About Mange
Mange is the common name for skin diseases due to parasitic Mites. Mites belong to the same scientific order as ticks, but are much smaller, microscopic in fact, and different types of mites can cause and carry diseases or cause inflammation and irritation of the skin in man and animals, the feathers of birds, and the leaves of plants.
For the purposes of this simplistic and practical article, there are three types of mange that we worry about in dogs and cats. The reason I divide them up into three groups is because the treatment is different for each group. Here we go:
Ear Mites: Ear mites aren't usually referred to as "mange" but it is, in fact, our most common mite problem in pets. Suspect ear mites if your cat has blackish ear wax or is scratching at it's ears. Dogs can get ear mites too, but the same symptoms in dogs are more likely to be an infection and not mites. Ear mites are contagious to other cats, and from cats to dogs, and vice versa, but they are not contagious to humans
Ear mites, like fleas have gotten pretty resistant to over the counter pesticides, so don't be surprised if your home treatment fails. But your vet will have no problem in either diagnosing or successfully treating this problem with the new prescription medications available. At our clinic, treatment consists of through cleaning of the ears followed by ivermectic drops, followed by an application of Revolution.
Demodex Mange
(also known as Red Mange)
Roger Ross, DVM
There are hundreds of different species of mites, most of them microscopic, that share our environment (dust mites) or parasitize our flesh. Mange refers to the disease that parasitic skin mites cause; namely damaged and inflammed skin along with secondary allergic and bacterial problems.
There are two classes of mites affecting dogs and cats. They both cause skin problems but they are quite different. They look different under the microscope, they have different life cycles, and most important from a practical point is that they require different treatments.
This article is about the Demodex Mange and is caused by different species of Demodex mites.
The other type of mange we commonly see (the contagious type) is known as Sarcoptic Mange. There's an article about this type of mange further down the page.
Here's some basic info:
Demodex mange in not contagious from one dog or cat to another. (Or to people)
Demodex often doesn't itch much. Mild cases simply show up as small patches of hairlessness. More severe cases, though, often involve secondary bacterial skin infections making the the situation look a lot different; inflammed, pustular, itchy, and quite awful.
Here's something that surprises a lot of people:
all dogs and cats probably have small quantities of demodex mites living in their skin just like all pets (and humans) have small numbers of skin bacteria.
The trouble is that in dogs (and occasionally cats) with the disease of Demodex Mange, the numbers of mites have multiplied to the point where they start to cause trouble, immune reactions, inflammation, irritation, and stimulation of the sebaceous glands.
The reasons for this aren't clearly understood but have to do with immune suppression and hormone changes. This disease is usually associated with puberty so is most common in puppies between 4 and 16 months of age.
But we also see it occasionally in any animal of any age that is immune suppressed, either genetically, from poor nutrition, from parasitism, or from certain medications and certain diseases.
Or from hormonal changes and stresses such as pregnancy or nursing. We also think that testosterone may be a culprit because castration often helps with the cure (although not usually critical to the cure...but if it isn't a breeding animal, consider this anyways.)
The diagnostic technique for detecting demodex mange is the same as for sarcoptic mange; we can usually find it easily under the microscope with skin scrapings.
The treatment is different though.
1. We look for causes of immune suppression or stimulation of the sebaceous glands.
We make sure the patient isn't infested with worms, other parasites, or on a poor diet.
2. Since patients with poor immune systems are susceptible to many diseases, we look extra hard for secondary infections, ringworm, and so forth.
3. Oral ivermectin is used by a lot of veterinarians because it often helps achieve a quick cure, but the dosing protocol is different for each vet, and some vets don't use it at all because this medication is NOT approved. That means that if anything goes wrong, and ivermectin is a potent drug, he or she might be considered legally liable for the problem. Using such medications is NOT illegal, but is rather called "off label".
We vets are fairly used to this situation; a lot of drugs, for example, legally available for humans, are known to be useful in animals too, but were never approved for that use, or at least for that particular animal. Getting a drug approved is very, very expensive, so the drug companies don't bother. And they like to avoid potential legal liability too. Besides, they know we're going to use them anyways, and by being off label they avoid both the expense of getting them approved for each species and they're off the hook legally if your pet happens to die from a medication.
At any rate, your vet may or may not recommend using ivermectin. Or maybe only if you take the precaution of first doing blood work to make sure the kidney and liver (which metabolize medications) are working well. Remember that demodex is associated with immune diseases that affect the whole body.
4. Dipping with amitraz pesticide. This is a very potent poison, so listen to instructions. Tell your vet if you might be pregnant.
This dip is also somewhat poisonous to the patient so pay attention to problems like vomiting and seizures. Keep in touch with your vet if there are problems. In fact, some vets insist on doing the dipping themselves in order to make sure there aren't major problems. I don't mean to over scare you, usually everything works out fine, but amitraz is a potentially dangerous pesticide, but it's about the only pesticide that works well.
The dipping is usually repeated at weekly intervals until all better. Sometimes this takes more than 6 weeks.
5. Some vets supplement this treatment with immune stimulants, vitamin and nutritional support, fatty acid supplements, and anti-oxidants.
In addition, we need to treat for any secondary infections, ringworm, etc.
Sometimes it helps to clip the hair coat prior to treatment to allow better penetration of the dip. Another helpful option for better dip penetration is to use a medicated scrub prior to dipping in order to remove crust, scales, and open skin pores.
I didn't tell you this, but some cases are mild enough that they are self curing. On the other hand, a very few cases are incurable. The pet responds to treatment, but only for a short period. This occurs with severe immune system deficiencies. Most cases are in the middle; the disease is serious and uncomfortable, as well as ugly and smelly, but quickly gets better with professional treatment.
Sarcoptic Mange
Roger Ross, DVM
Sarcoptic Mange:
This mite is very contagious from one pet to another.
This mite burrows into the skin to lay eggs and is extremely itchy. Dogs and cats with this type of mange itch "like crazy" and as a result of both the inflammation caused by the burrowing mites and the itching, the skin is soon very red, raw, and covered with secondary scabs, scales, and infection. There is usually a lot of hair loss too.
This type of mange is very contagious to both cats, dogs, and other carnivores, so if you have more than one pet, the other pets in your household or neighborhood may also be affected. Humans are only rarely susceptible to these particular mites as a disease except for a possible temporary rash.
Here's the thing: most people that call me at the clinic to tell me their dog has mange turn out to be wrong! They phone hoping I'll tell them what to do over the phone so they can avoid the expense and trouble of coming into the clinic, and that's understandable except for two big problems (and several legal ones).
Problem number one is that most skin diseases that people mistakenly call the mange turn out to be allergic or bacterial problems which requires a very different treatment than mange.
And problem number two is that if it is mange, we have to know which type, which we can only tell by looking at a sample under the microscope, to know which medication to choose, because there isn't a treatment yet that will cure both sarcoptic and demodex (red) mange.
The treatment for sarcoptic mange is as follows with possible variations by your vet:
1. Confirm diagnosis with skin scrapings and a microscope. (And veterinary knowledge)
2. Remove the surface scales and bacteria with a good medicated shampoo so that the dip can penetrate deep into the skin where some of the mites are hidden.
3. Apply an effective dip (poisonous pesticides...pay attention to your vet's instructions) to the surface of the skin and allow it to soak into the skin for at least 10 minutes before rinsing. Each time you do this you will be killing a large percentage of the adult mites, but you will also be leaving a small percentage of adults and a large percentage of eggs and larvae. Because of this, you will need to repeat the dips, usually weekly, for 3-8 times.
There are a lot of mail order pesticides and home remedies (motor oil, sulfur, kerosene) that will kill sarcoptic mites to different degrees, but you risk both poor results and a very sick dog (and probably a dead cat) if you don't use the newer prescription dips available from your vet. This is not a good time to skimp.
4. In addition to all the above, I now also apply Revolution (the fairly new flea and heartworm control product from Pfizer) every 2 weeks for a couple of times because Revolution also does a fair job of killing sarcoptic mites not only on the skin but also a lot of larvae living around the environment.
5. Speaking of the environment, it's probably not critical to wash all the pet bedding or to saturate the kennel with pesticides. These mites can only live for about 3 days off a warm body and besides, the larvae are resistant to the pesticides.
6. Treatment of the secondary problems if present. This often includes antibiotics for infection, and antihistamines to help control the itching.
7. Your vet may also recommend higher quality diets, vitamins, and/or fatty acid supplements to improve the general health of your pet's skin and to speed healing.
About Lice (Pediculosis)
We don't see this too much in this country, but there are two groups of lice; those that suck blood and tissue fluids, and those that bite and chew at your tissues. Lice spend their whole life cycle on the animals and are generally species specific which means you only get lice from close contact, and except in rare cases, you only get lice from members of your own species. (dogs, cats, sheep, horses, and humans or any creature you might sleep with all belong to different species)
This has never been a big problem in small animal medicine because any flea shampoo is likely to kill lice...just repeat every couple of days for a few times.
The only reason I mention the problem is that every year we get a few phone calls from anxious parents who have a child infested with lice and they want to make sure the family pet isn't the cause or a carrier. We, of course, would be happy to take skin samples and check under the scope, although I usually simply ask if the pet is itching a lot. If yes, then we check to see why. If no, I simply recommend a few baths in a pyrethrin (flea) shampoo as insurance. But again, lice are species specific.
The Fox Tail Problem
Roger Ross DVm
Here at the FoxNest Veterinary Hospital we don’t see any cases of Fox Tail, but if I ever convert my clinic to a “gentlemen’s club” I could put up a big sign...
Fox Tails are a huge problem each summer to pets living in the South West and California. These barbed little grass awns migrate up into ear canals, noses, throats, between toes, and other body openings leaving infected fistulas or tracts that cause a lot of irritation and often require surgery to fix.
You can save yourself a lot of money and your pet a lot of discomfort if you’ll inspect and groom your pet’s coat frequently for these awns (they look a lot like wheat shafts) so they can be removed before they penetrate and migrate deeply.
Removal is easily accomplished with a comb or tweezers IF you notice the awns before they get deep in the ears, nose, or other tissues and openings, but once the ear becomes inflammed, or the sneezing becomes severe (often with blood), or you see abscess’, you will need to take your pet to a vet for sedation-light anesthesia and surgical removal.
Additional treatment will also likely include:
Antibiotics to treat the secondary infection
Antihistamines to help reduce the tissue inflammation and irritation
Short term steroids, also to help reduce the tissue inflammation
Topical antibiotics and antiseptic flushes
Possible recheck and more aggressive treatment ... some of these cases are apparently very difficult.
