It seems that no matter why a dog is brought in, many quick-draw vets immediately fire their salvos of antibiotics and/or steroids. Most (or at least a great part) of the time, these are the wrong or ineffective approaches, but it’s a natural reaction, like smashing a snake even though the odds may be 50-to-one that it’s not a poisonous one. In my experience, simple cleaning does more than this automatic application of topical antibiotics or shots. If it is mange, keeping it dry and applying the right stuff is a better route. Even if it is not mange, the treatments used for demodex often combat other problems, too. Here is an excerpt from my GSD book plus a paragraph from one of my magazine/website articles.
Hot Spots — Dermatology is a complicated, sometimes frustrating study, as there are numerous ailments that can cause similar reactions and symptoms on the skin. Dermatologists almost never get called for emergencies, but often spend long hours trying to find the cause of the clinical signs. Most are found, if at all, by trying one thing after another until the problem clears up, the client runs out of money, or the patient dies or moves away. Some are relatively easy to treat and guess at the cause, such as “hot spots”. When diagnosed by your vet at higher cost, this condition is known as “acute moist dermatitis” or “pyotraumatic dermatitis” (py- or pyo- referring to pus). It is an annoying, perhaps painful inflammation brought on by self-inflicted trauma to the skin, either biting or scratching, in which bacteria infect the abraded skin and turn red within hours. Almost always (with the exception of mange), hot spots are caused initially by a flea bite, although the location of the sore is not always where the flea was; it may be that the flea saliva antigen circulating in the bloodstream stimulates a certain area to itch madly. Ticks also trigger some hot spots, but in both cases, the chances of a big raw spot are increased if the haircoat has not been groomed so that dead undercoat is removed. A damp dirty, unkempt environment encourages hotspots. If need be, treat the grounds, carpeted areas, and the dog for fleas, but if it were a wandering Ctenocephalides not in noticeable numbers, just attack the symptoms.
One good way to clean a raw hotspot is to soak it with rubbing alcohol and gently pull dead loose undercoat away with your fingers, or comb it away from the center, removing as much as you can. If you don’t mind the way the dog looks, cut the hair close around it so long hairs don’t lie over the sore. You must dry out the spot and keep it dry. The dog doesn’t like the taste of alcohol, so he’ll leave it alone while it dries. Repeat two or three times a day. Salves, creams, powders, and the rest are not as effective as alcohol drying. Prevention is a more a matter of keeping all dead undercoat stripped out than it is fighting the flea. Hot spots, as you might deduce, are more common in breeds with dense undercoat and/or long hair.
Most effective is the use of an iodine-containing preparation conveniently found in rural “feed-&-seed” stores in gallon jugs (one of these will probably last you all your breeding/feeding lifetime) or the sponge scrub pads sold by your vet—more expensive if you are paying for an office visit at the same time. Look for the identification “Povidone-iodine”. Use straight or with a little water. Apply it to the lesion and leave it on the dog a good long while. Rinse it off only if and when there is danger the dog might lick it. It forms somewhat of a lather if mixed with water and if there are many spots, it can be used in place of shampoo or as an additive to it. I have found this to be very useful for non-specific hot spots (caused by who-knows-what) and have never had a bad reaction. It seems to inhibit mange mites and other pathogens.
However, when a dog owner describes it as a lesion on the side of the face, it makes me think of demodex. That’s a common location for the localized form.
Demodectic mange — When one speaks of “mange,” it is usually this type, once called “red mange.” It is very difficult to treat because many of the mites that cause it are in a dormant stage in well protected hair follicles until the animal becomes sick from other causes. Such illness or other stress seems to “awaken” the mites that then come out of hibernation to do their dirty work. Combating demodecosis is largely a matter of curing the dog’s other ills, both physical and psychological. Years ago it was thought the only cure was euthanasia, but today a series of varying treatments in succession can have good results, if patience is part of the prescription. There is a definite and considerable genetic factor involved which determines how susceptible he will be to Demodex attack.
The rapid growth months of a pup’s life are stressful enough to contribute to susceptibility. Classic signs of infestation are hair loss on foreface, just below the ears, around elbows, and over the croup and base of the tail, plus itching and scratching. The scratching may open up the skin to secondary infection and require antibiotic therapy, perhaps daily and lifetime, even in mild cases. Insecticides used on the major portion of the dog by means of rag- or sponge baths may contain lindane (chlordane is no longer available) or rotenone in water emulsions. Benzoyl peroxide or benzoate cream is good to apply around the lips and eyes, though all can cause irritation. Do not attempt treatment except under the direction of a veterinarian well versed in the latest knowledge of the problem. Treatment may be worse than letting it run its course, in certain milder instances. The best thing you can do besides follow the vet’s direction is to give the pup vitamins E and C in order to help him build up his immune response. Demodex mites are on all dogs (and probably people) but the resistance to them is a matter of immune system “strength.” Thus, use of steroids is contraindicated because they compromise this immune defense.
“There are some remedies worse than the disease.” Publius Syrus, 1st Century B.C.
You would be disappointed if I weren’t consistent, so I’ll again point to genetic factors being almost certainly at the root of susceptibility to demodex. Stress and perhaps other environmental factors also play a part, of course, and the interaction of environment and genetic weakness may be too much for some dogs. In about 10% of dogs with localized demodecosis, the disease progresses into the generalized form, this being usually defined as five or more large hair-loss localities at or near the same time. The prognosis for the latter is much poorer in adult-onset cases, and heroic treatment is often in vain; but juvenile-onset generalized demodecosis is often less serious because many of these dogs have spontaneous “cures” without much help. However, if you have a youngster with generalized (or even some cases of localized) demodectic mange, you might be in for a regimen of dips, creams, and pills, and it might last a while. Mitaban™ is FDA-approved, but many vets use other therapies, such as high daily doses of ivermectin or the even more expensive Interceptor™ (milbemycin oxime) for as long as 8-9 months. If it is a localized case, remission in a couple of months is not uncommon even without treatment for the primary cause (the mite).
Flare-ups and occurrences of demodectic mange are more common in nervous or fearful dogs than in those with stable temperament. Thus, the most successful “treatment” seems to be lowering the stress level in the dog’s life. I recommend spaying any female that has demodex, at least the generalized expression, because estrus is always the most stressful period in a bitch’s life. And absolutely keep any affected dog from the opportunity to breed.