Case 12
You opt for a topical treatment instead of ivermectin because Wyatt is currently receiving spinosad-milbemycin for his flea and heartworm preventive. You prescribe topical selamectin application every two weeks for three applications.1
You counsel Wyatt's owners that sarcoptic mange can be a contagious disease between dogs and between dogs and people. You explain that if the owners develop a pruritic rash they should contact their physician. Sarcoptic mange mites can transiently infest humans causing a pruritic rash which is easily treated. Washing Wyatt's bedding in hot water is recommended but additional treatment of the environment with parasiticides is not required. In addition, you recommend that Wyatt not interact with any other dogs until after his treatment is complete. You prescribe another course of an anti-inflammatory dose of prednisone at 0.5 mg/kg tapered over two weeks to provide additional relief.
At Wyatt's follow-up visit in four weeks the owners report that finally Wyatt is feeling better and back to himself-happy and playing with only mild scratching. His owners currently rate the pruritus at 3 to 4/10, which is consistent with his previously controlled atopic dermatitis.
Given Wyatt's excellent response to therapy you surmise that occult sarcoptic mange was the cause of this pruritic flare. Possible sources of infection include his weekly trips to doggie day care or possibly from his outdoor environment (coyotes and fox populations can be a source of fomite contamination). You recommend the owners also contact the doggie day care facility regarding Wyatt's diagnosis.
Reference
1. Hnilica KA. Small animal dermatology: a color atlas and therapeutic guide. 3rd ed. St. Louis, Mo: Saunders, 2011.
Suggested Reading
1. Olivry T, Foster AP, Mueller RS, et al. Interventions for atopic dermatitis in dogs: a systematic review of randomized controlled trials. Vet Dermatol 2010;21(1):4-22.
2. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of atopic dermatitis: 2010 practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol 2010;21(3):233-248.
3. Marsella R, Sousa CA, Gonzales AJ, et al. Current understanding of the pathophysiologic mechanisms of canine atopic dermatitis. J Am Vet Med Assoc 2012;241(2):194-207.
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