What is the treatment for mange caused by mites?

Treatment of Mange Caused by Mites

For the treatment of mange caused by mites, topical permethrin or oral ivermectin is recommended as first-line therapy, with ivermectin at a dose of 200 μg/kg as a single oral dose being most effective for severe cases. 1

Diagnosis and Clinical Presentation

Mange is a skin condition caused by microscopic mites that burrow into the skin. The clinical presentation typically includes:

• Intense itching (pruritus)
• Skin rash with small red bumps
• Scaling and crusting of the skin
• In severe cases, thickened skin with cracks and fissures

Treatment Options

First-line Treatment:

1. Topical Treatments:

   • Permethrin 5% cream: Apply to the entire body from neck down, leave on for 8-14 hours, then wash off. May need to repeat in 1 week 2
   • Benzyl benzoate 5%: Can be used as an acaricide on carpets and other surfaces to kill mites 2

2. Oral Treatment:

   • Ivermectin: 200 μg/kg as a single oral dose for severe or widespread cases 1
   • May need a second dose after 1-2 weeks in some cases

For Crusted (Norwegian) Scabies:

Combination therapy is recommended:

• Topical permethrin 5% cream (full-body application repeated daily for 7 days then twice weekly until cure)
• PLUS oral ivermectin 200 μg/kg on days 1,2,8,9, and 15 2
• Severe cases may require additional ivermectin treatment on days 22 and 29

For Animal Mange:

• Selamectin: Effective topical treatment for pets with mange 3, 4
• Ivermectin: Has shown effectiveness in treating sarcoptic mange in various animals 5, 6, 7

Environmental Management

Mite infestations require treatment of both the affected individual and their environment:

1. Decontaminate bedding and clothing:

   • Machine wash and dry using hot cycle
   • Dry clean
   • Or remove from body contact for at least 72 hours 2

2. Environmental control:

   • Maintain indoor humidity between 35-50% to reduce mite populations 2
   • Use HEPA vacuum cleaners on carpeting and upholstery 2
   • Consider treating carpets with acaricides like benzyl benzoate if removal isn't possible 2

3. Personal hygiene:

   • Keep fingernails closely trimmed to reduce injury from scratching 2

Follow-up and Monitoring

• Symptoms may persist for up to 2 weeks after successful treatment
• Consider retreatment if:
  • Symptoms persist beyond 2 weeks
  • Live mites are still observed
  • New lesions continue to appear

Special Considerations

Treatment Failure

Treatment failure may occur due to:

• Resistance to medication
• Improper application of topical treatments
• Failure to treat all close contacts
• Failure to decontaminate environment
• Reinfection from untreated contacts

High-Risk Groups

For immunocompromised patients, debilitated individuals, or those with crusted scabies, more aggressive treatment is required with combination therapy as noted above 2.

Contacts

All persons who have had close personal or household contact with the patient within the preceding month should be examined and treated if infested 2.

Prevention

• Avoid direct skin-to-skin contact with infested individuals
• In endemic areas, avoid walking barefoot on beaches or soil
• Regular deworming of pets
• Pre-treating clothing with permethrin when exposure risk is high 8