Need help with lesions on emperor angel 2/18/09 Hello, crew: <Steve> This will be a long email but I want to give you full info of my tank, inhabitants, and diet. I have a 600 gallon tank with approx. 150 g sump tank that contains 650 lbs of live rock and the following livestock: 5" juvenile emperor angel 8" queen angel 6" miniatus grouper 8" panther grouper 9" Volitans lion 5" porcupine puffer 12" Naso tang 6" powder blue tang 7" Lunare wrasse 6" harlequin wrasse 13" snowflake eel 5" blue cheek trigger 5" niger trigger 6" pink tail trigger very large red hermit crab (none of the fish even try anything with him) no other inverts I feed the fish quite a varied diet as follows: twice a day I feed a varied combo of Nori alga, angel formula with sponge frozen cube food, life line frozen cube with Spirulina, mysis shrimp, prime flake food, spectrum pellets, Dainichi marine and veggie pellets. I mix and match all these foods during each feeding so I don't overfeed. I make sure the amount given at each feeding is fully consumed within 4-5 min. Every M, W, F, I feed meaty foods consisting of squid, krill, clam, scallops, and silversides. I don't just drop the meaty foods in, but rather try to focus on getting them to the groupers, lion, and puffer. I feed the eel and hermit one piece each with tongs M, W, and F. The wrasses and triggers always get some too as they are so fast. I don't feed any live foods or freeze dried foods. I soak the foods in Zoecon (soon I will try Selcon as I have some on order) and Kent marine Vit C. The water parameters are as follows: nitrate 20-30 ppm, nitrite undetectable, pH 8-8.4, temp 76, SG 1.021-1.022, <Too low...> calcium 420 ppm. <And Mg?> I do run a carbon filtration system (uncertain of exact size/model), UV filter, and ozonizer with orb controller that reads out 380-430 (generally reads about 400). I don't add any iodide or calcium or magnesium specifically to the water. I don't know exact skimmer make but there are two and each is rated for 600 gallons. Don't know exact watt of lighting but is a combination of actinic and VHO bulbs set up to give very nice visibility. No chiller, the water remains at 76 F by itself with two heaters. Tank was set up about 1 year ago and fish have been in it for about 10 months. All fish (including emperor angel-see below) have very healthy appetites and body mass. I have not found one type of food that every single fish in there will not go crazy for during feeding. My groupers go nuts over alga and sponges, and don't spit it out either. The queen angel occasionally chases the emperor and Naso for maybe 1-2 seconds and then forgets about them. The Naso seems to ignore this. The emperor moves away and then immediately continues doing what he was doing when the queen loses interest. This has never resulted in a fin damage or body damage that I have seen. Have had no disease outbreaks thus far (see below comments). All the fish seem to get along well and appear to be acting completely normal. The tank gets a 20% water change every 2-3 weeks. Now that you have the info, here is my main question: I need help figuring out what is affecting my emperor angel. I included some pics for you to see. I figure it is HLLE vs. hole in the head, <Yes... neuromast destruction...> but can't tell which one. The lesions are very symmetric over his face and around his mouth; and they started about 4 months ago, gradually. You really can't tell one side of his face from the other (lesions are very symmetric). Also, you will see the lesions going up his gill margins. As you can see, he is in the process of going toward adult coloration. Not sure if his pale looking face is just part of that change too, but it seems almost translucent to me, rather than a healthy white of the adult (his face is normally more pale and white than shown on the pics). And the pics may not show it, but I can almost imagine a slight red tinge around his mouth area (which I have read is a dietary deficiency issue). The lesions look like deep pitted acne scars and he has one or two perfectly round "holes" near his eyes. Again, all very symmetric. Absolutely no lesions along his body or lateral line area. Over the last couple of weeks, I think I am noticing two extremely tiny (1-2 mm size) holes under the chin area of the queen angel now. These too are symmetric (one on each side of midline) They are so tiny, however, that I am not sure that they aren't just a normal marking or something. The queen has beautiful and full perfect fins and adult coloration otherwise. None of the other fish show any detectable variances off of their normal coloration/markings, etc from the wild.  All (including the angels) have perfect fins and clear eyes. I have been adding some Hikari Metro+ to some of the frozen cube food in 3 day treatment cycles. I have done this for 2 three day cycles. I am just not sure what else to do or how long it should take to see some improvement. This is all a little tricky because the angel's face is white as an adult so I don't know how much of this is normal coloration change. Even though I suspect most if not all of this is HLLE or hole in head. I am kinda at my wits end. I thought I would be able to take care of this angelfish in this system by supplying appropriate diet, etc. I guess I may fall in with all the other aquarists in that I should not try to keep an angel. I just don't know what else to do here. Thanks for any advice, Steve <Does seem unusual... given the foods you list, the use of Zoecon... to have such a pronounced nutritional deficiency syndrome here... Do you have another system you could move this Angel to? Otherwise... perhaps the Selcon will help... I would supplement Iodide-ate maybe weekly with water changes... And possibly add "Miracle Mud" to your sump, culture a Red Algae there... Bob Fenner>

Re: need help with lesions on emperor angel 2/18/09 Bob, <Steve> Thank you for the quick response on such a lengthy email question and description. I will try what you suggested. I also will try some Hikari A and S marine pellets just in case. <Worthwhile> Regarding the SG, I thought having it a little low would help with Cryptocaryon, etc. <Does, but... the trade off in added stress can be a bad choice... Pomacanthus imperators from certain areas in particular are very susceptible to neuromast destruction syndromes> I saw the article on your website about a year ago of the guy with 20-30 angels, triggers and tangs in a 240 gallon aquarium that keeps the SG somewhere below 1.015 for that reason (no corals). <Yes... and is cheaper in terms of salt mix cost, and you can much higher stocking densities due to higher dissolved oxygen, and...> I will, of course, increase the SG if you feel that would be best. <I do... along with the "Mud", algal culture... these will importantly impart desirous chemicals, physical properties to the water that can reverse the damage here> I just thought it would not be as crucial for the fish. I was not sure if it could hurt the hermit crab. I will try to let you know if the condition of the angel improves by this summer. <Thank you> I do have one other question: my blue cheek trigger looks and acts great, and eats well. He is fat, but he is almost one year old and just doesn't seem to be growing at the rate of the other fish. Is that normal for that species? <Mmm, no... could be other factors at play. Please see my resp. in the Daily FAQs today re someone with a stunted Porcupine Puffer. BobF> Steve Bob, <Steve> Sorry, but I forgot 2 other questions regarding this emperor with neuromast destruction: 1. Should I keep trying the metro+ addition to the food in 3 day cycles, or is this condition completely different from what that medication is designed for? <None... see WWM re the use of Metronidazole/Flagyl... is very dangerous to continually, repetitively administer...> 2. Could lighting in the tank have any play in this? <Mmm, none as far as I'm aware... unless you give more credence to the possibility of stray voltage being an a priori cause of HLLE... but, the other fish livestock don't show symptoms as you note. Ohhh! I see the "angle" below...> I ask because I started to reduce the amount of time that the lights were on to reduce some alga growth on the live rock and glass. The fish would graze on the alga, but they could not keep up and every month I would scrape quite a bit off the rock when cleaning. I decided to manually turn on the lights only during feedings for about an hour each time and whenever people were over and wanted to see the tank. This resulted in the lights being on for 2-4 hours per day rather than the previous 8 or more hours per day (on a timer). This condition started to occur somewhere around the time I started to reduce the time the lights are turned on, so I just didn't know if that could be a factor. I know fish will do better with actual sunlight, but this is VHO and actinic bulbs. I just thought that with no coral in there it would be ok to reduce the lighting to feed time only, etc. The alga has diminished a lot and the rock looks more natural, but there is still plenty of surface alga on the rocks and the angels and tangs do graze on it. Thank you again, Steve <Good point... and... see WWM re lighting periodicity... better to have on... a timer... regular... and to have the algae to graze on as you state. B>

Free tank - north of Philadelphia... and HLLE success, Zebrasoma  – 03/10/08
Hi Crew,
<Alison>
I just thought I would send you this. If you feel it is inappropriate please just let me know. I'm moving soon - next week actually. After some very honest thinking I've realised that that best thing for my salt water fish would be to give them to my neighbor since he is a very good and experienced fish person who has similar philosophies. I'm moving from just north of Philadelphia to FL and my Sailfin tang is just too high strung in nature for me to want to risk his well being. Since I will be fishless for a while I thought I'd offer up my hospital tank to someone who may need it. Its a 30 hex that hasn't thankfully been used in two years. The seals may need replacing soon but when last operating it did not leak. They just look worn.
Also I would like to offer up a success story with a milder case of Hole in the Head. The Sailfin had it when I bought him. It continued until I drastically changed my husbandry after researching on your site. Since my main tank is a hex as well I added a deep sand bed, added well cured live rock, and took out the Magnum 350 I had running. I kept my bioload exceptionally low - just the tang, cleaner shrimp, brittle star, a damsel, and originally a pygmy angel (he died I think of old age having come from a tank where he'd been placed as an adult approx 12 yrs prior). I had a power head providing water movement, and an airstone to keep the O2 levels as high as possible. A very low maintenance, simple set up. The tank was dedicated to just the tang even though it was too small for him at just 60 galleons. I thought this was at least better than the 20 long the LFS had him in, and arranged the rock so he had multiple swim patterns. I thought about a second power head but didn't want to add additional vibrations to the tank since he shows great sensitivity to this. I fed him mostly organic Nori from Wegmans and Algae Plus Formula from Olsen Frozen Fish Food in NJ. I choose this brand over others because the ingredients were simple: marine algae, kelp, Spirulina, plankton, clam, krill, gelatin, and mussel. In about 6-9 months later there was no more hole in the head. He still has some marks on his face which I assume to be scars. Otherwise healthy and happy though still a high strung individual. I'll miss him greatly but he's taught me a lot. I know he made it through importation but I can't see putting him through that again since my life is very chaotic right now.
If anyone wants the tank please email me at alisongrieco@hotmail.com
Thanks,
Alison
<Thank you for relating your success with the Zebrasoma, HLLE... many will benefit... And I do hope/trust we will see you back in the hobby once you've settled into your new circumstances. Cheers, Bob Fenner>

Success in curing HLLE 05/30/2008
Hi WWM crew,
<<Good afternoon, Andrew today>>
I have always appreciated the fine work you do for the marine fish/reef keeping community, and keep up the excellent work!
<<Thank you for the kind words, much appreciated>>
This time I have something to offer. Not claiming to be an expert or anything, just one more success story and data point for the common HLLE problem among Surgeonfishes.
<<Ahhh...the best emails to receive, success>>
Some background: I have kept a Hippo Tang for several years, and he has always been healthy, active, and eats a lot. I have always fed him frozen brine shrimp, mysis shrimp, Spirulina pellets and krill pellets. However, due to bad LFS advice, he was stuck in a 37gal system for a while, which is way too small for such an active fish. A year later, he started developing HLLE. He had a small pit developing on both sides of his head, behind the eyes.
<<Such a shame>>
This year, I finally setup a 125g system with a 30g sump, and moved him over. He seems much happier, but the HLLE condition was still there, with no signs of improvement. Granted, it was only a very mild case, since the rest of the head and his body looked absolutely fine, but since this is not normal in wild specimen, I wanted to cure him. Two weeks ago, I started adding sushi Nori to his food. For the first day or two he refused to touch it. But persistence paid off when I shred the Nori in little pieces and mixed it to his favorite frozen mysis/brine shrimp, and he consumed everything with gusto.
<<Superb news>>
A week later, I saw blue color appearing on one side of the pit behind his left eye. It seems like the HLLE is starting to heal. I wish I could take pictures, but he wouldn't stay still for a portrait :-(
<<he he he he.. they never do stay still when you want them too>>
It seems HLLE is a diet related condition, but until he is fully healed, I will keep monitoring his progress for the coming weeks and report any more findings.
<<It is of my personal opinion, that diet is one of THE main contributors to HLLE, so, I agree>>
I thought the Hippo Tang is unique in Surgeonfishes due to it being a planktivore, but I guess having some more greens in his diet wouldn't hurt, and maybe the missing link to the mystery of HLLE.
<<I am really really glad you have been able to rectify the HLLE in the tang, such a beautiful fish, yet seen so often in captivity suffering from HLLE, along with the yellow tang, such a shame for them. I do hope that you email here will be a an invaluable read to others who are experiencing the same issue.>>
Hope this little piece of information is valuable!
Isaac
<<Many thanks for sharing your experience with us, and really glad you perceived to achieve a positive outcome. Kind regards, A Nixon>>

Persistent Hexamita/HLLE  9/9/05
Hello Crew !!!!
<Scott>
First let me start by saying what a wonderful wealth of knowledge you and your crew are!!! They are there at those times when you most need them.
<Ah, yes>
Anyway, I own and operate a custom aquarium design, installation and maintenance company in the Ventura County area.  I've been in the hobby for almost 20 years now and in business for 5 and  I've seen just about everything.
<Wait a while...>
From 1998 to 2001 I worked in Aquatic Research at Aquaria, Inc. (a.k.a. Marineland) under Dr. Tim Hovanec and was taught very well.  So, as I hope you can see, I'm not a fly by night operation and only insist on the best care for my clients!  
<Oh, yes... was contemporaneous with Tim at SDSU... some changes going on there now... am wondering what B. Sherman would/does think...>
Now for the problem, about 16 months ago I received a call from a someone who needed help taking care of their existing 500 gallon room-divider, saltwater, fish-only aquarium.  Apparently their current "fish guy" wasn't working out.  Since then, I have had a persistent problem with Hexamita/HLLE.
<Mmm... from what cause... is it really Octomita (necatrix)... nutritional (usually), water quality (second most commonly...)>
  The water quality was less than perfect when I started, but quickly got it back to center.  I have tried everything that I know of up to and including removing all fish (no small feat) and quarantining them for several weeks and letting the tank go fallow.  I have only lost one French Angel to this disease but I cant seem to get rid of it.  Every time I heal them up and put them back in the problem comes back.  I visit this tank 3 times a week and make sure that no overfeeding is occurring and that water quality remains prime.  The tank is fish-only, like i said, and has an old school undergravel filter with 3 Ocean Clear Canister Filters (1 Carbon, 1 UV with filter pleat, and 1 filter pleat only).  I am starting to wonder if it has something to do with what lies beneath those undergravel filter plates.
<Indirectly, likely so>
This tank has been through some tough times, much to the chagrin of my clients, and I cant imagine going to them and telling them that I have to completely tear it down. I've read tons of literature regarding this and have done many changes including attempting to remove stray voltage, feeding various types of properly balanced diets, and performing regular maintenance.  Any other suggestions would be wonderful.
Thanks a ton.
Scott C. Wirtz
Owner
Blue Marlin Aquatic Creations
<Mmm, the easiest, most assured route to go would be to add a "mud filter" in an attached sump (really) for improving water quality, providing useful biological molecules... You could try supplementing foods (Selcon, Zoe, Microvit...), even a one time dose of Metronidazole/Flagyl if you believe (I would check with smears, a scope) this is rooted in pathogenic protozoa... (I don't). If it were me, my service account (did this for nineteen years as well), I would go with the added sump, mud... lighting and macro-algae there (my choice? Gracilaria). Cheers, Bob Fenner>

Re: Persistent Hexamita/HLLE  9/10/05
Thanks for the info, Bob.
Unfortunately there is absolutely zero room for an added sump.  
<Even hanging something in the inside of the tank?>
You know these high end clients.... they need all the room the can get for their precious wines and the like.
<Oh yes... I also need this... for our "two buck Chuck" vinos>
Did I mention that this is a room divider tank between their main entrance and their sunken bar?  
<Negative>
Well, it is. I currently have them feeding Formula One and Two pellets soaked in Selcon and Zoe and then allowed to dry in addition to sheets of dried seaweed on a clip.  They don't want to touch or smell anything "offensive".  The only water quality parameter that I am having trouble with is temperature.  The tank regularly runs at 85 due to 3 T-2 pumps, very quiet but very hot with no chiller.  If i convince them to change out those pumps to Iwaki or the like and get the temp down, do you think that would help?
<Some, yes>
As an experienced service provider, am sure you can imagine how much difficulty it is to get people to change their ways.  Especially if it costs money !!!!!
<Oh yes... but, the choice of improving their livestock's health, appearance... given this clear choice? Another possibility... the water you use for changes? Do you haul it in? If this was run through a sump with the macro-algae and mud... this would be of great benefit. Bob Fenner>
Scott C. Wirtz
Owner
Blue Marlin Aquatic Creations

Re: Persistent Hexamita/HLLE  9/11/05
Bob,
<Scott>
The replacement water I use is first run through a Culligan Carbon Tank and then a Culligan Water Softener to prolong the life of my RO membrane, then it runs through a Kent RO/DI unit with a 5 micron prefilter and a 1 micron prefilter in place of the normal carbon block.  Currently am getting the TDS down from 250 ppm to approximately <5 ppm.  I then use Tropic Marin and allow it to sit in 300 gallon batches for approximately 24-48 hours while aerating, depending on client load.  How would I go about running this water through a sump with Macro Algae at this stage?
<You'd have to have a sump added to the process and recirculate this one customers water through it, over the mud...>
I haven't heard of doing this with replacement water before.  Although I don't have a problem with any of my other clients, this sounds like it would benefit all of my tanks.
Thanks again
Scott C. Wirtz
Owner
Blue Marlin Aquatic Creations
<Yes, would. Bob Fenner>

Coral Beauty HLLE?    7/1/06
Hi, question for you.
<Hello John>
I currently have a mid size coral beauty in my quarantine system.  I purchase him 16 days ago from a LFS.  While in the QT he has developed a
small patch (approx the size of a match head) on his L side near his lateral line.  The area appears to be pale in nature and irregularly circular.  At
first I thought he may have just bumped against something in the tank but now watching it over the past 15 days.  It appears to have grown ever so
slightly.  Also yesterday I noticed a very tiny pale patch on the R side of his head.  Is this the beginning of HLLE?
<Possibly.>
I feed sparsely (given that he is in a QT) brine shrimp and Omega sea veggie flakes once a day each.  
<A poor diet such as this can certainly aid in further development of HLLE, if that is indeed what it is.>
The QT is a 15 gal long w/AquaClear 200 filter and carbon pouch.  Airstone w/pump, heater, small powerhead and PVC piping.   1 gal water is changed daily.  If
this is HLLE should I attempt to treat it before placing him in my main aquarium or place move him in after he finishes out his QT time figuring the
better diet and water quality available in my larger system will fix him.
<You've just answered your own question here.  Better vitamin (Selcon, Vita-Chem) enriched diet and excellent water quality are the main factors in reversing HLLE.  There is no medication, in my opinion, that will effectively reverse this.  Do read FAQ's on this also.
http://www.wetwebmedia.com/hllefaqs.htm>
My main system is a 65 gal w/20gal sump, live rock.  Thanks for your comments,     
<You're welcome.  James (Salty Dog)>
John

HLLE in Fish Other than Surgeonfishes, Not the Happiest Place on Earth.. for a Fish.   1/30/07
Hi!
<Hello there, Mich with you today.>
Just returned from a trip last week to Orlando and was wondering about the health of 2 systems I visited. First was at Epcot, there I noticed in one of the buildings (In Nemo and Friends) which housed a huge aquarium that many of the fishes did not looked very healthy.
<Sad.>
Most of the fishes I saw, including yellowtail snappers, grunts and others, looked like suffering HLLE. The faces looked badly eroded and I was curious to know if in fact those kinds of fishes suffered from HLLE, I believed not.
<Yes it is possible.  HLLE most commonly affects tangs and angels, but can be seen in other species in captivity.>
Other thing I noticed was that the fins were badly damaged too.
<A shame.>
I also visited Rain Forest Café at Downtown Disney and although the systems looked better, I also noted the condition on some of the fishes there including Tangs and other species. Have any of you being there recently?
<Unfortunately, no.>
Can HLLE affect any species of fish in aquariums.
<Any may be too broad of a word here, but it can affect many different species in captivity.  -Mich> <<RMF concurs... the fishes in these systems are poster children for HLLE>>

Marine Hole in Head: What do I do?
I have a Kole tang with what looks to be Marine Hole in head. What steps should I take to try and save him. Will a freshwater dip do any good and how do you suggest I prepare the freshwater?
<A freshwater dip is unlikely to help this malady. IMO it would likely do more harm than good>
I have read that the hole in the head is primarily a Tang and Angel disease.
<Correct>
Will my others catch it
<Nope!>
and is it present only when they are stressed?
<Not contagious...>
I didn't notice anything wrong with the Kole until the day after I put him in the tank. I am thinking it was because he was stressed?!
<So this is a new addition to the tank? Well, the colors that a fish show when stressed can sometimes allow you to see HLLE that otherwise isn't noticed. I have had the same experience with a Sailfin tang. Please realize that...at a minimum the malady is present in this fish and it will...if not  at this moment, in the near future...need help. HLLE is a symptom of inappropriate environment and feeding. This is also not a problem that develops quickly.  Some authors have implicated electrical current in the tank as being a factor but this hypothesis has never been proven. Using a grounding probe in you tank will take away the possibility of this occurrence. Tangs and angels are affected most often because they feed heavily on macro algae that live in the ocean. You need to replicate the natural environment by either growing algae in your tank which is probably the best solution (Gracilaria is fabulous: IPSF is one distributor for this algae), or by feeding dried seaweed (not baked...dried) called Nori. Nori is sold in the Asian section of your local supermarket. Also consider adding a vitamin supplement (one that includes vitamin C) such as Selcon. Soak the food before feeding. As always...keep water quality optimized which means low organics, no ammonia, no nitrite and low levels (if any) of nitrate. Much more about this ailment at WetWebMedia.com. It can be cured but it tends to be slow to heal>
Any suggestions will be carefully considered and followed. Thanks so much.
<You got my brain droppings!>
Love your site and have been reading it religiously since discovering it.
<Thanks for the compliment! This is a service that the WWM crew enjoys providing. It's our pleasure to assist! David Dowless>
Jwithay from NJ.

My angel fish is looking dull!
Dear Bob
<David Dowless standing in this afternoon>
I have an Imperator angel I have had for about 5 years.   He is housed in a 100gal. aquarium. Filtered by 3 Eheim canister filters a 15 watt UV.  He has a few other tank mates such as a twin spot  wrasse,
<Do you mean the Coris wrasse? This baby gets to be more than 21" long!>
6 fire fish, long nose hawk, Flame angel, Flag fin, 3 butterflies.  In, addition I also have a protein skimmer.
<Is it producing a full cup of skimmate daily?>
Water parameters are close to 0 ammonia <.1ppm NO2, N03 between20 to 60.
<Ammonia and nitrite need to be zero all of the time.>
Salinity 1.020, temp 77. This was not always the case, however , I thinned out the population some time ago.  I did this because I had difficulty keeping the water parameters within the range I proffered.  I had blue tangs and a Koran angel that both had bad HLLE.  The Imperator I believe was also developing HLLE so I became extra faithful doing water changes and adding broccoli and spinach to the diet.  This seemed to arrest any HLLE in the Imperator however his color has dulled.  I should mention that in every other way he is fine.
<Poor water quality, poor diet, and overcrowding will do this..>
I occasionally put carbon in my canister filter some say this contributes to HLLE also, I do not do anything to guard against stray voltage.
<HLLE is an environmental disease: inappropriate diet and poor water quality due to overcrowding. Your tank needs to be thinned out even more. I don't know which ones to get rid of because I don't know their sizes or the specific species. Consider getting a copy of Scott Michael's Marine Fishes. It is an excellent pocket guide that would have helped you avoid overcrowding. You can get it online for less than $25>  
My fishes diet is extremely varied including frozen as well as dry foods and fresh veggies.
<Marine algae growing in the tank would also help>
I would welcome any advice you may have.
Thank you,
Charles Rayburn
<You're welcome, Charles. You can research even more on this and many other topics at WetWebMedia.com...David Dowless>

Re: HLLE Reversal
Hey WWM team,
Thanks again for your help.   My recipe for success in reversing my Powder Brown Tang’s HLLE was:
Conditions:
Fish only, 30 gallon hex with porcupine puffer, spotted hawk, and above mentioned tang.
Magnum hang off the back filter, under gravel filter, and Berlin Air Lift skimmer
Actions:
Replaced air stone
<Good idea>
Cleaned mechanical filter (ph dropped, so I added buffer for two days)
<Okay>
Started bolstering healthy bacteria with Cycle because so much organic material was rinsed off filter sleeve.
<Good move>
¼ Cup of Kent carbon replaced, running for three days per month (I used to just leave it in, but no more)
Kent Essential Elements and Coral Vite to replace trace minerals
Added 1800mg (two large gel caps) of Omega 3 and 6 to 4 oz. Bottle of Boyd’s VitaChem for food additive, which I put on OSI Spirulina and freeze-dried krill (for my puffer) feeding twice a day
Also added 1000mg garlic oil to VitaChem
Lowered specific gravity from .023 to .022 because temperature was above 23C
Results:
Tang’s HLLE is looking so much better now and it’s only been 3 days, and I did catch it early.   He did, however, develop a slight case of blood streaking (petecchia?) in his tail that I noticed yesterday, but looks better today too, though not completely gone.
<Excellent>
Please let me know if you have any thoughts/criticism on the above treatments.
<Good work, congratulations. Your apparent grasp of what the principal inputs/cause of HLLE (degraded environment, poor nutrition) are the same as mine. Bob Fenner>
Thanks again,
Jonathan

Reversing HLLE
Dear WWM Crew-
<Scott F. your Crew Member tonight>
I have a flame angel that has been in my tank for about 4 months now. About 2 months ago, it started to develop what looked like head erosion around his eyes and temple areas.  I checked my water and everything looked okay, but when I tested with a new test kit, it turned out that my nitrate was around 80, and my phosphate was around .5.
<Wow- that's some serious nitrate! Lots of ways to lower nitrate, all of which can be found on the WWM site- do investigate them and take action accordingly>
After discovering this, I immediately changed out 50% of the water, and did a few more water changes on a weekly basis and brought the nitrate down below 5 in a few weeks.
<Excellent! Way to go!>
After doing this, and with increased maintenance to maintain water quality, I hoped that the flame angels symptoms would go away.  Anyways, after a month, it seems as if the symptoms are getting worse, and I don't know why.  My tank is grounded, and I am feeding my tank Ocean Nutrition formulas, Nori, marine cuisine, HBH pellets, and Caulerpa, all coated in Vita Chem. Do you have any
ideas what could be making this head erosion worse, and do you have any ideas that I could try to reverse it?  Thanks!
<Well, the problem with HLLE is that no one is 100% certain what causes it to begin with...Poor water quality, stray voltage, improper nutrition (all of which you seem to have addressed) have been implicated in its occurrence. Another possibility is Hexamita, a protozoan. It sounds like the damage to the fish should have at least stopped, if not reversed, based on the actions that you have taken! My recommendations here would be to continue the good husbandry practices, feeding of high quality, vitamin-enriched foods, and careful observation. I'm of the opinion that it is an environmental and dietary-induced malady, and as such- can be arrested (if not reversed) by continuing what you're doing. You could also research the possible protozoan theory, and investigate treatment methods (in a separate aquarium, of course). However- I like what you're doing- give it more time, and I would not be surprised if the damage improves, or even disappears entirely in time. Hang in there! Scott F>

HLLE
Hey all, I just wanted to offer my observations on HLLE. I have a Hippo Tang that developed it about a year ago. I've recently been using Vita-Chem and Selcon heavily and have seen about a 50% reduction in the disease in about  8 weeks. For your readers out there, use it. It works. Thx  
<Thank you for this input. Will post to share. Bob Fenner>
Angelo

HLLE Permanency
I'm not having problems with this (knock on wood), but after reading the FAQs I was wondering. Can a fish with a severe case of HLLE ever fully recover?
<Probably not to its full coloration.>
Is the best one can do is stop it? or can it be "reversed" (scaring and holes)?
<It can be reversed. The amount of scarring and color is going to depend on the amount of HLLE.>
Thanks again for your guy's devotion, Mark
<You are welcome. -Steven Pro>