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Dermatology > Demodicosis > Flashcards

Demodicosis Flashcards

1
Q

What is demodicosis?

A
  • Inflammatory skin disease caused by the follicular mite Demodex canis
  • Disease state where the mites are prsent in much larger numbers
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2
Q

Where is Demodex canis usually found?

A
  • Normal habitant of skin/hair follicles generally found in small numbers in healthy animals
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3
Q

Is Demodex canis contagious?

A
  • No
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4
Q

is Demodex canis pruritic?

A
  • Not considered pruritic, but it can cause pruritus
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5
Q

Where does Demodex spend its entire life?

A
  • On the skin of the host
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6
Q

Where is Demodex typically found on the skin of the host?

A
  • Hair follicles and occasionally in the sebaceous glands
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7
Q

What are the life stages of Demodex (and # of legs for each)?

A
  1. Fusiform eggs
  2. Six-legged larvae
  3. Eight-legged nymphs
  4. Eight-legged adults
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8
Q

How long is the life cycle for Demodex?

A
  • 20-35 days
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9
Q

How are Demodex mites transmitted?

A
  • Spread from bitch to puppies in the first 3 days after birth
  • Nursing provides direct contact for transmission
  • Not transmitted or considered very difficult to transfer to dogs older than a few days old
  • Mites are not found in puppies born via C-section and raised away from the mother (i.e. in utero transmission does not occur)
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10
Q

Why do demodex mites proliferate in some dogs (juvenile onset generalized disease)?

A
  • Gene defect that is considered hereditary

- Thought to be autosomal recessive

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11
Q

What is thought to be underlying cause of generalized demodicosis in adults (and could be juveniles too)?

A
  • Probably T-cell defect
  • Somehow a depressed immune system
  • Think disease or drugs!
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12
Q

Predisposing factors for demodicosis

A
  • Age
  • Breed
  • Poor nutrition
  • Estrus
  • Parturition
  • Ectoparasites
  • Stress
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13
Q

Clinical lesions of demodicosis?

A
  • Alopecia (patchy/moth-eaten to complete)
  • Erythema
  • Comedomes
  • Papules
  • Pustules
  • Crusts
  • Draining tracts
  • Epidermal collarettes
  • Nodules
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14
Q

What are the two variants of demodex?

A
  • D. cornei (D. canis)

- D. injai

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15
Q

Is demodicosis easy to cure?

A
  • No

- OWNER FRUSTRATION IS BIG

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16
Q

What do demodex mites feed off of?

A
  • Follicular cells
  • Sebum
  • Epidermal debris
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17
Q

What can cause the pruritus with demodex?

A
  • Secondary pyoderma

- Possible hypersensitivity

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18
Q

Does D. canis survive off the host?

A
  • No
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19
Q

Differentials for folliculitis?

A
  • Demodex
  • Bacterial pyoderma
  • Dermatophytosis
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20
Q

What happens when demodex causes hair follicles to rupture or get irritated?

A
  • Folliculitis and furunculosis –> deep pyoderma

- Secondary pyoderma develops

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21
Q

How do you categorize demodex?

A
  • Localized vs generalized

- If generalized, juvenile onset vs adult onset

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22
Q

Localized demodicosis clinical signs

A
  • 1 to several areas
  • Patchy alopecia
  • Erythema
  • Scales
  • No to minimal pruritus
  • Face, forelegs
  • Usually 6 or fewer indicates localized; greater than 12 is indicative of generalized disease
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23
Q

Demodectic pododermatitis

A
  • Can be present on the feet of dogs without generalized lesions
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24
Q

When is the juvenile onset for localized democisosis?

A
  • Typically 3-6 months of age (<1 year usually)
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25
Q

Cause of juvenile onset for localized democisosis?

A
  • Immature immune system possibly
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26
Q

Progression of juvenile onset for localized democisosis?

A
  • Rarely progresses to generalized form

- Up to 90% spontaneously heal without treatment

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27
Q

Treatment of juvenile onset for localized democisosis?

A
  • Again, up to 90% spontaneously heal without treatment
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28
Q

Is juvenile onset for localized democisosis a genetic defect?

A
  • Not generally, if it resolves
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29
Q

How quickly can hair re-grow for juvenile onset for localized democisosis?

A

Usually within 30 days

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30
Q

Clinical sites that can be affected for democisosis

A
  • Face
  • Periocular area
  • Commissures of the mouth
  • Forelegs
  • Trunk
  • Rear legs
  • Paws (demodectic pododermatitis)
  • Bilateral ceruminous otitis
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31
Q

Do we treat localized form of demodicosis with miticidal drugs, and why or why not?

A
  • NO because you need to see if it will progress if you are planning on breeding the dog
  • If it does progress, that would be an indication that you shouldn’t breed this dog
  • Unless they are spayed or neutered and don’t have to see if it’s going to resolve or not
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32
Q

Monitoring and treatment for localized demodicosis

A
  • Wait and monitor monthly
  • If it resolves, no genetic defect
  • If it progresses to generalized, then there is a genetic defect and the animal should not be bred
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33
Q

When does juvenile generalized demodicosis present?

A
  • Starts <18 months of age
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34
Q

What characterizes juvenile generalized demodicosis?

A
  • Many localized lesions (maybe greater than 6-12)

- Involves head, trunk, leg, 2+ feet

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35
Q

Juvenile generalized demodicosis clinical signs

A
  • Large aras of alopecia
  • Erythema
  • crusts
  • Papules
  • Hyperpigmentation
  • Comedomes
  • Pustules
  • Epidermal collarettes
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36
Q

Clinical signs of concurrent pyoderma?

A
  • Papules, pustules, epidermal collaretteS
  • Crusts, exudate
  • Pain
  • Pruritus
  • Lymphadenopathy
  • Systemic illness
  • Sepsis
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37
Q

Generalized demodicosis pododermatitis

  • What is involved?
  • How to diagnose?
  • Complications?
A
  • may have feet involvement
  • Usually complicated by secondary infections
  • Can occur with body lesions
  • Difficult to scrape and treat (may consider hair plucks)
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38
Q

Where should you scrape for demodicosis?

A
  • Scrape at the comedomes
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39
Q

Summary of the features of juvenile onset generalized demodicosis

A
  • Starts as localized
  • <1 year age
  • GENETIC predisposition
  • Hence, DO NOT BREED these animals
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40
Q

When does adult onset generalized demodicosis tend to occur?

A
  • Usually >4.5 years

- Rare

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41
Q

What diagnostic test should you run on all old dogs with pyoderma?

A
  • Skin scraping
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42
Q

What should you look for with older dogs with generalized demodicosis?

A
  • UNDERLYING DISEASE OR DRUGS
  • e.g. hypothyroidism, iatrogenic HAC, neoplasia, etc.
  • > 50% have no underlying cause
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43
Q

What underlying diseases can contribute to generalized democisosis in adults?

A
  • Excessive corticosteroid use
  • Endocrinopathies (hyperadrenocorticism or hpothyroidism)
  • Parasitism
  • Neoplasia
  • Poor nutrition
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44
Q

What diagnostics should be run for adult generalized demodicosis?

A
  • CBC/Chem/UA
  • Heartworm and fecal checks
  • T4/TSH
  • ACTH stim or LDDST
  • Radiographs +/- U/S for neoplasia
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45
Q

Why should you look for underlying disease with adult generalized demodicosis?

A
  • You’re more likely to be successful if you find and treat the underlying disease
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46
Q

What drugs can contribute to generalized democisosis in adults?

A
  • Apoquel
  • Prednisone
  • Chemotherapeutics
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47
Q

What are the two primary methods to diagnose demodex?

A
  • Skin scrapings (multiple)
  • Hair plucks
  • Could also do a fecal float
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48
Q

Equipment needed for skin scrapings?

A
  • # 10 blade
  • Mineral oil
  • Slides and cover
  • Microscope
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49
Q

Where do you perform hair plucks?

A
  • Near eyes and feet
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50
Q

Sensitivity of hair plucks compared to skin scrapings?

A
  • About 50%
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51
Q

How do you perform skin scrapings?

A
  • Want blood on your blade
  • Squeeze affected skin to extrude mites from hair follicles
  • Minimum of 3 scrapes from lesional skin
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52
Q

Microscope tricks to view demodex?

A
  • 10x objective and lower your condenser
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53
Q

Where do you perform skin scrapings ideally?

A
  • Scrape over comedomes
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54
Q

What would histopathology findings show with generalized demodicosis?

A
  • Folliculitis/furunculosis +/- mites
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55
Q

Which breeds may need a biopsy to diagnose demodicosis?

A
  • Chinese Shar Peis, Old English sheepdogs, Scottish terriers
  • May require a biopsy to diagnose demodicosis
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56
Q

What should you never use to treat demodicosis?

A
  • CORTICOSTEROIDS
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57
Q

How to treat secondary bacterial pyoderma for localized disease (either intact or spayed animals)?

A
  • Oral antibiotics
  • Topical treatment (2-4% chlorhexidine
    or Mupirocin ointment)
  • Benzyl peroxide (follicular flushing properties and antibacterial/anti-staph properties)
  • Gel or shampoo, but shampoo is drying
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58
Q

Goodwinol ointment for treating localized demodicosis?

A
  • don’t use
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59
Q

General treatment principles for localized demodicosis

A
  1. Optimize health (improve nutrition and deworm)
  2. Treat secondary pyoderma (oral antibiotics and topical treatments like benzoyl peroxide or chlorhexidine)
  3. Recheck dog and rescrape in 3-4 weeks
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60
Q

What % of dogs with localized demodicosis will progress?

A

10% progress to generalized form

90% improve without treatment

61
Q

Should you use miticidal drugs for localized demodex?

A
  • No, you should not
62
Q

Treatment options for generalized demodicosis?

A
  • Weekly Mitaban (Amitraz dips)
  • Daily oral ivermectin
  • Daily oral milbemycin (interceptor)
  • Imidocloprid with moxidectin (advantage multi) which is weekly to biweekly
  • Isoxazolines
63
Q

Golden rule for length of treatment for generalized disease?

A
  • TREAT ONE MONTH BEYOND 2 negative skin scrapings one month apart
64
Q

Amitraz drug class

A
  • Inhibits monoamine oxidase (MAOI) and prostaglandin synthesis
  • Alpha-2 adrenergic agonist
65
Q

What is labeled treatment for amitraz, and what is actually effective?

A
  • Approved is every two weeks

- Weekly dips have increased efficacy

66
Q

Amitraz/mitaban side effects

A
  • Sedation
  • Disorientation
  • Bradycardia
  • Ataxia
  • Hypothermia
  • Vomiting/diarrhea
  • Pruritus
  • Hyperglycemia
67
Q

Antidotes for mitaban/amitraz if overdosed?

A
  • Yohimbine

- Antisedan

68
Q

What is the only licensed treatment for demodicosis?

A
  • Amitraz or Mitaban dips
69
Q

How to use Amitraz or Mitaban?

A
  • Use every week
  • Mix 1 vial in 2 gallons water
  • Sponge on entire mixture of product on patient
  • Let animal drip dry
  • Use half dose in small dogs
70
Q

In which cases should you avoid Mitaban/Amitraz?

A
  • Sedated animals because it can impact HR
  • Deep pyoderma
  • Diabetics (affects BG)
  • Small dogs (use half strength)
  • Concurrent use of Anipryl, amitriptyline, clompramine (MAO inhibitor)
  • Concurrent use of hydroxyzine
71
Q

Drug class of ivermectin?

A
  • Macrocyclic lactone
72
Q

MOA of ivermectin

A
  • Potentiates GABA gated chloride channels
73
Q

WHich solution of ivermectin should you use and how should it be given?

A
  • Bovine/equine injectable product
  • Oral dose daily
  • Use loading schedule to monitor for side effects
74
Q

Is ivermectin for demodicosis on or off-label?

A
  • OFF
75
Q

Which breeds shouldn’t get ivermectin and why?

A
  • Collies and shelties
  • Australian shepherds
  • Old English sheepdogs
  • White feet, don’t treat
  • MDR1 mutation can lead to accumulation and neurotoxicity
76
Q

Which drugs should not be combined with ivermectin?

A
  • Milbemycin
  • Selamectin
  • Mitaban
  • Ketoconazole
77
Q

MDR1 gene mutation

A
  • Abnormal P-glycoprotein pumps in blood brain barrier (typically responsible for pumping out the ivermectin)
  • Ivermectin accumulates in neurons, and neuro signs develop
78
Q

Side effects of ivermectin

A
  • Mydriasis
  • Anorexia
  • Ataxia
  • Tremors
  • Seizures
  • Coma
  • Death
79
Q

What do you need to make sure about your patient before giving milbemycin oxime or ivermectin?

A
  • Make sure they are negative for heartworm disease
80
Q

Milbemycin oxime (interceptor) drug class

A
  • Macrocyclic lactone
81
Q

Milbemycin oxime - mechanism of action?

A
  • Similar to ivermectin
82
Q

Dose of milbemycin for demodicosis relative to the dose of milbemycin for heartworm?

A
  • MUCH higher dose than for heartworm prevention
83
Q

Relative safety of milbemycin oxime for herding dogs?

A
  • Generally safer
84
Q

Cost of milbemycin oxime

A
  • Expensive
85
Q

Side effects of milbemycin?

A
  • Neurologic side effects like tremors and ataxia

- Start with 1 mg/kg and increase in 1 month if not responding (no change in mite count)

86
Q

Drugs that shouldn’t be used with milbemycin?

A
  • Mitaban
  • Ivermectin
  • Selamectin
87
Q

What is the treatment of choice for generalized demodicosis? Is it on or off label?

A
  • Isoxazolines

- These are off label

88
Q

MOA of isoxazolines

A
  • Inhibit GABA and glutamate gated chloride channels
89
Q

Efficacy of isoxazolines

A
  • VERY effective
90
Q

Isoxazoline safety in herding dogs?

A
  • Safe in MDR1 +
91
Q

Are isoxazolines insecticidal or acaricidal?

A
  • They are BOTH
92
Q

Which dose of isoxazolines should you use?

A
  • Intended labeled dosage
93
Q

Available products of isoxazolines

A
  • Bravecto
  • Simparica
  • Nexgard
  • Credelio
94
Q

How long does Bravecto last?

A
  • 3 months
95
Q

Which isoxazolines are safe for dogs with food allergies?

A
  • Bravecto (hydrolyzed pork)
  • Simparica (hydrolyzed soy)
  • Nexgard and Credelio are not
96
Q

Frequency of administration for Bravecto vs Simparica vs Nexgard vs Credelio

A
  • Bravecto is 90 days

- All the others are every 28-30 days

97
Q

Bravecto use in dogs under 6 months of age

A
  • He wouldn’t hesitate to use, but in theory the puppy might outgrow the dosage within 3 months
98
Q

What are five keys to success with treating generalized demodicosis?

A
  1. Use of isoxazolines (Bravecto and others)
  2. Minimum of three months of therapy (USUALLY longer)
  3. Avoid steroids (alters immune system and likely worsens clinical signs)
  4. Spay or neuter
  5. Treat secondary pyoderma
99
Q

How long to treat generalized demodicosis?

A
  • Minimum of three months

- Treat one month beyond 2 negative skin scrapings that are one month apart

100
Q

Monitoring while treating generalized demodicosis?

A
  • Monthly scrapes
  • CLinical cure BEFORE parasitologic cure!
  • Historical treatments could take months to get a negative scrape
  • Isoxazolines are very effective
  • Negative scrapes ON YEAR after last treatment
101
Q

WHat are you evaluating durning monthly skin scrapings?

A
  • Ratios of live to dead mites
  • Immature to mature
  • Look for eggs
  • Evaluate overall clinical picture and responsive
102
Q

Prognosis for generalized form

A
  • Guarded for complete cure unless you can find an underlying cause of disease
  • Excellent for clinical improvement and quality of life especially with isoxazolines
  • May need lifelong therapy
  • DO NOT breed juvenile onset generalized demodicosis
103
Q

What should be avoided for generalized demodicosis for the life of the patient?

A
  • Avoid steroids lifelong if possible
  • Avoid other immune-modulatory, anti-itch treatments like Apoquel and Atopica
  • Unless no other drug options exist or a medical emergency occurs
104
Q

What is considered a clinical cure for generalized demodicosis?

A
  • Considered cured if no clinical signs and mites are found 1 year after discontinuing treatment
105
Q

Appearance of Demodex injai

A
  • Long bodied mite
106
Q

Where does D. injai live?

A
  • Follicular mite that also lives in sebaceous glands
107
Q

Where is D. injai found?

A
  • Usually occurs or is found along the dorsum
108
Q

Clinical signs of D. injai

A
  • Seborrhea oleosa (greasy dermatitis) is a common clinical sign +/- alopecia
109
Q

What breeds get D. injai?

A
  • Typically terriers
110
Q

Treatment of D. injai

A
  • Treat like D. canis
111
Q

Appearance of Demodex cornei?

A
  • Short-bodied mite, basically D. canis (PCR)
112
Q

Clinical signs of D. cornei

A
  • May be pruritic, otherwise like D. canis
113
Q

Treatment of D. cornei

A
  • Treat like D. canis
114
Q

What does MDR-1 code for?

A
  • P-glycoprotein
115
Q

Which drugs are concerning with MDR-1 gene?

A
  • Ivermectin
  • Loperamide
  • Vincristine
  • Doxorubicin
  • Digoxin
116
Q

How to test for ivermectin sensitivity?

A
  • Cheek swab, $60 per test
117
Q

What are the three types of feline demodicosis?

A
  • Demodex cati
  • Demodex gatoi
  • Unnamed species
118
Q

How common is Demodex cati?

A
  • Rare
119
Q

Is D. cati contagious or pruritic?

A
  • Not contagious

- Not considered pruritic

120
Q

What forms of demodicosis can occur with D. cati?

A
  • Either localized or generalized
121
Q

Which form (generalized/localized) is more common with D. cati?

A
  • LOCALIZED
122
Q

Where does localized demodicosis usually occur with cats?

A
  • Nose, periocular skin, neck

- 1 to several small areas

123
Q

Signs associated with localized demodicosis in cats

A
  • Alopecia
  • Erythema
  • Crusting
  • Variable pruritus
  • Hyperpigmentation
  • Ceruminous otitis
124
Q

Generalized form of D. cati - clinical signs and location?

A
  • Same clinical signs

- Head, neck, trunk, limbs

125
Q

What concurrent diseases can cause generalized D. cati?

A
  • FeLV/FIV
  • Diabetes mellitus
  • Neoplasia
  • Hyperadrenocorticism
  • Toxoplasmosis
126
Q

Dfdx for D. cati in cats

A
  • Dermatophyte
  • Pyoderma
  • Causes of miliary dermatitis
127
Q

What is highest on the list for causes of folliculitis in cats?

A
  • Dermatophyte!

- Pyoderma and demodicosis are both rarer

128
Q

Diagnosis of generalized demodicosis in cats

A
  • Underlying disease search (minimum data base, FeLV/FIV, fecal, radiographs)
  • Skin scraping
129
Q

Treatment for localized demodicosis in cats

A
  • May be self limiting
  • Isoxazolines (Bravecto)
  • Lime-sulfur dips
130
Q

Generalized disease treatments for demodicosis in cats

A
  • Isoxazolines (Bravecto)
  • Lime sulfur
  • Amitraz
  • Ivermectin
131
Q

How long to do lime sulfur dips for generalized demodicosis in cats

A
  • Weekly until 1 month past negative scrapes
132
Q

Ivermectin in cats adverse effects

A
  • Can cause toxiciity
133
Q

Mitaban in cats adverse effects

A
  • Can cause ptyalism and sedation
134
Q

Prognosis for generalized D. cati treatment

A
  • Depends on ability to treat underlying disease
135
Q

What does ceruminous otitis look like in cats (i.e. clinical signs)?

A
  • Dirty ears

- Pruritus possible

136
Q

Treatment for ceruminous otitis secondary to Demodex in cats?

A
  • Topical ear mite treatments like Tresaderm
137
Q

How id Demodex gatoi different from other demodex mites?

A
  • SUPERFICIAL MITE (lives in stratum corneum)
  • PRURITIC
  • CONTAGIOUS
  • Short fat body
138
Q

Appearance of Demodex gatoi

A
  • Short, fat body
139
Q

Is D. gatoi contagious?

A
  • Yes
140
Q

Is D. gatoi pruritic?

A
  • Yes
141
Q

Where is Demodex gatoi?

A
  • In the stratum corneum
142
Q

State distribution of D. gatoi?

A

Gulf states

143
Q

Clinical signs with D. gatoi?

A
  • PRURITUS***
  • Alopecia
  • Excoriations
  • Crusting
144
Q

Where on the body does D. gatoi tend to be?

A
  • Head
  • Neck
  • Rear limbs
  • Flanks
  • Abdomen
145
Q

Dfdx for D. gatoi

A
  • Allergies
  • Psychogenic alopecia
  • Feline scabes (notoedric mange)
146
Q

Diagnosis of D. gatoi in cats

A
  • BROAD superficial scrapings
  • Scrape other cats
  • Treatment trial
  • Fecal**
147
Q

What objective should you use to find D. gatoi?

A
  • 10x and LOWER CONDENSER
148
Q

Treatment for D. gatoi?

A
  • TREAT ALL CATS
  • Lime sulfur dips for 6 weekly dips minimum
  • Improvement sometimes seen after 3 dips but may take as long as 12-15 weeks
  • Maybe Bravecto might help!

Dermatology (15 decks)

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