Demodex

Re: Demodex

Rajat — Sat, 27 Oct 2012 19:15:18 GMT

[quote user="patrick murphy"]

what steps would you go through in an effort to identify the immuocompromise in an adult dog, besides the obvious?

[/quote]

Well depends on what you call the obvious!

IMHO - T4 TSH FT4eQD, ACTH stim test+/-LDDST, thoracic and abdominal imaging and bloods+ full urinalysis would not be a bad recipe to look for a reason for immuno-suppression causing adult onset demodicosis.

Re: Demodex

Rajat — Sat, 27 Oct 2012 19:13:14 GMT

[quote user="James Laidlaw"]

Vet Record Sept 15, Page 272.

[/quote]

Thanks James- I know it is marketed as being such, and I will look up that study - in my hands though, Pro-Meris has had by far the best success for Demodex and Sarcoptes (while Aludex was out of stock for the latter). Since then I have used Promeris for treatment for Demodex, and been much happier. I have an adult onset demodex case who takes advocate for lungworm protection but also promeris for demodex- before promeris the demodex were rallying back.

I don't deny advocate is good for prevention in most cases- hardly ever see it in dogs getting advocate monthly.

Re: Demodex

Rob Loxley — Sat, 27 Oct 2012 15:25:28 GMT

[quote user="Iain McAllister"]the problem with amitraz is that it is very technique sensitive[/quote]

Exactly why I now book them in for the nurse to show them how to do it properly the 1st time (though we will for a fee do all subsequent baths). We previously once had a client apply the Aludex neat to the dog and leave it to dry - it was VERY sleepy!

Re: Demodex

Jo Cobbett — Thu, 25 Oct 2012 15:39:29 GMT

multi drug resistance protein, present in the blood brain barrier, and usually transports things like Ivermectin out of the brain. If there is a mutation and a faulty transporter, then ivermectin can accumulate in the brain causing toxicity. MDR mutation is most common in collies

Re: Demodex

patrick murphy — Thu, 25 Oct 2012 15:08:50 GMT

sorry what is amDr-1 when it's at home?

Re: Demodex

patrick murphy — Thu, 25 Oct 2012 15:03:24 GMT

what steps would you go through in an effort to identify the immuocompromise in an adult dog, besides the obvious?

Re: Demodex

David Mills — Thu, 25 Oct 2012 14:33:17 GMT

[quote user="Iain McAllister"]

PS you will find a lot of referral vets use this as they are often referred cases that have been on everything - the problem with amitraz is that it is very technique sensitive - if you don't get the bathing right then it can lead to failures

[/quote]

We find this is the key with a lot of our Staffies that come in hooching with it. How do people get it around the eyes and ears, for instance, without any problems? Many of us here now reach directly for the ivermectin (Panomec LA injectable used orally) at doses as stated - once a day, easy as pie, and high cure rate with these. I do think advocate has a role in preventing recurrence.

An Aussie vet who used to work in Melbourne swears that their demodex problem got so bad that they set up a swimming pool outside, filled it with amitraz, and simply let the owners bring their affected dogs and let them swim in it once a day; very similar to cows in Africa to rid them of ticks, actually.

Re: Demodex

James Laidlaw — Thu, 25 Oct 2012 14:10:15 GMT

Vet Record Sept 15, Page 272.

Re: Demodex

James Laidlaw — Thu, 25 Oct 2012 14:06:16 GMT

[quote user="Rajat"]I don't use Stronghold or Advocate for these cases- not strong enough IMHO[/quote]

I think there was a paper recently saying that Advocate every 4 weeks can be very good at preventing relapses in chronic demodecosis. Will try and find the link/location from my colleague...

Re: Demodex

Iain McAllister — Thu, 25 Oct 2012 12:53:34 GMT

Screen for MDR-1 mutation - if negative...

go oral ivermectin 1ml per 17kg PO for 6 months - first 2 weeks at half dose to check for side effects or you can even go 1/4 1/2 3/4 if you are cautious

Cephalexin for 6 weeks maybe more

Weekly baths with paxcutol

Skin scrape every 2 weeks for 2 months then monthly

This is a cost effective treatment with a very good chance of success that will mean minimal stress to pet, owner and vet without the need for coat clipping and exposure to harardous substances

Very strong chance of a cure vs Amitraz, Advocate and the rest - and Amitraz is hugely unpleasant to use - brings on your asthma doesn't it?. You have already tried licensed products without the desired the result so go for ivermectin - once you try it you won't look back!

http://www.melbvet.com.au/files/GKHJNBO0HJ/Demodicosis.pdf

Re: Demodex

Bob Russell — Thu, 25 Oct 2012 11:34:21 GMT

The numbers of cases of Pemphigus seen in the States seemed unconvincingly low in the article I read and the only Pemphigus cat we have has never been treated with it despite Promeris being our main flea product!

I have had good results with Promeris Duo for demodex but never had a success with Advocate.

Re: Demodex

Mark Holmes — Thu, 25 Oct 2012 11:23:28 GMT

Aludex was unavailable for a long time which is why many people had started to investigate alternatives. I have founds daily oral ivermectin effective. One dog showed neurological side effects which rapidly resolved on cessation. I have good success with weekly advocate which is on one study effective 85% of the time (cf 95% oral ivermec) Although I have always found aludex the best. Interestingly I have always dispensed it rather than done it at the clinic on the basis that the owner is likely to have far less lifetime exposure than the nurses. I don't see that to be a problem as long as they have poper instructions and are directed to read the enclosed leaflet.

Re: Demodex

Malcolm Ness — Thu, 25 Oct 2012 10:40:52 GMT

[quote user="Martin Atkinson"]Have you considered the health and safety implications of this?[/quote]

My good lady, the dermatologist, unsurprisingly has a number of these challenging Demodex cases on the go at any one time. Our nurses do the bathing and are suitably protected and gloved while working in a room that is purposely very well (actively) ventilated for just the reasons Martin suggests.

From memory, many of the cases are on longish term antibiotics and other treatments and all are shampooed prior to the Amitraz bath and all are monitored with skin scrapes and Live:Dead mite counts at each treatment. Almost all of these cases are referrals or second opinions that have already been treated elsewhere with single agent (Amitraz or Promeris) therapy. Again, from imperfect memory (bear in mind that I am a surgeon - skin is for cutting not treating) I believe that there have been some very unpleasant adverse reactions reported with Promeris - ?? induced Pemphigus folieacius (?? spelling).

My understanding is that most Demodex cases - esp the localised, juvenile cases - almost get better themselves (provided the urge to give a shot of 'steroid is resisted) but some others need aggressive, careful, targeted and long term treatment.

Re: Demodex

Martin Atkinson — Thu, 25 Oct 2012 10:07:02 GMT

[quote user="Richard Larkin"]Aludex works wonders, our nurses do weekly baths for 4 weeks then rescrape having sent the Owners off to Asda's cafe round the corner for an hour. [/quote] Have you considered the health and safety implications of this? Amitraz can have severe effects on the neurological system (even the smell of it gives me a headache) and is potentially carcinogenic and exposure even in small amounts from repeat contact is inevitable unless your nurses are wearing biological warfare suits. Are they aware of this risk? We have a policy of virtually zero application of topical parasiticides, I certainly wouldn't ask my staff to do it without their full informed consent. What is considered safe now may be viewed differently in the future: cf organophosphates - once considered safe now banned,

Re: Demodex

Rajat — Thu, 25 Oct 2012 10:03:13 GMT

Thomas, I too find Amitraz either shampoo or topically the best option.

I don't use Stronghold or Advocate for these cases- not strong enough IMHO

Anything upto a year I suppose could be juvenile then its adult onse (but I could be very wrong on that just from memory..) may be worth checking Tt4 and acth stim for cushings if a longterm problem or relapses..they can be frustrating. Oral ivermectin does work well too in some of these cases though obv off license and to be tried after all else fails...

Re: Demodex

peewit — Thu, 25 Oct 2012 09:25:44 GMT

We've been using promeris duo with great success in demodex and sarcoptes cases. Applied every 2 weeks for a whole box (ie 3 doses) seems to clear even the most mangy staffy! Safer than aludex from a H&S perspective too

Re: Demodex

Richard Larkin — Thu, 25 Oct 2012 07:53:28 GMT

[quote user="Evelyn Barbour-Hill"]

I'm not suggesting it will solve all your problems, but I think Aludex is the bee's knees.

[/quote]

Totally agree, I work in a charity hospital where the young demodex ridden Staffie is almost a daily visitor. Aludex works wonders, our nurses do weekly baths for 4 weeks then rescrape having sent the Owners off to Asda's cafe round the corner for an hour. The vast majority are clear on the rescrape.

Older dogs with demodecosis are normally immunocompromised and therefore treatment should be aimed at identyfying / treating this but even if no Dx found I find we generally clear the mange with 4 baths or have the situation where all you find are a few dead ones. However does tend to return in near future. I have used other products such as milbemycin and promeris (topical amitraz) without as much success.

Recently had a dog with assummed chronic sarcoptic mange (-ve on scrapes, inconclusive on serology) but generalised severe symptoms which has responded much better to amitraz than stronghold. by the way does anyone use sarcoptes serology much and how to you interpret 'inconclusive' results. Only used in this case as very clinically suspicous but repeated -ve scrapes.

Re: Demodex

ilanit — Thu, 25 Oct 2012 05:43:10 GMT

I agree with above. I really think Amitraz is most effective.

I would think prognosis in your JRT should be much more favourable since it's probably 'just' juvenile demodicosis which usually reponds to treatment quite well in my experience. The Bulldog is a different story. As you are saying probably has other underlying problems. We are having a similar case with a bulldog at our practice. Also demodex, pyodermitis, malassezia on and off. Probably also atopic! Very frustrating

Re: Demodex

Evelyn Barbour-Hill — Thu, 25 Oct 2012 01:56:54 GMT

I'm not suggesting it will solve all your problems, but I think Aludex is the bee's knees.

Re: Demodex

Michael Woodhouse — Thu, 25 Oct 2012 00:01:25 GMT

I'm not much of a pet vet, but there's always something else wrong. Sort that and dealing with the demodex is much easier.

(I do prefer Aludex as Tx)