also? It's been almost a week, and so far I don't detect any real improvement in the itching. It is somewhat under control at the moment because she is taking 2.5 mg of the Pred daily and the benadryl as needed. She is scheduled for 3 more dips. Basically, it seems that the only thing that relieves her itching at all is the steroid and I am very concerned about long term effects it will have on her. I really have to consider her quality of life, but I can't help but believe that there must be answer to her problem out there somewhere. What do you think? PLEASE HELP ME AND MY BELOVED RUTHIE. Jill
A: Jill-
Vet #3 (this sounds like the dating game), has proposed a direction for testing that most closely follows what I like to do in these cases. You have several alternatives for dealing with this situation while attempting to come to some conclusions about what is causing the itching. In addition, I tend to agree with the assessment that demodecosis does not normally produce itching of this degree of magnitude except through secondary bacterial infection which should be at least partially controllable with antibiotics. There are exceptions to every rule and I have seen an occasional intensely itchy dog with demodex. Since Mitaban also kills sarcoptic mange in most instances it is possible that there is a dual infection in some dogs. I would consider switching to a hypoallergenic diet, such as the new one Purina has come out with, Hill's i/d, one of the Innovative Diets foods or a homemade diet suggested by your veterinarian. If food allergy is contributing to the problem, removing the offending food may produce a significant reduction in clinical signs in two to four weeks, or possibly slightly longer. You can continue prednisone until it is apparent that there is a reduction in itching, if necessary. Another alternative is to ask for referral to a veterinary dermatologist. Specialists often see the odd presentations of normal diseases and the normal presentations of unusual diseases more than general practitioners. Often they can make a significant difference in cases that have been difficult for general practitioners. If this is an option in your area it would be worth considering. Skin biopsies have been helpful for us, even when we had to leave a dog on cortisones, which do have some effect on the biopsy but often not enough to make it worthless. I agree that the blood test is probably not as accurate as the skin testing for allergies but it can be done while the dog is on prednisone, so you might consider trying it, even though you have to be a little cautious about interpreting the results.
I have to admit that I was taken back just a little by the use of prednisone in a dog that has a previous diagnosis of demodectic mange that may have been generalized. Often, corticosteroids make it possible for the Demodex mites to really cause problems but if this happens they should be easy to find on skin scrapings. Since they aren't, it is probably OK.
Mike Richards, DVM
Q: If one breeds a dog that has had a case of demodectic mange to another dog that has had demodectic mange (both localized), is there more of a chance for generalized demodex to occur? Vince
A: Vince-
If both dogs had demodecosis that was local only and which they recovered fully from, without treatment, then there probably isn't an increased likelihood of generalized demodectic mange in the puppies, based on my understanding of the disease. It would be best to check out their siblings and parents for cases of generalized demodecosis before breeding, though. If either dog was treated with amitraz (Mitaban Rx) or other treatment generally successful at eliminating generalized demodecosis it is not possible to say whether or not their localized mange would have become generalized. It is quite common for owners to insist on treatment of localized mange and for vets to go along with the demand, to be sure to determine whether this happened, too. If one of the dogs was treated my best recommendation is to avoid this breeding.
Mike Richards, DVM
Q: Dr. Mike, have a one year old Croatian sheepdog. In the past six months she has had 3 ear infections which were treated with Amoxicillin and Panorex. She also had demodectic mange, for this she was given Goodwinol ointment. The ointment did not work, so she was given three mitaban dips every two weeks. The dips seem to have worked so far, her fur is growing back. I was informed that both of these problems can recur. When I asked my veteranarian if there was anything I could do to prevent ear infections, she responded with,"The dog is young and she might have them for the rest of her life." She also could not tell me what was causing the ear infections. I know that my veteranarian can't predict the future, but I do want the best care for my dog, but it can become very expensive with chronic problems. My question is, is it appropriate to ask my veteranarian for a consultation to discuss my concerns so that I can be informed and prepared for what can be done in the future. Or do I continue to bring my dog in for every ear infection and deal with it as a case by case basis?
A: shr- As long as you understand that your vet can only give you an educated opinion about the longterm prognosis of the problems you are seeing I think it is very appropriate to schedule an office visit to discuss these concerns. If your vet feels uncomfortable with this sort of prognosticating it may be worth asking for a referral to a veterinary dermatologist. Most are good about filling owners in on the long term prospects for diseases under their care.
It is possible that the ear infections could be a symptom of the demodecosis. Demodex will sometimes cause otitis. Overall, the chances of clearing up generalized demodecosis with persistant treatment is probably between 50 and 80% somewhere. It can be difficult to do and it is relatively expensive but the odds are good enough that I feel comfortable advising most clients to try for a cure.
Mike Richards DVM
Controlling chronic demodecosis
Q: Dear Dr. Mike, We have a three year old mix Border collie that has had severe Mange almost its entire life. Our vet has not been able find a cure for it. We have tried Mitaban, Ivomec, and various othe dips, etc. Do you have any additional ideas we could try? We will try anything! Thanks! Sandy
A: Sandy- There is some indication that long term use of antibiotics is helpful in controlling chronic cases of demodecosis. I am not sure how this works but perhaps relieving the skin of some of the immunologic burden allows it to fight the demodecosis better. Or perhaps a lot of the clinical signs are actually due to secondary bacterial infection. I may be necessary to use antibiotics for months in order to help. The only other medication I can think of for direct control of the mites that you did not mention was milbemycin (Interceptor Rx). This is an expensive option and not always effective, either, but it is another alternative. Some vets are increasing the concentration of amitraz (Mitaban Rx) used but I have not been willing to do this yet as we see some problems with toxicity at the recommended dosages. I do think continuous long term antibiotic usage may be beneficial even when the mites can not be eliminated. Mike Richards, DVM
Q: We have a 4 year old chow mix we got from the SPCA. Our vet looked at his skin (specifically his right elbow, right inner thigh and a spot on his back) and told us that it looked to be a classic case of demodectic mites. He scraped off a sample and looked at it under the microscope and told us that he did not find any mites but he doesn't scrape to deep. He gave us an antibiotic and cream to help with the problem. My wife has been reading up on the subject at the local library and is very concerned (to the point of tears) that our beloved animal will die. I have read on the internet several opinions on the subject and found one doctor who seems to believe it is no big deal and others who believe it is. Well is it? Also, without really testing the area again can our doctor be sure it is mites? What else could it be? Do you have any advice on the subject? We will probably take him to a dermatologist in the Dallas area soon to make sure he has mites or to find out what it is that he has. Any advice? Thanks Russ
A: Russ-Going to the dermatologist is the best course of action. If Demodex mites are causing the clinical symptoms it is a big deal in a four year old dog but at least 50% of the cases of chronic generalized demodecosis will respond to treatment satisfactorily and another 30 to 40% of the dogs will respond well enough that the condition can be controlled with chronic use of medications. Demodex is usually pretty easy to find on skin scrapings so I suspect it may not be the problem but once in a while (particularly in shar peis) it can be difficult to find. Sarcoptic mange may also be present. This mange is usually easier to treat and is much harder to find on skin scrapings. Lots of times we have just treated for it hoping to figure out whether it was the problem by the response to treatment. This works often enough that we keep on trying! The dermatologist will be able to give you a better idea which of these problems is present -- or what the problem is if neither mite is likely.
Mike Richards, DVM
Golden with demodex and other problems
Q: Hi! My name is Maricarmen, I have a female Golden Retriever and she has 8 months, since she was 4 months she's been diagnosed with hypothyroidism, and malabsorbtion, and anemia. She was first diagnosed with anemia caused by parasites. Then her anemia was cured, her blood level was O.K. now, but then she was diagnosed with malabsorbtion and hypothyroidism. Her hypothyroidism was controlled with a pill but she is still having trouble digesting her food. A month and a half ago she was diagnosed with mange, I don't really remember what kind of mange she has but the veterinarian prescribed Mitaban, and an ointment. I really want to know what you think about her case and what you recommend to me. She has all these troubles but she is a very hyperactive dog. Her mange started in her left paw, with red patches and abrasions , her skin is gray (because of the problems with anemia she had , when she was two - three months her skin wasn't this gray), so she also has like black and white patches. Her hair is falling but I don't know if it is because the heat here in Puerto Rico, or because of the Dip of Mitaban. We have given her 5 Dips ( weekly) and the condition is worst. What can I do is there a better medicine for her? Pl
also see Mitaban Toxicity
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...