The disease is diagnosed using a microscope to find mites in debris scraped off affected areas of skin. Once a diagnosis of Demodecosis (or "Red" Mange) has been made, there are several approaches to treatment.
As we discussed last week, your vet may opt to not even treat small, localized areas of the disorder in young pups, since they often outgrow it spontaneously. In other cases, these small lesions may be treated with an ointment containing the chemical Rotenone, which is an insecticide. Adults and more severely infected older pups may call for more drastic action.
There is only one product on the market specifically labeled for the treatment of generalized Demodecosis. This is marketed under the trade name of Mitaban, containing the active ingredient Amitraz. It comes in tiny individual bottles, designed to be mixed with water and used as a whole-body sponge-on or dip. As I understand it, this chemical is
somewhat unstable and breaks down easily after exposure to air, so it is not available in larger sizes. This means, of course, that this is a fairly expensive medication. Mitaban is a prescription product, and there can be side effects from its use, so you certainly want to work with your vet. First off, you want to know for sure what you're treating, and you want to discuss the potential side effects thoroughly. The Mitaban label calls for its use every two weeks. For how long? That varies, but basically it needs to be continued beyond the time the problem appears to be gone. This may take several weeks to a few months. Using antibiotics to help clear up any secondary bacterial skin infection will often make treatment of the primary disease much easier.
As I said earlier, I am not certain that you can ever say this disease is "cured"; sometimes all you can achieve is control of the problem. My chow-mix, Whitney, had a severe case of Demodex when I first acquired her; for years I still had to dip her once or twice a year to keep the condition under control. It tends to flare back up in times of stress, such as surgery, illness, or in Whitney's case, Obedience School. She has always been shy and slightly neurotic, and although she did fairly well in class, the whole thing was too much for her, and I dropped her out halfway through the course, partially bald. She hasn't had a problem in years, but I know it is there, lurking under her shiny black coat.
In a few instances, it seems that even control is impossible, and that is when we have to go beyond what is "approved" for treatment. This is a grey area, and when we enter this territory, owner and veterinarian have to work together even more closely. We may use a more concentrated solution of the Mitaban, and we may use it more often than the label recommends.
Other medications may have to be considered, such as Ivermectin or Milbemycin. (Both are approved for use in dogs, at much lower dosages, as heartworm preventatives.) We tend to use these as last resorts, the big guns that are pulled out when everything else has failed. Yes, we are taking bigger chances here, but by this point, it is a war-with the dog's health, and maybe its very life, at stake.
The final point that I need to emphasize here is that Demodectic Mange is not contagious to people. (I was surprised to find out, though, while doing the research for this article, that humans have their own Demodex mite, which apparently does not cause us any trouble.) Also, Demodecosis is essentially not contagious to other dogs. It probably does pass from affected mother to newborns while their immune systems are still not up to speed. I imagine it might be spread in some rare case where an immune-deficient adult was in contact with another affected dog. There is an inherited tendency toward developing the disease, and affected dogs should not be bred, especially those with the generalized form.
I hope I have made this difficult skin problem a little easier to understand, and I hope that I have also made it clear that this is not something to be approached with home remedies. Even with all the medications vets have available, Demodex can be a formidable opponent.