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CE Article #1

Canine Demodicosis
Kim L. Horne, AAS, CVT*
University of Minnesota

T
he mite Demodex canis is an ectoparasite and a nor-
mal inhabitant of canine hair follicles and sebaceous Key Points
glands of the skin.1–3 Mites are transmitted by direct • A lthough canine generalized demodicosis
contact between the dam and puppies shortly after birth.1,2,4 can be diagnosed with proper skin-scraping
Canine demodicosis occurs when an altered immune techniques, it can be challenging to treat.
response allows overproliferation of mites, leading to the • Adult-onset demodicosis should be investigated
development of clinical signs. This disease is most commonly for underlying causes.
caused by D. canis; however, other species, such as Demodex • Client education and compliance are critical to a
injai (a large-bodied mite) and Demodex cornei (a short- successful outcome.
bodied mite), may also be involved.3 Although diagnosis of
canine demodicosis can be straightforward, the disease can
be challenging to manage because of the length of treatment, Juvenile-Onset Form
the need to identify and treat underlying causes, demands on The juvenile-onset form typically presents before the dog
the client (time and financial commitments), and the need reaches 1 year of age.1 Young patients may present with
for frequent follow-up visits to the veterinary clinic. localized or generalized disease. Patients with localized
demodicosis may not need to be treated. If treatment is
Disease Classification recommended, topical therapy (e.g., benzoyl peroxide gel
Demodicosis can be classified as localized or general- q24h) can be administered to affected areas.1 Some dogs
ized, with a juvenile or adult onset. Prognosis and treat- with generalized demodicosis may initially present with
ment options vary, depending on the form of the disease. localized lesions; however, with time, their clinical signs
Criteria differentiating each form have not been uniformly become representative of the generalized form. To identify
established.2 patients with disease that will progress to the generalized
form, it is important not to use systemic miticidal therapy to
Localized Form treat patients with localized disease.2–4 In most cases, young
The localized form usually involves six or fewer focal areas dogs with generalized demodicosis should be treated sys-
of the body (FIGURE 1), often including the face and fore- temically because the disease can progress in a short period
legs.1,2 This form most often affects dogs younger than 1 of time. It is thought that the juvenile-onset generalized
year.4 Approximately 90% of cases spontaneously resolve,1,4 form develops as a result of an inherited immune dysfunc-
usually within 6 to 8 weeks,1,2 especially with juvenile tion; therefore, owners of patients with this form of disease
onset. should be advised that their dogs should not be bred.2,4

Generalized Form Adult-Onset Form

Generalized demodicosis is a more serious disease.1 The Adult-onset demodicosis is usually seen in adult dogs aged
generalized form is suspected if more than six areas of the 4 years or older.1 It is important to inform the client that
body are affected, two or more feet are affected, or an entire an underlying cause often exists and to look for concurrent
region of the body is involved.2 Approximately 30% to 50% diseases before treating the patient for demodicosis. If an
of juvenile-onset cases of generalized demodicosis sponta- underlying cause cannot be determined at diagnosis, moni-
neously resolve.1 toring should continue throughout treatment. The inability
*Ms. Horne discloses that she received a speaker’s honorarium from to identify and manage the underlying cause may decrease
Eli Lilly and Company in 2008. the likelihood of a successful outcome.1

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 CE Article #1

FIGURE 1 FIGURE 3

Localized demodicosis. Larval stage of D. canis (magnification: 100×).

FIGURE 2

Adult stage of D. canis (magnification: 100×).

Adult-onset generalized demodicosis with pruritus.

Underlying causes include diabetes mellitus, hyperadre- due to rupturing hair follicles. The severity of clinical signs
nocorticism (either naturally occurring or iatrogenic due to (e.g., fever, lymphadenopathy) can vary depending on the
glucocorticoid administration), neoplasia, treatment with extent of the disease and the presence and type of concur-
immunosuppressive agents, hypothyroidism, heartworm rent illness.
disease, intestinal parasitism, and leishmaniasis.1–5 To
identify an underlying cause, a thorough history should be Diagnosis
obtained and a complete physical examination performed. Demodicosis is seen most often in purebred dogs1,2 and pup-
A minimum database (i.e., complete blood count, serum pies and young dogs up to 18 months of age.2 Demodicosis
chemistry profile, heartworm test, fecal analysis, urinaly- is diagnosed by performing skin scrapings. To find mites,
sis) should be obtained. Additional tests for hyperadreno- it is necessary to obtain multiple, deep skin scrapings
corticism and thyroid function as well as radiography and from affected areas. Proper sample collection techniques
ultrasonography may also be warranted, depending on the are essential when scraping for Demodex mites. A spatula
case. or #10 scalpel blade can be used to collect the samples.
Mineral oil should be applied either to the spatula/blade or
Clinical Features directly to the area being scraped to ensure that the material
Many patients present with circular areas of alopecia. being scraped sticks to the scraping instrument. Scraping
Occasionally, patients present with a diffuse area of thin should be deep enough to produce capillary bleeding while
haircoat. Pruritus is usually absent unless a concurrent squeezing the area being scraped; this forces mites deep in
allergy or secondary skin infection develops (FIGURE 2). If the hair follicle to the surface. Microscopically, fusiform
untreated, these patients may also develop hyperpigmen- eggs, six-legged larvae, eight-legged nymphs, or eight-
tation and lichenification along with increased body odor legged adult mites (dead or alive) can be seen (FIGURE 3).
due to excess sebum production from sebaceous glands Ideally, for each scraping site, the number of mites (or at
associated with hair follicles. Draining tracts may also form least an estimated percentage, including dead and living

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BOX 1 FIGURE 4

Recording Skin-Scraping Results

Location:_________________________________________

Adults (alive):_ ____________________________________

Adults (dead):_____________________________________

Nymphs:_________________________________________

Larvae:___________________________________________

Eggs:____________________________________________
Fibrotic pododermatitis.
mites) in each life stage should be recorded in the patient’s
medical record (BOX 1). These results can be used to moni- Miticidal Therapy
tor the response to treatment at future rechecks. Amitraz (Mitaban, Pfizer Animal Health) is currently the only
Trichography may be used to search for adult mites treatment approved by the Food and Drug Administration
attached to the hair shaft. This procedure involves plucking (FDA) for canine generalized demodicosis. Bathing with a
some hairs in the direction of hair growth and placing them benzoyl peroxide shampoo before dipping may be benefi-
in mineral oil on a glass slide for microscopic examina- cial for its keratolytic effect and follicular flushing activity.
tion. Because trichography is not as reliable as skin scrap- Clipping medium- and long-haired dogs may facilitate dip-
ing for diagnosing demodicosis,2,3,6 it should complement ping by allowing better contact between the skin and the
and not replace skin scraping. Trichography may be help- dip solution. Mitaban dips are applied topically and licensed
ful for yielding mites when collecting samples from areas for use every 14 days.2 Mitaban is often used extra-label at
of the skin that are difficult to squeeze or scrape, such as weekly intervals.1,3 Product safety for pregnant animals or
interdigital and periocular areas.2,3,6 Negative results from for dogs younger than 4 months has not been established.
trichography do not rule out a diagnosis of demodicosis. The solution should be prepared as labeled (dilute 1 bottle
A punch biopsy may be needed if skin-scraping results [10.6 mL] of Mitaban with 2 gal of warm water) immediately
are negative and the index of suspicion for demodicosis is before application. The person applying the dip should wear
high. The biopsy may be necessary in patients with thick gloves and protective clothing, and the patient should be
skin (e.g., shar-peis) or chronic pododermatitis (FIGURE 4) treated in a well-ventilated area. Dip should not be toweled
when lesions are fibrotic.1–3 off; the patient should be allowed to dry naturally. Patients
receiving other monoamine oxidase inhibitors, such as ami-
Treatment triptyline and selegiline, should not receive this treatment.
The general health of patients diagnosed with generalized After the first treatment, patients may experience lethargy
demodicosis should be evaluated and managed before and sedation for 24 to 48 hours.2 This is less likely to occur
miticidal therapy is instituted. 1,2 Treatment typically with subsequent treatments. Other adverse effects include
involves specific miticidal therapy for demodicosis along bradycardia, hypothermia, and hyperglycemia.2–4 Patients
with adjunctive therapy, when needed. Treatment options with diabetes mellitus or facial involvement may not be
depend on many factors, such as patient history, extent and good candidates for this therapy.
location of clinical signs, and the patient’s breed. Before Metaflumizone plus amitraz spot-on (Promeris for
therapy for demodicosis is initiated, the veterinarian should Dogs, Fort Dodge Animal Health) is labeled to kill and
ask the owner to list any medications or supplements that control Demodex spp mites on dogs. In a recent study, the
the dog is receiving. The client’s ability and willingness to drug was administered to dogs either every 2 weeks or
administer a therapy should be discussed when choosing a monthly with a minimum dose of 20 mg/kg (i.e., 0.133
therapy, as should financial considerations. Client compli- mL/kg).7 Negative skin scrapings were obtained in 62.5%
ance is extremely important to the success of treatment. and 42.9% of the dogs receiving biweekly or monthly treat-
Patients with demodicosis should not be treated with glu- ment, respectively. These dogs were not followed up after
cocorticoid therapy or other types of immunosuppressive discontinuation of therapy.
drugs.1,2 ***

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FIGURE 5 dogs, it may improve client compliance through its ease

of administration (i.e., a chewable tablet).10 Milbemycin
oxime may be an alternative choice for breeds sensitive to
avermectin drugs (i.e., ivermectin, doramectin). The dos-
age is 0.5 to 2 mg/kg PO q24h,1,2 but most dermatologists
use 1 to 2 mg/kg.a A recent study showed that ivermectin-
sensitive breeds can have an adverse neurologic response
to milbemycin, although the toxicosis is less severe. The
findings suggest that sensitive-breed dogs treated with mil-
bemycin need to be monitored carefully because they may
experience ataxia.11
Imidacloprid 10% plus moxidectin 2.5% spot-on
Secondary bacterial skin infection. (Advantage Multi, Bayer Health Care, Animal Health
Division) was administered to dogs two to four times, at
Treatment using the products discussed below is con- 4-week intervals, at a dose of at least 0.1 mL/kg.12 In this
sidered off-label. Adverse effects of avermectins and mil- study, parasitologic cure was achieved in 27 of 30 dogs
bemycins are rare and include mydriasis, hypersalivation, after two to four monthly treatments. However, these dogs
lethargy, ataxia, seizure, coma, and death.2,3,8 A heartworm- were not followed up after remission.
negative status should be confirmed before beginning the
following therapies, and regular heartworm preventive Adjunctive Therapy
medication can be discontinued throughout treatment with It is important to treat secondary ear and skin infections
these products.a (FIGURE 5) because they often cause pruritus and resolving
Ivermectin (Ivomec injection for cattle and swine, them can make the patient more comfortable. If the patient
Merial) is a common first-choice treatment of many derma- has secondary pyoderma, oral antibiotics may be needed
tologists2,3,5 because it is easy to administer and reasonably until complete resolution of lesions, which is assessed at
priced. An injectable form of ivermectin is administered the first 4-week recheck appointment. Patients with deep
orally. The recommended dosage is 300 to 600 µg/kg PO pyoderma require longer treatment until complete resolu-
q24h.2–4 Starting with a low dose (e.g., 50 µg/kg or 25% of tion. Antibacterial shampoos such as benzoyl peroxide and
the target dose2,3) and gradually increasing to the target dose chlorhexidine can be beneficial for treating patients with
is often recommended to identify adverse effects in sensi- secondary pyoderma. Shampooing can be done weekly
tive patients.4 Clients should be advised that the solution or more often, as necessary. If an antibacterial shampoo is
has a bitter taste. Because of potential adverse effects on the used with an amitraz dip, the patient should not be sham-
central nervous system, this therapy should not be used in pooed between dip treatments.
ivermectin-sensitive breeds (i.e., collie, Shetland sheepdog, Reducing stress and providing adequate nutrition can
Australian shepherd, Old English sheepdog, other herding also improve success in managing demodicosis. Feeding
breeds)8 unless an MDR1 (ABCB1) gene test9 (www.vetmed. the dog a complete and balanced diet is important. Fatty-
wsu.edu/depts-vcpl) has been performed to determine the acid supplementation may also have a possible benefit.5
patient’s susceptibility to the toxic effects of ivermectin. Underlying conditions such as endoparasite infections and
Doramectin (Dectomax, Pfizer Animal Health) is a long- concurrent diseases should be treated.
acting avermectin that has been used at a dosage of 600
µg/kg SC once weekly.2,3 This drug should not be used in Monitoring Response to Treatment
ivermectin-sensitive breeds (i.e., collie, Shetland sheepdog, After treatment begins, patients should be checked every
Australian shepherd, Old English sheepdog, other herding 4 to 6 weeks until two consecutive negative skin-scraping
breeds).8 Any dog can be tested for the MDR1 (ABCB1) gene results are obtained. At each visit, a physical examination
mutation. should be performed and skin scrapings taken from the
Although milbemycin oxime (Interceptor, Novartis areas that were scraped initially and from any new lesions.
Animal Health) can be expensive for treating large-breed The results should be recorded and compared with those
from the previous visit. By the first recheck examination,
a
Sheila Torres, DVM, MS, PhD, DACVD. Personal communication,
University of Minnesota, Veterinary Clinical Sciences, St. Paul, MN, very few, if any, Demodex mites in immature stages should
January 2010. be seen. Ideally, the percentage of dead adult mites should

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 Peer Reviewed

be higher than the percentage of live adult mites. This indi-

cates that the owner is being compliant and the therapy is Glossary
working. Treatment should be continued for 4 weeks after Alopecia—absence of hair from skin areas where it
the second negative skin-scraping result.2,3 It is not uncom- is normally presenta
mon for treatment to take 6 to 12 months1 before two Ataxia—failure of muscular coordinationa
consecutive negative skin-scraping results are obtained.
Erythema—redness of the skin produced by
Once treatment is stopped, the patient is considered to be
congestion of the capillariesa
in remission. Rechecks and skin scrapings should be per-
Fusiform—spindle shapeda
formed every 3 to 4 months for the next year. Relapses can
occur within this time frame, so owners need to observe Hyperpigmentation—abnormally increased
their dogs carefully for evidence of disease. One year after pigmentationa
a second negative skin-scraping result and no recurrence of Iatrogenic—any adverse condition resulting from
disease, the patient can finally be declared cured.1–3,10 treatment by a medical professionala
Keratolytic—pertaining to or promoting softening
Prognosis and dissolution of the horny layer of the epidermisa
The reported successful cure rate for juvenile-onset gener- Leishmaniasis—infection caused by Leishmania
alized demodicosis is 70% to 80%.5 Dogs with adult-onset spp, which are parasitic protozoaa
generalized demodicosis have a significantly lower suc- Lichenification—hypertrophy of the epidermis
cess rate, primarily when the underlying disease cannot be resulting in thickening of the skin; exaggeration
cured or well controlled.4 Early diagnosis and therapy may of normal skin markings gives the skin a leathery,
shorten the length of treatment. Treatment can fail, and bark-like appearancea
some patients may need some type of therapy for the rest Pododermatitis (interdigital pyoderma)—an
of their lives. Pododemodicosis is especially difficult to cure inflammatory, multifaceted disease complex
and carries a poor prognosis.10 Additional factors such as affecting a dog’s feetb
estrus, parturition, stress, and poor nutrition can also play Pruritus—itching; an unpleasant cutaneous
a role in treatment failure.2,3 sensation that provokes the desire to rub or scratch
the skin to obtain reliefa
Client Education Trichography—plucking hairs from the skin and
Clients need to be well informed of the challenges, time, examining them with a microscopeb
and expense involved in treating canine demodicosis. It a
Adapted from Dorland’s Medical Dictionary. 28th ed. Philadelphia:
is important that they also have a good understanding of Saunders Elsevier; 1994.
b
Adapted from Scott DW, Miller WH, Griffin CE. Muller & Kirk’s Small
the disease. Patients often appear clinically normal after 1 Animal Dermatology. 6th ed. Philadelphia: WB Saunders; 2001.
to 2 months of therapy, but it is vital that owners do not
stop the treatment because mites may still be present and
a relapse is likely without the full treatment. Clients also cure using currently available treatments may take a long
need to understand that if their dog has been diagnosed time, treating secondary infections or underlying conditions
with adult-onset demodicosis but an underlying condi- can greatly improve the patient’s comfort and prognosis.
tion has not been found, an underlying disease could still
be predisposing the dog to demodicosis. Owners of intact Acknowledgment
dogs with generalized demodicosis should be advised to The author thanks Sheila Torres, DVM, MS, PhD, DACVD,
spay or neuter their dogs (1) because of the hereditary pre- and Sandra Koch, DVM, MS, DACVD, of the University of
disposition to develop the disease and (2) to eliminate the Minnesota College of Veterinary Medicine for their time
stress of estrus, which can exacerbate the disease. and support in reviewing this article.

Conclusion References
Treatment of canine demodicosis can be challenging, and 1. Scott DW, Miller WH, Griffin CE. Parasitic skin disease. Muller
& Kirk’s Small Animal Dermatology. 6th ed. Philadelphia: WB
therapeutic options depend on many factors, including type Saunders; 2001:423-516.
of demodicosis (localized or generalized, juvenile or adult 2. Gortel K. Update on canine demodicosis. Vet Clin North Am
Small Anim Pract 2006;36(1):229-241.
onset), patient history and breed, underlying causes, and 3. Tater KC, Patterson AC. Canine and feline demodicosis. Vet Med
client considerations. Although obtaining a parasitologic 2008:444-461.

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 CE Article #1

4. Mueller RS. Treatment protocols for demodicosis: an evidence- rosatellite analysis. J Vet Pharmacol Ther 2007;30(5):482-485.
based review. Vet Dermatol 2004;15(2):75-89. 9. Washington State University College of Veterinary Medicine
5. Mueller RS, Shipstone M. Parasites and antiparasitic drugs. Proc Veterinary Clinical Pharmacology Laboratory. Accessed January
Fifth World Congr Vet Dermatol 2004:302-305. 2010 at www.vetmed.wsu.edu/depts-vcpl.
6. Saridomichelakis MN, Koutinas AF, Farmaki R, et al. Relative 10. Holm BR. Efficacy of milbemycin oxime in the treatment of
sensitivity of hair pluckings and exudates microscopy for the canine generalized demodicosis: a retrospective study of 99 dogs
diagnosis of canine demodicosis. Vet Dermatol 2007;18(2):138- (1995–2000). Vet Dermatol 2003;14(4):189-195.
141. 11. Barbet JL, Snook T, Gay JM, Mealey KL. ABCB1-1 Delta
7. Fourie LJ, Kok DJ, du Plessis A, Rugg D. Efficacy of a novel (MDR1-1 Delta) genotype is associated with adverse reactions
formulation of metaflumizone plus amitraz for the treatment of in dogs treated with milbemycin oxime for generalized demodi-
demodectic mange in dogs. Vet Parasitol 2007;150(3):268-274. cosis. Vet Dermatol 2008;20:111-114.
Epub Oct 17, 2007. 12. Heine J, Krieger K, Dumont P, Hellmann K. Evaluation of the effi-
8. Geyer J, Klintzsch S, Meerkamp K, et al. Detection of the cacy and safety of imidacloprid 10% plus moxidectin 2.5% spot-
nt230(del4) MDR1 mutation in white Swiss shepherd dogs: case on in the treatment of generalized demodicosis in dogs: results of
reports of doramectin toxicosis, breed predisposition, and mic- a European field study. Parasitol Res 2005;97(suppl):S89-S96.

Article #1 FREE CE Test

The article you have read qualifies for 1.0 credit hour. To receive credit from Alfred State College, choose the best an-
swer to each of the following questions. Take the test online at Vetlearn.com.

1. Puppies usually acquire D. canis 6. The most reliable method of diagnosing canine
a. in utero. demodicosis is
b. from direct contact with their dam shortly after birth. a. superficial skin scraping.
c. from indirect contact with an infected dog. b. deep skin scraping.
d. from contaminated fomites. c. trichography.
d. clinical signs.
2. Which form of canine demodicosis should not be
treated with miticidal therapy? 7. The only FDA-approved treatment for canine demodi-
a. juvenile-onset, generalized demodicosis cosis is
b. juvenile-onset, localized demodicosis a. amitraz. c. milbemycin.
c. adult-onset, generalized demodicosis b. ivermectin. d. doramectin.
d. none of the above
8. Patients should be treated with miticidal therapy
3. A 6-year-old dog is diagnosed with canine demodi- until
cosis, and all of its feet are affected. Which form of a. clinical signs resolve.
the disease does this dog have? b. the first negative skin-scraping result.
a. juvenile-onset, generalized demodicosis c. 1 month after the second negative skin-scraping
b. juvenile-onset, localized demodicosis result.
c. adult-onset, generalized demodicosis d. 1 year after the second negative skin-scraping
d. adult-onset, localized demodicosis result.

4. Which underlying condition could be associated with 9. Patients are considered cured of generalized
adult-onset, generalized demodicosis? demodicosis
a. hyperadrenocorticism a. after clinical signs resolve.
b. hypothyroidism b. after the first negative skin-scraping result.
c. neoplasia c. 1 month after the second negative skin-scraping
d. all of the above result.
d. 1 year after the second negative skin-scraping
5. Which clinical feature(s) can be seen with canine result.
demodicosis?
a. alopecia 10. Which demodicosis case carries the poorest prognosis?
b. hyperpigmentation a. a patient with two areas of alopecia
c. thin haircoat b. a patient with pododemodicosis
d. all of the above c. a patient with facial involvement
d. a patient with pruritus

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