Demodex case - options?

Re: Demodex case - options?

Thomas Johnson — Wed, 25 Feb 2015 10:07:23 GMT

[quote user="Anthony Dennison"]

(though I suppose they do have a disintegrating arse, so I can't blame them)

[/quote]

I think I'll have to remember that description if I have an owner who's not taking the condition seriously! I think I've seen 2 in the past 4 years, the most recent one was a lovely GSD (yes, there is such a thing), and thankfully was quite mild and we were able to manage it with prednisolone.

Re: Demodex case - options?

Martin Atkinson — Wed, 25 Feb 2015 09:35:13 GMT

[quote user="Anthony Dennison"]Frustratingly it's always clients that don't have any insurance and cannot afford proper treatment or investigations, and the dogs are usually aggressive and impossible to handle or examine[/quote]That sounds pretty universal for any complicated/expensive-to-treat problem in my experience.

Re: Demodex case - options?

Anthony Dennison — Wed, 25 Feb 2015 09:22:26 GMT

[quote user="Kate Richardson"]

Thta's interesting- I don't see anal furunculosis either. Bred out? Last dog was my parents in law GSD who \I put to sleep last year (not for that, it was well controlled with cyclosporine (or ciclosporin if you prefer)

[/quote]

Must be location, I've seen 3 or 4 cases in the past 18 months. I know it's not particularly common, but it is there. Frustratingly it's always clients that don't have any insurance and cannot afford proper treatment or investigations, and the dogs are usually aggressive and impossible to handle or examine (though I suppose they do have a disintegrating arse, so I can't blame them)

Re: Demodex case - options?

Lindsey Edwards — Tue, 24 Feb 2015 20:19:53 GMT

+1 for brave to, good anecdotal reports and excellent compliance for extensive treatment time-give once for 90 day action!

Re: Demodex case - options?

Anthony Todd — Tue, 24 Feb 2015 19:34:17 GMT

Plot disease incidence against the Crufts winner and watch all those "desirable " conformation attributes leading to a massive increase in diseases linked to said desirable disease attributes!

Think of the tail set of Alsatians and the incidence of anal furunculosis, or mad cockers linked to the Crufts winner....

Re: Demodex case - options?

Kate Richardson — Tue, 24 Feb 2015 19:05:02 GMT

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 19:01:10 GMT

[quote user="Charlotte Marshall"]

Funny, I've used atopica several times for anal furunculosis and it's always worked really well. Better than any other treatment option I've tried in previous cases.

[/quote]I have no doubt this dog had multiple autoimmune issues going on but cost precluded further investigation or treatment and it was PTS. Its a bit like GDV's and limb fractures in dog RTAs, I just don't see anal farunculosis anymore. I hope that is not tempting fate. Nonetheless as said I've not found the need to use cyclosporin anyway.

Re: Demodex case - options?

Robin Grimmer — Tue, 24 Feb 2015 18:11:37 GMT

link for the free Demodex webinar - 24 hours and it's gone:

Re: Demodex case - options?

Charlotte Marshall — Tue, 24 Feb 2015 15:40:49 GMT

Funny, I've used atopica several times for anal furunculosis and it's always worked really well. Better than any other treatment option I've tried in previous cases.

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 14:08:23 GMT

[quote user="Clive Ansell"]As an aside, it is strange that although many are against corticosteroid steroid use, the use of Cyclosporin, also a powerful immunosuppressant, and often in cases without a definitive diagnosis, seems to be becoming almost as indiscriminate.[/quote]Not here it isn't, the one and only dog I gave cyclosporin to for anal farunculosis developed a fulminating deep pyoderma. I've not had a single case of dermatitis/atopy that has not responded to much less expensive/toxic therapies which, I may add for the sake of argument (literally probably), might include low doses of corticosteroids.

As for Apoquel - now we're talking, however that is unlikely to become used indiscriminately even when it is readily available due to its cost.

Re: Demodex case - options?

Clive Ansell — Tue, 24 Feb 2015 13:53:09 GMT

Has anyone used the new product Bravecto in attempting to treat Demodectic mange? I haven't, but at a recent CPD it was suggested by the rep that it may be effective and may well be trialled in the future: apparently the active ingredient Fluralaner is a novel molecule and has a dual mode of action on arthropod neurones, so in theory at least may kill Demodex ?

As an aside, it is strange that although many are against corticosteroid steroid use, the use of Cyclosporin, also a powerful immunosuppressant, and often in cases without a definitive diagnosis, seems to be becoming almost as indiscriminate.

Re: Demodex case - options?

Anthony Todd — Tue, 24 Feb 2015 11:17:12 GMT

[quote user="Martin Atkinson"]she''ll be giving boiled water to polydypsic dogs,[/quote]

Nah, nobody these days will do that; far too cheap, obvious,quick and eliminating, when there are so many "scientific" involved, expensive, diagnostic, procrastinatory and door- opening tests available.

Re: Demodex case - options?

Kate Richardson — Tue, 24 Feb 2015 10:53:33 GMT

LOL!!!

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 10:40:24 GMT

I've said all I'm going to, I'm not going to re-enter the steroid debate for Arlo's or anyone else's sake. I was just worried the drip feeding of your posts had indoctrinated Kate and next she''ll be giving boiled water to polydypsic dogs, wearing a burka and quoting the Koran.

Re: Demodex case - options?

Anthony Todd — Tue, 24 Feb 2015 10:19:14 GMT

[quote user="Martin Atkinson"][quote user="Kate Richardson"]Why not try a very low dose of pred?[/quote]Eek Kate you'v been reading too many of Anthony's posts!![/quote]

For the umpteenth time, and at risk of sanctions from Arlo, to say nothing of the abuse and denigration from about half of the great unwashed veterinary population*

I never, ever, ever, even suggest "a "low dose " of any steroid.

It is ineffective, creates side effects if given long enough and diminishes my reputation even further.

All of the negativity regarding steroids is when the dosage is prolonged and continuous, massive doses are used in humans as a single bolus.

A high dose as necessary [by current standards] or an adequate dose [by my standards, of trial and titration] is the only regime I have ever advised.

* reference from the Daily Mail available

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 10:02:20 GMT

[quote user="Kate Richardson"]Presumably your cases weren't being treated for demodex at the same time though and just assumed to be pred deficient and if it wasn't working. just give 'em more?[/quote]That's about right!

Re: Demodex case - options?

Kate Richardson — Tue, 24 Feb 2015 09:54:16 GMT

[quote user="Martin Atkinson"]

[quote user="Kate Richardson"]I just thought as it's a charity case and funds are likely limited, then I would take that risk for the sake of making the dog more comfortable.[/quote]Having seen a couple of dogs with generalised demodex and an iatrogenic Cushings case following ever-increasing doses of steroids given by a local dinovet who couldn't even be arsed to do a skin scrape, I wouldn't.

[/quote]

Low doses might be different story though? Presumably your cases weren't being treated for demodex at the same time though and just assumed to be pred deficient and if it wasn't working. just give 'em more?

Re: Demodex case - options?

Anthony Dennison — Tue, 24 Feb 2015 09:51:26 GMT

[quote user="tess"]

I spoke to our local dermatologist recently about a case which was still scraping positive after a couple of months. He said it wasn't unusual to need ivermectin in excess of 6 months and he had one case which took 10 months. Dont have any advice about the pruritis though other than very low dose pred, and keep on the antibiotics. ?Hibiscrub foot bath??

[/quote]

We have dogs at some of our branches that have been on ivermectin for over 18 months

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 09:47:27 GMT

Re: Demodex case - options?

Kate Richardson — Tue, 24 Feb 2015 09:24:25 GMT

[quote user="Martin Atkinson"][quote user="Kate Richardson"]Why not try a very low dose of pred?[/quote]Eek Kate you'v been reading too many of Anthony's posts!! [/quote]

Ha ha! I just thought as it's a charity case and funds are likely limited, then I would take that risk for the sake of making the dog more comfortable.

Re: Demodex case - options?

Martin Atkinson — Tue, 24 Feb 2015 09:08:33 GMT

[quote user="Kate Richardson"]Why not try a very low dose of pred?[/quote]Eek Kate you'v been reading too many of Anthony's posts!! If atopy is really suspected on top of the Demodex I would be shoving Malaseb washes, EFA supplements and anti-histamines at it. And as most cases of refractory demodex I've seen have had underlying medical problems I would do a full biochemical and haematological work-up before I hit the 'roids.

Re: Demodex case - options?

Robin Grimmer — Tue, 24 Feb 2015 07:29:58 GMT

Wouldn't this count as adult onset demodeciosis and therefore the prognosis much poorer? There was a recent excellent free webinar on demodeciosis from the Webinar vet, but it's only available for less than a week. Milbemycin is the treatment of choice, but very expensive so oral ivermectin probably your best bet.

Re: Demodex case - options?

David Mills — Tue, 24 Feb 2015 00:03:33 GMT

[quote user="Kate Richardson"]Being a Staffie he has probably had it since he was younger and was never treated properly if at all (big assumption there from me, but he is in a rehoming centre)[/quote]

I suspect this is right. We see a lot of these. The chances of a cure of junior generalised demodecosis in our experience are slim. Given this dog's chances of rehoming (none - unless one of the kennel staff take him/her) he would normally have been PTS by now.

[quote user="John Flynn"]Atopy is uncommon in Staffie's?[/quote]

It may just be that we see more Staffies than most but the whole rainbow of allergic skin disease is quite common in our population. Demodex very common in youngsters, normally localised.

To the OP, maximise the dose of ivermec towards the higher end of the dose range. Consider injecting s/c daily if oral compliance is questionable.

Re: Demodex case - options?

tess — Mon, 23 Feb 2015 23:36:50 GMT

Re: Demodex case - options?

John Flynn — Mon, 23 Feb 2015 22:48:24 GMT

Probably not very helpful, but worth double-checking the ivermectin dose with staff and that being adminstered correctly (if it is, then I reckon another few weeks and numbers of demodex will be waning); also checking cytology for level of concurrnet bacterial/yeast infection needing cleared.

Daily baths would be my preference to anything immunosuppressive in presence of deep pyoderma and generalised demodicosis, though I know some folks use a low-dose of pred successfully so I wouldn't be totally against this.

Atopy is uncommon in Staffie's?

Not sure thyroid testing going to be totally easy to interpretin patient with severe secondary infection like this, so I'd leave for now.

I know it's obvious, but at a rehoming centre I'd be bit concerned about ongoing flea bites also... would certainly be using a "fast-kill" product if possible as flea bites never help...