The Itchy Patients

Filed Under: Dogs, Practice Stories

The slight woman moved into the exam room holding a small Maltese. You could tell from her appearance that she was in a struggle for life all her own. Mrs. Poole wore the characteristic turban of a cancer patient. The terry cloth turban that covered her head showed not a hint of any hair protruding from under its depth. Her eyes were sunken, with dark lines underneath and her skin was pale.

But today, Mrs. Poole was focused on her pet, a four year old Maltese named Jazz. Jazz was itching terribly. The pruritis (severe itching) had become so bad the last couple of days that Jazz would not even take time out from his itching to eat. His skin was red hot, especially along the back edges of his ears, elbows and feet. The poor little guy would scratch for a few minutes at his left ear with his back leg, and then start chewing his feet before moving to another body area. Poor Jazz appeared to be in a frenzy, and paid little attention to the world around him. He had patches of hair loss below the elbows and his feet were raw: he was removing the top layers of his skin from his constant scratching and chewing. Mrs. Poole claimed Jazz had been acting this way for the past 4 days. Jazz started itching 6 weeks ago but the itching had intensified in the past week.

I quickly proceeded to run a diagnostic test and reached for a microscope slide and a bottle of mineral oil. While my technician Heather held Jazz, I picked up a dull surgical blade and told Mrs. Poole that I was going to scratch the area for Jazz, getting a skin scraping in the process. Large areas of Jazz’s irritated skin were scraped and the resulting crust and superficial skin layers were deposited onto the slide. Once I peered into the microscope there was a large oval mite with eight legs waving wildly at me from between fragments of skin and crust. Poor Jazz was suffering from sarcoptic mange.

Typically it is hard, if not impossible, to pick up these mites on a skin scraping. In less than a third of the proven cases of sarcoptic mange do you pick up mites on a skin scraping. This particular slide was also loaded with large oval eggs—indicating Jazz was soon due for a mite population explosion. Often diagnosis of sarcoptic mange is made on symptoms alone because mites and eggs are so hard to find. Poor Jazz had perhaps hundreds of these mites crawling around his small body. No wonder the poor little guy was itching so intensely. Even small numbers of mites can cause severe itching. After seeing the enormous number of mites I was beginning to itch myself.

In the examining room, I learned Mrs. Poole was also suffering from severe pruritis. She had pruritic red spots along her arms and waist. I asked if she had reported the pruritus to her physician. Mrs. Poole had talked with her oncologist but was told the itching was a side effect of her chemotherapy. Fortunately I had the answer to solve the problem for both herself and Jazz.

Sarcoptic mange mites are readily transmitted by direct contact between dogs and even people. Sarcoptic mange is easily treated in the dog through the use of topical insecticidal dips, weekly doses of ivermectin or successive doses of Revolution applied topically at 2 week intervals. Revolution is a topical product produced by Pfizer and provides relief against sarcoptic mange as well as many other parasites. Jazz was given a quick bath and dip with a shot of corticosteroid to help control the itching. Oral antibiotics were given because Jazz had so irritated his feet that he had a secondary infection. Sarcoptic mange in people is usually self-limiting—the mites cannot survive off the host animal. Since most people bathe daily, soap and water would usually take care of the mites on a person. Jazz would no longer be reinfecting her. I told Mrs. Poole she might obtain faster relief through the use of an insecticidal cream if her MD thought it appropriate. Now the oncologist would be able to put a stop to this "chemotherapeutic" side effect!

Jazz was provided with two doses of Revolution for follow up treatment. Revolution is furnished in individual dose tubes, and for sarcoptic mange is given at two week intervals. Jazz was given an initial insecticidal dip with Paramite. I told Mrs. Poole to use Revolution in one week and again 3 weeks after the initial dip treatment. Recovery was swift—for both patients.

Symptoms: itching, scratching

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