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Grumpy Old Man
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Demodex mites are part of the normal flora and fauna found on all dogs. In the case of localized demodectic mange, the bare and thin spots appear when the dogs immune system becomes depressed and the mites get out of control.

The real question you need to answer is why the immune system is depressed? Address that and the dogs natural defenses will get the mites under control again.

It is fairly common for a females immune system to go through some fluctuation as she goes through puberty (her first cycle). This combined with the hot spot and flea meds could drag her immune system down far enough to allow the mites to reproduce out of control.

In many cases of localized demodectic mange, rest and proper diet is about all that is needed for the problem to resolve itself.
 
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