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HH Health4 min read

Hole-in-Head Disease (Hexamita) and HLLE

Hole-in-head and head and lateral line erosion (HLLE) plague oscars, discus, and cichlids. Treatment with metronidazole works if caught early.

By 4848 One FarmPublished April 27, 2026

Recognizing the Disease

Small pits or holes appear on head and lateral line. Color fades to white in lesion areas.

Often progresses slowly. Fish may continue to eat for months while disease worsens.

Causes

Hexamita parasite (single-celled internal parasite).

Poor diet — vitamin C and mineral deficiencies.

Carbon overuse — strips trace elements from water.

Stray voltage from faulty heaters or pumps.

Treatment

Metronidazole (Flagyl): dose 250mg per 10 gallons every 48 hours for 3 doses.

Stop using activated carbon — it absorbs the medication.

Improve diet with frozen foods, vegetables, and high-quality pellets.

  • Soak food in Metronidazole for direct delivery
  • Increase vitamin-rich foods — bloodworms, brine shrimp, blanched vegetables
  • Test for stray voltage with an inexpensive multimeter

Recovery

Lesions stop growing within 1-2 weeks of treatment.

Pit healing is slow — months to years. Severe pits may scar permanently.

#hole-in-head#hexamita#HLLE

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