Introduction with Dr. Curtis Plowgian
[00:01:06] Dr. Lancellotti: Welcome everyone to Your Vet Wants You to Know. I am itching to talk about today’s episode. It is on scabies or sarcoptic mange, and I have a very special guest here to talk to you about scabies, Dr. Curtis Plowgian. He is a board certified veterinary dermatologist at the animal dermatology clinic in Indiana and he made his guest appearance on the show for our episode on steroids during the allergy series. It’s a great episode so if you have a chance to go back and listen to that, I highly recommend it. And he is joining us today to talk about scabies. Dr. Plowgian and I are a part of a group of veterinary dermatologists that will regularly share stories from pets that we’re treating. And I swear, he has diagnosed scabies in more pets than everyone else in the group combined, so it is really great to have him on the show today because he is going to share with us a wealth of knowledge about scabies pets.
[00:02:00]Dr. Plowgian: Thanks for having me on again. It was a good time last time and hopefully it’ll be a good one this time again.
[00:02:05]Dr. Lancellotti: Thank you so much for coming back. I’m really excited to talk to you about this.
[00:02:08]Dr. Plowgian: Yeah. So anybody who knows me and knows how I practice medicine and dermatology knows that scabies is my all time favorite skin disease. That’s for a couple of different reasons. It’s one of the only diseases in dermatology that we treat that we can actually cure, which is amazing. It makes a huge difference in pets lives and pet owners lives. And to me, personally, there’s nostalgia and a personal kind of “back to my roots” component of this disease. My first real year in dermatology was my dermatology internship that I did in Philadelphia with Dr. Ian Spiegel, and I owe my career and a lot of how I practice medicine to him. And we saw scabies there all the time, like 3 to 5 cases a week. There was a huge problem in the native fox and coyote population, so we saw it all the time. And so that’s where I cut my teeth on dermatology, I was cutting my teeth on scabies, and every time I see a new scabies case, it takes me back to my ‘derm’ roots in Philadelphia and my internship. I’m really happy anytime I can talk about this disease with anybody.
This image shows crusting on the face and edge of the ears of a fox with sarcoptic mange. Image courtesy of Dr. Ian Spiegel and Dr. Curtis Plowgian.
[00:03:16] Dr. Lancellotti: That’s great. I love that this is something that we can cure because we just manage chronic diseases all the time, so having something where we can actually fix the animal and that’s it, problem solved? It makes us feel like superheroes. It’s wonderful. I know you’ve seen a lot of different scabies cases over the years, far more than I have. Do you have any really good scabies stories that you want to share with our listeners today?
[00:03:40] Dr. Plowgian: Yeah. To me, they’re all good stories, but scabies is such a dramatic disease that each case seems to make a great story to tell people. Where someone was seen multiple times by their veterinarian, they were itchy like crazy, so they were seen by their human doctor and then they came to you and were finally able to get an answer. After 3 months of itching themselves and itching their dog and scratching their skin off, finally just brought them all the way back to that 0 out of 10 itching. Probably one of the most noteworthy ‘water cooler’ scabies cases I could describe was actually a case at the very end of my dermatology internship in Philadelphia. We saw an A-list Hollywood Academy award nominated actor’s dog for scabies. It was actually his mom who brought the dog in, but everybody in the hospital- it was a buzz that we were seeing his dog. That dog was a 14 year old dog who was crazy 10 out of 10 itchy for the first time and it turned out that he had scabies. Each case is kind of cool, but sometimes we get to see pretty famous people’s animals and it’s cool that I got to treat one of those for scabies.
[00:04:49] Dr. Lancellotti: Very nice. Did the dog feel better after it was treated?
[00:04:53] Dr. Plowgian: Yeah! When we saw him at the recheck- whole new dog. That’s one of the things that’s just so great about this disease. It just makes you want to put on your superhero cape and be “Captain Derm.”
An adult sarcoptes mite and two eggs from a skin scrape viewed under the microscope.
Sarcoptes scabiei, the cause of scabies/sarcoptic mange.
[00:05:05] Dr. Lancellotti: That’s awesome. I love it. So Dr. Plowgian, why don’t you talk a little bit to the listeners about exactly what scabies are and describe what it is when we say scabies. What are we talking about?
[00:05:18] Dr. Plowgian: Yeah. I’ll apologize in advance to any of our listeners if I’m making their skin crawl or making them itch by giving this description, but scabies are contagious, microscopic parasites. You can’t see them, but they live in the stratum corneum, which is the top most layer of the epidermis. They burrow into that stratum corneum and that’s where they live and that’s where they lay their eggs. That causes really intense itching and also sometimes red bumps and crusting. Some mites are contagious, others are not. Scabies are a contagious one, and this is one that can be contagious from animal to animal or even animals to people. The canine scabies mite is sarcoptes scabiei, but humans have their own variant of that mite. Cats have their own scabies mite called notoedres, but when a dog has scabies, the dog scabies mite can live and reproduce on the dog. They can live for a little while and bite people and make their skin itchy, but they can’t reproduce on the person. If it’s the canine variant of a scabies mite, it can’t reproduce on people, can’t reproduce in the environment, so they don’t have to be passed via direct contact because they can live for up to maybe 3 to 5 days on a person or on a surface or in your backyard. But ultimately, the carriers of this disease that keep it alive and keep it going are dogs and dog-like animals- wildlife foxes, coyotes, wolves- those kind of things. In Philadelphia, it was the local fox and coyote populations that just spread this to everybody’s dogs by walking through their yards.
[00:06:59]Dr. Lancellotti: Yeah, we’ve got a lot of coyotes here in Los Angeles. Despite being an urban area, there are coyotes all over the place.
[00:07:06]Dr. Plowgian: And it is a regional disease and that illustrates the difference, because as many coyotes as there are in Southern California (and I lived there and saw those every day), we didn’t have nearly the scabies burden in California that we did in Philadelphia. Now where I am in Indianapolis is somewhere in between, but this is definitely a disease that you may never see depending on where you live in the country. If you’re lucky or unlucky enough, if you’re an owner or a veterinarian, you may live in a part of the country where wildlife passes this to animals all the time.
[00:07:40] Dr. Lancellotti: Yeah. I think that’s something that’s important for people to understand, because there are a couple of different types of mange- and we’ll talk about demodex in another episode– that will cause demodectic mange. This is sarcoptic mange. And the big difference between a scabies mite that causes sarcoptic mange and a demodex mite that causes demodectic mange is that demodex are normal mites. They usually live in low numbers on the animal, whereas the scabies mites are not normal for the dog to have, so they are highly contagious. They’re something that the animal picked up from somewhere else, and we need to get rid of them.
What does a scabies infestation look like?
When an animal is infested with scabies, what are the most common things that the pet owner will notice?
[00:08:20]Dr. Plowgian: The most obvious thing that you already touched on is they’re going to be itchy. Scabies itch blows every other itch we see out of the water. I’ve seen dogs that still itched themselves under sedation and anesthesia. We have a 0 to 10 itch scale for our owners to quantify allergic itching and they turn it to 11. But the other things that you’re going to see- people can see red bumps on their skin. With dogs, it’s much more common for them to get crusts. The most common areas that get those crusts are going to be on their ears, their tips of their elbows, and their tips of their hocks (ankles). We don’t always see it, but when we see it, that’s another big red flag for scabies. The itching will be the itching that we see at home. These dogs will be licking and scratching and chewing themselves pretty much, unless they’re physically restrained to stop them, but you can also trigger their itch in reliable ways. One of the things we look for in a vet’s office is something called the pinnal-pedal response, where if you rubbed the dog’s ear, it’ll make their foot go like crazy. And there are journal articles citing the sensitivity of testing for scabies by just that test, and I think it was in the high 80’s. But the big thing is going to be their itching, and then also in their history, the fact that itching was contagious. There aren’t very many contagious causes of itching, and this is one where, not only will that dog be itchy, but potentially other dogs in the house who have never been itchy before are itchy. Or people in the house, especially once they spend a lot of time with the dog, develop itching on themselves.
Everyone is itchy!
[00:10:02]Dr. Lancellotti: Yeah, I love the story that you shared with our listeners on the steroids episode about the owner who was itching around her bra line (because that’s where they like to go), and she asked you if you wanted to see where she had her red bumps.
[00:10:19] Dr. Plowgian: Yeah. Tight fitting clothes is a place where a lot of people will get these lesions. I’ve found, in my last year, that the majority of the people in the house who tend to be itchy share a bed with the dog. Recently, I had a case where the people would be itchy when they spent too much time around the dog. But then, if they put the dog out in the backyard or they went to work for eight hours, their itch would start to go away the less time they spent around the dog. But a lot of times, the amount of itching is correlated to the time that the people are spending in close contact with the dog.
[00:10:56] Dr. Lancellotti: Yeah, and other pets can certainly be itchy too. If you’re noticing that it’s not just one pet in the household that’s itchy, there are more pets that are itchy too. I think that’s another red flag for this particular disease. Some pets are more sensitive than others to scabies. As far as how itchy they will get, we can see a range of itch. But for the most part, the animals that have that big infestation are going to be that 10 out of 10 itching. That itch is absolutely unmistakable, and you’re right, the animals have to be physically restrained to stop scratching. Even when you’re holding them down, they’re still trying to scratch at parts of their body where they’re affected. I’ve got some really good videos of that pinnal-pedal reflex that you mentioned before, so if listeners want to check out what we mean when we say pinnal-pedal reflex, they can go to the website yourvetwantsyoutoknow.com to see that test being performed on some animals that have scabies. So we’re going to rub the edges of the pinna (ear flap) together, and the animal is so uncontrollably itchy that their back leg will start to go up. So their foot (pedal) is going to go up and try and scratch at their ear. It’s a pretty nice test to give us some reassurance that we’re on the right path as far as thinking that this animal has scabies.
The puppy in these images had very mild redness and crusting, but was intensely itchy and had to be physically restrained to stop scratching himself.
Crusty skin is often a big clue to scabies.
[00:12:15] Dr. Plowgian: Yeah. As much as I love scabies, I’m terrible about taking pictures of my own cases. Some of the pictures that we have of this, I had to reach out to my mentor in Philadelphia, Dr. Ian Spiegel. He sent us some great pictures of some really crusty dogs with scabies so that you guys can see those lesions as well. Scabies certainly isn’t the only disease that can cause crusting, but specifically when it’s on those ears, points of the elbows, points of the hocks, it raises our spider sense for scabies or- our scabies sense.
[00:12:47] Dr. Lancellotti: Our scabies sense is tingling. I’m very thankful that he allowed us to use those pictures, so thank you very much. Hopefully, people will go and check those out so they can see these itchy dogs.
Severe crusting on the back (above) and ear (below) of a dog with scabies.
This dog with severe sarcoptic mange had crusting around the claws, on the back of the ankle (hock) and around the eyes.
Images courtesy of Dr. Ian Spiegel and Dr. Curtis Plowgian.
History is our best diagnostic test! (but skin scrape is a good idea too)
So, Dr. Plowgian, if a veterinarian does suspect that a pet has scabies, what other tests might they recommend and what are they looking for?
[00:13:05]Dr. Plowgian: The lab test of choice is going to be a skin scraping, which is what we do for all mites. Unfortunately, in the case of scabies, it only finds 30% to 50% of the time. I’ve found in my experience, if I have a really crusty dog, I’m a lot more likely to find the mites. If I have a dog that’s really, really itchy, but doesn’t have the crust and I’m just scraping areas where they’re itchy, I’m a lot less likely to find the mites. As I mentioned, the intensity of the itching, the history of contagious itch to other people and other dogs in the house- those things are so unique and so characteristic of scabies as a disease, whether or not I find it on a lab test, I’m going to treat for it. The treatment, which we’ll get to in a second, is really safe. Most of the time, if I have a pet who walks like a scabie and quacks like a scabie, I’m going to treat for it, regardless of what the test says.
[00:14:05] Dr. Lancellotti: Yeah, I think history for this disease is probably a lot more accurate than some of our diagnostic tests that we have available. It tends to be that response to treatment is our diagnostic test. If the animal responds to treatment of scabies and it gets better, then that’s our diagnosis.
Scabies mites seen under the microscope from a skin scrape of an infected dog.
Providing much needed relief from debilitating itch
So, let’s talk a little bit about treatment. These pets are absolutely miserable. They are in agony from that uncontrolled itching. They cannot stop. They can’t sleep. They can’t do anything except itch themselves. How are we going to get them relief?
[00:14:39] Dr. Plowgian: Today is such a great time to be a dermatologist because we have so many more treatment options for diseases than we did before, many of which are more successful, but also safer to treat diseases with. People used to have to treat scabies with high dose Ivermectin, which we treat heartworm with, and lime sulfur, which is a really stinky, nasty bath that you’d have to treat your dogs with. In addition to being unpleasant and potentially having side effects, they weren’t always 100% effective. Revolution is an older flea prevention, and that one is fairly effective at treating scabies, but you have to use it at twice the labeled dose. For fleas, it’s used every 4 weeks, but to treat scabies, you have to treat it every 2 weeks for at least 6 weeks. The new generation flea prevention, a class we call Isoxazoline (Nexgard, Bravecto, Simparica, Credelio), they tend to resolve the scabies faster- normally within 2 weeks instead of 6. You can use them at the same dose as you would use them for flea prevention, so at that dose, they’re very safe. We have very few concerns about side effects and like with demodex, they’ve revolutionized how we treat mite infections and infestations. In addition to what we treat with, it’s important to keep in mind that this is a contagious disease, so you need to treat every dog in the house. You don’t have to treat affected people in the house, because as we mentioned before, the mites can’t reproduce on people. But you do need to treat every dog in the house, even if the dogs aren’t itchy, because there can be asymptomatic carriers of the mites. Generally, I recommend the Nexgard or Bravecto or one of these Isoxazoline flea preventions because if there are foxes or coyotes in their area who are exposing their dogs to scabies, there’s a good chance their dog will get exposed again, and staying on these medications is the prevention as well as the cure.
[00:16:42] Dr. Lancellotti: Yeah. In a previous episode, I spoke on fleas and flea allergies and about the importance of year-round flea and tick prevention. Having them on one of these medications is not only helpful for preventing relapse of this really miserable disease, but it’s also helpful in preventing fleas and ticks and the diseases that they transmit as well. So, we truly are lucky, having this class of medication available, because it is shown to be one of the safest therapies that we have. Even in particular breeds like collies that have a certain genetic mutation, where some of the preventatives may be more risky for them to use, they have not been shown to have any adverse effects with this particular class of medications. I’m really thankful as a dermatologist to have this tool to be able to safely provide relief to these miserable dogs. Certainly, if your dog is diagnosed with scabies, this treatment is something that you should be very excited about giving your animal because they will find some relief really quickly. I think it is important to mention that sometimes when the mites start to die off, the animals can be really uncomfortable. For the first few days after the medication is given to treat the mites, we’ll sometimes use a really short course of a low dose of a steroid just to provide some relief by bringing that inflammation down, and to get that pet some comfort. As the medication to treat the scabies is working, they start to feel better really quickly.
[00:18:14]Dr. Plowgian: That’s a great point. We do have some great itch relief drugs out there. Steroids are one of our biggest guns against that. One other thing that these dogs can have when they’re really miserable is severe secondary infections, and we’re going to want to treat those if we find them as well. It’s one of those layers of dermatology cases. Give something for the underlying cause, something for the itch, something for the infection. Scabies cases are no different in that regard.
A disease with a life-changing cure
[00:18:40]Dr. Lancellotti: Beautiful. So Dr. Plowgian, what are some of your big takeaway points that you want the pet owners who are listening to this episode to remember? What do you want to drive home about scabies?
[00:18:50] Dr. Plowgian: Scabies isn’t the most common skin disease we see. Depending on where in the country you live, you may never see it. But it is something that, if it’s there, we really don’t want to miss it because this is something that can really make pets and owners miserable. One of the things we want to do in dermatology is improve the quality of life and improve the comfort level of our pets, and in this case, our owners. So if it’s there, we want to find it and we want to treat it. It also is one of the best diseases your pet could have (not necessarily in the short run, but the long run), because even though it’s one of the most extreme causes of itch that we’ll see, it’s something that we can cure. It’s not a lifelong condition like allergies or an autoimmune disease. If your dog is miserable and your vet is able to diagnose them with scabies, you won the ‘derm’ lottery . You’re going to have a cured dog, and that’s something that you can and be thankful for. One of the things with parasites in general (I see this with fleas, but I also see it with scabies from time to time), is that there’s a stigma where if a dog has mange or it has fleas or flea allergies that we’re not taking care of that pet. [They’re a mangey dog, they must be not cared for, or there must’ve been a problem with the hygiene.] I even had scabies case, in the last week, where the owner had done some research and had asked their vet if their dog could have scabies, and the vet actually told them that their dog couldn’t have scabies because their house was too clean and they live too well. But that’s not how this disease works. It’s not a disease that should have a stigma around it. It’s something to be celebrated because this is something that I can cure, and when it’s there, we find it and we treat it, so that we can start getting these dogs and owners feeling better.
[00:20:40] Dr. Lancellotti: Yeah. That’s great. It is a big relief to be able to provide an animal with a good night’s sleep after it’s itching itself uncontrollably with this particular disease. I am very thankful for you coming on and talking to pet owners about this and giving them some more information.
[00:20:56]Dr. Plowgian: Thanks for having me. It’s been a great time.
[00:21:00] Dr. Lancellotti: Many family veterinarians are very comfortable managing pets with scabies, but the link to find a veterinary dermatologist near you will be posted on the website as well, under the resources tab, if you want to consult with a specialist. If you have had a pet that has had scabies, I would encourage you to please join the Facebook group. Tell us about your success story and what your experience was so that other people can have some relief, knowing that there are other folks out there who have gone through the same thing that they have. You can follow us on Instagram or Facebook @yourvetwantsyoutoknow.
This corgi with sarcoptic mange had crusting, redness, and hair loss on the edges of the ears, the elbows, and the ankles. He was intensely itchy!
Photos courtesy of Dr. Ian Spiegel and Dr. Curtis Plowgian.
[00:21:51] I would like to end the episode with a segment called Scratching The Itch. The segment is designed to highlight something, whether it’s a human interest story or product or a website, that provides relief or just makes you feel good. Hence, scratching the itch. So, I would like to ask Dr. Plowgian if he has a “scratching the itch” that he would like to share with us today.
[00:22:13] Dr. Plowgian: I do. This time, not about derm. I’m able to broaden my horizons a little bit. Recently, I found out that one of my professors from undergrad is now teaching at Indiana university in Bloomington. I had studied under him and sang in his gospel choir at Denison university in Ohio, but now we’re back in the same state again. In the pandemic, we’ve been so isolated from everyone, and it’s nice, even if there are still physical barriers in place, to know someone is close to you. He’s someone who was really special to me and a role model to me growing up through college and undergrad. He was the gospel choir director at Denison university, but had also been a teacher and a gospel choir director at Ohio State (where he had gone to grad school). He taught at two schools, but then also ran church choirs, community choirs, and children’s choirs. He’s just one of those people who’s always doing something- just very invested and prominent in the community. And Denison was a school that had a relatively small black student union, and they had trouble recruiting black students to the school, and getting them to participate in things. But this was something that actually got people intermingling and mixing at the school. Dr. Wise was just such an amazing teacher about the history of gospel and of black music and of Negro spirituals, which were songs that came up that were passed through oral tradition of slaves, who were able to inevitably escape and be freed from slavery. But while they were facing those trials and tribulations, they used music as a way to connect to their religion and to other positive things in their life that gave them hope to keep them going forward. We’re going to share, on the site, a song that was written and directed by Dr. Wise. It’s an ‘a capella’ song, but he arranged the voices and clapping and stomping to emulate the sound of a train pulling into a station and then leaving out of the station. There’s a lot of “ch- won’t you get on board?” and things to simulate the chugging of the train. The soprano part is supposed to sound like a train whistle before the train pulls out of the station. His musical creativity is just amazing and he’s also probably the most talented musician that I’ve ever known. He could improvise accompaniments to songs just by listening. In our gospel choir, he would teach us by ear. He would sing us our parts and we’d sing them back to him, and he would sing the basses their part and he’d sing the Sopranos their part. His vocal range was just incredible. He’s just a person that I’ve been really happy to have had in my life, and whose example I try to follow, in terms of his positivity and his work ethic and his ability to positively influence the people around him. So, I was really happy to find out that we live in the same state again.
[00:25:52] Dr. Lancellotti: I love hearing stories about people that are able to create community around music and bringing people together from all different walks of life, to share in something that they love and makes them joyful like music. So, thank you very much for sharing that. Our listeners can find the song that you mentioned on the website, and they can listen and enjoy that music as well. Thank you very much, Dr. Plowgian, I appreciate it.
[00:26:35] Dr. Plowgian: No problem.
[00:26:36] Dr. Lancellotti: If you have suggestions for something to be featured on Scratching The Itch, you can contact me through the website or through social media and let me know. I look forward to your next visit on Your Vet Wants You To Know.