What can I use for malassezia when malaseb not doing anything?

Re: What can I use for malassezia when malaseb not doing anything?

patrick murphy — Sat, 14 Jul 2012 15:53:58 GMT

I very nearly did not post this but I stock Advocate only, and it works for me. sorry. and I do lots and losts of ears and skins.

Re: What can I use for malassezia when malaseb not doing anything?

Julie Innes — Sat, 14 Jul 2012 08:55:29 GMT

At least not this one- its not been on steroids! (It got them from it's previous vet, and they had no effect, but that was almost a year ago)

I've spoken to the owner, and they are going to consider referral. But I think they are considering euthanasia as the alternative. I'll let you know how it goes

Re: What can I use for malassezia when malaseb not doing anything?

Mark Frost — Fri, 13 Jul 2012 21:53:30 GMT

[quote user="Martin Atkinson"]

Back on my soap box: how many 'horrendous atopic dogs exacerbated by demodectic mange' are demodectic mange cases exacerbated by inappropriate use of corticosteroids for mis-managed or mis-diagnosed atopy?

[/quote]

I agree, although I suspect most are atopic dogs with secondary demodectic mange exacerbated by continued (mis)use of steroids without ongoing monitoring for additional pathology, rather than demodectic mange cases just given steroid with no underlying atopy. A reasonable number of atopic dogs end up on steroids for whatever reason (cost/effectiveness etc..) and as a new grad with the case mentioned above I certainly learnt my lesson in making sure these dogs are continually assessed as far as possible for secondary complications causing flare ups.

Re: What can I use for malassezia when malaseb not doing anything?

Mark Hedberg — Fri, 13 Jul 2012 21:42:46 GMT

[quote user="Martin Atkinson"]

[quote user="Mark Frost"]I too have been caught out with a horrendous atopic whwt that subsequently was exacerbated by demodectic mange. [/quote] Back on my soap box: how many 'horrendous atopic dogs exacerbated by demodectic mange' are demodectic mange cases exacerbated by inappropriate use of corticosteroids for mis-managed or mis-diagnosed atopy?

[/quote]Probably a good few out there...

Re: What can I use for malassezia when malaseb not doing anything?

Martin Atkinson — Fri, 13 Jul 2012 19:13:56 GMT

Re: What can I use for malassezia when malaseb not doing anything?

Mark Frost — Thu, 12 Jul 2012 16:42:26 GMT

I too have been caught out with a horrendous atopic whwt that subsequently was exacerbated by demodectic mange. In the end (following referral) he was treated with panomec PO (100mcg/kg day 1, increasing dose by 100mcg/kg per day until at 600mcg/kg on day 6 withdrawing if any neuro signs and continuing daily at 600mcg/kg until clinical resolution and 2 consecutive neg skin scrapes a month apart if possible). I have used this protocol with success subsequently but only after detailed discussion with the client re: potential problems!

More recently we currently have a whwt with malassezia that wont shift on sporanox (itraconazole) from a referral dermatologist.

For more localised malassezia problems, i.e feet or lip fold, I find the malacetic otic (now aural) or the malacetic wipes very effective.

Re: What can I use for malassezia when malaseb not doing anything?

Bob Russell — Thu, 12 Jul 2012 10:01:23 GMT

[quote user="Julian Earl"]

Another vote for demodex. It can cause a very severe, persistent and stubborn disease when you think you're treating something else!

I didn't know about the Milbemax thing and demodex - you learn something every day. But sorry to disappoint Bob, but we have had a ready supplyof the plain Milbemax - maybe Novartis look kindly on us?

[/quote]

We are clearly another practice that Novartis looks kindly on! We have never run out of Milbemax tasty but have been down to the last couple of tablets before the next batch come through.

Re: What can I use for malassezia when malaseb not doing anything?

Stephen Courtney — Wed, 11 Jul 2012 22:21:25 GMT

when you think what endless antibiotics, malaseb, atopica, visits back and forth cost, then referral is not really that expensive.

what i find hard is realising when to refer - ideally before spending too much of the clients cash reserves. it can take a while to realise how bad things really are.

a liitle tip - for some animals using malaseb every other day can make all the difference - and another little tip - sell the owners a bottle of neutrale shampoo as well. tell them to do the first lather and rinse with that - it is basically the same shampoo base as malaseb but has no meds in it, and is much cheaper. On the second lathering, using malaseb, you get a fantastic foaming, and overall reduce the volume of malaseb used by half or more.

Re: What can I use for malassezia when malaseb not doing anything?

Busybee — Wed, 11 Jul 2012 21:01:38 GMT

It was my boss' idea but I can't find the paper he got the idea from! But yes, it certainly worked very well in this case and was a lot cheaper!

Re: What can I use for malassezia when malaseb not doing anything?

Rajat — Wed, 11 Jul 2012 20:42:02 GMT

[quote user="Busybee"]

[quote user="Martin Atkinson"]How about using a systemic antifungal like itraconazole or nystatin[/quote]

We had an atopic dog that was on Atopica but kept getting flare ups, diagnosed as caused by malassezia overgrowth. The client was also getting twitchy about the cost of the Atopica. It was successfully treated in the end by introducing ketoconazole (Nizoral) tablets, so much so, that we could halve the required Atopica dose!

[/quote]

Ketoconazole has an effect of prolonging Ciclosporin's life (by inhibiting its metabolism) so I wonder if this was what helped to reduce/halve the atopica dose alongside treating the yeast infections...

Re: What can I use for malassezia when malaseb not doing anything?

Busybee — Wed, 11 Jul 2012 20:37:28 GMT

[quote user="Martin Atkinson"]How about using a systemic antifungal like itraconazole or nystatin[/quote]

Re: What can I use for malassezia when malaseb not doing anything?

Jo Cobbett — Wed, 11 Jul 2012 17:03:11 GMT

I heard something on a CPD session recently about Milbemax and Demodex, they used cat milbemax as it has a lower praziquantel:milbemycin ratio. I think it was a boxer, it needed a lot of cat milbemax tablets! Can't remember the milbemycin dose they used, I can look it up if you want, but I'm sure someone will beat me to it!

Re: What can I use for malassezia when malaseb not doing anything?

Julian Earl — Wed, 11 Jul 2012 16:44:48 GMT

Another vote for demodex. It can cause a very severe, persistent and stubborn disease when you think you're treating something else!

Re: What can I use for malassezia when malaseb not doing anything?

Rajat — Wed, 11 Jul 2012 16:25:26 GMT

[quote user="Jo Jones"]

Going a bit off topic, sorry, but if people don't trust advocate for mites etc, do you think it is effective against lungworm? And if not, what do people recommend for prevention?

[/quote]

IMHO Advocate is pretty good for prevention against lungworm..I don't like in demodex cases, second Bob's vote for Promeris Duo every 2-3 weeks! My chronic adult onset demodex case is on it (long term- monthly - alternating with Advocate for lungworm prevention!)

I have also used promeris duo for sarcoptes and it has worked a treat!

Re: What can I use for malassezia when malaseb not doing anything?

Bob Russell — Wed, 11 Jul 2012 15:57:03 GMT

[quote user="Martin Atkinson"]

[quote user="Bob Russell"]

No idea if it works. Milbemax has a treatment licence but not prevention. I understand this is a 'watch this space' issue!

All academic if Novartis cannot sort the Milbemax supply problems out!

[/quote] Its only Milbemax Tasty that's a problem isn't it? I hadn't though about Milbemax as a be practical preventive anyway although it 's licenced for prevention of lungworm so maybe its an option, but Advocate seems to work as prophylactically just not much cop for treating clinical cases of Demodex.

(apparently ACP is back!!) So is LA Immobilon.

[/quote]

No - all Milbemax apparently. We have some of the so called classic tablets but apparently even these are not available reliably.

Re: What can I use for malassezia when malaseb not doing anything?

Martin Atkinson — Wed, 11 Jul 2012 15:52:58 GMT

[quote user="Bob Russell"]

No idea if it works. Milbemax has a treatment licence but not prevention. I understand this is a 'watch this space' issue!

All academic if Novartis cannot sort the Milbemax supply problems out!

(apparently ACP is back!!) So is LA Immobilon.

Re: What can I use for malassezia when malaseb not doing anything?

Bob Russell — Wed, 11 Jul 2012 14:21:55 GMT

[quote user="Jo Jones"]

Going a bit off topic, sorry, but if people don't trust advocate for mites etc, do you think it is effective against lungworm? And if not, what do people recommend for prevention?

[/quote]

No idea if it works. Milbemax has a treatment licence but not prevention. I understand this is a 'watch this space' issue!

All academic if Novartis cannot sort the Milbemax supply problems out!

(apparently ACP is back!!)

Re: What can I use for malassezia when malaseb not doing anything?

Julie Innes — Wed, 11 Jul 2012 13:47:20 GMT

Ah- thanks for that Martin, good to know! I always learn something useful when I come on here!

Re: What can I use for malassezia when malaseb not doing anything?

Martin Atkinson — Wed, 11 Jul 2012 13:45:37 GMT

[quote user="Julie Innes"]I take it then you are talking about a different formulation fom the milbemax tablets we have in stock for worming? I did wonder..[/quote] Milbemax is fine but Interceptor is milbemycin on its own as a heartworm medication, it is cheaper and still made by Novartis but you will need an import licence.

Re: What can I use for malassezia when malaseb not doing anything?

Julie Innes — Wed, 11 Jul 2012 13:35:26 GMT

[quote user="Bob Russell"]

If you are going to try milbemax (if you can get it!) check with Novartis. It is the milbemycin part that treats demodex. Some nice cuddly dermatologist (or even one that is nice but not cuddly) may be able to supply some as it needs a special import licence from France!

I have been let down by Advocate so many times in the past that we don't stock it.

[/quote]

I take it then you are talking about a different formulation fom the milbemax tablets we have in stock for worming? I did wonder..

Re: What can I use for malassezia when malaseb not doing anything?

Jo Cobbett — Wed, 11 Jul 2012 13:28:33 GMT

Going a bit off topic, sorry, but if people don't trust advocate for mites etc, do you think it is effective against lungworm? And if not, what do people recommend for prevention?

Re: What can I use for malassezia when malaseb not doing anything?

Bob Russell — Wed, 11 Jul 2012 13:18:54 GMT

I have been let down by Advocate so many times in the past that we don't stock it.

Re: What can I use for malassezia when malaseb not doing anything?

Julie Innes — Wed, 11 Jul 2012 13:07:16 GMT

Thanks all! I've spoken to a dermatologist, and I think I'm going to try to persuade the client towards referral.

Interesting to hear people's lack of faith in advocate- I've never really had to use it in a case of definite demodex, so good to know for future reference! Also had never heard of using milbemax to treat demodex- I will bear that in mind too!

suspect there could well be bacterial overgrowth too, so if owner not keen on referral I'll definitely do a swab. Dog is off everything at the moment!

I hate these cases! She was doing so well as well, and is actually a really sweet wee westie, but horribly uncomfortable

Re: What can I use for malassezia when malaseb not doing anything?

Michael Woodhouse — Wed, 11 Jul 2012 12:07:38 GMT

Could we come off the antibiotics for a week and do a swab? Could be MRSA infection. None of the household work in healthcare?

NorClear is a vet ketoconazole shampoo if you want a different product and active to the miconazole in the malaseb.

Sometimes the best thing to do in these cases is stop treatment (as much as you can) and start from scratch.

(or refer if there is money)

Re: What can I use for malassezia when malaseb not doing anything?

Bob Russell — Wed, 11 Jul 2012 11:20:29 GMT

I am anything but a fan of Advocate. It seemed unable to deal with ear mites let alone sarcoptes or demodex.

Amitraz baths or even Promeris Duo worth a go!