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CI Cichlid4 min read

Hole in the Head Disease: Causes and Treatment

Hole in the head disease is a disfiguring condition in large cichlids. Causes are multi-factor — treatment addresses each.

By 4848 One FarmPublished April 21, 2026

Symptoms

Small pits appear on the face and head region. They can remain stable for months or worsen into large craters. Secondary infections turn pits into open ulcers.

Classic in oscars, discus, severums, and flowerhorns. Less common in African cichlids.

Multi-Factor Causes

1) Hexamita intestinal parasite (weakens immune system). 2) Poor diet (lack of vitamins A, D, fatty acids). 3) Activated carbon stripping trace nutrients. 4) Poor water quality.

Not one single cause — usually 2-3 factors combine.

Treatment Stack

Dose metronidazole 5mg/10L for 10 days (kills hexamita). Remove activated carbon. Feed vitamin-rich food (vita chem soaked pellets, fresh greens, beef heart).

Water changes 50% weekly to lower nitrate and TDS.

Long-Term Care

Healed pits leave pale scars but never fill completely. Prevention is the only cosmetic solution.

Maintain varied high-quality diet, avoid carbon in long-term setups, and keep nitrate below 20ppm.

#hole-in-head#HLLE#hexamita#disease

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