I’ve been fortunate in my years in practice that I’ve not seen many cases of sarcoptic mange in dogs. Part of that is probably because most places where I have worked regularly used products containing selamectin or imidaclopid/moxidectin as part of their routine parasite control plan.
These products are both very effective at eliminating Sarcoptes scabei var. canis when used at regular monthly treatment intervals, as would be common as part of a flea prevention programme.
On the odd occasion where an animal would be presented with characteristic signs of sarcoptic mange, the re-introduction of our regular flea control programme would quickly have the sarcoptes under control. However, a recent case of sarcoptic mange in a German Shepherd puppy had me reflecting on how much distress this parasite can cause and how this then impacted the client’s experience of getting a new puppy and developing a bonded relationship with the veterinary practice.
Leo, the German Shepherd, was purchased from a breeder as an eight-week-old puppy and his new owners noted him scratching almost as soon as they got him home. He came to my practice for his first veterinary exam about 10 days later, when the clients realised the pet shop shampoos and flea treatments they had applied at home were having no effect on his scratching and he was losing hair around his eyes and face.
On presentation he had a severe, generalised, crusty pyoderma and a thin hair coat over his entire body, with almost complete alopecia around the eyes and ear margins. There was no evidence of fleas, flea dirt or lice in the coat. We discussed the high possibility of sarcoptic mange with the owners, but they declined to have skin scrapes taken at that time. It was decided to start treatment for the secondary bacterial pyoderma, with a course of parenteral antibiotics (cephalexin 25mg/kg BID). A single injection of dexamethasone (0.04mg/kg SC) was given to alleviate the pruritus. A parasiticide was not applied that day, as the family member who brought the dog was unsure about what products had already been used in the last week, so we were waiting on this information before supplying any other treatments.
A review appointment was booked for two weeks later and the client was advised to bring the other information as soon as possible so we could start suitable parasite treatment. Ten days later, when we next heard from the client, both they and the pup were very unhappy. Some of the initial advice appeared to have been forgotten or misunderstood, and they had not returned for their parasite treatment. The client also reported that the litter mates of this pup had been handed into the local animal rescue centre with similar signs of skin disease.
Those pups were responding very well to chlorhexidine/miconazole baths, had negative skin scrapings and apparently received no treatment for mites. The client was upset that his pup had been distressed and scratching for the last few weeks.
He felt we had misdiagnosed the condition by suggesting Sarcoptes scabiei mites were most likely responsible for the skin condition and that oral antibiotics were unnecessary when a shampoo seemed to be working well for the other pups.
Although, as clinicians, we could see an improvement in the dog’s general skin condition with the reduction in secondary bacterial infection, the owner was not able to appreciate this and the level of pruritus was severe and distressing to both the animal and owner.
The client agreed to skin scrapings which were taken from the ear margins and elbows. These were found positive for Sarcoptes scabei var. canis and an imidaclopid/moxidectin spot-on treatment was prescribed. A buster collar was used to help reduce the ongoing self-trauma and chlorhexidine/miconazole baths were started twice-weekly. There was a noticeable improvement in clinical signs every two weeks at his re-checks, but it was two months after the first application of imidaclopid/moxidectin before the owner was able to remove the buster collar for the last time.
In my experience, clients who are upset and feel their animal is suffering, especially after they have already received treatment, can quickly decide to leave for advice elsewhere. Infestation with the Sarcoptes scabei var. canis mite causes intense pruritic, which is distressing for owners to watch and can quickly lead to dissatisfaction with the veterinary service being provided. In this case this was exacerbated by the impression that other similar cases were being treated more successfully.
Thankfully we were able to manage the client’s expectations and reassure them that treatment of the mites, once diagnosed by skin scrapings, would be effective. Later research into the case of the pups at the rescue centre revealed that they had received an oral uralaner treatment as soon as they had arrived in the centre, as is standard as part of their routine parasite control programme.
There have been anecdotal reports of the efficacy of uralaner being used off-licence against Sarcoptes scabiei var. canis, and recently there have been some papers published on this subject which showed negative skin scrapes and improvement in clinical signs within two to four weeks (Romero et al., 2016; Taenzler et al., 2016).
In the increasingly competitive veterinary market, we cannot overlook the importance of parasite control. It is an area where clients have endless options on how to treat their pets and we need to continue to work hard to educate clients on which parasites are a problem in our local areas.
Comprehensive preventive healthcare plans can help with this by showing our clients we want to help them keep their pets well and protected from disease and parasites. It’s important to me that the health plans in my practice incorporate a full range of parasite protection, using quality products and are good value for the client, as well as pro table for the practice.
