DEMODECTIC MANGE- CULPRIT - DEMODEX CANIS Demodectic mange is caused by a microscopic mite called Demodex canis.  All dogs raised normally by their mothers possess this mite as mites are transferred from mother to pup via cuddling during the first few days of life.  (After the pup is older it is unable to pick up demodex mites. Puppies raised by hand, do not ever get demodex mites.)  For some reason, conditions change in certain dogs to allow demodex mites to "gain the upper hand;" the mites proliferate and can cause serious skin disease. Mites are not transmitted to people or other dogs except from mother dog to pup as described. Demodectic mange (unlike Sarcoptic mange) is not contagious.   Mites live inside hair follicles -- a difficult place for miticides (chemicals that kill mites) to reach.   Mites are a normal residents of dog skin; it is only in some individual dogs that mites cause problems. CURRENT TREATMENT OF CHOICE -- IVERMECTIN Ivermectin is a broad spectrum anti-parasite medication generally used for food animals and horses.  It is licensed for use in dogs and cats as a heartworm preventive and as a topical ear mite therapy at this time thus the use of this medication to treat demodicosis is not approved by the FDA. When ivermectin was a new drug it was hoped that it could be used against demodectic mange mites. At first it was found ineffective but later it was determined that daily doses are needed (most other parasites can be controlled with wormings spaced several weeks apart.) Ivermectin is inexpensive relative to Milbemycin (see below) and involves no labor intensive bathing. It DOES, however, taste terrible if given orally (it may be necessary for the owner to learn how to give ivermectin as an injectable treatment.) THIS MEDICATION IS NOT SAFE FOR USE IN COLLIES, SHETLAND SHEEPDOGS, AUSTRALIAN SHEPHERDS, OLD ENGLISH SHEEPDOGS, AND SOME WOULD SAY, ANY HERDING BREED. Sensitivity to ivermectin may not be predictably limited to “collie breeds” and thus it is often prudent to use a lower test dose before initiating the relatively high doses of ivermectin needed to treat demodicosis. Not all individuals of collie heritage are sensitive to ivermectin and a test is in development to determine whether an individual should be able to safely take ivermectin or not. There is a range of ivermectin doses used in the treatment of demodicosis and it seems that higher doses do clear infection faster than lower doses. This means that if a lower dose has been ineffective, a higher dose may still work. This does not mean that a pet owner should experament with ivermectin doses on their own as there is some potential for lethal toxicity if this drug is not used appropriately. For more information on Ivermectin, click here. TRADITIONAL TREATMENT -- AMITRAZ (MITABAN) DIPS Unless the animal is largely bald or has a short coat, complete clipping will be required for maximal contact with the dip. Dip should be preceded by a benzoyl peroxide bath (Oxydex™ or Pyoben™ Shampoo).  This helps clear up skin infections and also helps open the hair follicles so the dip can penetrate to the mites. Shampoo must sit on the pet at least 10 minutes before rinsing. CAUTION:  this type of shampoo can stain jewelry and clothing. Dip is applied by sponge.  Gloves should be worn while applying dip.  The dip dries on the dog's fur and should not be rinsed off.  The dog should not get wet between dips. Dipping occasionally yields mild sedation as a side effect.  Very small dogs may become highly sedated and require an antidote but this is unusual. For your convenience, dipping and bathing may be performed at the hospital thus allowing for veterinary supervision in the event of side effects. Dipping/bathing is recommended every two weeks on the bottle of dip. Most universities are finding that the cure rate jumps from 25% to 80% when dip is used at double strength and applied weekly.  No toxic effects have been seen using the dip in this way and this is our current recommendation except in very small dogs and puppies. The pet's skin is scraped every 2 weeks until 2 consecutive scrapings are negative.  Dipping/bathing is discontinued and the pet is rechecked in one month. Dipping/bathing are reinstituted if mites are again found. AMITRAZ DIPPING SHOULD NOT BE USED IN TOY BREEDS OR IN VERY YOUNG PUPPIES. NOTE:  Amitraz is a drug of the monoamine oxidase inhibitor class.  People who are taking selected serotonin reuptake inhibitors (such as Prozac®) could have a bad reaction to the use of amitraz if they administer dips to pets. SOMETHING ELSE YOUR VETERINARIAN MIGHT TRY -- INTERCEPTOR® Interceptor (active ingredient: Milbemycin oxime)  is normally marketed as a monthly heartworm preventive; when it is used on a daily basis, it is effective against generalized demodicosis. This discovery was welcomed by the veterinary profession as finally demodicosis could be treated without labor intensive dipping. The downside to this treatment is expense plus an owner can expect to be using this medication daily for up to 3 months to achieve cure. INTERCEPTOR MAY BE USED IN ANY PATIENT SAFELY; THE ONLY DOWNSIDE IS EXPENSE.   RELAPSE? Relapse is always a possibility with generalized demodicosis but most dogs that relapse do so within a 6-12 month period from the time they appear to have achieved cure.  When relapse occurs it is often because the dog appeared to be normal and the owner did not return for the appropriate rescrapings. The final scrape is performed one month after treatment has stopped. SARCOPTIC MANGE IS A COMPLETELY DIFFERENT DISEASE. Click here for information on Sarcoptic mange. WE WISH IT WASN’T NECESSARY TO ADD THIS In older times, some 30 years ago, dipping dogs with demodectic mange in motor oil was a popular home remedy. Skin exposure to motor oil can cause rashes and skin destruction in severe cases. The hydrocarbons can be absorbed through the skin and cause a dangerous drop in blood pressure. If motor oil is licked off the coat, resultant vomiting can lead to aspiration of motor oil into the lungs and pneumonia. Kidney and liver damage can result from motor oil dipping.   PLEASE: DO NOT DIP YOUR DOG IN MOTOR OIL! Always check with your vet when you consider using Ivermectin orally.  There is a specific recipe for dogs.

INJECTION: TWO TO FOUR TREATMENTS A newer, but not FDA-approved treatment, involves the use of Ivermectin, a powerful anti-parasite medication. Ivermectin is especially helpful for pets who will not allow direct treatment of their ears. Most Ivermectin injectable protocols involve shots weekly or every two weeks. This is a highly effective method of ear mite eradication but there are some limitations.  Certain breeds of dogs are sensitive to this medication and cannot take it. Certain individuals have similar sensitivities which cannot be predicted by breed. Injectable ivermectin is not approved for the treatment of ear mites in small animals. I        If you think your pet has an ear infection, see the vet for proper evaluation rather jumping straight to an over-the-counter remedy. You will need the right diagnosis before you can intelligently choose an ear treatment  product. It might also be a yeast infection that looks like mites too.   Shop by Animal   Advanced Se   Ivomec 1% (Generic) A parasiticide for the treatment and control of internal and external parasites in cattle and swine A 1% Ivermectin for internal & external parasites of cattle & swine. Treat & control gastrointestinal round & lungworms, grubs, sucking lice & mange mites. Label may be different than shown.     Be sure to have the ears re-checked according to your vet’s recommendations. Success will not be met unless the ear canal is thoroughly cleaned. This is true whether a topical solution or one the systemic products is used. WHAT IF THEY JUST DON’T SEEM TO EVER GO AWAY? Was the mite infection confirmed initially? Remember, it is easy to be fooled by the presence of a discharge that appears “mite typical.”   Has the mite infection been confirmed after therapy? Sometimes, a telltale hard bit of ear wax must be removed from the ear before comfort is finally achieved.  Sometimes a bacterial infection remains though the mites are long gone.  Treating for ear mites when there are none present, will not achieve results.   Were all the hosts in the family treated? If all pets were not treated, begin again this time including all pets in the protocol.   Consider using one of the new products. Do not make the diagnosis of ear mite infection yourself.  If you think your pet has an ear infection, see the vet for proper evaluation rather jumping straight to an over-the-counter remedy. You will need the right diagnosis before you can intelligently choose an ear treatment  product.

SARCOPTIC MANGE (ALSO CALLED "SCABIES") THE ORGANISM AND HOW IT LIVES SARCOPTES SCABEI   Sarcoptic mange is the name for the skin disease caused by infection with the Sarcoptes scabei mite. Mites are not insects; instead they are more closely related to spiders.  They are microscopic and cannot be seen with the naked eye. Adult Sarcoptes scabei mites live 3-4 weeks in the host’s skin. After mating, the female burrows into the skin depositing 3-4 eggs in the tunnel behind her. The eggs hatch in 3-10 days producing a larva which, in turn, moves about on the skin surface eventually molting into a "nymphal" stage and finally into an adult. The adults move on the surface of the skin where they mate and the cycle begins again with the female burrowing and laying eggs. Female sarcoptes mite burrowing in the skin and leaving a trail of eggs behind her. Her presence generates an inflamatory response in the skin similar to an allergic response. APPEARANCE OF THE DISEASE The motion of the mite in and on the skin is extremely itchy.  Further, the presence of mites and their eggs generates a massive allergic response in the skin which is even more itchy. Dog with dematitis problem typical of sacrcoptic mange. Note: Many dogs do not develop the classical ear margin crusts until later in the disease. Mites prefer hairless skin thus leaving the ear flaps, elbows and abdomen at highest risk for the red, scaley itchy skin that characterizes sarcoptic mange. It should be noted that this pattern of itching is similar to that found with airborne allergies (atopy) as well as with food allergies. Frequently, before attempting to sort out allergies, a veterinarian will simply treat a patient for sarcoptic mange as a precaution. It is very easy to be led down the wrong path (pursuing allergy aggressively) if one considers sarcoptic mange an unusual or unlikely possibility. As the infection progresses, eventually most of the dog's body will be involved. Classically, though, the picture begins on the ears (especially the ear margins), the elbows, and abdomen. The term "Scabies" refers to mite infestations by either Sarcoptes scabei or other mite species closely related to Sarcoptes scabei.  While Sarcoptes scabei can infect humans and cats, it tends not to persist on these hosts. When people (including some veterinarians) refer to "sarcoptic mange" or "scabies" in the cat, they are usually referring to infection by Notoedres cati, a mite closely related to Sarcoptes scabei.  In these feline cases, it would be more correct to refer to "Notoedric mange," though the treatment for both mites is the same.  Notoedric mange, in cats, generally produces facial itching and scabbing. DIAGNOSIS When an animal with  sarcoptic mange scratches itself, it breaks open the tunnels that the mites have burrowed into and the mites are killed (though the itch persists due to toxins in the skin). The result is that the mites can be very difficult to confirm by skin scraping tests.  (Probably mites are confirmed in 50% or fewer of sarcoptic mange cases).  Since negative test results do not rule out mite infection, a "Maybe Mange" test is frequently performed. This consists simply of treating for sarcoptic mange and observing for resolution of the signs within 2-4 weeks. Of course, if mite presence is confirmed by skin scraping, then one knows immediately the cause of the itching and need not be concerned about allergy possibilities or other diseases and the condition can be addressed with confidence. BIOPSY - Mange mites are rarely seen on a skin biopsy sample, though, if the sample is read out by a pathologist who specializes in skin, the type of inflammation seen in the sample can be highly suggestive of sarcoptic mange. This is an example of a skin disease where it makes a difference whether the pathologist reading the sample specializes in reading skin samples. TREATMENT While sarcoptic mange is difficult to diagnose definitively, it is fairly easy to treat and a number of choices are available. DIPPING - Anti-bacterial or anti-itch shampoos preceed one of several anti-mite dips. Paramite dip (an organophosphate), Mitaban dip (Amitraz), and Lime-Sulfur dips given weekly are usually effective. Disease typically resolves within one month. Dips are often used in combination with one of the other treatments listed below. IVERMECTIN - This is one of the most effective treatments against Sarcoptes scabei yet is is off-label as far as the FDA is concerned. There are several protocols due to the very long activity of this drug in the body. Typically an injection is given either weekly or every two weeks in 1-4 doses. In most cases this treatment is safe and effective but some individuals have a mutation which makes ivermectin very toxic at the doses used to kill mites. These individuals are usually of the Collie family: Collies, Shetland Sheepdogs, and Australian Shepherds are classically affected. There is now a test that can determine if any dog has the mutation that makes ivermectin use dangerous. For more information on ivermectin use click here. SELAMECTIN (REVOLUTION®) - Selamectin is an ivermectin derivative recently marketed for the control of fleas, roundworms, hookworms, ticks, ear mites and sarcoptic mange mites. Normal monthly use of this product should prevent a sarcoptic mange problem but to clear an actual infection studies show an extra dose is usually needed after 2 weeks for reliable results. This product is probably the best choice for Collie or Australian shepherd breeds. Click here for more information from the manufacturer on Revolution Click here for more information from the manufacturer on Revolution. ALL DOGS IN A HOUSEHOLD WHERE SARCOPTIC MANGE HAS BEEN DIAGNOSED SHOULD BE TREATED. MILBEMYCIN OXIME (INTERCEPTOR® OR SENTINEL®) - Milbemycin Oxime is approved for heartworm prevention as a monthly oral treatment. Happily, it also has activity against sarcoptic mange and several protocols of varying success have been recommended by different dermatologists. This is another medication that one might find recommended. For more information from the manufacturer, visit their page for Interceptor: http://www.petwellness.com/dog_inter_home.asp or their page for Sentinel: http://www.petwellness.com/dog_sent_home.asp HOW THE INFECTION IS SPREAD Sarcoptic mange mites are usually spread by direct contact from host to host. While mites can live off of a host for days to weeks depending on their life stage, they are only infective for 36 hours which means that environmental decontamination is generally not necessary. Mite infections on humans are self-limiting (ie they go away on their own) as the mite is not able to complete its life cycle on the "wrong" host. The condition is extremely itchy, though, while it lasts. The mites are most active where skin is warm (in bed and where clothing is snug). IF A SARCOPTIC MANGE ANIMAL IS PRESENT IN THE HOME, IT IS A GOOD IDEA TO WASH ANY BEDDING IN THE WASHING MACHINE (OR REPLACE WITH NEW BEDDING), AND WASH ANY COLLARS OR HARNESSES.-

ANSWERING YOUR QUESTIONS ABOUT EAR MITES (Otodectes cynoti) WHAT ARE EAR MITES? Ear mites are tiny infectious organisms resembling microscopic ticks.  The mite can just barely be seen as a small white dot with the naked eye but usually must be detected by examination of a sample of ear wax under a microscope.  Infection usually produces a characteristic dry black ear discharge commonly said to resemble coffee grounds. Because of the classical appearance of this discharge, infection is often diagnosed based on the presence of such discharge though without visual confirmation of the mite under the microscope, it is possible to be led astray.  The discharge is composed of ear wax, blood, inflammatory biochemicals, and ear mites themselves. THE BIZARRE EAR MITE LIFE CYCLE The mite lives on the surface of the ear canal skin, though sometimes migrates out onto the face and head of its host.  Eggs are laid and hatch after 4 days of incubation.  The larva hatches from the egg, feeds on ear wax and skin oils for about a week and then molts into a “protonymph,” which in turn molts into a “deutonymph.”  The deutonymph mates with the adult male. What seems especially bizarre to us mammals, is the fact that the deutonymph has not yet developed a gender at the time it mates with the adult male. After mating, the deutonymph molts into either an adult male or an adult female. If she becomes a female, she will be gravid with eggs as a result of the mating. If he develops into a male, there are no consequences to the mating and he is ready to mate with deutonymphs of his own choosing.  The adult mite lives approximately two months happily eating ear wax and skin oils. The life cycle (the time it takes for an egg to develop into an adult mite ready for parenthood) requires 3 weeks. Most ear mite cases are found in cats. Dogs can be infected as well but, since dogs more commonly get ear infections of other types, ear infections in dogs rarely involve mites. HOW DID MY PET GET EAR MITES? Ear mites readily transmit from host to host by physical contact.  Ear mites came from some other animal with whom your pet has been socializing. Because mites are easily transmissible by physical contact, treatment for mites often must include all household pets. WHAT HARM COMES FROM EAR MITE INFECTION? The presence of the mites is very inflammatory and can generate very irritating ear infections.  Skin disease can also result from infection by the ear mite. __________________________________________________________________ IS THIS CONTAGIOUS? Ear mite infection is certainly contagious among cats and dogs.  Typically, the victim is an outdoor cat.  Humans have been reported to develop skin rashes rarely; in general, we may consider that a human pet owner is extremely unlikely to experience any symptoms when their pet is infected with ear mites.   HOW DO I GET RID OF EAR MITES? TOPICAL TREATMENTS: AT LEAST THREE WEEKS USAGE There are numerous products available for ear mite eradication.  Most older and over-the-counter products contain insecticides which do not kill incubating mite eggs. Because of this limitation, such products must be used for at least the duration of the 21 day life cycle of the mite. Some specialists recommend a 30 day treatment course  with such products. TOPICAL TREATMENTS: AT LEAST TEN DAYS USAGE Another approach involves the use of a topical ear product called Tresaderm® (manufactured by Merial) which contains an antibiotic for any secondary bacterial infections, a cortisone derivative for the inflammation, and thiabendazole to kill yeasts and mites.  This is an excellent ear product and is able to kill the developing mite eggs.  This cuts the treatment course down to 10-14 days and provides an excellent oily lubricant with which to clean     ALLERGIES He might have an ear infection down deep in the inner ear caused by allergies.Change your diet, usually the kibble, and stick with that for 2 weeks and see if there is a difference.  Your vet should look at the pug to determine any of this. There are a lot of medications that can help, an where from antibiotics like Baytril, and Monetamax, Which is gentamycin, mometasone, AND clotrimazole suspension.  You can only get this from your vet.