The diagnosis of sarcoptic mange is made on the basis of suggestive history, compatible clinical signs, microscopic examination of skin scrapings and response to therapy. Response to therapy sometimes is used as a diagnostic test because the sarcoptic mange mites can be very difficult to find on skin scrapings. Your veterinarian will probably recommend the following: Superficial skin scrapings. Most skin scrapings are positive for the sarcoptic mange mite in less than 50 percent of cases. Skin scrapings should be superficial and cover a broad expanse of skin. The best areas to scrape are the ear margins and elbows. Avoid areas of skin that the animal has mutilated. Areas with thick crusts are suitable areas.
Fecal flotation. Mites may observed during microscopic examination of feces for parasites because the mites may be swallowed when the dog chews on its skin.
Potassium hydroxide digestion of hair, crusts, and scales collected in large quantity. The material is digested in potassium hydroxide and centrifuged. This material is examined microscopically for mites and their eggs.
Skin biopsy. Occasionally mites may be seen on microscopic examination of skin biopsy specimens, but this method is not a very sensitive. Papules are the best lesions to biopsy.
All extremely pruritic dogs with typical clinical symptoms should be treated. Dogs with non-seasonal pruritus that is poorly responsive to treatment with cortisone-like drugs (glucocorticoids) should be treated for sarcoptic mange to rule out this possibility.
All animals in the household should be treated. Various treatments may be used to eradicate sarcoptic mange mite infestation. They include:
Lime sulfur (LymDip®) 2 to 4 percent: mix 4 to 6 ounces per gallon of water and apply once every 5 to 7 days for a total of 6 treatments. Lime sulfur is the treatment of choice for puppies less than 4 weeks old and animals that cannot be treated with ivermectin. Ivermectin should not be used in collies, shelties, Australian shepherds, or Old English sheepdogs due to the risk of serious and potentially life-threatening toxicity.
In dogs with long hair coats, the hair should be clipped to insure good contact of the product with the skin. Cleansing with a keratolytic (anti-dandruff) or antibacterial shampoo may advisable before using the lime sulfur dip. The dip should be applied thoroughly taking care not to miss any part of the body. Lime sulfur dip can dry the skin excessively and be irritating to some dogs. To decrease the drying effect of the dip, baby oil may be added to mixture.
Animals with white hair coats will turn yellow for a few days after treatment due to the presence of sulfur in the dip. The sulfur in the dip imparts a strong odor of "rotten eggs," which may be very offensive. Lime sulfur also has an anti-pruritic effect, and temporary improvement even may be seen in dogs whose pruritus has a different cause.
Ivermectin at a dosage of 300 micrograms/kg (0.3 mg/kg) given orally twice at 2-week intervals or given 4 times at weekly intervals can be used in some animals to treat sarcoptic mange. Treatment of sarcoptic mange with ivermectin represents an "off-label" use of the drug. Ivermectin should not be used in collies, shelties, Australian shepherds, Old English Sheep dogs. Ivermectin has been reported to cause life-threatening nervous system toxicity in these breeds.
In most dogs with sarcoptic mange, pruritus is reduced by at least 50 percent 7 to 10 days after the first treatment and pruritus gradually disappears within 4 weeks.
Milbemycin (Interceptor®) at a dosage of 0.5 to 1 milligrams per pound of body weight once weekly for 4 weeks also is an effective treatment for sarcoptic mange. Milbemycin should be used with caution in ivermectin-sensitive breeds due to the potential of similar adverse effects.
Amitraz (Mitaban®) also is an effective treatment for sarcoptic mange. It is not approved for this use however. To treat sarcoptic mange with amitraz, the drug is applied at the same concentration used for the treatment of demodectic mange (1 vial in 2 gallons of water) and administered as 3 to 4 dips given at 2 week intervals.
Amitraz should be used at 25 to 50 percent strength in toy breeds due to increased risk for toxicity in smaller breeds. Sedation is the most common adverse effect of amitraz. Amitraz should not be used in geriatric or sick animals and in those with diabetes mellitus because amitraz may cause a temporarily high blood sugar level.
Selamectin (Revolution®) is an avermectin type drug that also can be used as treatment for sarcoptic mange. Selamectin is rapidly and completely absorbed through the skin and is safe for use in ivermectin-sensitive breeds. One treatment is sufficient to eradicate infestation. However, in severe cases a second application may be necessary.
Bedding should be washed at high temperature or discarded. Vacuuming is recommended to eliminate possible reinfestation.
Secondary bacterial skin infections are common and may require antibiotic therapy. Superficial bacterial infections often are treated for 4 weeks with antibiotics whereas deep infections may require treatment for 8 to 10 weeks.
Prevention consists of avoiding contact with infected animals. Mites do not survive very long in the environment, and direct contact is necessary to become infected.
Therapy must be carried out over the entire life cycle of the mite (for 3 weeks). With appropriate therapy, pruritus and skin lesions should resolve completely.