Mange in Bali – Scabies vs Demodex

Mangy street dogs – they are everywhere in Bali sadly. Skin disease is one of the most common presentations for dogs brought to Sunset Vet, accounting for nearly 30% of all our caseload. What is most sad is that this skin disease is so easily treated and yet some poor street dogs (and owned dogs for that matter) suffer so needlessly. Furthermore there is a misconception among some locals here in Bali that a dog with skin disease is more likely to have rabies, which is obviously nothing to do with skin disease.

There is a huge amount of skin disease amongst Bali’s stray dog population for several reasons. Firstly the climate is favourable to the proliferation of bacteria, fungi and parasites that cause skin problems. Secondly, the large amount of free-roaming dogs helps the transfer of contagious skin disease such as scabies. Thirdly, many of these free-roaming dogs are either strays or have poor or uneducated owners who do not take them to the vet when they start showing symptoms, either due to mistakenly believing that they are a risk to human health, or through worry about the costs.

The word ‘mange’ can be used for any skin disease caused by mites. There are many different types of mites and each of them causes a different type of mange. The two types discussed here, Scabies and Demodex, account for 99% of the mange in Bali so these will be discussed in greater detail. It should be noted that not all dogs with skin disease have mange – bacterial and fungal infections are also very common in Bali. Furthermore a dog may have several skin diseases simultaneously, often a case of mange will become open sores due to self excoriation (scratching until the skin bleeds) and these wounds will then get a secondary bacterial infection necessitating a course of antibiotics on top of the mange treatment.


SCABIES (Sarcoptic mange)

The most widely known is the circular shaped mite Sarcoptes scabiei, which burrows tunnels through the skin causing an intense itchiness. Most of the damage is done by self trauma as any animal with scabies will scratch itself raw leading to bleeding sores. Scabies and ringworm (a fungal disease) are the two canine skin diseases transmissible to humans so if your pet is scratching it is wise to seek quick treatment.

Diagnosis is confirmed by seeing the mites microscopically via a ‘skin scrape’ at your local vet clinic, and there are several treatment options:

  1. Subcutaneous injection of ivermectin (for severe cases a second shot is needed a week later).
  2. Topical spot-on such as Revolution or Advocate, containing an ivermectin-like drug.
  3. An oral anti-parasitic drug such as Bravecto (usually a single dose is sufficient to kill all scabies mites).


In addition to the above, a medicated shampooing using Sebazole may be helpful or if severe, a course of antibiotics (if the self trauma from scratching has caused a secondary bacterial infection). However some street dogs will not tolerate medical shampooing without sedation if they are not used to being handled.

Applying a monthly spot-on such as Revolution or Advocate, or giving an oral medicine such as Bravecto, also provides protection from contracting scabies from the environment. Your dog does not need direct physical contact with another dog suffering from mange, it is supposedly enough to lie down in the same spot where a mangy dog has previously been lying.

It should be noted that whilst a subcutaneous injection of ivermectin may be enough to kill the scabies mites on the dog at that moment in time, this drug does not have any protective effect to stop the dog picking up scabies again a week later, unlike Revolution or Bravecto.


DEMODEX  (Demodectic mange)

The second type of mange widely prevalent in Bali is Demodex, and this one is a little harder to get rid of. Caused by the cigar shaped mites Demodex canis or Demodex cati, these parasites live in and feast on hair follicles, causing the hair to ultimately fall out and the dog to go bald. Eventually chronic scarring can give the skin that thick grey leathery appearance that we sometimes see on stray dogs in Bali. Unlike scabies, demodex is not contagious to other dogs, but is thought to have a hereditary component and is passed from mother to pups during nursing. In fact it is normal for both dogs and even humans to have small numbers of demodex mites living in the hair follicles, and it only becomes a problem if the immune system is weakened and the demodex mites start breeding uncontrollably.

Diagnosis is also via skin scrape at your local vets, and once confirmed there are three treatment options:

  1. Give liquid ivermectin orally every day for 6-8 weeks.
  2. Apply a spot-on treatment (called Advocate) weekly.
  3. Give a single dose of Bravecto orally (treatment of choice at Sunset Vet for convenience and efficacy).
  4. Amitraz scrubs twice a week until the skin is completely clear.

Whichever option is chosen it is advisable to treat for a further two weeks after a negative skin scrape, to ensure that all of the mites are eradicated. Although demodex is eminently curable, it takes a lot longer to do so than curing scabies.

Previously the treatment for demodex was always either daily oral ivermectin liquid for 6 weeks, or weekly amitraz washes. Neither of these were practical for treating stray dogs suffering with terrible demodectic mange, without hospitalising them for the duration of treatment at great expense.

Although Bravecto was registered as an ‘anti-tick and flea drug’, it was noticed that a single dose also cured demodex. At Sunset Vet we started using it ‘off-label’ for the treatment of demodex and the results were spectacularly successful. Dogs that were completely bald started to regrow their fur after just a single dose. Dog rescuers could now give a single Bravecto dose to a stray with mange, and watch with pride as the skin disease resolved and hair grew back within weeks.



Do you have a dog – stray or owned – living in your neighbourhood who is constantly scratching? Do you pass by a dog on the way to work who has hair loss or open sores? What if you could fix that dog by giving it a single tasty dog treat, and then see his/her beautiful coat grow back over the next few weeks? That is now the case for many cases of mange, all it takes is a single dose of Bravecto (Rp.200k for a 10-15kg dog such as most adult Bali Dogs). Consider keeping a dose under your motorbike seat to help a stray in need.

Sunset Vet offers veterinary services via their Kuta (24hr) and Ubud (8am-10pm) clinics. For further information or to make an appointment call them on 03619348915 (Kuta) or 0361975296 (Ubud), or visit or or Instagram:       sunset_vet_bali


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