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FAQs on Freshwater Head & Lateral Line Disease, HLLE, HITH (Hole In The Head)... Cures

Related Articles: Head and Lateral Line Disease (HLLE), Freshwater Diseases, FW Disease Troubleshooting, Ich/White Spot Disease, Freshwater Medications,

My Frontosa, HLLE tissue damage - 7/1/08
Hi, I wrote you before about my Front, Georgie and his hole-in-the-head problem, and that I treated him with Medizole and Furnace, I then noticed it looked like fungus so I treated him again with just the Furnace, It looked like it went away but his holes didn't look any better, so I then treated him with some medication called Hole-in-the-Head by JUNGLE, and he still looks like this, is there any hope?
<To heal the wounds from the neuromast destruction? Mmm, yes... with time, good nutrition, water quality...>
( I sent you a couple pics) I have had him for a long time( we think he is around thirteen years) and he has always been healthy but know I am at a loss, usually when I treat my fish I have good luck if I catch it right away, I am sending you a few pics and see if you can see what you think,
Thank you for your time,
John Cline
<Have seen worse cases remit. Do try feeding Spectrum pellets exclusively, being religious re weekly water changes... Read here: http://wetwebmedia.com/hllefaqs3.htm
and the linked FAQs files in this series above. Bob Fenner>

Cichlid With Hole-In-The-Head 4/8/06
I have a 9” red flame cichlid that has developed raw spots on its head (above the eyes and below the dorsal fin, and between his eyes) they developed after his tank mate died about 3 weeks ago. The spots seemed to have blood circulating to them because I see red within the areas. I do 25 -30 % water changes about every 10 days (55 gal whisper 3 filter) I have also been adding aquarium salt (1 tablespoon a day for three days now). I have had the water tested and is within the norm. He is the only fish in the tank and has stopped eating for at least 4 days, spends a lot of time on the bottom. When I turn on the light he comes to the top to eat, if he even bothers to take any Hikari cichlid gold pellets, he just seems to swim backwards any spits them out. These spots are not deep; they seem to be just on the surface. The one above his eyes is approx ½” across and slowly getting bigger. He has had these spots before but this big and not for this long. Any help you can provide would be much appreciated Thank you Dave
< Do a 50% water change, vacuum the gravel and clean the filter. Treat with Metronidazole and Nitrofuranace. When he starts to eat , offer some live food live washed earthworms, and watch for ammonia spikes because the medication will affect the biological filtration.-Chuck>

Hole in the Head and Eye Problems ... Oscars - 03/27/06
Hi WWM Crew, I have had Oscars since 1980 and never had any problems with them before. I believe that is because I pay such careful attention to water quality and diet. However, just recently one of my two 12" Oscars starting laying on the bottom and gasping for air. This has gone on about a week. The pH, Nitrates and Ammonia are perfect. I feed them Hikari pellets. The one in question has one boated eye and lays on the bottom of the 80 gallon tank. If I reach in and touch him he has good energy and swims strongly across the tank. He can also come up for food but lately I can tell it is getting harder for him. The only other symptom is a slight hole in the head which I treat but can never seem to make go completely away. I have tried Maracyn TC as I thought it was bacterial. Then MarOxy as the Maracyn TC did nothing so maybe it was fungal. This also did nothing. I have tried salt and several water changes but nothing seems to work. Any thoughts?
Art
<Most eye problems, as well as Hole in the Head, start when too much organic matter starts to build up in a tank. Please re-test the water. After a few rounds of meds you have probably lost your cycle. Also, when doing a water change always use a gravel vac to remove as much waste as possible. Hole in the Head is caused by a protozoa. Metronidazole is the drug of choice. However the wounds caused by the protozoa can become infected by bacteria or fungus. Keeping your system pristine will help greatly. This will also help with his breathing and eye problems. Should the eye begin to swell, add Epsom salt at the rate of one tbls per 5 gallons. Replace the Epsom salt in the new water when doing a change until the swelling goes down. Don>

Gouramis With Hole-In-The-Head - 05/23/2006
Hi there. OK. My eyes hurt. Been reading your FAQ's. Can't find definitive info on what I'm looking for. I seem to have a Hole in Head "outbreak" in my aquarium. I have a 60gal, heavily planted, tank; plenty of lava stone and wood for hiding. Penguin 400 filter, CO2 diffuser, 17 Gouramis, a Pleco and a small Cory. Water changes are every other week, (sometimes weekly if I think it needs it) Filter cartridges rinsed bi-weekly, changed monthly (per advise of LFS). Ammonia 0, Nitrite 0, Nitrates tend to be in the hi 20's, touching 30, but I attribute part of that number to plant fertilizers. Some products tote amazing cures, some say nothing helps Hole in Head. Any suggestions on how to rid the fish of this? Also.. is this contagious like Ick? I do see it on 2 or 3 fish, but not the other tank mates... at least not yet. Thanks. You guys are great John
< Usually this is a problem with some New World cichlids and not associated with Gouramis. Do a 50% water change, vacuum the gravel and clean the filter. Treat the tank with Metronidazole and see if that helps. It could just be a bacterial infection and it may respond to antibiotics like Kanamycin. If you do decide to use antibiotics then watch for ammonia spikes because it may affect the biological filtration.-Chuck>

Oscar With Hole-In-The-Head 9/12/06
Hi crew. I have an Oscar which appears to have a hole in the head. I am not sure whether it is HITH disease. It appears to be very dull. Can you help me out with the cure and other things to cure it. Thanking you
<Do a 50% water change, clean the filter and vacuum the gravel. Upgrade the diet top include more live and frozen foods. Treat with Metronidazole and keep the lights off.-Chuck.>

Gold Severum.........is this hole in the head? Asymmetrical? No 8/14/06
hey guys, first off, great site as always.
I have had a 150 gallon(6 foot tank)) setup for quite some time. Currently housing
6 inch gold Severum
7 inch Jack Dempsey
3 inch Oscar
4 inch Red jewel
3 1/2" Green terror
(2) 5 inch banded Leporinus
4 inch Gibbiceps Pleco
8 Buenos Aires tetras
<Must be fast!>
I have 2 Emperor 400's for filtration
<And lots of big regular water changes I hope>
Recently I had a aggression problem that caused me to have to give away my 6 inch Green Severum, as he was attacking the Gold Severum often, and when he wasn't, he was extremely aggressive going for food. Since then I noticed that what I originally thought was a bite wound on the side of the Gold Severums face has not healed. As i look at it now I am thinking that either the wound is not healing or they may just have been open sores from the beginning.
Both are on the left side if the head, behind the eyes, and before the gills. There is no "pitting" as i have seen HITH described, however it does look like the larger sores I have seen in HITH pictures online.
<Mmm...>
Would treatment of non-healing wounds be much different than a treatment for HITH (if that's what this is?).
<Are identical... improved nutrition, and water quality... sometimes coupled with the use of a protozoacide>
I will add that i had been lax with maintenance these last 2 months the last 2 months of my wife's pregnancy), however, It had always been top-notch until now.
<Oh>
Hopefully i can solve with increased maintenance, and frequent water changes for a few weeks. Since i prefer not to have to set up a hospital tank if I can avoid it.
<I would not here>
Also, one last question. Regarding stocking. Will this tank be able to handle another Oscar without having to displace the current inhabitants?
<Not a good gamble, no>
I realize that having two fish that will be 12 inches long each may tax even this tank.
Thanks in advance for any help you can throw my way!
<If the pitting is not "symmetrical... bilaterally", that is, about the same on both sides of the fish, this is not likely HLLE, HITH... but "just" sores or pitting from poor water quality. Bob Fenner>

Experts Asking Experts, Hole-In-The-Head On A Flowerhorn 12/19/06
Good morning, Crew! I hope this day finds you well.
Inspired by your example, I have been helping people with their fishy questions by volunteering at AllExperts.com. So far, everything has been very straightforward, but yesterday a gentleman overseas asked me about his Flowerhorn. I hope you don't feel that I am asking you to "do my homework" for me, but before I suggest any other treatment besides salt, I wondered if you wouldn't mind sharing your opinions on what appears to be wrong with this cichlid. Before he sent me the pictures, I told him it was probably Head and Lateral Line Erosion (HLLE). Although the pattern of erosion is not what I expected to see based on his descriptions, I still believe that HLLE is the causative agent here - but I wanted to double check with the real experts!
Thank you so much for your assistance, you have always been so reassuring and helpful. There are so few free resources like this on the web at large...what you have here is remarkable. Happy holidays to all of you! I hope that a fab getaway is in your future! Nicole
< The exact cause is not known. Generally a 50% water change, vacuuming the gravel and cleaning the filter improves the water quality and slows the progression of the disease. Treatments of a combination Metronidazole and Nitrofurazone have had some success. Some aquarists have also had good luck with Clout. After treatments have arrested the disease, a more nutritious diet with fresh ingredients and high vitamin and mineral contents speed the recovery. Vitamin C seems to be a key vitamin in getting a full recovery. many Flowerhorn breeders are obsessed with color and developing the fatty hump on the males. These high fat diets usually develop into diseases like bloat and the hole in the head that this Flowerhorn seems to have.-Chuck>

Chocolate Cichlid With Hole-In-The-Head Disease 3/27/07
Hello; I thank for the great website. My experiences as an aquarium keeper have been greatly enhanced by what I have learned on your site. I purchased a 4 inch black ghost knife, and a 3 inch chocolate cichlid two days ago. They are both in quarantine in a 30 gallon tank; 79F, 0 ammonia & nitrites, nitrates 10-15. The tank has been running with a Pleco and Synodontis (and a few other temporary 'guests') for about a year an half. The BGK and chocolate cichlid are to eventually move into a 100 gallon Amazon tank. The problem and question: After looking at the chocolate cichlid closely, he appears to have HLLE small lesions behind the eyes on both sides of his head. Three or four holes on each side. If I do a treatment with Metronidazole on this tank will I be endangering the black ghost knife?
< The BGK should be unaffected by the treatment.>
I've read about their sensitivity to medications.
< They are mainly sensitive to dyes.>
I plan to treat the tank every two days, after 30% water changes, as the package instructions state, for ten days. Then, follow up with a good diet and added vitamins. Any other suggestions or information greatly appreciated. Thank you very much in advance, Anna
< Should like a solid game plan.-Chuck>

Repeated hole in the head disease, Metronidazole Treatment For HITH - 6/1/07
> My T bar Cichlid is suffering from his 3rd bout of hex this time he has a small visible pin sized hole above his eye and the usual white strongly pooh. Last time in September 2006 I treated the tank with Metronidazole 5mg/L and he recovered well. I have done a water exchange today and added metro at 5mg/L. Is this repeated dosage likely to harm my other fish? 2 cat fish 3 rainbows, 2 giant Danios and 1 rosy barb?
< If treated as recommended this medication should have no effect on the other fish.>
> Also do I need to do 50% water changes in between adding the dosages on the 2nd 4th and 6 days?
< Metronidazole is affected by organics in the water. The cleaner the water the better the medication will work. Water changes also reduce organic waste. The tank is getting cleaner. The water is getting better and the medication is getting more effective. Sound pretty good to me.-Chuck>
> Many thanks for your help

Treating An Oscar with Hole-In-The-Head – 1/04/08
I have an Oscar that has hole in the Head Disease. I have treated him on two different occasions over a three month period with Fish-Zole. The places on his head just don't seem to want to heal. He is in a 75 gallon aquarium with a canister filter which gets cleaned once a week. He gets a 25% water change once a week. His water quality is in the good range on everything. He gets a variety of foods (no feeder gold fish). He gets pellets, sticks, krill and a mixture of beef hearts, garlic, spinach, vitamins and other ingredients twice a week. He also gets Vita-Chem added to his pellets 5 times a week. He has a very good appetite and seems to be growing. Should I treat him with the Fish-Zole again or is there something else That I can use to heal the places on his head. I don't want to loose him. Your help will be greatly appreciated. Thanks in advance. Nancy
< This disease takes its own sweet time to heal. If the lesions are not getting any bigger then you fish is probably cured. The wounds left behind are typically very slow to heal. They first turn black and then slowly start to close up. Check the nitrates. Try and keep them under 20 ppm. Your treatment methods are very sound and hopefully caught in time.-Chuck>

Treat Oscar With Hole-In-The-Head Part II 1/5/08
I checked the nitrates they are 10 ppm. Some of the places seem to be turning black but he has a few places that seem to be getting deeper. The largest one is about 1/8 across and the others are smaller. They are white in color. I have enclosed a couple of pictures. Maybe you can get a better idea of my problem. Thanks again. Nancy
< This infection is pretty severe. Never seen it this wide spread before. Look for a medicated food with Metronidazole in it. Add it to your fishes regular diet. Keep the water clean and the diet nutritious like you have been. Drs FosterSmith.com sell a medicated food called Anti- Parasite. It has Metronidazole in it. Add this to the diet. Keep tract of the disease by taking pictures of your fish once a week. Date them and compare them over time to see if he is getting better.-Chuck>

Oscar With Hole-In-The-Head Gets Treatment 1/7/08
Thank you for your quick response. If you look at the picture that I have attached. The places midway up toward his dorsal fin and midway down his side are not the holes that I am talking about. He did those places on the gravel in the bottom of his tank. The holes are located beneath his gills and to the right of his eye which seem to be healing and the small ones on top of his nose. I have started him on the medicated food and also added some MelaFix to his water. Will see how this does. He really doesn't know what to do with those little pellets of food but I am sure he will find out. Thanks again for your help. Nancy
<Don't feed him for a few days and he will be hungry enough to eat the new medicated food. It looks like you are doing everything you can possibly do.-Chuck>

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