Title: Demodicosis

{{Short description|Animal disease caused by hosting of mites (genus Demodex)}}
{{More citations needed|date=May 2011}}
{{Infobox medical condition (new)
| name            = Demodicosis
| synonyms        = Demodectic mange, red mange
| image           = Demodectic mange 2.jpg
| image_size      = 280px
| caption         = A dog with severe demodectic mange
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| field           = [[Dermatology]], [[veterinary medicine]]
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'''Demodicosis''' {{IPAc-en|,|d|E|m|@|d|@|'|k|ou|s|I|s}}, also called '''Demodex folliculitis''' in humans&lt;ref name=cmaj2017&gt;{{Cite journal
 | author = Claude Bachmeyer
 | author2 =  Alicia Moreno-Sabater
 | date = June 26, 2017
 | title = Demodex folliculitis
 | quote = Demodex folliculorum is a saprophytic parasitic mite of the pilosebaceous follicle and seborrheic glands and is found mainly on the face of adult men.[1,2] The role of Demodex mites in inflammatory skin conditions remains controversial, but is suggested by the efficacy of topical or oral antiparasitic therapy. Demodex folliculorum should be considered whenever a rosacea-like or papulopustular eruption of the face fails to respond to standard therapy for rosacea, and no bacterial pathogens can be implicated.[1] The condition is characterized by itchy pustules, follicular scaling and dryness, conglobata demodicosis with nodulocystic lesions, and blepharitis.[...] Treatment recommendations are supported by case reports and include crotamiton cream, tetracyclines, and topical or systemic metronidazole. Topical and oral ivermectin may be effective in severe cases, although these are not readily available in Canada.
 | journal = [[Canadian Medical Association Journal]]
 | volume = 189
 | issue = 25
 | pages = E865
 | doi = 10.1503/cmaj.161323
 | pmc = 5489393
 | pmid = 28652482
 | url = https://www.cmaj.ca/content/189/25/E865.short
 | access-date = December 15, 2021
 }}&lt;/ref&gt; and '''demodectic mange''' ({{IPAc-en|d|E|m|@|'|d|E|k|t|I|k}}) or '''red mange''' in animals, is caused by a sensitivity to and overpopulation of ''[[Demodex]]'' {{abr|spp.|species (plural)}} as the host's immune system is unable to keep the mites under control.

''[[Demodex]]'' is a [[genus]] of [[mite]] in the [[Family (biology)|family]] [[Demodecidae]]. The mites are specific to their hosts, and each mammal species is host to one or two unique species of ''Demodex'' mites. Therefore, demodicosis cannot be transferred across species and has no [[Zoonosis|zoonotic]] potential.&lt;ref&gt;Izdebska JN, Rolbiecki L. The status of ''Demodex cornei'': description of the species and developmental stages, and data on demodecid mites in the domestic dog ''Canis lupus familiaris. Med Vet Entomol''32:346 – 357, 2018.&lt;/ref&gt;

==Signs and symptoms==
===Humans===
[[File:Demodicosis.jpg|thumb|upright=1.3|A 28-year-old man with demodicosis and electron micrograph of his skin showing a ''Demodex folliculorum'', {{Circa|0.33}} millimeters in length&lt;ref&gt;{{cite book |doi=10.5772/61850 |isbn=978-953-51-2252-4 |chapter=Observation of Fungi, Bacteria, and Parasites in Clinical Skin Samples Using Scanning Electron Microscopy |author=Ran Yuping |title=Modern Electron Microscopy in Physical and Life Sciences |editor=Janecek, Milos |editor2=Kral, Robert |publisher=InTech |year=2016|s2cid=53472683 }}&lt;/ref&gt;&lt;!-- This is content from a predatory publisher (intechopen.com); recommend finding an alternative source for a comparable image, but I hesitate to remove the image at this time. --&gt;]]

Demodicosis in [[human]]s is usually caused by ''[[Demodex folliculorum]]'' and may have a [[rosacea]]-like appearance.&lt;ref&gt;{{cite journal |pages=3–6 |doi=10.1080/000155502753600795 |doi-access=free|title=Demodicidosis Revisited |year=2002 |last1=Baima |first1=B. |last2=Sticherling |first2=M. |journal=Acta Dermato-Venereologica |volume=82 |pmid=12013194 |issue=1}}&lt;/ref&gt;&lt;ref name=pmid19231642&gt;{{cite journal |pages=453–62 |doi=10.1016/j.jaad.2008.10.058 |title=Demodicosis: A clinicopathological study |year=2009 |last1=Hsu |first1=Chao-Kai |last2=Hsu |first2=Mark Ming-Long |last3=Lee |first3=Julia Yu-Yun |journal=Journal of the American Academy of Dermatology |volume=60 |issue=3 |pmid=19231642}}&lt;/ref&gt;  Common symptoms include [[Hair loss#Infection|hair loss]], itching, and [[inflammation]]. An association with [[pityriasis]] folliculorum has also been described.&lt;ref name=pmid19231642/&gt;

Demodicosis is most often seen in folliculitis (inflammation of the hair follicles of the skin). Depending on the location, it may result in small pustules (pimples) at the base of a hair shaft on inflamed, congested skin. Demodicosis may also cause itching, swelling, and [[erythema]] of the eyelid margins. Scales at the base of the eyelashes may develop. Typically, patients complain of eyestrain.

===Dogs===
{{main|Canine demodicosis}}
[[Image:Demodex mite 1.JPG|thumb|upright=1.3|''[[Demodex canis]]'']]
Minor cases of demodectic mange usually do not cause much itching but might cause pustules, redness, scaling, leathery skin, hair loss, skin that is warm to the touch, or any combination of these. It most commonly appears first on the face, around the eyes, or at the corners of the mouth, and on the forelimbs and paws. It may be misdiagnosed as a &quot;hot spot&quot; or other skin ailment.

In the more severe form, hair loss can occur in patches all over the body and might be accompanied by crusting, pain, enlarged lymph nodes, and deep skin infections.

Typically, animals become infected through nursing from their mother. The transmission of these mites from mother to pup is ''normal'' (which is why the mites are normal inhabitants of the dog's skin), but some individuals are sensitive to the mites due to a cellular immune deficiency, underlying disease, stress, or malnutrition,&lt;ref name=&quot;CAPC&quot;&gt;[http://www.capcvet.org/recommendations/demodex.html Ectoparasites - Demodex (Mange Mite)] {{Webarchive|url=https://web.archive.org/web/20111007024936/http://www.capcvet.org/recommendations/demodex.html |date=2011-10-07 }} Companion Animal Parasite Control (March 2013).&lt;/ref&gt; which can lead to the development of clinical demodectic mange.

Some breeds appear to have an increased risk of mild cases as young dogs, including the [[Afghan Hound]], [[American Staffordshire Terrier]], [[Boston terrier|Boston Terrier]], [[Boxer (dog)|Boxer]], [[Chihuahua (dog)|Chihuahua]], [[chow chow|Chow Chow]], [[shar pei|Shar-Pei]], [[Collie]], [[Dalmatian (dog)|Dalmatian]], [[Dobermann|Doberman Pinscher]], [[Bulldog]], [[French bulldog|French Bulldog]], [[English bull terrier|English Bull Terrier]], [[miniature bull terrier|Miniature Bull Terrier]], [[German Shepherd Dog|German Shepherd]], [[great dane|Great Dane]], [[Old English sheepdog|Old English Sheepdog]], [[American Pit Bull Terrier]], [[West Highland white terrier|West Highland White Terrier]], [[rat terrier|Rat Terrier]], [[Yorkshire terrier|Yorkshire Terrier]], [[Dachshund]], and [[Pug]].

===Cats===
There are two types of demodectic mange in cats. ''Demodex cati'' causes follicular mange, similar to that seen in dogs, though it is much less common. ''Demodex gatoi'' is a more superficial form of mange, causes an itchy skin condition, and is contagious amongst cats.

===Other===
Demodectic mange also occurs in other domestic and wild animals, including captive pandas.

==Diagnosis==
===Dogs===

For demodectic mange, properly performed deep skin scrapings generally allow the veterinarian to identify the microscopic mites. The demodex mite is rarely found on clinically normal dogs, meaning that the presence of any number of mites in a sample is very likely to be significant. Acetate tape impression of the skin is another method to identify mites.  In breeds such as the [[West Highland White Terrier]], relatively minor skin irritation which would otherwise be considered allergy should be carefully scraped because of the predilection of these dogs to demodectic mange. Skin scrapings may be used to follow the progress of treatment in demodectic mange.

Alternatively, plasma levels of zinc and copper have been seen to be decreased in dogs with demodicosis.&lt;ref name=&quot;:4&quot;&gt;{{Cite journal|last1=Dimri|first1=Umesh|last2=Ranjan|first2=R.|last3=Kumar|first3=N.|last4=Sharma|first4=M. C.|last5=Swarup|first5=D.|last6=Sharma|first6=B.|last7=Kataria|first7=M.|date=2008-06-14|title=Changes in oxidative stress indices, zinc and copper concentrations in blood in canine demodicosis|journal=Veterinary Parasitology|volume=154|issue=1–2|pages=98–102|doi=10.1016/j.vetpar.2008.03.001|issn=0304-4017|pmid=18440148}}&lt;/ref&gt; This may be due to inflammation involved in the immune response of demodicosis which can lead to [[oxidative stress]], resulting in dogs with demodicosis to exhibit higher levels of [[antioxidant]] productivity.&lt;ref name=&quot;:4&quot; /&gt; The catalases involved in the antioxidant pathway require the trace minerals zinc and copper. Dogs with demodicosis show a decrease in plasma copper and zinc levels due to the increased demand for antioxidant activity.&lt;ref name=&quot;:4&quot; /&gt; Therefore, this may be considered as a potential marker for demodicosis.&lt;ref name=&quot;:4&quot; /&gt;

==Treatment==
===Dogs===
Localized demodectic mange is considered a common puppyhood ailment, with roughly 90% of cases resolving on their own with no treatment. Minor, localized cases should be left to resolve on their own to prevent masking of the more severe generalized form. If treatment is deemed necessary, Goodwinol, a [[rotenone]]-based insecticide ointment, is often prescribed, but it can be irritating to the skin. Demodectic mange with secondary infection is treated with [[antibiotic]]s and medicated shampoos.

For more severe generalized cases, [[Amitraz]] is a parasiticidal dip that is licensed for use in many countries (the only FDA approved treatment in the USA) for treating canine demodicosis. It is applied weekly or biweekly for several weeks, until no mites can be detected by skin scrapings. Demodectic mange in dogs can also be managed with [[avermectin]]s, although there are few countries which license these drugs, which are given by mouth daily, for this use. [[Ivermectin]] is used most frequently; [[collie]]-like herding breeds often do not tolerate this drug due to a defect in the [[blood–brain barrier]], though not all of them have this defect. Other avermectin drugs that can be used include [[doramectin]] and [[milbemycin]].

Recent results suggest that the [[ATCvet code QP53#QP53BE Isoxazolines|isoxazolines]] [[afoxolaner]] and [[fluralaner]], given orally, are effective in treating dogs with generalized demodicosis.&lt;ref name=&quot;BeugnetHalos2016&quot;&gt;{{cite journal|last1=Beugnet|first1=Frédéric|last2=Halos|first2=Lénaïg|last3=Larsen|first3=Diane|last4=de Vos|first4=Christa|title=Efficacy of oral afoxolaner for the treatment of canine generalised demodicosis|journal=Parasite|volume=23|year=2016|pages=14|issn=1776-1042|doi=10.1051/parasite/2016014|pmid=27012161|pmc=4807374|doi-access=free}}&lt;/ref&gt;&lt;ref&gt;{{cite journal|last1=Fourie|first1=Josephus|last2=Liebenberg|first2=Julian|last3=Horak|first3=Ivan|last4=Taenzler|first4=Janina|last5=Heckeroth|first5=Anja|last6=Frénais|first6=Regis|title=Efficacy of orally administered fluralaner (BravectoTM) or topically applied imidacloprid/moxidectin (Advocate®) against generalized demodicosis in dogs|journal=Parasites &amp; Vectors|date=2015|volume=8|doi=10.1186/s13071-015-0775-8|pmid=25881320|doi-access=free|pmc=4394402|page=187}}&lt;/ref&gt;
Because of the possibility of the immune deficiency being an inherited trait, many veterinarians believe that all puppies with generalized demodex should be spayed or neutered and not reproduce. Females with generalized demodex should be spayed because the stress of the estrus cycle will often bring on a fresh wave of clinical signs.

===Cats===
Cats with ''Demodex gatoi'' must be treated with weekly or bi-weekly sulfurated lime rinses. ''Demodex cati'' are treated similarly to canine demodicosis. With veterinary guidance, localized demodectic mange can also be treated with a topical keratolytic and antibacterial agent, followed by a lime sulfur dip or a local application of Rotenone. Ivermectin may also be used. Generalized demodectic mange in cats is more difficult to treat. There are shampoos available that can help to clear dead skin, kill mites and treat bacterial infections. Treatment is in most cases prolonged with multiple applications.&lt;ref&gt;{{Cite book |title=Cat Owner's Veterinary Handbook |last1=Eldredge|first1=Debra M. |last2=Carlson|first2=Delbert G. |last3=Carlson|first3=Liisa D.| last4=Giffin|first4=James M. |publisher=Howell Book House |year=2008 |pages=144 |isbn=9781630267643}}&lt;/ref&gt;

==References==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB     = 33039
|  ICD10          = {{ICD10|B|88|0|b|85}} ([[ILDS]] B88.020)
|  ICD9           = {{ICD9|133.8}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  = article
|  eMedicineTopic = 1203895
|  MeshID         =
}}

{{Mite-related diseases and infestations}}
{{Authority control}}

[[Category:Dog diseases]]
[[Category:Arthropod infestations]]
[[Category:Parasitic infestations, stings, and bites of the skin]]