The treatment of Demodectic mange is usually accomplished with lotions, dips, and shampoos. Fortunately, 90% of demodectic mange cases are localized, in which only a few small areas are involved and can often be treated topically. A treatment that has been successful for years has been a 1% rotenone ointment (Goodwinol ointment), or more recently, a 5% benzoyl peroxide gel applied daily. Bathing periodically with a benzoyl peroxide shampoo and feeding a high quality diet and a multivitamin with a fatty acid may also help some dogs. Most of these localized lesions will heal on their own and do not require overly aggressive treatment.

If a dog develops generalized demodicosis more aggressive treatment is usually required. Studies show that between 30% and 50% of dogs that develop the generalized form will recover on their own without treatment, but treatment is still always recommended for the generalized form. The treatment of choice continues to be Amitraz dips applied every two weeks. Amitraz is an organophosphate, and is generally available under the product name Mitaban. It is a prescription product and should be applied with care. Humans should always wear rubber gloves when applying it to their dog, and it should be applied in an area with adequate ventilation. It is recommended that longhaired dogs be clipped short, so that the dip can make good contact with the skin. Prior to dipping, the dog should be bathed with a benzoyl peroxide shampoo to help remove oil and cellular debris.

Most dogs with generalized demodicosis require between 4 and 14 dips. After the first three or four dips, a skin scraping should be performed to determine if the mites have been eliminated. Dips should continue until there have been no mites found on the skin scrapings taken after 2 successive treatments. Some dogs develop sedation or nausea when dipped, and toy breeds in particular are sensitive to amitraz. Half strength dips should be used on these sensitive animals.

Ivermectin should not be used in Collies and similar breeds.

Some dogs may not respond to this treatment, and the frequency of the dips may have to be increased or additional treatments may need to be instituted. Two other products, which though they are not licensed for the treatment of demodectic mange, are being widely used by veterinary dermatologists and general practitioners with some good results. One of these is ivermectin, which is the active ingredient in Heartgard, however, the concentration in Heartgard is not high enough to be effective against Demodex. Larger daily doses of liquid ivermectin must be given and should only be used under close veterinary supervision. Another drug, Milbemycin oxime (Interceptor), has also been given daily and been shown to be effective on up to 50% of the dogs that did not respond to Mitaban dips.
Dogs that have generalized demodicosis often have underlying skin infections, so antibiotics are often given for the first several weeks of treatment. In addition, we usually recommend the dog be put on a good multivitamin/ fatty acid supplement. Because Demodex flourishes on dogs with a suppressed immune system, it is wise to check for underlying causes of immune system disease, particularly if the animal is older when they develop the condition.

Demodectic mange is not an inherited condition, but the suppressed immune system that allows the puppy to be susceptible to the mites can be. Remember that all puppies receive the mites from their mother, but only a few have ineffective immune systems and develop the mange. This sensitivity can be passed genetically through generations. Individuals that have a history of demodectic mange, and their parents and siblings, should not be bred. Through careful breeding, most cases of generalized demodicosis could be eliminated.