It can be normal for dogs to have them in small amounts (don’t worry, remember they aren’t contagious), but they can grow in large numbers when a dog’s immune system is slightly weakened. Typically we see them in puppies, but we can see them in older dogs who have severely weakened immune systems.
The typical treatment is Ivermectin, the same medicine in Heartgard that prevents heartworm disease, but it must be taken orally every day for 2-6 months. I typically am not bothered by the amount of Ivermectin used to prevent heartworms in my patients once a month, but given every day, it can cause negative side effects, including tremors. The good news is that the negative side effects should resolve within a week of starting the daily treatments. Sentinel, another monthly heartworm preventative, can be given daily for treatment, and dogs seem to have fewer side effects. Of course, this would cost about $8-10 a day, which is rather expensive.
To me, the problem with the treatment is that it is fundamentally a problem of a weakened immune system, not an infection. So for long-term good health (which is always my goal), I have a very difficult time giving a weakened immune system daily pesticides. Sure, it will kill the mites, but how much more weakened are we making the immune system? So about 3 years ago, I stopped treated Demodex with pesticides and started treating them by strengthening the puppy’s immune system and allowing the puppy to self-heal. I have been thrilled with the results! I don’t even carry Ivermectin in the hospital anymore. I don’t need it anymore.
I treat most of the puppies with the same things: good nutrition, a Chinese herbal remedy called Wei Qi Booster, and a glandular supplement called Immune Support. I also check the puppies for imbalances using Traditional Chinese Veterinary Medicine, to see if they have signs of digestive deficiency or poor blood circulation, and treat accordingly using food therapy and/or herbal medication. I find this treatment takes sometimes an extra month or two to complete, but I feel so much better about the health of the puppy. I actually see the Demodex mites as a blessing, because it gives me a window into their immune system, which is so crucial for long-term good health. Without the Demodex, these puppies look very healthy and happy, so we would have no other clue that their immune system needed a little boost.