Reader Question
My doberman was diagnosed with demodectic mange as a puppy. We have been treating it by dipping weekly with Ectodex as well as a dose of 3mg of Dectomax once a week. He is 4 years old now and we have not had any bad outbreaks again but have had to keep him on chronic Dectomax treatment (suggested by our vet) as we do notice a swelling of skin between the paws, especially the moment we stop the treatment. About a month ago, he got a severe case of swolen lymph glands (in the neck), so our vet took some blood but its come back inconclusive as to exactly what the reason might be. The vet speculates that he might have lymph cancer (his bloodwork could not confirm this). He was treated with antibiotics (also for tick bite fever or allergies), but nothing has helped. The swelling still persists. He does, however, react to cortisone (prednisone) and it brings down the swelling quite a bit, but with the mange condition, this is obviously not ideal. Our vet seems to have her mind set that it must be cancer (so suggests we see a specialist who will conduct further tests under full sedation to confirm this), but I cannot help but think that the underlying mange condition has something to do with the swolen nodes. There are currently no visible signs of the mange, except for a dry skin look/patchyness in his neck area. I've read somewhere that if the nodes are big and identical in size, this indicates that it's
not cancer but more related to mange. Can you offer any opinions, as we are currently at a stalemate as far as further treatment goes. Vet says I must keep him on prednisone (to keep down the swelling), but surely this is going to supress the immune system and trigger a bad case of mange. What are your thoughts on this? I will appreciate any help you may offer.
Answer from Our Team
This is a difficult situation, and it's understandable that you want to explore every possibility. Demodectic mange can cause swollen lymph nodes, especially when it's widespread or there's a secondary skin infection, because the nodes react to inflammation in the skin. But swollen nodes also have many other causes, including tick-borne infections and lymphoma, and we're not aware of good evidence that nodes of equal size rule out cancer. In fact, lymphoma often causes several nodes to swell evenly.
The way to know is to sample the nodes. Your vet or a specialist can examine cells from a node or take a biopsy, and it's worth asking how steroids might affect those results, since prednisone can shrink some cancerous nodes and make diagnosis harder. You're right that steroids can make demodectic mange worse, so discuss that trade-off openly with your vet.
It may also help to ask whether a newer chewable treatment, such as an isoxazoline, could control the lingering paw mange. Please don't change or stop his medicines without your vet's guidance. Read more about demodectic mange and how it's managed.
This is general information, not a diagnosis. Please follow your own vet's advice.
