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Discussion Starter #1
My 6 mos old pup has generalized demodex mange (diagnosed by vet). It seems to be affecting him everywhere but his head. He is not bald - yet - but he has lost a good bit of fur and continues to shed copiously.

Brief history:

  • When we got him at almost 4 mos old, he had a skin infection as evidenced by rash on belly and scaly skin on the back of his head near his neck. The vet called it puppy seborrhea and he took Cephalexin for 10 days. It cleared up.
  • A month later I noticed bumps again and washed him with Keto-C (anti-fungal anti-microbial) shampoo and took him back to the vet the next day. The bumps were almost gone (thanks to the shampoo) so she gave me another round of Cephalexin to use if it got worse and told me to watch for more hair loss as he might have demodex mange. He was already starting to lose hair on his legs. I didn't use the antibiotics!
  • Fast forward another month. Periodic washing with Keto-C kept any rash under control (could have been from hot, humid weather) but hair lose had continued to get worse. He was scratching more too, especially along his sides and back.
The vet did skin scrape tests and saw two things that MIGHT have been mites but said to treat him for mites anyway because he had all the other classic symptoms. She prescribed Ivermectin for 30 days for the mites, Hydroxyzine (antihistamine) for the itching, Cephalexin (antibiotic) and to continue washing with Keto-C or Benzoyl peroxide (which I had ordered on my own). I didn't question the Cephalexin at the time (too many questions about the other issues) but when I got home, I decided not to give the Cephalexin because he didn't have skin bumps or redness so it didn't make sense to give it.

It's been eight days now that he's been on the Ivomec. I started out bathing him every day, but his shedding (especially along his back) and itching for getting worse, so I started skipping a day or two between baths. The Hydroxyzine helps the itching and I can tell when it wears off that the itching is still present. He has also developed scaly skin (dandruff) along his back. So now I'm wondering if it was wise to withhold the antibiotics. I don't like using them prophetically which is why I hesitated.



Can anyone who has experience with demodex mange comment on whether or not antibiotics are a necessary part of the treatment? Also at what point should I start to see improvement in the hair loss or any indication that the mite problem is lessening?
 

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Yes, I've dealt with more demodex dogs in rescue than I can remember.

If it's just demodex, you don't need abx. However, it's rarely "just" demodex because opportunistic "bad guys" like staph and yeast like to invade where the skin is already damaged and vulnerable. They tend to infect dogs secondary to mites (and even simple allergies). However, they're diagnosed via a skin scrape -- the vet spots them on a slide under the microscope.

Ask your vet clinic if the vet diagnosed staph via the skin scrape -- it would be in your patient chart, so they could easily look it up for you by phone.

If you want to pursue it and can afford to do a little better diagnosing, I would send a sample out for culturing, if they already found staph (it's a good general practice with antibiotic-resistant staph emerging in dogs). Progressive vets are culturing routinely now, but old school vets aren't yet processing that the antibiotic-resistant era is no longer coming...it's already arrived. The culture will tell you what exact organism it is, and whether it's resistant to any drugs commonly used in dogs. If you happen to have staph that's resistant to cephalexin, you'll know you need a different drug. Most staph still responds to cephalexin though, so many vets still reach for it reflexively. It's probably the right drug...but only a culture can tell you with certainty.

If that's what you're treating, and it is sensitive to cephalexin, then the next problem is "how long?" Short courses don't help generalized staph infections, in my experience. We've had to do them for at least a month (or longer) to win the war, when the staph is deep in the skin and all over. We also do the antimicrobial baths at least weekly or sometimes even 2x a week wit these dogs. OTOH, localized staph infections (small patches) can sometimes be treated just with the shampoo, or at most a shorter course of abx. In fact, I like to try to knock it out topically first (as you were doing with your shampoo), to try to avoid screwing up the gut flora unnecessarily.


For the demodex, ivermectin has been the standard treatment for years, and it does work. However, I think it's kind of old-school -- the dose needed to treat demodex is HUGE (something like 1000x what we use for heartworm prevention), and not all dogs can tolerate it. Most do fine though. We've had great luck using NexGard. We've also used Advantage Multi successfully, but I think the NexGard is better -- and the research supports that:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807374/

When you make progress on the mites in 2-4 weeks, the itching lessens, and then the scratching goes away, and then around weeks 4-6 you may start start to see tiny fuzz of new hair. The dog will look spotted or mottled (like an aussie shepherd) when the fuzz starts growing, but after around 12 weeks, the coat should start to look normal again.

Just know that it's a process that takes a lot of time and patience to unfold.

While treating it, do pay close attention to health and nutrition. Demodex explodes because of a problem in the immune system that failed to keep the mites in check. It always is a sign of a run down immune system -- so think of it as a "symptom" rather than a "cause." When you get that immune system running optimally, the body keeps the mites in check on its own. So do some investigating on what might have run it down -- chemicals in your environment, quality of diet, undiagnosed food allergy, stress...? (I have seen some of these dogs who cycled through rounds of demodex in their lives get dramatically better on limited-ingredient allergy-food or non-kibble alternative diets. I have a hypothesis that some of them are food allergy sufferers whose immune systems are out-of-whack because they're eating food that makes them sick -- but this is pure conjecture on my part with no scientific support whatsoever.)


If there's staph, this immune system is more of a challenge for you. The antibiotics kind of set you back further because they destroy gut flora -- but sometimes it has to be done! Supplementing probiotics at the halfway point between your two daily doses might be helpful (you can't give them with the meds, or the meds just kill them!). Giving probiotics with 6-hour bovine colostrum may make them more helpful (it's a human supplement -- I use the Immune Tree brand). (Purina had a study showing that a probiotic + colostrum produced a healthier gut flora than either one alone.) All this is just geared toward trying to get the body's own immune system engaged in the battle against the mites.


This also provides an explanation for ruling out immuno-supressive diseases:
https://petdermatologyclinic.com/canine-demodex-mite-infection-nexgard-and-bravecto/
 

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Discussion Starter #3
Thank you Magwart for the informative response. I have a call in to my vet to ask for further info concerning the antibiotics. I figured the demodex issue would be a long process since the Ivomec was prescribed for 30 days. I've read that it can take even longer in some cases. I just didn't have any idea as to when to expect to see any improvement. As for the immune system, I too suspect diet. I've tried 4 different LB puppy foods none of which he tolerated. He gets diarrhea from them so I've stuck with the original food the breeder was using (Annamaet Encore) which he does tolerate. I've started supplementing Wild Salmon Oil and Evening Primrose Oil. Both of these are supposed to help the immune system and the skin. I concur with your recommendation of a probiotic and will look into it. Thank you again.
 

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Discussion Starter #5
It seems that editing a post is not an option and I can't stand that I have a misspelled word.

"I don't like using them prophetically which is why I hesitated."



....should have been.....


"I don't like using them prophylactically which is why I hesitated." :grin2:
 

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One of my dogs was diagnosed with demodex. Adult one (4 years old), not puppy.

He was getting weekly shots + pills twice a day for itching.
 

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I've had two dogs with demodectic mange. What did the trick for both of them was being dipped with Mitaban (amitraz) over the course of several weeks. It looks like they've quit producing it as of July 31, but it's possible that your vet might still have some?
 

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I had one dog with démodex mange- she was given two ivermectin shots that were spread out. This helped her right away it was quick and stopped the suffering with the insane scratching. she not have any problems after that.
 

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@LeoRose, Mitaban is gone, but for those who prefer dips, some dogs are helped by old fashioned lime sulphur dips, which is still available. I probably wouldn't choose it as a "stand alone" treatment, but it will likely help as an adjunct (bonus: it's antibacterial and antifungal). My vet swears that they help the skin heal faster from demodex too -- the problem is no one wants to use them because they stink so badly (you have to leave the lime sulphur on the skin for it to work, so your dog smells like rotten eggs). It has to be done outside (e.g, in a kiddie pool) due to the odor, and you have to dilute it properly to avoid a chemical burn on you and the dog.

We had a thread about this a while back in which @carmspack posted some information about sulphur as a skin nutrient that caused it to make sense.
 

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Discussion Starter #10
My pup may have turned a corner on these demodex mites. He didn't wake up itching this morning, for the first time in a while (even with being on Hydroxyzine) and when I bathed him this morning he only shed a little (what I would consider a normal amount during a bath). I did call my vet and found out that she did indeed see bacteria in the skin scrapes but when I described the progression of things, she recommended holding off giving it too him unless he gets more crusty sores or has large patches of hair loss. I hope this morning was a sign of progress and that my little guy can get back to growing healthy. Thanks again for all the information on this thread.
 
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