Demodectic Mange

Mangebeforeside_2 This is the "before" picture I took today.  I have high hopes that I’ll be showing you some much nicer "after" pictures in the coming weeks.   "Lucky" is a stray dog who showed up about six weeks ago.  The extremely nice man who adopted him tells me that he actually looks a little better after the treatments they’ve been doing, but it seemed to him like the progress was a little slow with the dipping treatment their previous doctor prescribed.  What, you’re not happy with the whole body as a running sore?

You’ll hear a lot of folks refer to any dog with hair loss as "having the mange".  Mange properly refers only to the skin diseases caused by an infestation of microscopic bugs from the mite family.  One of the more common kinds is that caused by Demodex canis.  These tiny bugs live deep in the hair follicles.  Parasitologists tell us that a small number can be found on almost any dog, apparently causing no problems.  When they over-multiply, they damage the hair follicle, causing the hair to fall out.  If they continue out of control, they do enough damage that bacteria living on the skin take advantage of the "open door" and set up shop to cause a severe skin infection.  In Lucky’s case, he now has deep pyoderma (pus in the skin that goes all the way to the lowest layers of skin).  This is a pretty severe complication and is responsible for most of the discomfort experienced by the dog.

Red_mange_neck_2 Here is a less severe case.  She has lots of hair loss, but no deep infections.  She’s a pretty good illustration as to why this is sometimes known as "red mange".

Dogs that are stressed by illness, pregnancy or simply rapid growth as puppies may experience transient bouts of localized demodecosis.  This manifests as a small hairless spot or spots. The skin is smooth and it doesn’t seem to itch.   The vast majority of these individuals will heal spontaneously as their own body defenses crank up and get the mites in check.  They do not require treatment of any kind as a general rule, though persistent cases may benefit from topical treatment of the spots.  Whole-body dipping is NOT indicated for these patients.

When the dog is more severely compromised, generalized demodecosis may result. Sometimes this happens with chronic illness in a young dog.  If it happens in an older dog, you really need to search for some serious underlying disease.  There are some dogs whose immune system simply does not recognize the mite as being a problem.  These dogs mount no defense at all against the mites and they run rampant, with much secondary damage as well.  Lucky could be one of these dogs, but we hope not.  If the dog’s body defenses do not participate in the treatment, cure is unlikely.

Most dogs can be cured with today’s treatments.  Thirty years ago the only treatment was daily dipping with a very toxic (and stinky) insecticide.  It seldom worked.  People tried everything from rubbing the dog with raw meat to burnt cylinder oil.  They didn’t work.  Then came amitraz, first in an orchard spray chemical, then the currently approved form called Mitaban.  You bathe the dog in medicated shampoo to flush the debris from the hair follicles so the dip can get in.  You dry the dog thoroughly for a few hours so that the follicles aren’t full of water.  Then you soak him in the amitraz dip.  If he soaks up enough to work, he feels a little bad or "drunk".  Once per week seems to be the most effective regimen. 

Daily oral treatments with high doses of ivermectin or milbemycin oxime are much less nasty to perform and (with ivermectin) actually cheaper than the dipping process.  In many dogs this systemic treatment is more effective at killing the mites, as well. 

In any case, prolonged treatment is needed to eliminate the problem. Treatment generally takes two to four months in a severe case like Lucky’s.  One also needs to treat the secondary problem.  In a severe case like this, dipping alone is unlikely to be successful.   Lucky will need to take antibiotics for the skin infection for at least three weeks (the length of time needed to grow a new layer of skin).  Nutritional supplements to boost his immune system are needed.   We also need to get rid of any other debilitating problems (like the hookworm infestation that had not been treated yet).  Medicated shampoos help clear the debris from his skin and hair follicles, depriving the parasites and bacteria of their support.

Look for Lucky’s first "after" picture in about two weeks.

52 thoughts on “Demodectic Mange

  1. Brenda says:

    hi i just wanted to know if humans could get red mange? i have a dog who has it and she just had puppies and it looks like there getting it too i just dont want it to be harmful for my family

  2. Doc says:

    Hello, Brenda,

    This parasite is only transmitted by prolonged direct contact of bare skin to bare skin, i.e. a puppy nursing its mother.

    I do not believe that there is any likelihood that you or your family will be affected by the Demodex mite (“red mange”).

    Sarcoptic mange mites (Scabies, on the other hand, can be acquired from your dog (or your pig, for that matter) by fairly casual contact. It looks like chiggers on steroids (itches like it, too).

    Thanks for reading and writing.

  3. vonya says:

    I got a husky pup 3wks ago she is 13 wks old and has demodectic mange per the vet and is taking mitiban baths every 2 wks and antibiotics each day. however the sores are going away but it seems ALL of hair keeps falling out even where there was no sores, the mange covered 60% of her body,only has hair on her back and tail but it is falling out more each day!! what can I do??? will she loose all her hair?? will she scar and will her hair grow back?? her skin was red and bleeding alot but now its more a light pink color,she looks like she is getting better but the hair thing has me worried please email me if you can help Thanks to anyone who can offer help or home treatments!!!!

  4. Doc says:

    Hello, Vonya,

    The demodex mites live in the hair follicles and damage them. This causes the hair to fall out. The damaged structure is easily invaded by bacteria, which is what makes the sores.

    The good news is that your sore places are clearing up and the skin is beginning to look a healthy pink. This is the beginning of recovery.

    Even after all the mites are dead (which will take a while, as their eggs will still be hatching out), it will take a while for the hair follicles to heal to the point that they can begin growing new hairs.

    Let your veterinarian monitor the situation. It sounds like your pup had a really bad case, and it may take a while.

    It’s important to minimize other physical stresses on the dog, and good nutrition is very important to support the dog’s immune system.

    All the drugs in the world will NOT work if the dog’s own defense system isn’t working well. Just getting more mature will help this, but nutritional support is very important. A high-quality diet, plus some supplements may be helpful. I like Immuplex, made by Standard Process, but I’ll bet your own veterinarian can help you with this.

    There are some other drug therapies if the Mitaban isn’t working, but it sounds like you are making progress.

    Good luck.

  5. JeanLucas says:

    HI Can some one tell me how long these mites will last. I had my dog to the vet 3 weeks ago and he gave her a shot of steroids and and a allergy pill. my dog cries and whines. I know she is miserable. I took her back to the doctor today another (200.00)More steroids and allergy pills

  6. Doc says:

    Hello, JeanLucas,

    There must be some miscommunication going on here.

    Corticosteroids (forms of cortisone) would not be indicated for the treatment of mange mites. They would be used to treat allergies.

    Allergies require lifelong management – they do not get cured.

    Mange mites can almost always be brought under control, though it can take two months or more of treatment.

    The treatment would NOT be some type of steroid. These are used in allergies because an allergy is a malfunction of the body’s defense system. You suppress the body’s defenses with the steroids. That would NOT be a good thing to do if you have mange mites.

    You should ask your veterinarian to clarify what your dog’s diagnosis is, and what is being treated here. I cannot believe that steroids are being given for mange mites. That doesn’t make sense.

  7. Mackeah says:

    My vet has been treating my dog with Ivermectin since October (4 mos) for demodectic mange. For the past 2 mos, he gave prednisone shot for itching. She’s migrated to pills, one a day for a week and then tapering off completely. Last scratch test showed the mites are now dead, but we’re using Ivermectin for one more month. Thoughts?

  8. Doc says:

    Hello, Mackeah,

    Usually there isn’t much itching from the mite infestation at this point. This leads me to suspect that your dog has an additional situation going on, like an allergy or skin infection.

    The dermatologists have told me that you want to treat the dog until multiple skin scrapings are negative (you cannot find any mites, not just finding only dead mites), and for at least two weeks afterward.

    Sounds to me like your veterinarian is right on track.

  9. caval says:

    Hi.. will the hair grows back on the affected areas? I think my dog lost her appetite due to this. I just sent her to the doctor for treatment. It seems very serious.initially it was just 2 small patches, now it became very serious. Im very worried.

  10. Doc says:

    Hello, Caval,

    Generally speaking the hair does grow back once the mites and secondary skin infections are under control.

    Talk with your veterinarian about your concerns.

  11. Roxanne says:

    We rescued a puppy from humane society.. We’ve had her 11 months now… She’s been suffering from what all 3 different vets say is scabies/ mites!! She’s had Ivermectin injections 3 of them 2 weeks apart…she’s been given revolution.. She just had Promeris which almost killed her!….still Severe patches …tons of hair loss. we have her on no corn or wheat. Anutifungal shampoos and sprays. Benadryl. Nothing has worked. I’m at a loss and I don’t see the light! Help!

  12. Doc says:

    Hello, Roxanne,

    I understand your frustration.

    The dermatologists tell us that when a young dog has itchy skin problems, it is scabies (sarcoptic mange mites) “until you prove it isn’t”.

    That being said, one would still like to have actually seen the mites on a skin scraping.

    Sometimes we feel that we are ruling the mites in or out by treating appropriately. Usually, Revolution given three times, 2 weeks apart is very effective. If the dog gets well, that’s what it was. If not, it could be something else entirely.

    Frequently, dogs with severe skin problems have multiple things going on. They did in fact have sarcoptic mange mites. They also have 3 other things. You have to treat the other things, as well.

    There has obviously been some effort to do this, but it doesn’t sound like it worked.

    If I were presented with this dog, the very next thing I would do would be to perform skin biopsies. We need a diagnosis here, not just more treatments.

    The biopsies should be cultured, as well as sent to a dermatopathologist (a pathologist who specializes in skin disease).

    Referral to a veterinary dermatology specialist would be ideal, but is not always practical.

    It is very possible that the previous treatments have helped part of the problem, but you need to know what ALL of the problems are in order to treat effectively.

    It is also possible that the dog has some other underlying illness that needs to be treated in order for her immune system to function properly. She should be screened for other illness with basic bloodwork, urine specimen, stool specimen, and maybe a thyroid test.

    I wouldn’t be too worried about corn and wheat. If the biopsy suggests allergy problems, you could look at a real dietary elimination trial.

    Bottom line: we need to find out what all of this dog’s problems are.

  13. Breanna Morgan says:

    Hello, I have 2 dogs with domodex mange.. Before my little boy (Sarg) came into our home, I got my little girl (Bella), she had already had mange when I got her I had no idea why puppies fur was falling out & she had bald patches everywhere!! Once diagnosed with demodex mange, she was put on oral ivermectin once everyday for a month! It started to help, but at the same time she lost so much weight & hardly has an appetite! Once Sarg had caught the mange too, i put them both on advocate, once a month treatment between the shoulders. They’ve only had 1 treatment of that each, a week ago. They both have lost soooo much fur & have a fair few sores (getting worse from scratching). But Bellas skin Is still more dark, dry & flakey, where as Sarg is really red/pink not so dry & flakey but more scabby & in some areas looks like it’s a really bad rash rather than anything else.. I’m also finding it hard to get ontop of the sores as they scratch to the point they’re bleeding & the sores just get bigger!
    My babies are sooo miserable! Since the advocate, they have lost so much more fur! I guess it’s working already but my question is, will their fur grow back? & how roughly long after the mites are dead & gone, will it take for it to grow back?
    Any advise is greatly appreciated, thankyou ?

  14. Doc says:

    Hello, Breanna,

    I have had the best luck with the daily ivermectin, but it can certainly longer than two months of treatment in severe cases. There are reports of using moxidectin (in Advocate, US brand is Advantage Multi) to treat Demodex, but it isn’t as widely used.

    You don’t mention any treatment for skin infection. Demodex is often called “red mange” because the mites damage the hair follicles, which then are very susceptible to secondary bacterial infections. This is like turning all your pores into painful, itching pimples.

    Medicated shampoos with benzoyl peroxide (no more than 5%) can help flush debris from the hair follicles.

    Many of these dogs need to take systemic (by mouth) antibiotics for several weeks to clear up these secondary infections. When that is done, they are usually much improved in their overall health and condition while treating the mites.

    You also need to handle any other problems, such as intestinal worms, or poor nutrition, etc.

    Your veterinarian should be able to provide you with an antibiotic medicine that will concentrate in the skin (many do not).

  15. Katie says:

    Hi there!

    My puppy was diagnosed with demodex mange about 2 weeks ago. Initially it was two spots on her face and the vet recommended just some benzoyl gel. It quickly progressed to cover her entire face and neck. Her face became extremely swollen and we got her back to the vet. She has been on ivermectin a couple of days now, but the swelling is still pretty apparent, especially around her eyes (very squinty looking) Now her skin hase become very pink but also completely dried with lots of scabing/flaking. She’s very itchy! Is this normal? Does this mean the ivermectin has begun to work?
    Also, I know once the mites are under control to prevent the mites from flaring up again we need to get her immune system in tip top shape.. Any suggestions? We are giving her multi vitamins, but I’d love any other tips.

  16. Doc says:

    Hello, Katie,

    It’s pretty common to have secondary infections with demodectic mange. We often have to treat with antibiotics for a couple of weeks or longer to deal with that aspect of the problem.

    I recommend a high-quality name-brand puppy food instead of a generic or house-brand.

    Relief Spray and Relief shampoo have moisturizers and a local anesthetic to soothe the skin, and this may be helpful to you.

    Talk to your veterinarian about your concerns.

  17. Doc says:

    Hello, Greg,

    With localized cases like that, the hair almost always grows back. As the dog matures or gets past whatever was stressing the body, the immune system regains control, gets the mite numbers down, and the hair follicle begins to function normally again.

  18. Margaret says:

    I have a 1 & half year old Dalmatian mix with pit bull & he seems to have mange, I believe. I can’t afford to take him to the vet yet so I’ve been treating him with some medicated shampoo & some mange medicine I rub into his fur & so far it’s working. He hasn’t had any new outbreaks or scratching & his old scars he had are going away. He seems to be a little more comfortable & back to his old self so my question is what else can I do to keep him from having another outbreak until I get him to the vet?

  19. Doc says:

    Hello, Margaret,

    Without skin scrapings and cultures, it is diffficult to be sure of the diagnosis.

    If you are dealing with mange mites, there is a promising new product called Bravecto. It is sold for tick and flea control, an oral chew. There is a study showing good results in controlling demodectic mange with a single dose. This is not why the product is sold, nor does it have this on the label indications, but it appears to work.

    This would need to be obtained from your veterinarian, as it is a prescription product. It is certainly easier than any other treamtent.

  20. Mia says:

    I just recused a puppy with mange. Puppy went through all treatments and all tests came back negative. How long will the hair take to grown back? It’s on his face (all over) and front legs. Do you recommend fish oil to speed up process.

  21. Doc says:

    Hello, Mia,

    If fish oil would make hair grow, my forehead wouldn’t be rising daily.

    It DOES help them make their normal coat oils, which are necessary to maintain the skin’s barrier function. It DOES slow down the production of histamine, so you have less problems with allergic type itching. It is a good thing to do.

    Ordinarily, if you have negative skin scrapings, you are already starting to grow some hair. If you don’t see progress in a couple of weeks, ask your veterinarian to re-evaluate the puppy.

  22. Rebecca says:

    Hi there, we have a 4 month mini dachshund who weighs 3 pounds, we noticed her hair on top of her head was thinning so we took her to the vet they did a skin scraping and discovered what the vet said was a definite demodex mite. Since she’s so small they have us bathing her everyday with a medicated shampoo and she is taking ivermectin liquid starting with an almost minuscule dose progressing to a larger dose at 21 days, she itches a bit but seems ok so far. My question is we slept with the dog about 4 days ago and both my husband and I woke up up a definite rash on our bodies, him on his chest mainly and me on my arms and a little on my stomach, those were the exact places we were holding the puppy as she slept. We have seen one dr who had no clue what a demodex mite was so she just prescribed us permethrin 5% (what she would do for scabies) which we used but saw no result. The rash is not super itchy. Is it even possible for us to have gotten her mites from her? And should we be sterilizing and cleaning everything she uses? Thank you in advance!!! Rebecca

  23. Doc says:

    Hello, Rebecca,
    The canine demodex mite is not considered to be transmitted to humans. Even between dogs, it requires prolonged direct contact of bare skin to bare skin, which only really happens with a puppy nursing its mother.

    I don’t know what your rash is, but it is very unlikely to be demodex. The mite cannot survive off the host, so treating the environment is not necessary for that.

    Skin fungus infections are transmissible to humans. Most dogs with skin fungus (“ringworm”) have obvious sore places, but we often see cats who are carriers and look normal. We use a new sterile toothbrush to comb through the hair and collect dander for culture to check for the dermatophyte fungus (the fungus that causes ringworm).

    We have been using ivermectin to treat demodex for quite a while. Some new compounds show great promise, under the trade names Bravecto and Nexgard.

  24. sandra C says:

    What type of food and supplements could I use to help my new dog with d. mange to not get another outbreak. I heard it can get worse with a high carbohydrate diet and that omega 3’s are helpful….

    Also, would working a dog like this (via traveling, training, crating etc) aggravate her condition? IE: life stresses

  25. Doc says:

    Hello, Sandra C,
    Pups with localized cases usually develop enough immunity that they don’t have recurring problems unless severely stressed: pregnancy, severe injuries, severe illnesses, cancer, etc.

    Dogs that have more generalized cases usually require long-term treatment with ivermectin before the parasite gets under control. There are some very encouraging results with a new product called Bravecto, giving it orally only once every 3 months. I have tried a related compound, Nexgard, with very poor results, having to go back to the ivermectin.

    I don’t know that any particular nutrient is going to be making things worse. A well-balanced diet is important to support the dog’s general health, which is what you want to do. The Omega 3s are helpful in maintaining the dog’s natural skin barrier function, which is good in preventing secondary infections. I don’t think it will have a great deal of direct effect on the mites.

    As long as the dog maintains good physical condition (i.e. not worked until losing weight), I don’t think that training, crating or traveling will make things worse.

    I would avoid drugs that suppress the immune system, like any form of corticosteroid, Apoquel, or cyclosporine.

  26. Amy says:

    Hello, I have a pug puppy who is 11 weeks old. I got her off someone who had him off the breeder, after I brought him home I noticed lumpy spots on his head and chin and a little hair loss. I took him to the vet and they said puppy acne and prescribed antibiotics. It seemed to help and thought he would be fine. A couple of weeks later I went away for 4 days and my mum had him. When i came back his skin was a totally different colour, he has gone from pink to almost black mainly on his stomach and tail… It’s possibly all over but hard to tell under his hair. He also has spots now on his tummy near his pelvis and around his back legs and fur loss on his front legs, they look like human spots. I took him to the vet and at first said the darkening was normal but saw how worried I was and agreed it could be an allergy or mange. He is on nex guard (not done a skin scraping) just to see if it helps if it is mange. Do these symptoms sound like mange? I want to bath him but not sure if I should or what I should use? I am worried about him and it’s frustrating as I don’t exactly what it is, I know before doing a skin scraping it is hard to tell I just wanted your opinion. Thanks.

  27. Doc says:

    Hello, Amy,
    The veterinary dermatologist always recommend a skin scraping in cases like this. I would certainly be concerned about Demodex (“red mange”). Slick-haired dogs often do get bacterial skin infections, and the antibiotics should help with that. Sometimes you have to use a different medicine – there’s no one antibiotic that kills all germs.

    Medicated shampoos with chlorhexidine are good to kill fungus and bacteria.

    I often see temporary dark spots on the skin when it is healing from a pimple-type rash.

    Bravecto is a tick and flea control that has been shown to be effective in many cases of Demodex. Nexgard is a very similar compound, so one would think it would help. I have used it in two pretty severe cases and it did not help either of them. Not exactly a controlled study, but not a ringing endorsement, either.

  28. Elle says:

    I have a 2 year old rescue German shep mix. She started off cleaning her feet and legs frequently.mthe vet said allergies – change her food and give her apoquel. One month later she was still cleaning biting and scratching and her hair started to fall out. Vet said continue apoquel and try revolution. She had her first dose last week. She is still losing hair and her coat is very greasy. Her ears twitch a lot and she scratches under her legs until they are raw and scabby. No numbs or pus.Her appetite is normal. Are we on the right path? I don’t see anyone else reporting oily/ greasy coat.

  29. Doc says:

    Hello, Elle,
    Any condition that causes excessive scratching and chewing will result in secondary changes in the skin over time. Flaking of the skin and excessive skin oil secretion will eventually occur whether the underlying cause is allergy, infection, mange mites or whatever.

    Apoquel acts to suppress the itch receptors in the skin that are aggravated by allergic reaction. It has many fewer side-effects than corticosteroids like prednisone and other forms of cortisone. The prescribed dose given twice daily for two weeks usually gets itching due to environmental allergens under control. It is not likely to be helpful for food allergies.

    Simply changing diet is not adequate to diagnose a food allergy. One must eliminate ALL of what the dog has been eating previously. Feed ONLY a special hypo-allergenic diet. No treats. No flavored medication. “No nothing” but the diet.It takes four to 12 weeks to see if it is working.

    Treating three times with Revolution at 2-week intervals usually clears up Sarcoptic mange mites (Scabies), but it has no effect on demodex mites.

    Excessively greasy skin can be improved by bathing with an anti-seborrheic shampoo once or twice weekly. Decontamination of the skin by bathing also removes things you are allergic to from the skin surface.

    Oral supplements with Omega-3 fatty acids can help, as can topical products to enhance the skin’s natural barrier function (like Dermoscent 6, or Douxo spray).

  30. Iza says:

    Hello. My 2 month old french bulldog was diagnosed with demodex mange. Luckily we cought it at a very early stage. It’s mainly on his face and behind the ears. No inflamated spots, no itchiness. He started Milbemycin along with antibiotics. What worries me is that after he started the medicine, his baldness got worse. He definitly looks worse then he did 2 weeks ago even though the second scrubbing showed no signs of live mites( only dead ones) . Is this normal? Does it get worse before getting better??? Thank you. Iza

  31. Doc says:

    Hello, Iza,

    There is no regular rule about it getting worse before it gets better. Usually it just gets better.

    However, it is certainly possible that damaged hair follicles continue to lose hair, even though the mites are being killed.

    If the problem continues to worsen, your veterinarian will re-evaluate the treatment. Sometimes you have to treat secondary skin infections. Sometimes you need to use a different drug.

    I wouldn’t be too worried at this point. Just keep your veterinarian informed of how things are going.

  32. Sara Jenness says:

    Hello! I have been searching the internet to find an answer to how you will know that the ivermectin is working? My 10 year old chihuahua was diagnosed about 3 weeks ago after being treated for a standard bacterial skin infection. Since starting the ivermectin, the skin is definitely less red and more a natural pink, and looks less thick. However, we are still seeing the patch of hair loss grow, flaking around the fur surrounding the patch and pin head, I’m assuming, scabs on the furless area. It almost feels like sandpaper. She definitely seems happier since beginning treatment. Hoping we are on the path to recovery as blood work came back great. Thanks for any help you can provide!

  33. Doc says:

    Hello, Sara,

    The mites live in the hair follicles. Even though you are probably killing them, it takes a few weeks for the follicles to recover and begin to grow new hair.

    Some continued hair loss (small) is probably not a problem.

    Rechecking the skin scrapings can give you an idea as to how the treatment is working.

    When the diagnosis is first made, we typically see a lot of mites, and all the different life stages of the mite: egg, larva, nymph, adult. As the patient begins to recover, we typically see fewer mites and fewer life stages present.

    Treatment is generally continued until the dog looks normal, and one can no longer detect mites on a skin scraping. Then we treat for two more weeks.

    It is also important to fully treat the secondary skin infections that develop in the damaged hair follicles.

    Medicated baths can help with the pet’s recovery.

  34. Michael says:

    In the past few months Ive hit a bit of financial hardship and concurrently, I have noticed my 6 yr old moodle has developed patches. I thought it might be mange. I put some hydrogen peroxide through an oatmeal shampoo and it seemed to settle but recently whatever it is has flared and he has missing fur on ankles, stomach, chest and face. Heaps of other animals here with nothing like it. I’m a few weeks off being able to afford a vet consultation and was wandering if I could try the wash treatment I did when I first discovered the patches? Is there anything I could get him to minimise the itch other than the oatmeal part of the wash? I have him in a head cone and I’m looking for…booties. Is there an over the counter anti-hystemine? I’m kind of embarrassed for people to see him in public 🙁 I have that medicated (predominately iodine) wash too, will that help?

  35. Doc says:

    Hello, Michael,
    The oatmeal shampoo is soothing, won’t cause problems. A tamed iodine wash (povidone iodine or “betadine”) is safe, and would help kill bacteria or fungus on the surface of the skin.
    I cannot recommend a dose of antihistamine without seeing your dog. If you have taken him to your veterinarian in the past, you could call and ask for a recommendation.

  36. Rachel says:

    My dog has demodex and I am currently treating with ivermectin orally 1/10 cc per pound of body weight every 24 hours. (Do you agree with that dose?) I also bath her with blue Dawn dish soap and benzoyl peroxide shampoo. Could you please tell me the type of antibiotic and mg you recommend for the secondary infection, she is 72 pounds? Also what do you recommend to treat the secondary yeast/fungal issues that seem to come along with demodex? Thanks in advance.

  37. Doc says:

    Hello, Rachel,

    The dose I usually use is 600mcg/kg. That’s about 300mcg per pound (mcg = micrograms, NOT milligrams= mg). Ivomec is 10,000 mcg per ml, so you are giving about 1000 mcg per pound, which is quite a lot. If the dog is tolerating it, it may be fine. You should really consult with your veterinarian about this.

    Benzoyl peroxide has a follicular flushing effect to help clean the junk out of the hair follicles. This should make it easier to clear the secondary infections.

    I like Cephalexin as my first choice in these, but again you should consult the doctor who is actually seeing your dog.

    Dawn is really drying to the skin. It’s great if you’ve been caught in an oil spill, but is a little too much for a lot of dogs.

    Yeast infections can be treated topically with shampoos that contain miconazole and chlorhexidine. When you use a medicated shampoo, you need to leave the lather on for at least 10 minutes, 15 is better,then rinse thoroughly.

    Systemic antifungal drugs like ketoconazole are good, and terbinafine is usually pretty good, and more economical.

    For systemic medication doses, you really need to talk to the doctor who is seeing your dog.

  38. Dee James says:

    Our french bulldog pup is being treated by our vet for demodex mange. She is getting oral Ivermectin. I am bathing her twice a week with a medicated shampoo, my question do you keep shampoo on a puppy for ten minutes? We are both soaked after 2 minutes!! Is there a trick to this..of so please share!!

  39. Doc says:

    Hello, Dee,

    First, I would definitely plan on getting wet.

    I would put on some music I enjoy a lot.

    I would have the puppy hungry, and have a lot of very tiny treats to give during the process.

    And I would plan on getting wet. Did I say that already?

  40. Doc says:

    You could also consider wrapping her in a towel. We’re just interested in ten minutes of skin contact. She’d still be wet, but she wouldn’t be shaking it on you.

    Then rinse and dry her after the time is up.

  41. Doc says:

    I don’t have any experience using it. It is sold as a dandruff shampoo. It may or may not help with the follicular flushing (like benzoyl peroxide does). It wouldn’t do anything to kill the mites.

    A lot of doctors are having good luck with drugs like Bravecto and Nexgard.

  42. Caroline Thornton says:

    Our GSD rescue started balding around her eyes so we took her to the vet and they did a skin scrape and said it’s most likely Demo Mange. She was given a dose of Bravecto and then she has to take Ivermectin once a week for 4 weeks. It’s now week 2 and she is bald all over her face, neck, chest, and legs! She is losing more hair! IS THIS SUPPOSED TO HAPPEN? Or should I be freaking out?

  43. Doc says:

    Hello, Caroline,

    Bravecto, Credelio, Nexgard all have had good results in treating many cases of demodectic mange.

    A small amount of additional hair loss wouldn’t bother me, but what you’re describing sounds like there is more than one problem going on.

    Your wording that a skin scraping says it’s “most likely Demodectic mange” kind of bothers me. When we see multiple mites and multiple life stages (eggs, larvae, nymphs and adults) then that’s pretty definitive.

    If you just see one adult mite, that’s a little less convincing. Many dogs are carriers and have a few adults, but no problems.

    I don’t think you should be freaking out, but I DO think you should be giving your veterinarian some feedback. I would say that this is an unexpected result and I would want to re-evaluate the patient in light of what is happening now.

    When your doctor doesn’t hear from you, he/she just assumes that things are going okay. Since things are not going okay, you need to contact the doctor.

  44. Mary robinson says:

    Hello my name is Mary ,I have 15 yorkies.and they got ringworms.even though most doesn’t look like it.i have been dipping them n their babies for 15 days now in lime and suffer dip.but I checked this morning and now one of the pups has Los hair behind the ear.why is it not working

    • Doc says:

      Hello, Mary,
      Lime sulfur is a good, safe anti-fungal. It will work better if the affected areas have the hair clipped short first, and then all the scale and crud scrubbed off with a good anti-fungal shampoo. A 4% chlorhexidine is good. It is also important to be sure that there are no other health problems that would hurt their immune systems.

  45. Olivia says:

    Hello, my dog (Female, 45lb) began itching and losing hair so much it hurt to watch in October of 2020, she was roughly 1 yr 6 mo old. As money was tight due to the pandemic, we did not get her to the vet until February 2021 when the diagnosis of Demodex mange without skin scraping and secondary skin infection came about. She was given bravecto and a four-week course of cephalexin. Did multiple medicated shampoos also. It worked completely, then about five weeks after being healed, she had a touch of blood in her feces which was ruled out as stress by the vet and Demodex seemed to come back (still no skin scraping). Another round of cephalexin for about 5 weeks and another dose of bravecto starting in early June 2021. Nothing worked this time; took her to a different vet, explained the situation, was told bravecto should be working, and received another dose of cephalexin in September ’21. Still, nothing working, go back for skin scraping in November ’21, Demodex confirmed; still given a couple of weeks worth of cephalexin and prescribed one shot of dectomax a week for six weeks. Still not working. Another vet in late December ’21 provides a miracle… we start nexgaurd, one week of cephalexin, and 20mg prednisone starting at 2/day for three days, 1/day for three more days, and 1 every other day until gone (28 pills total). It worked so quickly, that she was back to herself (minus all the hair loss) in a matter of 4-5 days. But, as the prednisone began to wear off, she became uncomfortably itchy again. This time we get a 30-day injectable of some steroid that kind of worked, but not as well as the prednisone. Have been doing a monthly dose of nexgaurd (sometimes not on time, kind of expensive) and prednisone since February ’22. Still, when prednisone is beginning to wear off, she gets itchy all over again and since we are nearing 6 months of use, we’ve been discussing the prednisone’s long-term effects. Doing the prednisone cures everything, but I am aware of the side effects but do not want to go backward in the Demodex cure process. What do you think? I would appreciate any helpful words, I do not want her to live a miserable life
    I feel I should mention she is 3 yrs 2 mo old now, eating an all-natural diet for about a month now, happier and healthier than ever, and has no other problems.

    • Doc says:

      Hello, Olivia,
      The prednisone (and other corticosteroids) relieve inflammation, but also dampen the immune response some. I would be cautious about giving long-acting injections to a demodex patient, as you can’t “take it back” if the dog gets worse.

      I have had better results with Credelio than the other isoxazolines (Simparica, Nexgard, Bravecto, etc.) on the demodex.

      Because demodex lives deep in the hair follicles and damages them, secondary bacterial sink infections are common. Treating with an antibiotic like Cephalexin for 3 to 6 weeks is often helpful. If it’s not working as well as it did, you may need to switch to another antibiotic.

      Using medicated shampoos for the skin infection can also help.

  46. Amanda Patton says:

    My pitbull baby is almost 2 years old. She had a skin scraping and demodectic mange was confirmed. They had her on apoquel, prednisone and cephalexin. All worked great but as soon as the medication stopped, she would get bad all over again! I started giving oral ivermectin. Started the first three days with 0.3 ml, the next three days I gave 0.4 ml, next three days I have 0.5 mls and now I give 0.6 mls daily with no increase in the amount. She isn’t eating great, but still eats everyday. She is skinny and kinda sluggish at times. My question is, her skin started drying and peeling after starting the ivermectin. Is this normal? I bathe her twice weekly with benzoyl peroxide too! Her skin is no longer red, more of a pinky color but with widespread peeing and drying which makes her itchy

    • Doc says:

      Hello, Amanda,
      The twice-weekly bathing with the benzoyl peroxide shampoo is probably why her skin is getting so dry.
      I am assuming that you have stopped the prednisone. It is anti-inflammatory, but also suppresses the immune system, which will slow recovery. We usually don’t combine it with apoquel.
      If there is deep skin infection (as there often is with demodex), it may be necessary to give the cephalexin antibiotic for 4 to 6 weeks.
      I have had really good look with Credelio tablets and demodex. If the ivermectin doesn’t seem to be doing the trick, you might ask you veterinarian about using one of the isoxazolines, with Credelio seeming to work the best for me.
      If this problem didn’t start until she was an adult, it’s also good to do other diagnostics to be sure there isn’t some additional underlying disease problem that has compromised her immune system. Dogs get infected as nursing puppies, but their immune system usually keeps the mite in check unless something else is wrong.

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