What is the treatment for mange in a dog?

Treatment of Mange in Dogs

Primary Recommendation

For sarcoptic mange in dogs, administer selamectin topically at a single dose, with a second monthly dose if needed, or use newer isoxazoline products (fluralaner, afoxolaner, sarolaner) which provide extended protection and high efficacy. 1, 2, 3

First-Line Treatment Options

Selamectin (FDA-Approved)

• Administer once as a single topical dose for sarcoptic mange treatment 1
• A second monthly dose may be required in some dogs 1
• Monthly use will control any subsequent sarcoptic mange mite infestations 1
• Resolution of pruritus occurs in approximately 50% of dogs 30 days after first treatment and approximately 90% of dogs 30 days after second monthly treatment 1

Isoxazoline Class (Highly Effective Alternatives)

• Fluralaner (oral or topical), afoxolaner, and sarolaner demonstrate excellent efficacy with single-dose treatment providing sustained acaricidal activity 2, 3
• Fluralaner provides parasitological cure with >90% of dogs mite-negative by Day 28 and 100% mite-free by Days 56-84 after a single treatment 3
• These products offer the advantage of extended duration of action, preventing re-infestation from in-contact animals and fomites 3

Macrocyclic Lactones (Additional Options)

• Moxidectin and milbemycin oxime can lead to parasitological and clinical cure 2
• Ivermectin at 200 mcg/kg can be used, though not FDA-labeled for this indication 4

Treatment Protocol

Initial Management

• Treat all dogs in the household simultaneously, regardless of clinical signs, as sarcoptic mange is highly contagious 3
• Do not clean ears or remove debris before treatment when using selamectin, as many animals will still have debris after treatment 1
• Cleansing of infested areas is recommended only after treatment to remove debris 1

Monitoring and Follow-Up

• Expect clinical improvement within 30 days, with full resolution by 60-90 days 1, 3
• Pruritus typically improves in 50% of cases after first dose and 90% after second dose 1
• Skin scrapings on Days 28,56, and 84 can confirm parasitological cure, though therapeutic trial is often used diagnostically due to low sensitivity of skin scrapings 2, 3

Critical Clinical Considerations

Diagnostic Challenges

• Sarcoptic mange is difficult to diagnose via skin scraping due to low mite numbers and low test sensitivity 1, 2
• Therapeutic trial is frequently used to confirm diagnosis when clinical signs are suggestive 2
• Clinical similarity with other pruritic conditions and cross-antigenicity complicate diagnosis 2

Zoonotic Risk

• Sarcoptic mange is a zoonotic disease that can be transmitted to humans through close contact with infested dogs 5, 6
• Human infections are typically self-limiting but cause skin irritation and itching for multiple days 5
• Household members should be advised of this risk and monitored for skin lesions 6

Environmental Considerations

• Treat all in-contact animals and consider environmental contamination from fomites 3
• Sarcoptes scabiei mites can survive in the environment temporarily, requiring sustained acaricidal activity to prevent re-infestation 3
• Cleansing of hairbrushes, bedding, and other fomites with disinfectant is recommended 5

Product Selection Strategy

Choose fluralaner or other isoxazolines when:

• Single-dose convenience is prioritized 3
• Extended protection (12 weeks) is desired 3
• Multiple dogs in household require treatment 3

Choose selamectin when:

• FDA-approved product is specifically required 1
• Concurrent flea or heartworm prevention is needed 1
• Cost considerations favor this option 1

Common Pitfalls to Avoid

• Do not treat only the symptomatic dog—all household dogs must be treated simultaneously to prevent re-infestation 3
• Do not rely solely on skin scrapings for diagnosis—negative scrapings do not rule out sarcoptic mange 1, 2
• Do not discontinue treatment prematurely—pruritus may persist for 30 days after successful mite elimination 1
• Do not overlook zoonotic transmission—advise owners about human health risks 5, 6