Demodicosis can be challenging to treat, under even the best of circumstances. The therapeutic goal is to resolve the hair loss, scaling, crusting, redness, rawness and other skin symptoms associated with the condition. The key to a good outcome is early identification of the problem and consistent treatment with oral and topical products. Many if not most cases of localized juvenile demodectic mange will resolve spontaneously as the puppy’s immune system matures, with or without treatment. Over time, the immune systems of most healthy dogs are able to suppress abnormal proliferation of Demodex mites. Still, most owners of dogs identified as having demodicosis choose to treat their dogs rather than simply hope and wait for the infestation to resolve.
There are several ways to treat demodectic mange. Currently, daily doses of oral ivermectin, milbemycin or moxidectin, and/or frequent periodic dips with Amitraz (brand name Mitaban), continued over a number of months, are the treatments of choice. Not all of these treatment protocols are officially labeled or approved for use in dogs with this disorder. Benzoyl peroxide gels and shampoos can be helpful to loosen the hair follicles and flush out the mites from specific patchy areas. The affected skin areas should be clipped or shaved to facilitate penetration of the medication into the hair follicles. Monthly skin scrapings will help the veterinarian and owner monitor the dog’s response to treatment. Most authorities recommend continuing treatment until the animal no longer has any obvious signs of mange, and then slowly weaning them off of the oral and/or topical medications over a period of 30 to 60 days additional days.
Oral vitamin E supplementation has been described as an adjunct to standard therapy, although there is no reliable scientific evidence proving that it helps to resolve cases of demodectic mange. If dogs develop secondary bacterial skin infections (pyoderma) as a result of demodicosis, the veterinarian will prescribe a course of antibiotics until the infection is resolved. Corticosteroids, which are often used to control severe itchiness, probably should not be used in dogs with demodectic mange, because they function in part by suppressing the animal’s immune system. Of course, new treatments are always under development. Owners of affected dogs should consult closely with their veterinarians to be sure that they are receiving the most up-to-date therapy that is available.
It is important for owners to recognize that treatment with ivermectin can have some potentially serious adverse side effects. Most of these are neurological in nature and include weakness, disorientation (ataxia), excessive salivation, collapse, coma and possibly even death. Collies and Collie crosses have a greatly increased risk of having bad side effects from being treated with ivermectin. Amitraz (Mitaban) can also have unpleasant side effects, including sedation, drowsiness, lethargy, depression, itchiness (pruritis), vomiting, diarrhea, dizziness, hyperglycemia and a staggering gait.
The prognosis for dogs with demodectic mange is quite variable. As treatment progresses, if skin scrapings reveal an increasing number of dead mites and a decreasing number of juvenile mites, the outlook is promising. Young dogs with localized juvenile demodicosis typically have quite a good prognosis and, with or without treatment, usually recover with no adverse repercussions from the condition. Adult dogs that develop demodicosis are much less likely to recover spontaneously and tend to have a more guarded prognosis. Approximately 10% of affected dogs will never be cured and will require medical management for life. However, if the owner is willing to commit the time, energy and cost of intensive treatment for a dog with demodectic mange, that dog probably will be able to live a full, content and happy life without suffering many if any adverse consequences from the mites.