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Making Sense of Mange

April 10, 2011

Mange in Dogs

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“Doc, we looked online and saw pictures of mange.  We’re so afraid this is contagious red mange and all our other dogs are going to get it,” said the American Pit Bull Terrier, Hailey’s mom.

Demodex & Sarcoptic Mange

You may have read many websites that describe mange and you’re more confused than ever.  First, go to a veterinarian.  A simple skin scrape cytology test will find demodectic mange, or demodex.  Demodex is a cigar-shaped long, thin insect too small to see without a microscope.  It is believed to be passed from mother to puppy during birthing.  After that original transmission, it is not contagious!

Demodex: Easy to find, Difficult to treat

Sarcoptes: Hard to Find, Easy to treat

The other dog mange is sarcoptic mange, also called “red mange” in some parts of the United States.  Sarcoptic mange is a fat little round insect too small to see without a microscope.  It is highly contagious between warm-blooded animals.  It lives deeper in the hair follicles of the skin and only comes to the surface 25% of the time when a skin scrape cytology is performed.

Any attack on the skin will irritate and change the skin.  Redness, heat, pain, and swelling are the body’s hallmarks of inflammation.  Whether an insect, like a flea or mite, bacteria, fungus, or yeast attacks the skin, the damage will look similar.  Any of the infections can mimic each other, because they are attacking the same skin system.  Tests performed by your veterinarian, along with experience, and the tenacity to look for typical signs and patterns will nail the diagnosis for you.

One last thing to remember: just because you think you know what is wrong with your puppy, the battle doe not end there.  Hailey’s mom figured her skin was sore from fleas.  And it was.  But she did not seek help for over three weeks.  During those weeks, the sore skin allowed the demodex to grow and bacteria to set in.  A smaller problem grew much more complicated because of the delay.

Typical Patterns

Clown Face of Demodex

Usually, demodectic mange starts as a “clown face” look of baldness around the eyes.  Sometimes even conjunctivitis for no reason at all is the first sign that the demodex is at the edge of the eyelids and bothering the puppy.  That’s what happened to Hailey.

“The animal shelter gave her ointment for conjunctivitis.”

“Did she have an upper respiratory infection?” asked Doc Truli.

“What do you mean?”

“Has she had any sneezing or coughing?”

“No. not at all,” said Hailey’s mom.

That’s strange. Any time something doesn’t “fit,” Doc Truli is suspicious that we don’t have the picture.  Puppies usually do not get conjunctivitis for no reason.  She could have been stressed, or been in a dirty environment before the shelter. Or she could have hidden demodex on the edges of her eyelids, where we can’t perform the skin scrape test.

Any time something doesn’t “fit,” Doc Truli is suspicious that we don’t have the whole picture.

Doc Truli advised Hailey’s parents to watch for baldness or thinning of the fur.  Sure enough, 1 week later, she returned with demodex lesions showing all over her face and legs.

Bald Tops of Paws and Toes

If your puppy’s toes are bald on the tops of the knuckles, get checked for mange.  But what about older dogs?  Juvenile demodectic mange is common.  After the age of 1 1/2, it is very unusual for a dog to develop demodectic mange for the first time.  This demodectic mange is called adult onset.  Adult onset mange indicates a problem with your dog’s immune system.  Your veterinarian can check for hypothyroidism and can evaluate your dog’s history for allergy patterns which would suppress the immune system and allow mange to grow.

Mange in Unexpected Cases

Doc saw a 5-year-old German Shepherd Dog with an open, bleeding skin infection at the base of his neck, in between the shoulder blades.  The Shepherd already finished two powerful and long courses of antibiotics.  Why didn’t the antibiotics work?

Proper Skin Diagnostic Tests

  • Skin Scrape Cytology – find and count mites & fungus deep in the hair follicles
  • Skin tape Cytology – find and count bacteria & yeast colonizing the surface of the skin
  • Dermatophyte fungal culture – make sure there’s no zoonotic, contagious ringworm fungus
  • Check those ears!  After all, the ear canal lining is just special skin in a sunless damp hole in the head!

A skin scrape cytology test revealed demodex mange mites mixed with the infection.  Mange mites and bacteria work together to alter the pH acid-base balance of the skin and they release enzymes to make each other happier.  So, if you treat the bacteria and not the mange, then the problem never cures.  Once the Shepherd received treatment for both the infection and the mites, his sores went away and he felt comfortable again!

Demodectic Mange Treatment

Demodex is considered a normal commensal on dog skin.  This means that some demodex is natural and does not cause disease.  Anything that is natural, but growing out of control, is far trickier to control than an unnatural, foreign invasion infecting the skin – like sarcoptic mange.

Demodex takes a minimum of 6 weeks and a maximum of up to a year or longer to control, or cure.

Treatments for Demodectic Mange

  1. Treat bacterial infections
    1. prescription medicated shampoo
    2. systemic antibiotics
  2. Support nutrition and healing
    1. Good quality dog food
    2. Omega 3 Fatty Acids & Vitamin E (ask for Vet Rx)
  3. Kill demodex
    1. Only FDA approved treatment: Mitaban dips
    2. “Off-label” treatments:
      1. Oral daily ivermectin
      2. Promeris topical drops
      3. daily milbemycin (Interceptor brand) tablets

Hailey’s system did not take well to the prescription FDA-approved Mitaban dips.  She experienced lethargy, vomiting, and some diarrhea.  She switched to Promeris topical dewormer and felt much better.  So far, she is 2 weeks into treatment and you can see in the slide show, her fur is starting to fill in!

More Reading About Dog Skin Diseases

VirtuaVet’s: Gigantic, red, bald, angry, sore Hot spot

VirtuaVet discusses Allergic skin disease

Skin Infection Caused by swimming in the pool

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