Veterinary Dermatology 2004, 15, 75 89

Blackwell Publishing Ltd.

Treatment protocols for demodicosis: an evidence-based

review
RALF S. MUELLER
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State
University, Fort Collins, CO 80523, USA
Abstract Publications discussing the treatment of demodicosis in the dog and cat are reviewed. Based on the
evidence in the literature, amitraz rinses at 0.025 0.06% every 7 14 days, and oral daily ivermectin at 300 g kg1,
milbemycin at 2 mg kg1 and moxidectin at 400 g kg1, respectively, can all be recommended for the treatment
of generalized canine demodicosis. Ivermectin and moxidectin should be initiated at lower doses and patients monitored for possible adverse effects during therapy. In cats, 2% lime sulfur dips and amitraz rinses at 0.01250.025%
have been used successfully.
Keywords: amitraz, cat, demodicosis, dog, ivermectin.

OVERVIEW
Canine demodicosis is one of the more common skin
diseases encountered in veterinary practice.1,2 Demodex
canis is a normal member of cutaneous ecology of the
dog,3,4 but in some situations overpopulates resulting
in skin disease. Two forms are recognized, a localized
form and a generalized form. Localized demodicosis
occurs most commonly in young dogs, less than a year
of age. Typical lesions are erythematous and alopecic
patches on the head and/or forelegs. Pruritus and fine
scaling may be present.2 Spontaneous remission occurs
in most patients.2,5,6 There is no uniformly accepted definition of localized vs. generalized demodicosis.2 The
author considers involvement of an entire body region,
more than five focal areas and/or paw involvement
indicative of generalized demodicosis.
The lesions seen with generalized demodicosis are
variable and may include comedones, follicular papules
and casts. More severely affected patients have deep
folliculitis and furunculosis with severe haemorrhagic
exudation and thick crusting. Demarcation between
affected areas and normal skin is abrupt. Lymphadenopathy is common. Secondary bacterial infections are
invariably present. Staphylococcus intermedius is the most
common infecting organism, but secondary infection
with Pseudomonas aeruginosa or Proteus mirabilis may also
occur.2,7 In some dogs only pododemodicosis is present.
Pain and pedal oedema is especially prominent in large
dogs.2 Canine demodicosis can also cause otitis externa.8,9
Feline demodicosis is rare and only a few cases have
been reported.10 29 Alopecia, scaling and/or crusting are
commonly seen.10,16,18,27 Lesions caused by D. cati are
found most commonly on the head and neck; cerumiCorrespondence: Ralf S. Mueller, Department of Clinical Sciences,
College of Veterinary Medicine and Biomedical Sciences,
Colorado State University, Fort Collins, CO 80523, USA. E-mail:
rmueller@colostate.edu
2004 European Society of Veterinary Dermatology

nous otitis externa may occur.2,19,27,28 The trunk seems

to be more commonly affected with D. gatoi.18 Pruritus
may or may not exist, although D. gatoi was associated
with moderate to severe pruritus in the majority of
reports.12,23,29 Ceruminous otitis externa due to D. gatoi
has also been reported.11

PATHOGENESIS
Demodex canis is an obligate parasite of the dog and
low numbers of mites are part of the normal cutaneous
fauna.3 Demodex mites are transmitted from the bitch
to the nursing neonates within the first days after birth.30
Stillborn puppies or puppies delivered by Cesarean
section do not harbour mites.31,32 Transmission of clinical disease from affected to healthy dogs has not been
possible except in one study.33 The life cycle involves
fusiform eggs hatching into six-legged larvae, moulting
into eight-legged nymphs and finally maturing into
adults.3 In the dog, D. canis is the most commonly recognized mite2 but a short-bodied3436 and a long-bodied
Demodex species37,38 have also been described. In the
cat, a short-bodied D. gatoi has been reported12,13,23,29,39
in addition to the more common D. cati. An unknown
third species has been reported in the cat.13 It has been
suggested that the short-bodied mites of the dog and
cat inhabit the stratum corneum12,29,36 and the canine
long-bodied mite resides in the pilosebaceous unit.37,38
When considering the pathogenesis of demodicosis
in dogs, it is important to distinguish between juvenileonset and adult-onset generalized disease. In the former,
certain breeds are at risk.2 Rigorous culling of carrier
dams and sires reduces, if not eliminates, juvenile generalized demodicosis from breeding kennels. Analysis
from two kennels suggested an autosomal recessive mode
of inheritance.2 Other predisposing factors mentioned
in the literature include short hair, poor nutrition, stress,
oestrus, endoparasites and debilitating disease.2,40
75

76

R. S. Mueller

In the last 30 years, a large amount of research has been

carried out to attempt to clarify the immunological events
allowing for the development of juvenile-onset generalized demodicosis. Unfortunately, the precise pathomechanism is still unclear. No abnormalities have been
identified in nonspecific32,41 and humoral immunity42,43
in dogs, although abnormalities of cell-mediated immunity have been reported in several studies. 41,4447
Adult-onset demodicosis can be triggered by drugs or
diseases altering the immune response. Hypothyroidism,
hyperadrenocorticism, leishmaniasis, glucocorticoid
therapy, neoplasias or chemotherapy have all been
reported in dogs with adult-onset demodicosis.40,4851
In the cat, demodicosis due to D. felis is usually associated with systemic disease such as chronic upper
respiratory tract infection,10 diabetes mellitus,15,22 feline
immunodeficiency virus infection,52 feline leukaemia
virus infection,16 hyperadrenocorticism,15,24 systemic
lupus erythematosus,16 squamous cell carcinoma in
situ53,54 and toxoplasmosis.16 However, idiopathic
feline demodicosis occurs rarely.14 In cats affected with
D. gatoi, concurrent food adverse reaction, diabetes mellitus and actinic dermatitis have been reported.17,18

DIAGNOSTIC METHODS
The standard method to diagnose demodicosis is microscopic evaluation of material obtained by a deep skin
scraping.2,55 Affected skin is scraped in the direction of
hair growth until capillary bleeding occurs. It is recommended to squeeze the skin prior to and during the
scraping to push the mites out from the hair follicles.
Lesions on paws and faces are difficult to scrape. Trichograms show Demodex mites in 50% of dogs with
demodicosis.56 Skin biopsy may be needed in some
patients to confirm the diagnosis. It may also be needed
in some breeds such as Old English sheepdogs, Scottish terriers and Shar peis with demodicosis.2,57 As
Demodex spp. is part of the normal cutaneous fauna,
occasionally a mite may be found on skin scrapings or
biopsies of normal patients.4 In evaluation of dogs with
skin disease even the presence of low numbers of mites
is of significance. It may be necessary to obtain multiple scrapings, trichograms or biopsies. If demodicosis
is suspected, continued diagnostic steps need to be made
until the diagnosis is confirmed or denied. Histopathological features of demodicosis are an interface mural
dermatitis, nodular dermatitis and/or folliculitis and
furunculosis with intrafollicular Demodex mites. In some
patients, perifollicular granulomas surrounding mite
fragments may be present.58,59

TREATMENT
To evaluate the treatment protocols for demodicosis in
small animals, an electronic search of the Medline and
CAB Abstracts databases was performed, using the terms
dog, canine, cat or feline and demodicosis or demodex. The

search was limited to articles in English, German, French

or Spanish. To increase the retrieval of additional veterinary
medical citations, textbooks of veterinary dermatology2,6,6062 and the four volumes of Advances in Veterinary
Dermatology6366 were also searched. Similarly, the bibliographies of all articles and book chapters discussing treatment of demodicosis were searched for additional citations.
Finally, an electronic message was sent to members of
the veterinary dermatology community (Vetderm listserve,
12 February 2003) to request information of any completed clinical trials involving therapy of demodicosis.
Unfortunately, many publications did not differentiate dogs with localized from those with generalized
demodicosis and failed to acknowledge the possibility
of self-cure of the former in the face of therapeutic
intervention. Those studies were not included in this
review. Therapy for generalized demodicosis is deemed
successful if remission is maintained for 12 months
after cessation of treatment,2 yet the follow-up period
in most studies did not uniformly extend to 12 months.
An evidence-based recommendation of drugs for
treatment of generalized demodicosis is formed after
careful scrutiny of the evidence of efficacy and harm
of the interventions reported below. The strength of
recommendation qualifier was modified from the 1996
report of the US Preventive Services Task Force67 as
either good or fair evidence for use of the medication,
insufficient evidence for/against use of the medication, or
fair or good evidence against use of the medication. The
basis for such recommendation statements is as follows:
1 When more than one study, including at least one welldesigned trial providing sufficient outcome details
and at least 12 months follow-up period, support
efficacy of the drug tested without common harmful adverse effects, there will be good evidence
for recommending the use of this medication.
2 When one well-designed trial or several studies without appropriate follow-up period provide support
of efficacy of the drug investigated, there will be fair
evidence for recommending the use of that drug.
3 When only one study without follow-up period was
conducted, or multiple studies yield controversial
evidence of treatment effect, it will be concluded
that there is insufficient evidence for/against recommending prescription of the medication tested.
4 When one well-designed study or several less detailed studies provide evidence of lack of efficacy, or
efficacy associated with common harmful events,
there will be fair evidence against recommending
the use of this medication.
5 When more than one study, including at least one
well-designed trial, support the lack of efficacy of
the drug tested, or support any efficacy but with
unacceptable side-effects, it will be concluded there
is good evidence against recommending the use
of the drug evaluated.
When studies were evaluated, the total number of
patients and the number of dogs with adult-onset

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 75 89

Demodicosis treatment
demodicosis included were recorded as well as the
animals considered cured, the follow-up period, the
number of patients with disease recurrence during this
follow-up period, the number of animals not responding to treatment clinically and/or microscopically and
the number of patients maintained in clinical, but not
microscopic, remission. Animals lost to follow-up or
patients in which the treatment was discontinued due
to adverse effects were considered treatment failures.

CANINE DEMODICOSIS
Localized demodicosis resolves spontaneously in the
majority of dogs, thus mite-specific therapy is not necessary until the disease generalizes. Dogs with generalized demodicosis should not be used for breeding because
of the strong genetic basis of the disease. Abstinence
from miticidal treatment of localized demodicosis allows
identification of those patients with progressive disease. If desired, topical and/or systemic antibacterial
therapy for the treatment of secondary bacterial infection may be initiated. Benzoyl peroxide gel or mupirocin ointment are particularly suited. A secondary
bacterial folliculitis is present in the majority of dogs
with generalized demodicosis. Cytological evaluation
of impression smears may reveal bacteria. If organisms
are present, cocci and rods should be differentiated.55
The most common bacterium isolated is Staphylococcus
intermedius. Empirical therapy for 38 weeks is usually
appropriate. The most common gram-negative bacteria
found in canine demodicosis are Pseudomonas aeruginosa or Proteus mirabilis. If rods predominate, bacterial
culture and sensitivity is recommended, as the resistance pattern of these organisms is more unpredictable.
In addition to systemic antibiotics, antibacterial shampoo therapy is frequently used to remove crusts and treat
bacteria topically. Benzoyl peroxide shampoo is most
commonly recommended because of its presumed
follicular flushing activity.68
Specific miticidal therapies for generalized demodicosis are summarized in Table 1. Some of these therapies are no longer marketed due to their patient or
environmental toxicities and have been replaced with
safer alternatives but are discussed for the sake of completeness. At this time the most commonly used therapies are amitraz and macrocyclic lactones such as
ivermectin and milbemycine oxime.
Ronnel (O,O-dimethyl 0-(2,4,5-trichlorophenyl) phosphorothioate), an organophosphate and cholinesterase inhibitor, was the first routinely recommended
therapy for generalized demodicosis.32,41,69 Topical 4
8.5% ronnel applied to one third of the body daily to
every third day was either used alone or in combination
with systemic ronnel at 5070 mg kg1 orally with a
success rate of 80100%. Despite limiting amount of
body surface and frequency of treatment, organophosphate toxicities of salivation, emesis, diarrhoea, miosis,
bradycardia, tremors, dyspnoea, convulsions and death
may occur. In one study, 2/20 patients died, one due to

77

organophosphate poisoning, in the other, necropsy did

not identify a reason for the sudden death.69 Because of
the potential for severe side-effects in both the patient
and person applying the treatment, the use of ronnel is
no longer recommended. Phoxim is an organophosphate
compound still marketed in Europe and was shown to
be an effective therapy in four dogs with generalized
demodicosis at 0.1% topically once weekly.70 No follow-up
period was reported in any of these studies.
Amitraz (N-(2,4-dimethylphenyl)-N[[(2,4-dimethylphenyl)imino]methyl]-N-methyl-methanimidamide) is
an acaricide/insecticide of the formamidine family and
was the first product licensed for use in the treatment of
generalized demodicosis. Its development marked a
significant step forward in the therapy of generalized
demodicosis and remained the standard of therapy for
more than 20 years. Amitraz is a monoamine oxidase
inhibitor, an 2-adrenergic agonist and inhibits prostaglandin synthesis.71,72 Amitraz is applied topically. To
maximize skin contact for efficacy, clipping of the hair
coat in medium- and long-haired dogs is essential. The
use of an antibacterial shampoo to remove crusts and
bacteria is recommended before the rinse.6,71 Rinsing
should be performed in a well-ventilated area and protective clothing should be worn by the handler, as adverse
effects such as respiratory problems have been observed in humans.2,51,73,74 Dogs should not become wet
between rinses to maximize efficacy. Recommended
treatment protocols vary from 0.025% amitraz used
every 2 weeks in the USA75,76 to 0.05% weekly in Germany
and Australia.77,78 A report from France recommended
0.1% amitraz once weekly.79 Higher concentrations
and/or frequencies seem to be associated with a higher
success rate.80 Daily therapy with 0.125% amitraz on
alternating halves of the body was reported to be efficaceous for 73% of 32 dogs with generalized demodicosis
resistant to conventional therapy.81 Recently, amitraz
at 1.25% weekly was used successfully to treat generalized demodicosis in eight dogs that had failed to respond to amitraz at lower concentrations.82 These dogs
were premedicated with atipamezole at 0.1 mg kg1
intramuscularly once and yohimbine 0.1 mg kg1 once
daily orally for a further 3 days in an attempt to counteract the 2-adrenergic activity of amitraz which results
in bradycardia, a decrease in rectal temperature and
hyperglycemia.72 In patients with pododemodicosis or
demodectic otitis externa a mixture of amitraz and
paraffin or mineral oil (0.13%,75 0.5%9 or 2%2 amitraz) has
been recommended topically daily to every three days.
Eleven dogs with generalized demodicosis (nine with
juvenile-onset and two with adult-onset) were treated
using collars containing 9% amitraz, which were replaced
every 3 weeks.91 Nine dogs were pronounced in remission after 9 weeks, two others were still showing clinical
signs. No follow-up period was specified.
Combining the results of studies reporting the efficacy of amitraz rinses as therapy for canine generalized
demodicosis, 693 dogs, of which 72 were reported as
adult-onset patients were treated.35,38,48,49,7578,8090
The studies used 0.0250.06% amitraz every 714 days.

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 7589

Reference

No. dogs
included
20
8
20
88
1
14
6
6
34
4
36

86
73
91
7
48
100
109
78
38
121
118
82
54
85
85
85
88
88

40
10
11
46
21
20
31
25
3
40
99
8
23
21
4
3
2
2

88

88
80
83
136
81
103
120
119
51
37

2
14
49
9
32
12
30
26
18
1

Drug and dose evaluated (administered orally

unless noted otherwise)

Evaluation
criteria

Separation of juvenileand adult-onset

Follow-up
period (months)

Ronnel 8.5% topically on 1 / 3 of body every 3 days

Moxidectin at 200 400 g kg1 every 24 h
Moxidectin at 300 400 g kg1 every 24 h
Milbemycin oxime at 0.5 2 mg kg1 every 24 h
Amitraz rinses at 0.06% weekly
Sprayed 1 2 with herbal preparation
Maggacite rinse every 12 h for 7 days
Deltamethrin rinse every 12 h for 7 days
Amitraz (% not mentioned)
Amitraz rinses at 0.025 0.05% every 3 7 days
Vitamin E 200 mg dog1 every 4 h (17)
Amitraz rinses 0.025 0.05% weekly (9) or both (10)
Amitraz rinses at 0.025% every 14 56 days
Ivermectin at 350 g kg1 every 24 h
9% amitraz collar every 3 weeks
Milbemycin oxime at 0.5 2.3 mg kg1 every 24 h
Amitraz rinses at 0.1% every 7 days
Ivermectin at 600 g kg1 every 24 h
Ivermectin at 600 g kg1 every 24 h
Amitraz rinses at 0.05% every 7 days
Amitraz rinses at 0.025% weekly
Milbemycin oxime at 0.5 mg kg1 every 24 h
Milbemycin oxime at 0.5 1.6 mg kg1 every 24 h
Amitraz rinses at 1.25% every 7 days
Doramectin at 200 g kg1 SC every 7 days
Amitraz rinse at 0.05% every 7 days
Ivermectin 490 g kg1 SC every 7 days
Deltamethrin rinse 0.005% every 7 days
Muramyl dipeptide at 0.2 mg kg1 SC every 7 days
Muramyl dipeptide at 0.2 mg kg1 SC every 7 days
and amitraz rinses at 0.025% every 3.5 days
Muramyl dipeptide at 0.2 mg kg1 SC
every 7 days and amitraz rinses at 0.05% every 3.5 days
Amitraz rinses at 0.025% every 3.5 days
Amitraz rinses at 0.03 0.06% every 7 14 days
Amitraz rinses at 0.025% every 14 days
Closantel SC at 5 mg kg1 once then 2.5 mg kg1 every 7 days
Amitraz rinses at 0.125% on half of body every 24 h
Ivermectin at 400 g kg1 every 24 h
Milbemycin oxime 0.52 3.8 mg kg1 every 24 h
Milbemycin oxime at 1 2 mg kg1 every 24 h
Milbemycin oxime at 1 2 mg kg1 daily
Milbemycin oxime at 2 mg kg1 daily

CE
CE, SS, FU
CE, SS, FU
CE, SS, FU
CE, FS, FU
CE, SS
CE, SS
CE, SS
CE, SS, FU
CE, SS, FU

Yes
Yes
Yes
No
Yes
No
No
No
Yes
Yes

8 12
3 12
12
3 12
12
None mentioned
None mentioned
None mentioned
3 48
9

18
8
17
77
1
14
6
6
7
2

CE, SS
CE, SS
CE, SS, FU
CE, SS
SS
CE
CE, SS, FU
CE, SS, FU
SS, CE
CE, SS, FU
CE, SS, FU
SS, CE, FU
CE, SS, FU
CE, SS, FU
CE, SS
CE, SS
CE, SS
CE, SS
CE, SS

Yes
No
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes

None mentioned
None mentioned
6 12
None mentioned
Up to 48
None mentioned
12
12
12
18 36
12
12
6 36
7 54
None mentioned
None mentioned
None mentioned
None mentioned
None mentioned

36
18
5
9
29
14
14
23
20
2
39
84
8
12
21
2
0
2
2

CE, SS

Yes

None mentioned

CE, SS
CE, SS
CE, SS
CE, SS
CE, SS, FU
CE, SS, FU
CE, SS, FU
CE, SS, FU
CE, SS, FU
CE, SS, FU

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

None mentioned
6
None mentioned
None mentioned
12
14 23
12
12
12
No

2
8
23
6
14
5
16
18
13
1

No. dogs pronounced cured

R. S. Mueller

69
125
127
122
35
134
135
135
49
77
89

78

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 75 89

Table 1. Studies and case reports evaluating the treatments of canine demodicosis*

Table 1. Continued.
Reference

No. dogs
included
27
245
6
6
6
1

105
101
104
87
102
131
32

1
10
12
5
1
11
20

41
84
84
76
70
106
106
107
126
108

48
17
4
172
4
26
26
12
22
13

Ivermectin 300 g kg daily

Amitraz rinses at 0.025% every 14 days
Homeopathic Suphur 200 at 5 drops daily
Homeopathic Heparsulphuris 200 at 5 drops daily
Homeopathic Psorinum 200 at 5 drops daily
Amitraz at 0.025% every 14 days, then
milbemycine oxime at 1 mg kg1 every 24 h
then ivermectin at 400 g kg1 every 24 h
Ivermectin at 600 g kg1 every 24 h
Ivermectin at 1.5 mg kg1 of 0.5% pour-on 3 times a week
Ivermectin at 600 g kg1 daily
Amitraz rinses 0.03% every 7 days
Ivermectin at 600 g kg1 every 24 h
Lufenuron at 13.3 15.8 mg kg1 three times a week
Ronnel 8.5% topically and
50 70 mg kg1 orally every 24 h
Ronnel 8.5% on 1 / 3 of body every 24 h
Amitraz rinses at 0.025% every 7 14 days
Ivermectin at 400 g / kg SC every 7 days
Amitraz rinses at 0.025% every 14 days
Phoxime rinses at 0.1% weekly
Ivermectin at 1 6 200 g kg1 SC every 7 14 days
Moxidectin 1 4 200 g kg1 SC every 7 14 days
Ivermectin at 450 600 g kg1 every 48 h
Moxidectin at 400 g kg1 every 24 h
Ivermectin at 200 g kg1 every 7 days SC

Evaluation
criteria

Separation of juvenileand adult-onset

Follow-up
period (months)

No. dogs pronounced cured

CE, SS, FU
CE, SS, FU
CE, SS
CE, SS
CE, SS
CE, SS

Yes
Yes
Yes
Yes
Yes

12 24
12
None mentioned
None mentioned
None mentioned
2

23
164
0
0
0
0

CE, SS, FU
CE, SS, FU
CE, SS, FU
CE, SS
CE, SS, FU
CE, SS
CE, SS

Yes
Yes
Yes
No
Yes
No
Yes

6
13
12
1
6
None needed
None mentioned

1
1
10
3
1
0
20

CE, SS
CE, SS, FU
CE, SS, FU
CE
CE
CE, SS
CE, SS
CE, SS, FU
CE, SS
CE

Yes
Yes

None mentioned
12
12
None mentioned
None mentioned
None mentioned
None mentioned
4 15
None mentioned
None mentioned

43
0
1
158
3
16
18
11
16
9

No
Yes
No
No
Yes
Yes
No

Demodicosis treatment

*SS = skin scrapings, CE = clinical examination, FU = follow-up period, SC = subcutaneously.

Data obtained from author.

79

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 7589

40
75
33
33
33
138

Drug and dose evaluated (administered orally

unless noted otherwise)

80

R. S. Mueller

Reported treatment success varied between 0 and 100%

(Table 2). Adult-onset demodicosis responded less
favourably to therapy. However, in many patients, underlying disease was not pursued, diagnosed or treated. A
marked limitation in some studies was that patients
were not followed after initial remission. In those studies with a follow-up period of 12 months35,75,78,81,84
recurrence of demodicosis diagnosed by skin scrapings
occurred in 29 of 254 dogs (11%).
Adverse effects with amitraz therapy were depression,80,84 sleepiness,75,85 ataxia,80 polyphagia/polydipsia80
and vomiting and diarrhoea.82,85 With 1.25% amitraz,
generalized erythema, scaling and an unpleasant odour
were noted.82
Systemic macrocyclic lactones such as avermectins
(e.g. ivermectin, doramectin) and milbemycins (milbemycin oxime and moxidectin), are broad-spectrum
antiparasitic agents produced by the fermentation of
various actinomycetes and have been used more recently
for the treatment of generalized demodicosis. They bind
selectively and with high affinity to glutamate-gated
chloride channels resulting in increased cell permeability for chloride ions and cause neuromuscular blocking
resulting in paralysis and death of the parasite. They
also interact with gamma-aminobutyric acid (GABA)
sites. Mammalian safety is due to mammals not having
glutamate-gated chloride channels in the peripheral
nervous system. In mammals, GABA is a central nervous system neurotransmitter and these drugs do not
cross the bloodbrain barrier.92
Ivermectin is the fermentation product of Streptomyces avermitilis and in small animals is licensed only
for the prevention of dirofilariasis at a dosage of 6 g kg1
once monthly. However, it is widely used for the treatment of ecto- and endoparasites at doses of 200

400 g kg1 weekly or every other week.9399 Its usefulness

for the treatment of generalized demodicosis was first
reported in the mid 1980s.84 In the last two decades,
several reports evaluating various dosages and protocols have been published.40,73,84,85,100109 An early protocol,
treating with ivermectin at 400 g kg1 subcutaneously
once weekly did not demonstrate much efficacy(0 and
54%).84,85,106,108 In the first study using this protocol,
only one of the four dogs treated maintained remission
for more than 12 months.84 The other studies do not
report a follow-up period period.85,106,108 Thus, their
results should be interpreted with caution as approximately one quarter of dogs with generalized demodicosis treated with ivermectin orally in one study relapsed
within the first 12 months.109 To evaluate whether the
bovine topical formulation could be used, 1.5 mg kg1
of 0.5% pour-on solution was administered three times
weekly for 36 months to 12 dogs with chronic generalized demodicosis.101 Only two dogs had negative skin
scrapings after 3 and 5 months of treatment, and one
of them relapsed 2 months after cessation of therapy.
Seven reports evaluate the use of ivermectin at
300600 g kg1 daily orally for the treatment of generalized demodicosis in the dog.40,73,100,102104,109
They included a total of 120 patients (Table 3). The
mean duration until the first negative skin scraping
ranged from 6.5 to 28 weeks, the mean treatment duration was 1033 weeks. The success rate of treatment in
the study using 300 g kg1 daily40 was comparable with
the efficacy in the two studies using 600 g kg1
daily,100,104 whereas it was decreased in a study using
350 g kg1 daily73 and even lower in another administering 450 g kg1 of ivermectin daily.103 Similarly, higher
dosing100 did not result in shorter mean times to achieve
negative skin scrapings compared with lower dosing.40

Table 2. Details of the analysis of a number of studies35,38,48,49,75 78,80 90 evaluating amitraz therapy for the treatment of generalized demodicosis
in the dog
Generalized demodicosis
( juvenile- and adult-onset)
Total no. of dogs
In clinical and microscopic remission post therapy (%)
Maintained in clinical remission with ongoing therapy (%)
Relapsed (%)
No response (%)
Other reason for negative outcome (lost to follow-up
cessation of therapy due to adverse effects, etc.) (%)

693
452 (65)
63 (9)
33 (5)
38 (5)
107 (15)

Adult-onset demodicosis
72
23 (32)
22 (31)
6 (8)
21 (29)

Table 3. Details of the analysis of a number of studies40,73,100,102104,109 evaluating daily ivermectin therapy for the treatment of generalized demodicosis
in the dog
Generalized demodicosis
( juvenile- and adult-onset)
Total no of dogs
In clinical and microscopic remission post therapy (%)
Relapsed during 12 months post cessation of therapy (%)
No improvement with therapy (%)
Other reason for negative outcome (lost to follow-up
cessation of therapy due to adverse effects, etc.) (%)

120
81 (68)
21 (18)
1 (1)
17 (14)

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 75 89

Adult-onset demodicosis
16
11 (69)
2 (13)
3 (19)

Demodicosis treatment
Alternate day ivermectin therapy at 450600 g kg1
was evaluated in 12 dogs.107 Ten responded to therapy,
but the follow-up period periods varied from 4.5 to
15 months (data obtained from author).
Adverse effects in all of these studies were rare and
included lethargy, oedematous wheals, ataxia and mydriasis. These developed as late as 10 weeks into treatment.40,104,108 Severe adverse effects of ivermectin have
been reported previously in dogs and cats.110 115 Collies
are particularly sensitive, in one study half of the 14 Collies
treated with ivermectin at 200 g kg1 developed severe
adverse effects.116 However, acute severe toxicity may
rarely develop in an individual of any breed. One report
recommended to gradually increase the dose of ivermectin administered from 50 g kg1 to 100, 200 and
300 g kg1 during the first days of treatment to identify sensitive animals.110 Because of the relatively long
half-life of ivermectin117 serum concentrations of ivermectin administered daily continue to increase for weeks
before reaching equilibrium at much higher levels than
with weekly therapy. Thus, chronic toxicity due to
cumulative therapy may develop with prolonged daily
ivermectin treatment.
Milbemycin oxime is the fermentation product of
Streptomyces hygroscopus aureolacrimosus and in most
countries is approved only for the use of monthly
heartworm and intestinal parasite prevention in dogs
at a dose of 0.5 mg kg1. There are eight reports on the
use of milbemycin oxime at 0.53.8 mg kg1 for generalized demodicosis.7,37,51,118122 The mean duration to
achieve negative skin scrapings was 826 weeks, mean
treatment duration was 1230 weeks. Results of the
six studies providing sufficient detail and a 12-month
follow-up period are summarized in Table 4.7,51,118121
Several studies have shown a higher success rate with
higher doses.7,51,119 This finding was negated when
reviewing the overall data, with the inclusion of two large
Swedish studies that reported very high success rates
with low-dose milbemycin treatment.118,121 When these
studies were excluded, an increased success rate was
detected with higher doses of daily milbemycin (Table 4).
The reason for different success rates in the Swedish vs.
all other studies is unclear, but may relate to differences
in genetic make-up of the canine population or sensitivity of Demodex mites to milbemycine oxime. Another
possible reason is that many dogs in other studies had

81

failed prior conventional therapy and thus may represent

a different study population.7,51,120 As with amitraz
therapy, a lower success rate was observed with adultonset demodicosis. 118120 No correlation was detected among treatment outcome, breed and sex.118 120
Duration of disease prior to treatment onset was not
correlated with treatment outcome in two studies.119,120
In another study the average duration of disease prior
to onset of therapy was 2.3 months in dogs cured by
therapy and 6.7 months in dogs not completely responding.118 Rare adverse effects were stupor, ataxia and
trembling in two dogs at 3.8 mg kg1 day1,120 transient
vomiting7 and lethargy.51 The safety of high-dose
milbemycin oxime in avermectin-sensitive Collies has
been evaluated.123 Five avermectin-sensitive Collies were
treated with 5 mg kg1 and 10 mg kg1 of milbemycin
oxime, two developed depression resolving within 24 h
of the 5 mg kg1 dosing and all dogs developed ataxia
and depression resolving within 24 h of administration
of 10 mg kg1.123 In another study evaluating six Collies
and six Shiba Inus, no adverse effects were seen with
once daily dosing of up to 2.5 mg kg1 for 10 days.124
These findings support the wide safety margin of
milbemycin oxime. However, as occasional sensitive
patients will develop neurological adverse effects,
particularly at higher doses, thorough client education
and appropriate monitoring is indicated.
Moxidectin is another milbemycin that was evaluated for the therapy of canine generalized demodicosis.
Twenty-six dogs were divided in different groups and
treated with various protocols of moxidectin injected
subcutaneously at 200 g kg1 weekly or every other
week for 14 doses.106 The success rate varied from 33
to 100%, and adverse effects were not seen. A follow-up
period was not mentioned. Three studies have evaluated moxidectin at 200400 g kg1 day1 orally,125 127
two of which126,127 employed the initial gradual dose
increase advocated for ivermectin.110 Combining the
studies, 52 dogs with generalized demodicosis, 41 with
juvenile-onset and 11 with adult-onset demodicosis,
were treated with oral moxidectin. Thirty-one (76%)
of the dogs with juvenile-onset demodicosis were in
remission after 814 weeks, seven were lost to followup. Of the eleven dogs with adult-onset demodicosis,
nine were in remission after 816 weeks. Two dogs
developed ataxia, one at 0.28 mg kg1, the other in the

Table 4. Details of the analysis of a number of studies7,51,118121 evaluating daily milbemycin oxime for the treatment of generalized demodicosis
in the dog (Number of dogs [excluding two Swedish studies118,121 ])

Total no of dogs
In clinical and microscopic
remission 12 months post therapy (%)
Relapsed during 12 months
post cessation of therapy (%)
Negative skin scrapings not
achieved with therapy (%)

Low dose therapy (0.51.5 mg kg1 day1)

High dose therapy (> 1.5 mg kg1 day1)

Juvenile generalized
demodicosis*

Adult-onset
demodicosis*

Juvenile generalized
demodicosis*

Adult-onset
demodicosis*

175 [62]
101 (58)
[16 (26)]
42 (24)
[15 (24)]
31 (18)
[31 (50)]

64 [18]
35 (55)
[4 (22)]
4 (6)
[4 (22)]
24 (38)
[10 (56)]

57
38 (67)

14
5 (36)

11 (19)

8 (57)

7 (12)

1 (7)

*Numbers do not add up, as some dogs did not fit in any of the specified categories.
2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 7589

82

R. S. Mueller

second week of treatment. One dog became lethargic,

inappetent and started vomiting. Moxidectin was
discontinued in all three dogs showing adverse effects.126
In the first study presented, remission during a followup period of 12 months was required to pronounce cure
(data obtained from author).127 In one of the other
studies, dogs were not followed126 in the last, the followup period varied from 3 to 12 months.125 As moxidectin is
a macrocyclic lactone and has a similar mode of action
to the other drugs in this group, the success rate and rare
adverse effects are not surprising. However, more studies
with longer follow-up period periods are needed to identify potential benefits and disadvantages of this drug.
Doramectin is the final macrocyclic lactone successfully used for therapy of generalized demodicosis.54
Twenty-three dogs were injected weekly with 600 g kgsubcutaneously for 523 weeks. Ten of the dogs were
cured, seven relapsed after 124 months (two of which
responded to repeat doramectin treatment) and six were
lost to follow-up. None of the animals in this study showed
any adverse effects with therapy. Further investigations
are needed to evaluate doramectin for the treatment of
generalized demodicosis.
A number of other drugs have been evaluated for the
use of generalized demodicosis. As an immune aberration is considered an important factor in the development of generalized demodicosis and proliferation of
lymphocytes in affected dogs is suppressed41 immunomodulatory agents have been evaluated for the treatment of demodicosis. Levamisole has been used in two
studies41,128 both of which showed a positive effect on
lymphocyte proliferation assays, but not on clinical or
microscopic resolution of demodicosis. The levamisole
dose varied from 3 to 10 mg kg1 given at different intervals.
A mycobacterial cell wall component, muramyl dipeptide, was injected subcutaneously at 0.2 mg kg1 weekly
in dogs with generalized demodicosis either as monotherapy or in combination with amitraz at two different
concentrations (0.025 and 0.05% twice weekly) and compared with therapy with amitraz alone at 0.025% twice
weekly.88 Remission was achieved in all dogs. The study
numbers very small (two dogs per treatment group) and
there was no follow-up period, thus it is difficult to ascertain if the muramyl dipeptide was of any benefit. Muramyl
dipeptide also increased the lymphocyte response to
mitogens without reaching the comparative values of
healthy dogs.129 Adverse effects were not mentioned.
Lufenuron is a benzoylphenyl urea and chitin synthesis inhibitor. As chitin is found in the shells and
exoskeletons of all life stages of Demodex spp.130 it was
proposed that this compound might interrupt the life
cycle of the Demodex mite. Lufenuron was used at mean
doses of up to 15.8 mg kg1 three times weekly for 2
3 months with no success.131
A Brazilian study of 36 dogs with generalized
demodicosis evaluated the potential benefit of 1 g of
vitamin E daily, weekly amitraz rinses at 0.05% or a
combination of both therapies.89 Although all dogs
went into remission, the dogs on combination therapy
had the shortest time until remission (7.1 weeks vs. 7.3 weeks

with amitraz only and 8.5 weeks with vitamin E only).

Compared with a control group, affected dogs had lower
serum vitamin E concentrations. However, it was not
known if inadequate dietary intake of vitamin E at the
beginning of the study or the disease caused this difference. Another study evaluated mean serum vitamin E
concentrations of dogs with pyoderma, dogs with generalized demodicosis and normal dogs and failed to
detect a statistically significant difference between groups,
although the mean levels of the dogs with demodicosis
were lower than those of the control group.132
Homeopathic preparations containing Sulphur 200,
Heparsulphuris 200 or Psorinum 200 were given orally
at 5 drops daily for 5 weeks to three groups of six puppies experimentally infected with Demodex canis.33
The post-treatment mean demodicosis indices133 were
significantly lower in the groups treated with Sulphur
200 and Psorinum 200 compared with the group treated
with Heparsulphuris 200 and a control group, but neither complete clinical nor microscopic resolution could
be achieved. An herbal preparation containing extracts
of Cedrus deodara, Azadirecta indica and Embelia ribes
was sprayed on lesions of 14 dogs with apparent generalized demodicosis.134 Dogs were reevaluated after 24 h
and if D. canis mites were still present on skin scrapings, dogs were retreated once. Subsequent weekly skin
scrapings for 6 weeks were negative in all dogs.
Deltamethrin sprayed on three dogs with generalized demodicosis at 0.005% did not decrease clinical
signs or mite numbers on scrapings after 3 weekly applications.85 Deltamethrin at 12.5% was used in another
report and compared with an indigenous preparation
containing extracts of Mallotus phillipensis, Oleum pinus,
Oleum terebinth and Sulphur sublimatum. Topicals
were applied twice daily until skin scrapings were negative, which took 7 days in the group treated with the
indigenous preparation and 11 days for deltamethrin.135
Dogs had to be restrained for 1 h after the topical
application to prevent excessive licking. All dogs went
into remission and skin scrapings were still negative
one month after cessation of therapy.
Closantel
({N 95-chloro-4-(4-chlorophenyl
cyanomethyl)-2-methylphenyl}-2-hydroxyl 3,5 diiodobenzamide) is an anthelminthic of the salicylanilide
family and was used to treat nine dogs with generalized
demodicosis at a dose of 5 mg kg1 subcutaneously for
the first injection and 2.5 mg kg1 for subsequent weekly
injections.136 Six dogs were in remission after six injections, and in three dogs, negative skin scrapings could not
be achieved, although clinical improvement was noted.
A follow-up period was not specified.
In one dog with adult-onset demodicosis, treatment
of the primary disease resulted in resolution of the
demodicosis.38 In another study evaluating dogs with
adult-onset demodicosis49 4/9 dogs in which the primary
disease was diagnosed and treated successfully could
be cured. In contrast, only 3/25 dogs in which such a
disease could not be diagnosed or treated could be cured.
This emphasizes the need for pursuing and treating concurrent diseases in patients with adult-onset demodicosis.

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 75 89

Demodicosis treatment
FELINE DEMODICOSIS
Case reports and studies evaluating the treatment of cats
with demodicosis are summarized in Table 5. Twentyfour cats were treated with lime sulfur dips at 1.62% every
57 days.12,14,16 18,52 Sixteen of these cats were infested
with D. gatoi and eight with D. cati. Twenty-two cats were
cured after 46 weeks. One cat failed to respond to the
dips within the first month,14 another one responded
clinically, but skin scrapings stayed positive.16,126 Interestingly, two cats initially were treated with weaker concentrations (0.5 and 1%, respectively) without effect, but
went into remission when the concentration was increased to 2%.18 Adverse effects were not reported in any of
these cats. An Elizabethan collar is useful to prevent oral
ulceration and gastrointestinal signs, which are possible,
if the cat grooms itself before the dip has dried.137
Amitraz at a concentration of 0.01250.025% twice
weekly to every other week was used in 13 cats (11 with
D. cati and 2 with D. gatoi) for the therapy of demodicosis.11,14,15,21,23,25 All but two cats were cured after
24 weeks. Adverse effects were seen in one cat developing sedation and ptyalism after the first dip.14 Two cats
with D. cati did not respond and were euthanized (1) or
died (1) due to nephritis and concurrent FeLV/FIV.15
Rotenone was used in four cats at 0.75% in methylated spirit on one third of the body daily,13 as an ointment
topically daily,14,26 or as ear drops mixed with mineral
oil (1 part of rotenone with 3 parts of mineral oil) twice
weekly for a cat with demodectic otitis externa,19 respectively. Only two of these cats recovered19,26 one failed to
respond14 and one became anorexic after 4 days and
died another 4 days later although therapy had been
discontinued.13 Other topical organophosphates used
for the treatment of one cat with demodicosis each include
0.1% fenchlorphos twice weekly20 and phosmet at 0.087%
as a single treatment29 with good success. One cat was
maintained on weekly malathion rinses with good
control of clinical signs but persistent positive skin
scrapings.16
Three cats with D. cati were treated with doramectin
at 600 g kg1 subcutaneously weekly for 23 injections.54 Demodicosis resolved in all three cats; one stayed
in remission for 4 years, the other two cats were euthanized 46 months after resolution of the demodicosis
due to the primary squamous cell carcinoma in situ.
Adverse effects were not seen in any of the cats.
In one report, three cats with squamous cell carcinoma
in situ resolved their demodicosis without mite-specific
therapy when the primary disease was treated successfully with retinoids.53 This emphasizes the importance
of addressing the underlying disease when at all possible.

CONCLUSION
Implications for practice
Based on the criteria outlined at the beginning of this
section, there is good evidence for recommending
amitraz (weekly to fortnightly rinses at 0.0250.05%),

83

ivermectin (300600 g kg1 daily), milbemycin oxime

(2 mg kg1 daily) and moxidectin (400 g kg1 daily)
orally for the treatment of canine generalized demodicosis. Owing to the extremely rare, but possibly severe
adverse effects of macrocyclic lactones, an initial gradual dose increase and careful monitoring are indicated.
There is fair evidence for the use of higher concentrations of amitraz rinses at higher frequencies and weekly
doramectin at 400 g kg1 subcutaneously. There is
insufficient evidence for or against recommending the
use of amitraz collars, muramyl dipeptide, closantel,
deltamethrin, vitamin E, phoxime, herbal and homeopathic preparations. There is fair evidence against the
use of pour-on or injectable weekly ivermectin and lufenuron and good evidence against the use of ronnel and
levamisole. If a patient does not respond to any given
treatment, it is recommended to switch to another therapeutic option. Of 124 dogs reported to have failed their
first of various treatment options,54,73,77,81,82,84,104,119,127
76 patients (61%) went into remission with a change of
therapy. Similarly, of 40 dogs that relapsed after initial
remission,75,76,81,82 28 patients (70%) went into remission after a repeat treatment with the same or another
medication. A follow-up of at least 12 months after treatment cessation was recommended before a cure should
be pronounced.2 In four studies, in which the follow-up
for individual cases extended to 2 years or more, a recurrence of generalized demodicosis after more than 12
months was reported in 6 of the 32 cases (19%).7,38,40,54
Based on these reports, it seems prudent to alert owners
to the possibility of future recurrences even if dogs are
in prolonged remission after treatment.
In cats there is good evidence to recommend lime sulfur dips at 2% weekly for the therapy of demodicosis and
fair evidence for the use of amitraz rinses at 0.0125
0.025% weekly and doramectin at 600 g kg1 weekly subcutaneously, although the number of cats treated with the
latter two drugs is rather small. There is fair evidence
against the use of organophosphates in cats, particularly
in light of the effective and safe alternatives available.
Implications for research
There is insufficient evidence to recommend many
drugs with potential benefit for our patients with demodicosis and further studies will be needed to confirm or
refute the possible benefit or harm of these medications
for the treatment of generalized demodicosis. Examining the published trials and case reports of treatment
modalities for demodicosis, it quickly became apparent that many studies are difficult to evaluate. Future
studies evaluating demodicosis should report affected
body areas, time elapsed until complete clinical remission, until the first negative skin scraping and until cessation of therapy as well as follow-up period periods
for juvenile- and adult-onset demodicosis separately.
Details on adverse effects and maintenance therapy in
patients with recurrent demodicosis and clinical, but
not microscopic, remission should also be reported. This
will allow better comparison of results and enhance
our knowledge about therapy of demodicosis.

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 7589

84

Reference

No. cats
included

Drug and dose evaluated

Evaluation
criteria

Underlying
disease identified

Follow-up period
period [months]

Cats pronounced
cured

13

7
None

1
0

None mentioned
None mentioned
after 1 successful
therapy of relapse
1
24 48

4 10

3 (as long as
primary disease
controlled)
3
1
2

11

Amitraz

CE, SS

52
13

1
1

CE, SS, FU
CE, SS

12
14

1
1

Lime sulfur dipgs 2% every 5 days

Rotenone at 0.75% in methylated spirit daily
on 1/3 of body
1.6% lime sulfur dip
Rotenone ointment (contact dermatitis), then lime
sulfur (deterioration), then rinses at 0.0125% every 7 days

Dermatophytosis (1)
Allergies (1)
FIV
None

CE, SS
CE, SS

None
None

26
15

1
6

Rotenone ointment daily

Amitraz

CE
CE, SS, FU

53

Only treated with retinoids for SCC in situ

CE, SS, BX

54
29
16

3
1
3

Doramectin at 600 g kg1 SC every 7 days

Paramite at 0.5 oz/gal once
Lime sulfur dips at 2% every 7 days

CE, SS, FU
CE, SS
CE, SS

16

Malathion dips at 2% every 7 days

None
FIV (1), FeLV (3)
Iatrogenic Cushings
Squamous cell
carcinoma
(SCC) in situ
SCC in situ (2), FIV (1)
None
Pretreated with
prednisolone (1) FeLV
(1#), toxoplasmosis (1#)
Systemic lupus
erythematosus

17
18

3
15

20

18
None mentioned

24

CE, SS
CE

Food adverse reactions (2)

Food adverse reaction (3)
diabetes mellitus (1),
FIV (1), actinic dermatitis
(1) feline acne (1)
Pretreated with progestagen
hormone testosterone
thyroid
None
None

Clinically
controlled
but positive SS
3
15

None
None mentioned

1
1

CE, SS

None

None mentioned

Lime sulfur dips 2% weekly

Lime sulfur dips every 5 7 days

CE, SS, FU
CE, SS

Fenchlorphos rinses at 0.1% every 3.5 days

after premedication with atropine

CE, SS, FU

21
23

1
1

25

Amitraz rinses at 0.0125% weekly

Amitraz at 0.025% twice weekly
on affected areas
Amitraz rinses at 0.0125% weekly

*SS = skin scrapings, CE = clinical evaluation, FU = follow-up period, SC = subcutaneously.

Short bodied mite (Demodex gatoi ).

4 48
None mentioned
30 48

1
4

R. S. Mueller

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 75 89

Table 5. Studies and case reports evaluating the treatments of feline demodicosis*

Demodicosis treatment
ACKNOWLEDGEMENTS
The author would like to thank Drs Emmanuelle Bensignor, Mandy Burrows, Birgit Holm and Tiffany Tapp
for providing study details not in the published abstracts;
and to Drs Sonya Bettenay and Helen Power, whose
efficient feed back on the manuscript is gratefully
appreciated.

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Rsum Cet article tudie les publications relatives au traitement de la dmodcie chez le chien et le chat. En
se basant sur les preuves de la littrature, il est possible de recommander lutilisation de lamitraze en lotion la
dose de 0.025 0.06% tous les 714 jours, et par voie orale livermectine 300 mcg/kg, la milbmycine 2 mg/kg
et la moxidectine 400 mcg/kg chez le chien. Livermectine et la moxidectine devraient tre dbutes des doses
plus faibles et une surveillance doit tre ralise vis vis dventuels effets secondaires. Dans lespce fline, des
bains de lime sulfur 2% et des lotions damitraze 0.01250.025% ont t utiliss avec succs.
Resumen En este artculo se revisan publicaciones que discuten el tratamiento contra la demodicosis en el perro
y gato. Segn la literatura, el amitraz en enjuagues al 0.0250.06% cada 714 das, y la ivermectina oral diaria
a 300 mcg/kg, la milbemicina a 2 mg/kg y la moxidectina a 400 mcg/kg, respectivamente, se pueden recomendar
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Demodicosis treatment

89

para el tratamiento de la demodicosis canina generalizada. La ivermectina y la moxidectina deberan iniciarse a

dosis ms bajas y deberan monitorizarse los pacientes para controlar posibles efectos adversos durante la terapia.
En el gato, se han utilizado con xito los enjuagues en un 2% de sulfuro de lima o en amitraz al 0.01250.025%.
Zusammenfassung Es werden Verffentlichungen, die sich mit der Behandlung von Demodikose beim Hund
beschftigen, errtert. Basierend auf Hinweise in der Literatur knnen 0,0250,06% Amitraz-Splungen in
ein- bis zweiwchigen Abstnden, tgliche orale Gabe von 300 mcg/kg Ivermectin, 2mg/kg Milbemycin, beziehungsweise 400 mcg/kg Moxidectin fr die Behandlung der generalisierten Demodikose beim Hund empfohlen
werden. Mit Ivermectin und Moxidectin sollte in geringerer Dosis begonnen werden und Patienten sollten in
Hinblick auf mgliche Nebenwirkungen whrend der Therapie berwacht werden. Bei Katzen wurden 2%-ige
Schwefelkalk- und 0.01250.025% Amitraz-Splungen erfolgreich eingesetzt.

2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 7589