Hole In The Head Disease (HITH)-

Hole in the head disease (HITH for short) has been the bane of Discus, Oscars, Angels and assorted other cichlids for years. It seemingly appears for no reason, pitting the heads of our charges, often leading to permanent scarring and/or death. And all the time the hobbyist is doing their level best to cure the problem with little or no success. This leads the hobbyist to the belief the problem is incurable and the reasons un-known.

Hopefully, I will be able to clear up some of the mystery, and maybe even point you in the direction of a cure and prevention. OK, first. What exactly IS HITH? Well, the term is fairly descriptive. Pits form in the head of the fish. These at first appear to be pinholes, and progress steadily to the point of large open wounds. It often migrates from the head to the lateral line and will sometimes follow the lateral line down the body of the fish. Needless to say, this is distressing to both the fish and the owner.
Now we know what it is, but how does it happen? Just what causes this phenomenon? It is commonly thought that the Hexamita parasite is the cause. It is often found in conjunction with HITH, therefor leading to this belief. However, I am firmly of the belief that Hexamita is merely being opportunistic, and is not the cause.

In the early 80’s, I had an outbreak of HITH amongst my Discus. After a lot of drugs and hand wringing, I decided that I was getting miss information. A friend of mine at the time was kind enough to take swabs of the wounds on the fish that had yet to pass. He prepared slides and we discovered that in all but one of the fish, the concentrations of Hexamita were not sufficient to be the cause of the problem.

So Hexamita is what it is NOT, so what is it? The holes are very similar to the lesions that we get when we suffer from scurvy or rickets. Both vitamin deficiency diseases. So I decided to supplement the fishes diet with multivitamins. This treatment had a dramatic effect on the fish. I saw improvement in about a week’s time. All but one of the worst off made a full recovery. There was some scarring, but otherwise the fish were fine. Using vitamin supplements has proven itself to me over the years since in preventing and treating HITH.

There is however, another cause for HITH that very often accompanies dietary reasons. This is long term exposure to low levels of nitrates. This is especially true in cases involving Oscars and other large cichlids. Prolonged exposure to levels above 50 ppm will eventually lead to the on set of the disease.

Now that I have discussed the two causes of HITH, lets work on treatment. We will do the easy one first. The reduction of nitrates.

If you have hi levels of nitrates, the easiest way to solve this is to increase the number and volume of water changes you do. This should reduce the nitrate levels to within acceptable levels. If you still have hi levels even after improving your water changes, then you may want to check your tap water. Fairly often, tap water will contain nitrates. If this is the case, you will need to use either a de ionizing unit, or an RO unit. Setting up a denitrator is another possibility, but it is complicated to say the least.

Overcrowding, overfeeding and the feeding of feeders are also major contributors to hi levels of nitrates. Reduction of feedings and number of fish, and no longer using feeders will go a long way towards helping also.
Once you have addressed the nitrate issue, you need to look at the fish’s diet. First, are you feeding a variety of foods? While the flake and pelleted foods available today are of much higher quality than years ago, other foods should still be fed. Frozen foods are an invaluable addition to a fishes diet. It’s the closest thing you can get to feeding live foods without having to have a bunch of worm cultures around to gross out your wife/husband. On all but the larger fishes menus should be brine shrimp, blood worms, mosquito larvae (also known as glass worms), daphnia, plankton, tubifex (please, that is a whole article to itself) and any number of spirulina and specialty formulas out there.

The most common live food available (at least in my area) is black worms. You can buy large portions live, store them in the fridge (another spousal issue) and feed them live for several days. Just be sure to rinse them daily. Then you can freeze the remaining worms for later use. White worms are also an easy live food to culture, but are not sold in LFS very often.
For the larger fish, earthworms, crickets, chopped shrimp and other larger foods do well.

With a varied diet, you will go a long way to improving your fishes health, and prevention of HITH, but it probably wont cure it. To do this, you need to add a vitamin supplement to their food. There are several vitamin supplements available on the market that you dose to the tank. Stay away from these. They are a waste of money in my opinion. Vitamins are very unstable in water. They break down and dissipate quite rapidly. Also, fish do not absorb vitamins to any great degree through their skin or gills. Even if they did, the vitamins break down to quickly as I said.

Given this, you have to dose the fish’s food. This is best accomplished using pellets. I use liquid vitamin supplements that I get at health food stores. These supplements have a very hi dosage, which is good considering their instability in water. I use a multivitamin or vitamins B, C and D if I cant find the multivitamin. Just place the pellets in a bowl and use just enough of the supplements to cover the pellets. Allow them to soak until they are slightly mushy but still firm. Sort of al dente. Then feed away. When treating the disease you should feed this every day. Once or twice a week should do for prevention.
For picky fish that just plain refuse to eat prepared foods (Discus) I take a different approach. The day before I freeze the remaining portion of black worms, I dose them with the vitamins, and allow them to sit for 24 hours. This kills some of the worms, but not too many. Then I freeze them. I have no way of knowing just how much of the vitamins they absorb, but it has worked for me.

Now, if you can not find the liquid supplements, you can use any of the regular multivitamins. You will need a mortar and pestle to grind them however. Grind one up into a very fine powder. Dissolve it into a small amount of water, then soak the food in that. That was the way I had to do it when I first started.

So there it is. I hope I cleared up some confusion without adding any. If you have any questions, or would like to discuss this more, feel free to contact me at

Written by Don Dickson




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