Hole in Head Disease: Hexamita Treatment Guide

**Quick Answer:** Hole in head disease (HITH) causes pitted lesions on a fish's head and lateral line. It's commonly caused by Hexamita parasites combined with poor water quality and nutritional deficiencies. Treat with metronidazole ($20-25), improve water conditions, and enhance diet with vitamins. Recovery takes 2-6 weeks.

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What is Hole in Head Disease?

Hole in head disease (HITH), also called head and lateral line erosion (HLLE), creates distinctive pitted lesions on a fish's head and along the lateral line. These start as small white pits that gradually enlarge into crater-like holes. It primarily affects cichlids, especially oscars and discus, but can occur in other species.

Symptoms

Small white pits on head and face

Pits enlarging into visible holes

Lesions along lateral line

White stringy feces (indicates Hexamita)

Loss of appetite

Lethargy and hiding

Color fading

In severe cases, holes can expose bone

Causes

**Primary causes:**

Hexamita parasites (most common)

Poor water quality (high nitrates)

Nutritional deficiencies (vitamin C, D)

Activated carbon removing nutrients

Stress from overcrowding

Inadequate diet variety

**Contributing factors:**

Lack of water changes

Old tank syndrome

Feeding only dry foods

Low oxygen levels

Poor filtration

Treatment Steps

1. **Test water immediately** - Check nitrates (should be <20ppm).

2. **Large water change** - 50% with matched temperature water.

3. **Medicate with metronidazole**:

- API General Cure ($20-25)

- Seachem Metroplex ($22-28)

- Dose in water and food

4. **Improve diet**:

- Soak food in vitamin supplements

- Add fresh/frozen foods

- Include vegetables for herbivores

5. **Remove activated carbon** - Can strip vitamins from water.

6. **Maintain pristine water** - 25% changes every 3 days.

7. **Continue treatment** - Full 10-14 day course essential.

Vitamin Enhancement

Add to food:

Vitamin C supplements

Garlic juice (immune boost)

Selcon or VitaChem

Fresh vegetables (peas, spinach)

Quality varied diet

Water Quality Focus

Critical parameters:

Nitrates: Below 20ppm (ideally <10)

Ammonia/Nitrite: 0ppm

pH: Stable (no swings)

Temperature: Species appropriate

Dissolved oxygen: High

Recovery Timeline

Week 1: Stop progression

Week 2-3: White growth in holes

Week 4-6: Holes begin filling

Month 2-3: Significant healing

Complete healing: 3-6 months

Note: Large holes may never fully close but will heal over.

Prevention

Weekly 30% water changes

Nitrates always below 20ppm

Varied diet with vitamins

No activated carbon long-term

Quarantine new fish

Reduce bioload if needed

Quality filtration

Species Most Affected

Oscars (very common)

Discus

Other large cichlids

Tangs (marine HLLE)

Large predatory fish

When to Worry

Seek help if:

Holes rapidly enlarging

Multiple fish affected

No response to treatment

Secondary infections developing

Fish stops eating completely

Common Questions

**Will the holes completely heal?**

Small holes often heal completely. Large holes may heal over but leave indentations. Function returns even if appearance doesn't fully recover.

**Is HITH contagious?**

The Hexamita parasite can spread, but HITH typically only develops in stressed fish with poor conditions.

**Can I prevent scarring?**

Early treatment gives best cosmetic results. Vitamin C particularly important for tissue repair.

**Why did only one fish get it?**

Individual fish have different stress tolerances and immune systems. Dominant fish often affected due to territorial stress.

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