Generalized demodex is a rewarding disease to treat because therapy greatly improves the dog's quality of life using reasonably safe and affordable medications. Client education is required for successful management of this disease.
Remember the following tips to prevent owner frustration regarding demodex therapy:
1. Prognosis for clinical response is excellent even though the prognosis for complete cure is guarded. Thus, some dogs require life-long therapy to keep the mites controlled.
2. Although amitraz dips are the only FDA approved therapy, daily oral ivermectin or milbemycin is recommended because these drugs are easier to administer and are potentially safer.
3. Insufficient duration of therapy is the most common cause of relapse and owner frustration! Remind the owner that the minimum duration of therapy is three months because daily therapy should be continued for one month past two negative scrapes spaced a month apart. In many cases, it takes several months to reach the first negative scrape.
4. If demodex recurs after appropriate therapy, the patient will require life-long therapy. Consider using oral ivermectin or milbemycin given three times per week as life-long maintenance therapy.
5. If generalized demodex develops in a young dog, that dog must be spayed or neutered to prevent transmission of the genetic defect that causes demodex.
6. If generalized demodex develops in an older dog, screen for underlying diseases such as endocrinopathies and neoplasia. If a treatable cause is found, demodex may be curable. If no cause is found, the dog may require life-long therapy.