What is the treatment for demodectic or sarcoptic mange?

Treatment of Demodectic and Sarcoptic Mange in Animals

For sarcoptic mange in dogs, selamectin should be administered as a single topical dose, with a second monthly dose often required for complete resolution. For demodectic mange, oral fluralaner or topical imidacloprid/moxidectin are the most effective treatments based on recent evidence. 1, 2, 3

Sarcoptic Mange Treatment

Sarcoptic mange is caused by the mite Sarcoptes scabiei which infests various animals including dogs, cats, swine, foxes, cattle, and coyotes. The treatment approach varies by animal species:

Dogs:

1. First-line treatment:

   • Selamectin applied topically as a single dose 1
   • A second monthly dose is typically required in many cases
   • Resolution of pruritus occurs in approximately 50% of dogs 30 days after first treatment and 90% after second treatment

2. Alternative treatments:

   • Moxidectin at 0.2-0.25 mg/kg orally or subcutaneously weekly for 3-6 treatments 4
   • Amitraz 1.25% solution applied weekly (typically requires 1-3 treatments) 5

Clinical monitoring:

• Treatment success is determined by resolution of clinical signs (primarily pruritus)
• The difficulty in finding sarcoptic mange mites on skin scrapings makes clinical improvement a key indicator of treatment efficacy

Demodectic Mange Treatment

Demodectic mange is caused by Demodex mites and requires a different treatment approach:

Dogs:

1. Most effective treatments (in order of efficacy) 2, 3:

   • Fluralaner (oral) - single administration provides 100% mite elimination by day 56
   • Imidacloprid/moxidectin (topical) - applied every 28 days for three treatments
   • Doramectin (oral or parenteral)
   • Sarolaner (oral)
   • Milbemycin oxime (oral)
   • Ivermectin (oral) - not recommended as first choice

2. Treatment comparison:

   • Single oral fluralaner administration reduced mites by 99.8% at 28 days and 100% by 56 days 3
   • Topical imidacloprid/moxidectin (three applications at 28-day intervals) reduced mites by 98.0% at 28 days, 96.5% at 56 days, and 94.7% at 84 days 3

Other animals:

• For exotic or farm animals with mange, treatment protocols may need to be adjusted
• South American camelids (llamas, alpacas) with sarcoptic mange require subcutaneous moxidectin (0.2 mg/kg) every three weeks for up to eight treatments 6

Treatment Monitoring and Duration

• Skin scrapings should be performed before treatment and at regular intervals (typically every 28 days)
• Treatment should continue until:
  1. No mites are found on multiple skin scrapings
  2. Clinical signs have resolved (reduction in erythema, crusts, scales)
  3. Hair regrowth is evident

Potential Complications and Considerations

• Side effects may occur with treatment:

  • Moxidectin: Side effects reported in 17% of dogs with sarcoptic mange 4
  • Side effects are more common with subcutaneous administration than oral administration
  • Amitraz can cause side effects that may require antidote treatment (atipamezol, yohimbine) 5

• Environmental management:

  • Bedding should be washed
  • Other animals in contact should be evaluated and potentially treated
  • Sarcoptic mange is potentially zoonotic and can cause temporary skin irritation in humans 7

Special Situations

• Generalized demodicosis is more challenging to treat than localized disease
• Immunocompromised animals may require longer treatment courses
• Secondary bacterial infections may require concurrent antibiotic therapy
• Pregnant or nursing animals require careful consideration of treatment options

Treatment success is ultimately determined by complete resolution of clinical signs and absence of mites on skin scrapings, with most protocols requiring 1-3 months for complete resolution.