The word “mange” conjures up images of sickly dogs infested with a nasty, highly stigmatized skin parasite, which is contagious to other dogs and to humans. So it’s no surprise that many owners are aghast when their young dogs are diagnosed with puppy mange.

The first type of mange — the scary, nasty one — is sarcoptic mange, also known as scabies. It is caused by a vile parasite named, unsurprisingly, Sarcoptes. It is common in developing countries and in dogs anywhere who live in conditions of suboptimal care and hygiene.

Puppy mange is something different altogether. It also is caused by a skin parasite. However, the parasite, called Demodex, is ubiquitous. It is present on virtually every dog. Most puppies contract the parasite very soon after birth, possibly while nursing (although there is some debate about how puppies contract the parasite, it is widely agreed that almost all puppies do contract it). Demodectic mange (another name for puppy mange) therefore generally doesn’t otherwise spread from dog to dog — it is not possible for a dog to catch something he already has.

Puppy mange earned its moniker because most dogs’ immune systems are able to effectively prevent the skin parasites from causing any symptoms. However, in young dogs with immature immune systems, the parasite sometimes gets a bit out of control. Symptomatic puppy mange is most common in dogs younger than 18 months; however, dogs of any age with compromised immune systems may develop symptoms.

The most common form of puppy mange is the so-called localized form. Dogs with this form of the condition develop small bald patches. The face frequently is affected, as are the forelimbs and the chest. However, the patches can occur anywhere on the body. The patches may shift over time — new ones may form while hair regrows on old ones. The patches usually aren’t red or itchy. In general, this form of puppy mange is quite harmless, and it generally does not behave in a contagious fashion.

Rarely, puppy mange can lead to complications. Secondary, opportunistic bacterial or yeast infections may cause exacerbated hair loss as well as scaling, itching, and redness. Some dogs (Pit Bulls seem to be especially predisposed) may develop a more serious form of puppy mange — the so-called generalized form.

Dogs with generalized demodicosis lose hair over large portions of their bodies. Some develop significant secondary infections, which can be very uncomfortable and malodorous.

Puppy mange can be diagnosed with a technique called skin scraping. A scalpel blade is used to abrade (scrape) the skin at the margin of a bald spot. Skin, hair, and debris will accumulate on the blade. Skin scraping, when properly done, will cause a small amount of blood to ooze from the scraped area; however, it generally is not painful for the dog.

After a skin scraping, the material that has accumulated on the scalpel blade is evaluated under a microscope. The Demodex organisms often will be visible in significant numbers. If so, a diagnosis of puppy mange is made. And even if not, a tentative diagnosis still might be made based upon the dog’s age and clinical symptoms.

Traditionally, treatment for puppy mange has depended upon the severity of the condition. For mild, localized puppy mange, I have generally recommended benign neglect (which is a fancy way of saying do nothing until the problem solves itself).

More serious cases historically have been treated with anti-parasite medications. The original treatment for puppy mange was a series of so-called Mitaban dips, and it is still widely in use (and it is the only treatment that is officially approved for use in the USA). Dogs undergoing this treatment receive a series of baths with a product called amitraz. The product has a strong odor, and it makes my eyes water. It has the potential to cause neurological side effects — most notably sedation — in humans and dogs.

Another treatment for puppy mange is a medication called ivermectin. This medication is generally given orally or by injection. However, it cannot be used safely in many Collies, Shelties, and other dogs who are prone to the MDR1 genetic mutation. In the olden days, vets used to have a saying about ivermectin: “white feet = don’t treat.” Now, thankfully, we have a blood test for the mutation.

Medications that are similar to ivermectin also may be employed in certain instances. Milbemycin (Interceptor) can be used, but is expensive. Moxidectin (sold most commonly in combination with imidacloprid as Advantage Multi) is frequently used, especially in Europe where the product has a label claim about Demodex. It is best to test dogs for the MDR1 mutation before using these products as well.

Dogs with secondary infections may require antibiotics or antifungal medications.

Dogs with generalized demodicosis often require several months of treatment; however, the overwhelming majority recover fully over time.

Although medications are often used for treatment of puppy mange, one should not forget that the condition really has more to do with the immune system than with the parasite. Dogs develop symptoms when their immune systems fail to suppress the parasites. Therefore, in recent years many experts have begun to focus on treatments that help the dog’s immune system help the dog.

These treatments are not rocket science. I’m not talking about special interferons or other advanced immune system boosters.

Rather, owners of dogs with puppy mange should focus on their dog’s overall health. Elimination of fleas and intestinal parasites will improve health and strengthen the immune system. Good nutrition helps to support a strong immune system. Dogs who are well cared for can still develop puppy mange, but they will recover from it faster.

Regardless of the circumstances, be patient. My pal Buster had localized puppy mange for several months after he was adopted from the shelter. The only treatments he needed were love and time.

Read more by Dr. Eric Barchas:

• Let’s Talk About Dogs and Euthanasia: When Is It Time? Should You Be Present?
• What to Do Before You Get to the Vet in 12 Emergency Dog Situations
• 12 Dog Emergencies That Need Immediate Veterinary Attention

Got a question for Dr. Barchas? Ask our vet in the comments below and your topic might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)