Congenital subcutaneous mite in dogs. Subcutaneous mites in dogs: symptoms and treatment. Photo: what a tick looks like on a dog

Ticks in dogs tend to become more common as the weather gets warmer. Summer residents are opening the season, some have holidays or holidays just around the corner, and owners are spending more and more time with their pets fresh air, enjoying the anticipation of summer with them. And at this moment it is important not to forget about the danger that awaits our four-legged friends in the green grass and trees...

Watch also general condition pet.

• A day or two after the bite, the animal becomes lethargic and begins to refuse food.
• Itching appears at the site of the bite - the pet itches, rubs against various objects, and rolls on the floor.
• After some time, it becomes easier to find the tick - after drinking blood, the insect swells, becoming more noticeable. Ticks are the causative agents of such a dangerous disease as.

Serious danger

Your dog was bitten by a tick, you noticed a tick bite on your dog. What to do? How to remove a tick from a dog, how to remove it?

All these questions are of acute concern to animal owners who are faced with this problem. Undoubtedly the most The best way

get rid of the bloodsucker immediately.

But if for some reason this is not possible, then you can cope with the encephalitis tick at home.

Detecting ticks in the ears is doubly difficult. They climb into the ears and there they feed on blood, wax and particles of the epidermis. Of course, this causes incredible discomfort for pets. Itching appears, which intensifies every day. Cats and dogs itch with their claws and eventually injure themselves. Therefore, ears need to be treated immediately. The first symptom of ear mites in dogs is a discharge from the shell. They have Brown color And bad smell . When we're talking about

about ear mites, it will not be possible to do without medication treatment. But the veterinary pharmacy will advise you on a whole range of drops with antifungal and anti-inflammatory effects.

Do not allow your pet to interact with cats, which often carry infections. Be carefull! This is the first rule not only when fighting ticks - almost all diseases can be easily cured if noticed in time. Let us remind you once again - if you notice and begin treatment, and not wait until the animal gets better. Unfortunately, many owners, seeing, turn to friends for help, consult with “experts” on Internet forums, or rely on their own meager experience in treating animals. And all this - instead of taking the weakening pet to the veterinarian. Alas, lost time is often worth four-legged friend life. Therefore, we remind you once again: no matter what torments your pet - itching, indigestion or nausea, do not self-medicate - consult a doctor immediately.

Remedies for ticks in dogs

Forest ticks are dangerous because they can cause infections and transmit dangerous diseases, such as piroplasmosis, hemobartonellosis, Lyme disease. To protect the animal, it is necessary to engage in active prevention, treating the dog with special preparations throughout the season.

There are a lot on sale now various means against ticks in dogs: collars, sprays, zoo shampoos, drops on the withers, etc. They differ not only in the form of release, but also active ingredients . The most simple means

is a collar, but it is more effective against fleas than against ticks, since it mainly protects the withers. It's also easy to lose.

Zoo shampoo against ticks is also not particularly effective. It will only get rid of those that have already appeared. Drops on the withers are more effective. When buying them, you should pay attention to the fact that they are intended specifically for ticks. Dog breeders recognize the drug FrontlineR from Merial as the safest and most effective. Also high-quality drugs from Bayer (Advantix), Hartz, Pfizer (Stronghold).

The validity period of such anti-tick drops is 30 days, after which re-treatment is necessary. It is very important to follow the dosage of medications. This is not a case where “you can’t spoil the porridge with butter,” so if the collar is large, you don’t need to wind it several turns, but rather cut off the extra centimeters.

The number of pipettes with drops on the withers must strictly correspond to the weight of the dog. For every 10 kilograms of dog weight you need to buy one pipette. For puppies and very small dogs weighing up to 2 kg, it is better to choose a spray.

Infection occurs through contact with a sick animal or from mother to puppies and is very long and difficult to treat with the help of acaricides (Amitrazine, Ivermectin, Ivomec) and immunomodulators.

How to detect subcutaneous mites in dogs?

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Ticks pose a danger not only to humans, but also to animals. Most often, it is dogs who suffer from their bites, since owners of cats, especially purebred ones, rarely let their pets go outside.

May pose a certain danger argasid mites- a species that is quite rare in our climatic conditions. The insect is very large, its body can reach a size of 3 cm (although it may look different before and after feeding). If such an insect bites a dog, you should immediately treat the wound and take the animal to a veterinarian. Such insects can be carriers of dangerous diseases such as typhoid, encephalitis, plague, borreliosis and others.

The most harmless of all types of ticks, hair mites, can lead to the development of cheyletiellosis or “stray dandruff”. The disease is generally harmless. It can be easily dealt with at home by treating the animal with acaricidal agents. If the condition is advanced, then the presence of this insect can lead to baldness of the animal or the appearance of a secondary infection.

Dog tick- a frequent phenomenon, so there is no need to worry too much, the main thing is to “detect” the symptoms in time and begin treatment

Symptoms of different types of tick bites in dogs

Different types of ticks have different symptoms.

Symptoms that develop after a tick bite in dogs

It is very difficult to understand that a dog has been bitten by an ixodid tick. The animal may not react to the bite, shake the insect off itself, and at first not show signs of concern. In addition, the bite may not entail any consequences. In the most severe cases, dogs begin to develop piroplasmosis. The symptoms of this disease are:

Canine piroplasmosis requires quick and systemic treatment. If the situation is neglected, the animal’s kidneys, liver and central nervous system may be damaged.

Symptoms indicating the presence of scabies mites in dogs

About the presence of scabies, ear mites are indicated by the following symptoms:

Disease caused ear mites, called otodectosis (ear scabies). In particular severe cases The dog develops sarcoptic mange (pruritic scabies). As a result, on the animal's body Ulcers, ulcers, fistulas may appear, the skin may become rough, and pigmentation may change. If the situation with the ears is neglected, otitis media and even meningitis may develop. These are serious pathologies that can even lead to the death of the animal.

Symptoms indicating the presence of subcutaneous mites in dogs

Symptoms, indicating the presence subcutaneous mite, the following:

• itching (at first weak, then gradually intensifying);
• hair loss (usually the process starts from the muzzle and then spreads throughout the body);
• roughening and discoloration skin;
• unpleasant odor from the skin.

Subcutaneous mites are the causative agents of a disease such as demodicosis.

There are two forms of this disease: focal (less dangerous, with which self-medication is still possible) and generalized (more dangerous, in which the internal organs; Treatment of this form of the disease is carried out only by a veterinarian).

If the insect begins to actively manifest itself, it means that the animal has problems with the immune system, perhaps there is some kind of inflammatory process. If diagnosis and treatment are not carried out in a timely manner, internal organs may be damaged.

It is clear that ticks of these species can cause great harm animal. The question arises of how to get rid of them, as well as what preventive measures measures must be taken to prevent them from appearing or clinging to the animal.

How to remove a forest tick from a dog yourself when you find one

It is quite difficult to protect a dog from a forest tick bite. Many owners have encountered the problem of removing an insect that has already “attached” from the animal’s skin. This process is quite labor-intensive, the main thing is not to panic and not make unnecessary and sudden movements.

First you need to understand What does a tick look like on a dog? And it looks like this:

• the insect's body is located in vertical position above the skin, and the body may be swollen with blood;
• head (with special suction cups) - under the skin.

1. Apply Vaseline or cream to the tick on the dog in order to block its access to oxygen (some experts say that this is not necessary, since ticks are already inactive during the period of active “feeding”).
2. Using a thread tied around the insect's body, or a special device such as tweezers (can be bought at a pharmacy), carefully and carefully unscrew the tick.

The main thing is not to tear the body away from the head during the twisting process. An insect head remaining in a dog’s body will certainly lead to inflammation and various complications.

3. Treat the wound with any antiseptic ( alcohol solution, iodine, hydrogen peroxide).

If you are afraid to carry out the procedure yourself, it is best to contact a veterinary clinic. Doctors will carry out the procedure quickly and painless for your pet.

How to get rid of scabies mites in dogs

In case of infection with scabies mites, if only the ears are affected, you can try to cure the animal yourself.

1. Gently (using exclusively cotton pads) clean your ears from brown plaque. Do not use cream, just a little lotion or clean warm water.
2. Treat the ears by special means, such as “Frontline”, “Aurikan” or “Otovedin”.

If the infection has spread to the entire body of the animal, it is better to consult a specialist. Most likely, he will prescribe special antibiotic therapy.

Important. Be sure to isolate the sick dog from other animals, if there are any in the house. Insects of this species quickly “migrate” from one animal to another.

How to get rid of subcutaneous ticks in dogs

As mentioned above, the subcutaneous mite is activated only if the dog has problems with the immune system. A visit to the doctor is inevitable. The veterinarian will prescribe the animal a course of immunoregenerative therapy. The veterinarian will also prescribe:

Important. Throughout the course of treatment, the veterinarian is required to regularly make special scrapings from different parts of the dog’s body to check for the presence of ticks.

Prevention

In order to save your pet from insects, you should regularly various kinds preventive measures:

• treat the animal with acarecidal agents against dog ticks, wearing special collars;
• monitor the animal’s contacts (avoid contact with sick, scabies-infected dogs);
• regularly inspect your ears (for the appearance of brown plaque) and clean them;
• Wash your dog several times a year with special tar-based shampoos.

In any case, if the dog has been bitten by a tick, or there is a suspicion that the dog has scabies or subcutaneous species these insects, it is best to contact a specialist. He will spend competent diagnostics, will install the real reason anxiety of the animal and provide therapy. There’s no point in delaying your appeal. dog ticks They multiply very quickly, especially when they find themselves in an environment favorable for this. Timely treatment - pledge of long and happy life your pet.

With the onset of the warm season, the number of diseases caused by tick bites in dogs increases sharply. With the onset of spring, dog owners begin to worry about how to protect their pet from this problem by any means. A tick bite in itself is not so terrible for a dog; dangerous pathogens are contained in the tick’s saliva, which can cause whole line dangerous and sometimes fatal diseases for dogs.

Dogs walking through tall grass or dense bushes are especially at risk, where they are especially likely to pick up a tick. Therefore, when returning from a walk, it is necessary to carefully examine the dog’s fur. The tick that has just attached itself to the dog's skin is the size of a pinhead. Over time, after he drinks blood, he grows to the size of a bean and is impossible not to notice.

General information about ticks

Some ticks that attack dogs drink blood, others chew the skin, and others feed on skin secretions and lymph.

• Ixodidae (Ixodidae) are the largest ticks, which in a hungry state reach 2-3 mm in length, and after sucking blood - up to 1-1.5 cm.
• Scabies (internal, ear).
• Subcutaneous (demodectic).

Mouth organs (piercing, gnawing, cutting, sucking). In all ticks they are formed by the first two pairs of limbs, the chelicerae and pedipal. ixodid ticks they consist of a pair of cutting chelicerae and a hypostome (an outgrowth of the lower edge of the oral opening, covered with spines), tracheal or cutaneous respiration. Eyes are usually absent, less often there are 1-2 pairs. The stomach is saccular, in blood-sucking ticks with blind outgrowths that fill with blood during blood sucking. The excretory organs are represented by a pair of Malpighian vessels. Blood-sucking mites have well-developed salivary glands, the secretion of which prevents blood clotting. All ticks are dioecious. The difference between females and males is well expressed, fertilization is internal. Most ticks are oviparous. The six-legged larva is the most characteristic feature ticks.

The life of a tick can be roughly divided into four stages: egg, larva, nymph and adult. The total lifespan of a tick is about two months. After the tick drinks blood, it falls off and the larva begins to molt. Subsequently, the larva moves to the next stage of development, becoming a nymph; the nymph molts, turning into an adult tick, which is capable of leaving behind offspring. Ticks reproduce thanks to the female's ability to lay eggs.

Considering that ticks that attack a dog multiply quickly and create optimal conditions for the development of bacteria and viruses, the owner should not delay treating the dog for ticks.

The process of a tick attacking a dog.

Hungry ticks find their prey thanks to the presence of special thermal sensors. A dog passing by a bush or grass on which a tick is sitting becomes an object of attack, the tick makes a jump and, clinging to the hair, remains on the dog.

Having latched onto a dog, the tick begins to look for the place on the dog’s body that is least covered with hair (skin around the ears, neck, legs, abdominal area, etc.). Further digging into the skin with its tentacles, the tick pierces the skin and begins the process of sucking blood. It becomes almost impossible to tear it away from the dog at this time, and only after the tick has completely drunk blood does it fall off the dog’s skin.

Symptoms of a tick bite in a dog.

A tick bite in itself does not pose a serious threat to a dog’s body. The danger comes from diseases that are transmitted by a tick bite to a dog. Here are a few common symptoms occurring in a dog after a tick bite:

• lethargy, low activity, the dog lies down more.
• Change in urine color (urine becomes dark, sometimes acquires a brown, brown or red tint).
• The visible mucous membranes and sclera of the eyes have an icteric tint.
• Body temperature rises to 40°C and above.
• Shortness of breath appears, the dog has difficulty breathing.

Diseases caused in dogs by tick bites.

Lyme disease(tick-borne borreliosis) is an acute infectious disease caused by bacteria – Borrelia garinii and Borrelia afzelii.

Infection of a dog occurs almost exclusively through tick bites, which in dogs, unlike in humans, are not accompanied by local erythema. Depending on the region, up to 25% of ticks are carriers of borreliosis. The reservoir of pathogens consists of wild animals (ungulates, rodents). In dogs, contact infection through urine is possible. Incubation period is 1-2 months.

Symptoms. A few weeks or even months after a tick bite, a dog develops anorexia, fever, lameness, swelling and tenderness in one or more joints, muscles or spine, lymphadenopathy and proteinuria as a result of developing glomerolonephritis. When examining blood in a veterinary laboratory, we note leukocytosis. In punctate from the affected joint - increased amount neutrophils. Some sick dogs have symptoms of acute dermatitis, polyneuritis with hyperesthesia in the back or paresis.

Diagnosis Borreliosis is diagnosed based on the detection of the pathogen in the blood, sometimes in urine or cerebrospinal fluid, as well as serologically in a veterinary laboratory.

Differential diagnosis. The disease must be differentiated from polyneuritis and arthritis.

Treatment. Ampicillin, 20 mg/kg 3 times a day orally, tetracycline, 20 mg/kg 3 times a day orally, in persistent cases penicillin G, 22,000 IU/kg 3 times a day intravenously for 10 days. When joints are affected, aspirin or phenylbutazole is used for pain relief.

Ehrlichiosis. (canine tropical pancytopenia, canine rickettsiosis). The disease is widespread in tropical and subtropical areas, but this disease should not be written off either.

Infection with ehrlichiosis occurs through the saliva of the tick and in in rare cases through blood transfusion or through infected needles. The incubation period is 8-20 days. Especially to this disease German Shepherds are predisposed.

Ehrlichia penetrate blood monocytes and enter the reticuloendothelial system with them, causing lymphoreticular hyperplasia in the liver, spleen and lymph nodes. Subsequently, infected monocytes spread ehrlichia to the lungs, kidneys and meninges, where the pathogen attaches to endothelial cells blood vessels leads to vasculitis and bleeding. Depending on the resistance of the dog’s body and the virulence of ehrlichia, spontaneous recovery occurs or chronic depression develops bone marrow and pancytopenia.

Symptoms. In sick dogs, acute, subclinical and chronic phases of the disease are distinguished. In the acute phase, which lasts 2-4 weeks or often goes unnoticed, veterinary specialists record temperature surges up to 41°C, anorexia, dyspnea, swelling lymph nodes, purulent conjunctivitis and rhinitis, splenomegaly and in some cases irritation of the meninges with hyperesthesia, seizures, muscle contractions, polyarthritis, paralysis cranial nerves or back of the body. When the acute phase transitions to the subclinical phase, we note thrombocytopenia, anemia and leukopenia. Subsequently, after 6-17 weeks (even without treatment), the dog recovers or develops a chronic form of the disease as a result of the inability of the body itself to destroy ehrlichia. At chronic form The main disease in the dog is anemia with thrombocytopenia and spontaneous hemorrhages in the mucous membranes, internal organs, serous cavities, V abdominal cavity or swelling and secondary infections.

results laboratory research . In the acute phase, we note thrombocytopenia, anemia, leukocytosis and monocytosis. In the chronic phase there is pancytopenia and bone marrow depletion. In addition, there is mono- and polyclonal hyperglobulinemia and biochemical changes in the blood that correspond to the organic lesions present in the dog.

Diagnosis. Serological detection by indirect immunofluorescence.

Differential diagnosis. The disease is differentiated from hemobartonellosis, autoimmune cytopenia, lymphosarcoma, leukemia, panmyelophthiosis and hemolysis caused by medications or poisons.

Forecast. Unfavorable in progressive cases, favorable with timely treatment. In the chronic form, recovery can take 3 months.

Treatment. Antibiotics are used for treatment: tetracycline 3 times a day, 22 mg/kg, for 14 days; doxycycline 10 mg/kg (maximum 25 mg/kg) for 7-10 days. As additional treatment blood transfusions, the use of B vitamins and short-term treatment with prednisolone (2-7 days, 0.5 mg/kg) are used.

The causative agent is the mite Otodectes cynosis, which has a flat body oval shape and length 0.3-0.7 mm. The first three pairs of limbs are well developed, the fourth pair is rudimentary in females. Suckers are located on the first and second pairs of limbs, and in males - on all four. Has a gnawing proboscis.

Biology. Mites live on the surface of the skin, feeding on the outer layer of the epidermis, exfoliated epidermal cells, scales and crusts of the skin. Development occurs with the participation of a male and female through the larval stages (egg, larva, protonymph, teleonymph, adult mites).

Infection occurs through contact with a sick person ear scabies dog and through care items. Humans can also carry ticks. Otodectosis most often affects young dogs aged 1.5 to 6 months, as well as long-eared dogs. Otodectosis is most often recorded in spring and autumn. The main source of otodectosis are ownerless and stray dogs. Infection hunting dogs possibly from infested hares, foxes and other wild animals. The tick is resistant to external environment and at home. The disease in a dog can be severe and result in the death of the animal.

Pathogenesis. While moving and feeding, the tick sharp limbs and the body is annoying nerve endings skin inner surface auricle and external ear canal. It is released from the affected areas of the skin tissue fluid, which dries out and forms scabs and crusts. When a secondary infection penetrates into the affected areas of the skin, an inflammatory reaction develops, sometimes perforation occurs eardrum and the inflammatory process moves to medium and inner ear. In the case when the inflammatory process spreads to the meninges and the dog develops meningitis and the animal quickly dies.

Clinical picture. As a result of itching, the sick dog constantly worries, shakes its head, scratches the affected ear with the claws of its front and pelvic limbs, rubs the affected ear against surrounding objects. With severe infestation, the dog constantly moves and practically does not sleep. Upon examination, abrasions, scratches, wounds, pustules and areas of baldness are visible on the head and ears. Otodectosis in dogs is often accompanied by weakening of hearing, up to its complete loss. The affected ear may discharge of various nature discharge, often serous, which later gives way to purulent. When examining the ear canal, the veterinarian finds brown or black crusts of dried exudate, which sometimes clog the entire ear canal. There is damage to the skin around the ear, on the inner and outer surface auricle. In severe forms of otodectosis, the dog experiences an increase in body temperature 1-2°C above normal.

At malignant course Otodectosis in a dog results in perforation of the eardrum, inflammation of the middle and inner ear and often the meninges in the form of meningitis. When a dog has meningitis, owners note: sharp increase body temperature, refusal to feed, severe depression sets in, seizures and nervous phenomena appear. A sick dog tilts its head towards the diseased ear (bowheadedness), makes manege movements, and the disease often ends in death.

Diagnosis Otodectosis is diagnosed based on the characteristic clinical picture illnesses and positive results examination of scrapings of the inner surface of the auricle and the contents of the ear canal for the presence of mites.

Treatment of the ears of sick dogs with aerosol and acaricidal foams is carried out without first removing crusts from the affected skin. For this purpose, acrodex, actol, amitrosine, psoroctol, perol and other drugs are used.

At severe swelling and ear inflammation use circular novocaine blockades using various antibiotics. The treatment regimen in the form of blockades should be carried out by a veterinary specialist at the clinic, who takes into account the sensitivity of the antibiotic to the microflora and its side effects.

For inflammation of the middle or inner ear, symptomatic treatment using antimicrobial, antihistamine and analgesic agents.

Prevention. To prevent infection, contact of pets with stray cats and dogs. Regularly conducts veterinary clinic clinical examination of the dog for timely detection of otodectosis.

Ticks in dogs can cause a disease called sarcoptic mange. You can find out about this disease in our article -.

Another common disease in dogs caused by ticks may be demodicosis.

How to remove a tick from a dog's body

In order to remove a tick from a dog’s body, you must first apply a drop of water to the bite site. vegetable oil, gasoline, alcohol and leave them on the skin for several minutes. After these procedures, the tick will fall off on its own or weaken its grip and we will remove it using tweezers. It is best to grab the tick with tweezers in the head area and begin to twist it so that the tick’s head does not remain in the dog’s body.

Removal with thread. We tie the tick with a thread on both sides and, as in the previous case, begin to carefully and slowly unscrew it from the skin.

After removing the tick, in order to prevent the spread of infection, the wound must be treated with a 5% iodine solution.

Removing ticks using special shampoo. To do this, you will need to buy a drug at the pet store that kills tick larvae and weakens the effect of the tick itself. The remaining ticks after washing will need to be removed manually.

However, the dog owner should in no way think that after removing the tick from the dog’s body, the danger of its infection with one or another infectious disease has completely disappeared. Infectious diseases, depending on the type of infection, the dog may develop after several days or months.

Signs of subcutaneous mites in dogs are often similar to symptoms skin diseases bacterial and fungal in nature:

• , sometimes so strong that the animal scratches itself into blood.

• , on early stage noticeable in areas with short hairline- muzzle, ears, hind legs, stomach, genital area.

• Anxiety, aggression – illnesses causing itching extremely painful for the dog.

• In advanced stages - weakness, development of secondary pathologies.

Before treating an animal, the true root cause must be determined. Most subcutaneous mites are microscopic in size, so making a diagnosis by eye is highly not recommended. Having discovered suspicious symptoms, you need to give the dog an anti-drug - it partially relieves the itching and show the animal to the veterinarian.

Note! Some skin diseases have characteristics, but most of them are very similar and the only correct method of diagnosis is skin scraping.

Demodicosis

Important! Veterinarians often prescribe Essentiale Forte as a therapy for the liver. The method is not guaranteed to be useful, since the drug contains substances that provoke the activity and reproduction of the pathogen.

• Hypoallergenic diet and antihistamines – abrupt change diet is not recommended, but is necessary for demodicosis. The animal is transferred to a specialized industrial feed premium quality. Many manufacturers produce food for dogs suffering from demodicosis. Antihistamines slightly, but reduce itching.

Important! A sudden transfer from natural to industrial feeding can cause dysbiosis; it is recommended to give the animal special nutritional supplements With .

• Detomax type injections are extremely dangerous therapy, which is allowed only if the possible positive effect outweighs the risks.

Very important! Detomax and its analogues are called “lethal injections” in dog breeding circles - some pets are simply not able to tolerate such aggressive therapy. However, the instructions clearly state clinical indications, including demodectic mange, which gives veterinarians a reason to prescribe the drug “to everyone.” Be careful!

There are no developed preventive drugs for demodicosis. Complete care and feeding are also not guarantees. Many pets have genetic predisposition to the disease, therefore, recovered individuals are discarded from breeding.

Every dog ​​has subcutaneous mites (another name is demodexes), but they do not always manifest themselves. What triggers the development of the disease? What are the signs and how to treat subcutaneous mites in a dog? More about this in the material below.

The disease occurs in two forms:

• scaly (another name is squamous);
• pustular (another name is pyodemodecosis) - may be a consequence of the scaly form or an independent disease

Attention! According to its prevalence, the disease can be localized (local) and generalized (general).

Symptoms of demodicosis in dogs manifest themselves differently depending on the type of disease:
Scaly demodicosis– the most light form. Round bald patches appear on the dog's body (usually on the face and paws). The skin in these areas turns slightly red and may become rough and cracked.
With pustular demodicosis the skin swells, pustules form on it (their color can be yellowish, brownish-red or even black), from which pus is released. If an infection is added to the disease, pyoderma occurs, which leads to the formation of ulcers. The skin itches a lot, becomes wrinkled, moist, thick, and smells unpleasant. The skin on the head (ears, muzzle, eyebrows) and paws of the animal is primarily affected.

Symptoms of subcutaneous mites in dogs with a localized form- these are 4-5 lesions (no more), and their diameter does not exceed 2.5 cm. In other cases, demodicosis is generalized. In order to make a diagnosis, the veterinarian examines the animal, then performs a deep scraping from the affected area of ​​the skin (the upper layers of the epithelium are removed with a scalpel until blood appears and placed on a glass slide). The resulting tissue is examined under a microscope. If 1-2 individuals of subcutaneous mites were found in the scraping, the procedure is carried out again to confirm the diagnosis.

Folk remedies