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How I approach... Demodicosis
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Introduction
The diagnosis and treatment of demodicosis has evolved since it was first described in 1842 (1). Indeed, as recently as 1979 one publication (2) noted: “Demodectic mange, particularly in the generalized form, may be one of the most persistent of diseases and often responds poorly to treatment,” but times have changed; a recent dermatology textbook states “the prognosis for generalized demodicosis has improved dramatically since the mid-’90s.....with intense treatment, most cases, probably near 90%, can be cured, but it may take nearly a year” (3).Over the past few years, newly identified mites and new shapes of old mites have been reported. Before you can identify the mite, however, you first need to find it; miss-ing the mite will certainly decrease your success rate! Knowing where to look is therefore critical. Appropriate treatment recommendations and prognosis will vary with the clinical presentation, the Demodex species and the life stages identified. As in all therapies, one must consider the risks associated with treatment; some former recommendations have been found to have no effect on speed of resolution, whilst adjunctive therapies may be helpful and necessary – but some could lead to fatal drug interactions. This article therefore reviews the various presentations of demodicosis and discusses the most effective diagnostic techniques, as well as considering treatment options and potential pitfalls.
Key Points
- The diagnosis and treatment of demodicosis has evolved since it was first described. In the last few years, newly identified mites and new shapes of old mites have been reported.
- Demodicosis can be either localized or generalized, and may be juvenile or adult in onset, but the clinical appearance can vary markedly.
- The traditional diagnostic tests of skin scraping and trichograms are still valid, but good sampling technique can increase the chances of successfully identifying the mite.
- Appropriate treatment recommendations and prognosis will vary with the clinical presentation, the Demodex species and the life stages identified.
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