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Demodicosis (Red Mange) in Dogs

By: Dr. Rosanna Marsalla

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Diagnosis In-depth

Diagnosis of demodicosis is based on clinical presentation and positive deep skin scrapings.

  • Skin scrapings. When performing deep skin scrapings it is important to avoid scarred, fibrotic and ulcerated areas. Areas with blackheads are suggested areas for skin scrapings.

    The skin should be squeezed and several skin scrapings should be done in the same direction of the hair growth until capillary bleeding is obtained. Hair plucking may be a suitable technique in some dogs in which skin scrapings may not be positive in spite of suggestive clinical signs.

  • Skin biopsy. In most cases mites can be found on skin scrapings if they are performed appropriately. The exceptions are shar-peis, lick granulomas and severe pododermatitis with deep pyoderma. In these cases a skin biopsy may be necessary to make a diagnosis.

    Folliculitis, perifolliculitis and a pyogranulomatous infiltrate are commonly found on histopathology.

    Treatment In-depth

  • Three forms of treatment currently exist for demodicosis. They are amitraz dips (Mitaban®), milbemycin (Interceptor®) and ivermectin (Ivomec®).

  • Mitaban is the only FDA approved treatment for demodicosis. The approved protocol is one dip every two weeks until three consecutive biweekly negative skin scrapings are obtained. Based on the results of previous studies, however, most veterinarians use mitaban weekly rather than every two weeks. The increased frequency significantly increases the efficacy of this therapy.

    The mixture (1 vial/2 gallons of water) should be prepared fresh every week and should not be stored and re-used for additional dips. Treatments should be completed in a well ventilated area and gloves must be worn when administering therapy.

    Dogs with medium/long hair coat should be clipped. Dogs should be bathed before the dip. A follicular flushing agent is recommended (benzoyl peroxide shampoo) to increase the efficacy of the Mitaban® dip.

    Most dogs require six to nine dips to have negative skin scrapings. Therapy should be continued until three consecutive negative scrapings are obtained. Dogs should not be allowed to get wet in-between dips. Dogs should not be sedated the same day of the dip.

    Use 25 to 50 percent strength in toy breeds as they are at increased risk for adverse effects. Adverse effects include depression, anorexia, vomiting, itchiness, low body temperature, staggering, slow heart rate, sedation, high blood sugar level and death. Yohimbine can be used as reversal agent for amitraz toxicity. Use label dose or 2 label dose subcutaneously pre- and/or post-dip.

  • milbemycin at 1.5 to 2.5 mg/kg per day is an alternative treatment for demodicosis. The average dog will require 90 days of therapy. In cases longer treatment may be required. Milbemycin has the same potential for adverse effects as ivermectin has thus it should be used with extreme caution in ivermectin-sensitive breeds.

  • Ivermectin daily at 200 to 600 mcg/kg until 3 negative skin scrapes is another option. Efficacy is dose-dependent thus increased success is seen at the higher end of the dosing interval. It is recommended to build up the dose gradually to minimize the occurrence of severe adverse effects. It should not be used in ivermectin sensitive breeds (e.g. collies, shelties, Australian shepherds and other breeds). Monitoring of therapy consists in making scrapings from 5 representative sites, always including muzzle and 2 locations between toes. This is the treatment of choice of many veterinarians. It is given daily until resolution of signs then gradually weaned over 2 to 3 months.

  • Moxidectin (Cydectin Injection) has also been recommended and used with some success.

  • Vitamin E has been used as a immunomodulator as an adjunctive therapy to the above standard therapies.

  • Antibiotics may be recommended to treat secondary skin infections and pyoderma.

    Mite counts should be recorded and animal should be re-scraped in the same sites and new lesions every 30 days. Treatment should be continued at least 30 days beyond last totally negative scraping.

    Dogs should be scraped one month after discontinuation of therapy. It is important to remember that besides the eradication of the mites it is vital to address the secondary bacterial skin infections and ensure that no concurrent diseases exist that could impair the ability to respond to treatment.

    Follow-up

    The juvenile onset demodicosis is genetically inherited thus affected animals should not be used for breeding.

    The adult onset form of the disease is related to an underlying disease and there is no prevention for it.


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