about demodecosis

Re: about demodecosis

Jenny Smith — Mon, 10 May 2010 17:54:43 GMT

Was this to me?!

[quote user="Rob Smith"]

Just curious...you said you used Malaseb because of "concurrent pyoderma". This is an interesting way of managing pyoderma. Apart from anything, it is off license - was the owner informed of this? Malseb is licensed for "seborrhoeic dermatitis associated with Malassezia pachydermatis and Staphylococus intermedius" in dogs. Surely this is a breach of the cascade as there are products licensed for treating bacterial infection of the skin....

[/quote]

I was just recalling the case I'd seen, I must have managed to get myself confused. Still learning, so it happens from time to time! Looking back at my notes, some malassezia were noted on the tape strips taken, so this could be the reasoning behind using the malaseb as a treatment option, I think I've managed to merge two different itchy dog cases into one in my head - sorry for the confusion.

Jenny

Re: about demodecosis

Rachel Blackmore — Sat, 08 May 2010 05:35:17 GMT

I am in Australia, have recently seen a lot of generalised juvenile demodecosis. We use doramecton (dectomax) subcutaneously once a week for 6-8weeks, ( base length on response and scrapes)

Most have a great response after first or second injection. All have resolved really well, most only taking 6weeks.

Re: about demodecosis

Charlotte Marshall — Thu, 06 May 2010 21:41:24 GMT

I have used oral ivermectin but only in non responsive generalised cases. I used the injectable panomec and gradually increased the dose up to required level over several days. I found the protocol in a dermatology book at some point. However it is my last resort treatment and I haven't used it for a while.

Re: about demodecosis

Rob Smith — Thu, 06 May 2010 19:19:18 GMT

Re: about demodecosis

Sean Dunne — Thu, 06 May 2010 16:19:31 GMT

I've had daily Milbemax work brillantly well in some very seriously affected old dogs. I've used it when aludex doesn't seem to be working after 4 weekly washes or if the owners are asthmatic. The first few times I used it i took advice form Liverpool Uni , Novartis and the VMD . No one was entirely clear on the praziquantal issue. The VMD couldn't give me a yes or no on importing Interceptor so I stuck with Milbemax trusting the Uni's advice. I have not had a problem yet.

Bayer reps have told me they wish demodicosis wasn't on the advocate box. It doesn't work except in puppies who get better anyway.

In Ireland we used to use oral ivomec pretty much as first line but that was 10 years ago. I would suspect a cascade type setup exsists now.

Re: about demodecosis

Aurelijus vet — Thu, 06 May 2010 11:54:46 GMT

What is the treatment protocol with panomec

Re: about demodecosis

Arlo Guthrie — Thu, 06 May 2010 07:42:45 GMT

[quote user="anthony chadwick"]do you see both of the posts I have done just getting into the site[/quote]

Hi Anthony, yes. If you post more than once to the same thread, I find it can take a couple of seconds for the most recent post to display. Not sure why.

Re: about demodecosis

anthony chadwick — Thu, 06 May 2010 07:13:19 GMT

panomec is the one I use

do you see both of the posts I have done just getting into the site

Re: about demodecosis

anthony chadwick — Thu, 06 May 2010 07:12:04 GMT

stronghold does not work selamectin not active against demodex panomec orally is best treatment but obviously off licence

Re: about demodecosis

Vikki Halliday LLB — Thu, 06 May 2010 04:53:18 GMT

[quote user="anthony chadwick"]ivomec can be given orally at 1ml per 17 kg[/quote]

Anthony, which oral ivomec preparation are you using?

[quote user="robloxley"]

Does anyone still believe Advocate works??

[/quote]

I have found Advocate to work well for Sarcoptic mange, but not for demodex.

Re: about demodecosis

anthony chadwick — Thu, 06 May 2010 00:10:32 GMT

Thanks Rob, it is the skin vet.co.uk

milbemycin is very good because there doesn't seem to be the problem with sensitivity in collies. However, it is not available on its own in UK and I would be reluctant to daily dose with praziquantal.

Ralph Mueller presented at the last world derm conference in HK and felt it was a useful product but it really doesn't eradicate numbers. When used sensibly the sheep ivomec panomec works very well but avoid anything looking like a collie and do your ivomec sensitivity blood test

Re: about demodecosis

Rob Loxley — Wed, 05 May 2010 23:51:10 GMT

[quote user="anthony chadwick"]If you register for my newsletters at www.theskinvet.com[/quote]

Assume you mean www.theskinvet.co.uk

Re: about demodecosis

anthony chadwick — Wed, 05 May 2010 23:43:27 GMT

For recalcitrant cases ivomec can be given orally at 1ml per 17 kg. I would advise first sending a blood to Idexx to check for a mutation making the dog more sensitive to ivomec ( the MDF1 gene , I think) This is done in Germany and takes about 2 weeks.

Obviously this is off label and informed consent is required. It is usually well tolerated but I usually give for 3 months often with the first month on antibiotics also.

I only treat generalised cases. Localised do not require treatment. Advocate tends to lower demodex numbers without eradicating them. If you register for my newsletters at www.theskinvet.com I will send you a newsletter all about demodex. If anyone else would find that useful please feel free to register

Re: about demodecosis

Robert Wilson — Wed, 05 May 2010 23:41:41 GMT

I haven't found Advocate works at all and still use Aludex as mainstay of treatment.

Have worked in practices where they did inject Ivomec (without any apparent problems) but I always thought I was told that Demodex are not killed by ivermectin very well. Has anyone tried Stronghold?

Re: about demodecosis

Rob Loxley — Wed, 05 May 2010 23:32:07 GMT

Does anyone still believe Advocate works??

Aludex; frontline spray in very young puppies; haven't tried promeris; have previously used off-label oral ivermectin daily (in an OESD after MDR1 testing). Moxidectin orallly is another option, or importing milbemycin under an STA. I remember a dermatologist saying daily milbemycin would be treatment of choice if it was easily available - any comments?

Adult onset then I'd be searching hard for underlying problems.

Re: about demodecosis

Laurence Webb — Wed, 05 May 2010 20:48:48 GMT

I've found Advocate ineffective and I don't like Aludex washes much (risks to operator and irritant reactions in patient) but I've found Promeris works well. If that fails I'd use Aludex washes before resorting to oral ivermectin after trialling it at a low dose first. I've not tried milbemyxine daily but I suspect it's horrendously expensive as well as concerns about praziquantel overdose/justifying and STA

The only time I've used Advocate recently for demodex has been in puppies that have been too small to used Promeris or Aludex, but often that's just something do do for a couple of weeks before they get big enough to use an amitraz product.

Re: about demodecosis

Jenny Smith — Wed, 05 May 2010 18:54:56 GMT

I've just seen a case of demodecosis (today!) whilst on my derm rotation. College's treatment protocol is once weekly aludex baths for 4 treatments, and then recheck the dog. Have advised the client to wash the dog with malaseb (concurrent pyoderma) just before applying the aludex, and to not wash the dog or allow swimming between the aludex rinses so it is able to remain in the fur. This was a bulldog, so hair not too long (or too much of it for that matter) but there was talk of clipping up longer haired dogs to give better access for the aludex.

Apparently oral milbemycin oxime can be used as a treatment if aludex is not working. Liverpool uni are using milbemax daily (although there are some worries from my lecturers about the concurrent praziquantel overdose) but milbemycin oxime can be imported as a sole formulation tablet.

Jenny

Re: about demodecosis

Aurelijus vet — Wed, 05 May 2010 14:42:03 GMT

I agree, Advocate/Malaseb/Aludex(Amitrase) is a good choice for demodecosis treatment.I have now started to use immune therapy.I have 5 years old ,not spayed german shepard male.Diagnosis;demodecosis,Malassezia canis and pioderma.I use the assignment Cycloferon (Meglumyn acridonacetat)(not aproved for animals) 75 mg. sid one wk.Cycloferon promotes the release of interferon.This treatment introduced russian vets.Be viewed or this treatment successful.

Re: about demodecosis

Clive Ansell — Wed, 05 May 2010 11:03:29 GMT

I agree with all the other posts, Aludex is the treatment of choice. Weekly baths and skin scrapes, with 3 more baths after negative scrapes. I find Advocate doesn't work.

I got caught out 3 or 4 years ago. A young pruritic SBT that had been to several practices and had seen many vets within the same practice, had been dispensed the standard package of Advocate/Malaseb/ab's/preds with only little improvement. The clients declined any investigation, and seeing it had had Advocate for so long I subconsciously ruled out demodex. many weeks later a colleague did a free of charge skin scrape and guess what - found demodex.

Re: about demodecosis

Vikki Halliday LLB — Wed, 05 May 2010 10:21:04 GMT

I've tried Advocate and have not been happy with the treatment, and I always tend to reach for Aludex as a first line,

Interestingly I had a similar case of periocular demodicosis in a young cocker spaniel, which a colleague had been treating with Advocate, but which did not clear up until we had her in for sedation and localised (and very careful) periocular treatment with Aludex.

Interestingly some dogs who are prone to Demodex seem to respond well to monthly Advocate but only once you have the majority of the infestation under control with Aludex. The Advocate seems to keep a lid on it until something else causes a flare up, but I've never managed to completely clear some dogs of it, they just seem to be refractory to all treatment and still have positive scrapes. These scrapes are very difficult to interpret, and sometimes you need to spend half an hour at the microscope to ensure you don't miss the juvenile stages.

Interestingly have heard of oral panomec being used, but never tried it. Is it possible to dilute the equine oral paste, or do you need to use the injectable, in which case why not give it by injection?

Re: about demodecosis

Evelyn Barbour-Hill — Tue, 04 May 2010 23:05:26 GMT

Aludex is the cornerstone of treatment for me.

Daily Milbemax is a nice idea, I would never have thought of that.

Re: about demodecosis

jenny overton — Tue, 04 May 2010 21:48:21 GMT

I have a case of Demodecosis in a young cocker spaniel, I started treating it in Sep 2008, when it came to me it had a very generalised version-its trunk was sore and infected and feet and face and most of the rest of its body also showing signs. It was quite ill. Its scrapes had multiple large demodex mites-it was covered in them! I initially started it on malaseb twice wkly and aludex once a wk, alongside amox/clav and carprofen for its severe infection. This cleared the trunk/bathing parts of its body fine but I was still left with demodex in its face which wouldn't clear and also its feet proved difficult to completely clear.

At this point i spoke to bayer about alternating advocate alongside aludex for its face as i still didn't feel the body was completely clear. They said as long as each advocate application was a week apart from each aludex application it should be fine (i.e. once every 4 wks replace aludex with advocate). Also I had moved swiftly onto ceporex for abx support as it is proven to be the most reliable abx to use in a lot of these cases.

However still this wasn't enough and after a good few months of treatment we had reached a standstill with still unresolved areas of demodex on the dog, particularly eyes and face and ears. So i stopped the aludex and advocate and moved to using a daily dose of Milbemax (which is off license) at 0.5-1mg/kg sid, this worked well and eventually a year later then dog was finally clear on scrapes and of signs from demodex.

Sorry I forgot to mention in the middle of all this when the dogs skin was healthy enough for an op I did also spay her (which is also advised to contribute to treatment).

We all went away happy with the piece of mind that she was clear for the time being. That was sept 2009. Up until a few wks ago (Apr 2010) she remained clear and very healthy with no lesions. Then out of the blue her feet and chest have come up and we have started just on the simple bathing routine again.

The problem i found that towards the end of treatment while lesions were still apparent it started to prove more and more difficult to read the scrapes. Even while they were negative for a while you could tell the problem was still there, it was just not so obvious on the slides. Although they were there i suspect they were scarce and quite small. So I found it more difficult to trust scrapes but this was a very severe case and in many cases 3 negative scrapes with no c/s is usually enough i think.

I've also spoke to dermatologists who used oral ivomec off license (panomec at a diluted dose) However in a young dog, despite it not being a collie, i didn't have the confidence to try this.

I'd be interested to know what anyone else thinks.

Re: about demodecosis

Utlendigur — Tue, 04 May 2010 20:58:03 GMT

Haven't seen one for a while, but would probably start with Advocate and go to Aludex if not working ( ie still postive skin scrapes). It would be hard to justify using s/c ivermectin under the cascade

I'd also make sure there were no underlying conditions eg Cushings

Re: about demodecosis

sophia guymer — Tue, 04 May 2010 19:29:22 GMT

Aludex washes, three times with week in between, then scrape, if neg, wash three more times then scrape again, need two (if my memory is correct, I would have to check really, not done one for a while) or three clear scrapes before stopping washing. If pos, continue as above with the need of 2 (or 3) clear scrapes before stopping.

We do now also have adocate which claims to treat for demodex but I wouldn't count on that alone.

Used to use ivermectine for it when I saw practice in ireland but wouldn't dare use it now (in england). Definately would not go near collie (cross) with ivermectine.

As I say though, haven't had one in a long while so may be my views are out of date, would check when the next one comes along.