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Hole In The Head Disease 

What is Hole in the Head Disease in Fish?

Updated on February 03, 2023
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Reviewed by Don Spaeth
Petco’s National Aquatic Care, Education and Programs Manager

Symptoms   | Causes | Diagnosis and treatment  | Prevention

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Keeping an aquarium can be a rewarding journey into pet parenthood. Fish are lively, colorful and can provide wonderful ambiance in your home. They can also be lower maintenance when compared to other pets. That being said, you still need to look out for the health of your finned friends just like you would with any other pet. Illnesses like hole in the head disease are serious and need to be treated quickly.  

There is no one specific cause of hole in the head disease—also called HITH. Some fish may develop this chronic condition because of a parasite like Hexamita or improper aquarium conditions and water quality. The proper hole in the head disease treatment depends on the cause of your fish’s ailment and the type of fish being treated. This disease can affect many different species of freshwater and marine fish. This condition is often called head and lateral line erosion or HLLE.  

Read on to learn more about how this disease can affect fish health & wellness and how you can help your pet get better. 

Symptoms  

There are several signs of hole in the head disease to keep in mind. Unfortunately, you may not notice that your pet fish has this illness until there are visible physical manifestations, including the ones below. 

  • Depigmented skin along their lateral lines—a series of sensory organs on their head and along their flanks used to detect movement, vibration and pressure gradients 
  • Eroding holes along the head and flanks that make it look like the fish’s skin is being eaten away 
  • Lesions that can worsen into open ulcers and adversely affect the fish’s appetite and energy level  

Early signs of hole in the head disease may seem subtle, especially if your fish already has light coloration. If your pet develops pale patches and lesions along their head and sides of their body, it’s time to take action. There may be just a few spots at first, but the disease can progress rapidly. As hole in the head disease worsens, your fish can likely become lethargic or stop eating.  

What causes hole in head disease?

There is no one specific cause of hole in the head disease and avoiding it altogether may not be possible. Keep the following causes in mind as you arrange and maintain your aquarium.  Maintaining great water quality and stress-free conditions—as well as offering a varied diet—is your best line of defense against HLLE.

Poor water quality If your aquarium is dirty and your nitrate levels are elevated, your aquatic life is more susceptible to disease. Hexamita infection in fish may be more likely if you don’t clean your enclosure often enough with the proper aquarium cleaning supplies.  

Inadequate nutrition

If your fish don’t have the right balance of vitamins and nutrients in their food, they may be more likely to develop this disease.  This usually presents itself when aquatic life is offered only one type of food. Ensuring a wide variety of foods—such as insects, high quality pelleted diets and frozen or fresh foods—are offered is key.

Viral infections

Some contagious infections rip through an aquarium and suppress your fish’s immune system. These conditions may also lead to hole in the head disease.  

Too much activated carbon

Some filtration systems use activated carbon to absorb contaminants, aid in aquarium water clarity and reduce odors. Some aquarists believe activated carbon may irritate a fish’s lateral line by removing some beneficial minerals and unfortunately lead to illness. 

Stray voltage

If you use an electrical appliance in your saltwater aquarium—such as a heater— some electricity may leak into the water if the equipment is damaged or isn’t functioning properly. This may cause your tropical fish’s hole in the head disease,  triggering lesions on the head and along the lateral line.  

Once your fish has hole in the head disease, other bacteria may take advantage of the illness and enter through the lesions or holes. This is why treating the condition as soon as possible and ensuring the aquarium water is of optimal quality is important. In most cases, this illness will not be fatal to your fish if addressed promptly.  

Diagnosis and treatment 

Your vet can diagnose this condition simply by looking for lesions and pale spots in your fish. However, figuring out the exact cause may be trickier. Your vet will probably recommend aquarium improvements to reduce environmental stressors. Hexamita treatments typically consist of medicated food that helps eliminate the parasites.  

Your recommended treatment plan may include some of the following. 

Improving water quality Upgrade or add new aquarium filters and media and change the water more frequently to improve the environment and reduce bacteria, parasites and other possible causes of hole in the head disease. If you have tropical fish, you may also need to adjust your aquarium salt and mineral levels. 

Changing your nutritional plan

Your vet may also recommend that you alter what you feed your fish. You may need to find a new formula or offer a wider variety of food options rotated throughout the week. You may also need to determine the appropriate amount of food offered to ensure everyone gets fed.

Isolating affected fish

An affected fish may need to be moved to a separate aquarium while recovering. This is recommended if the cause is a suspected bacterial or viral infection that may be contagious.  

Reducing activated charcoal usage

Changing how you filter your aquarium may improve the health of your aquatic life.  

Medication

Your aquatic vet may prescribe a topical gel containing becaplermin to help heal any lesions caused by the disease. If a secondary infection is present, you may be instructed to provide your fish an antimicrobial medication. 

Preventing hole in the head disease 

Once your fish recover from this illness, you’ll want to set up your aquarium for success. Taking these four steps may help you avoid future instances.  

  1. Reduce activated carbon usage There are many ways to filter water, including sponges and bio-sand, meaning you might not necessarily need to use carbon full-time. If this disease becomes a common issue, it’s probably worth reducing the amount of time you use carbon—or even remove it completely.  
  2. Test the water periodically for stray voltages If you’re using an electrical piece of equipment in your tank, you should periodically test for electricity in the water.  
  3. Feed fish based on species Not all fish require the same diet. Cater your fish food to the type of fish in your aquarium to avoid nutritional imbalances or deficiencies. 
  4. Change water more often Frequent water changes can stop the degradation of aquarium water and reduce the buildup of bacteria and debris.  
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