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Chronic wounds/scabs on hind foot

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  • Chronic wounds/scabs on hind foot

    Curious for input from the COTH collective on this.

    We've talked about these chronic scabby things before.

    This mare has had these since I purchased her ... oh, eight years ago. I expected them to heal and didn't give them much thought.






    At some point early on, I had the vet look at her, and she called them scratches and said they'd go away if treated like scratches. Did that, they did not. When scabbed, the scabs are thick and ... horny? These really aren't anything like any sort of scratches I've ever seen.

    Over the years, I've tried several different things to get them to heal, with some success, but they just come back in exactly the same place. Including: wrapping with various topicals (medical honey, hydrogel, triple antibiotic ointment, chlorhexidine ointment or spray, I think I used ivermectin at one point, in case they were summer sores) will = healing after 8-12 weeks. She's been on systemic antibiotics at various points with no change. Emollient topicals get the scabs to soften, and that's how I got the scabs off here, but little healing happens. I tried fetlock rings last year (thinking maybe she's interfering, although we don't really see that) and *something* did clear up some smaller chronic scabs, I was also using gall salve on her. Benign neglect (aka leaving her the hell alone for long periods of time) has not produced any sort of change.

    For the most part the horse is 100% not bothered here. These bother me more more than they bother her. Given that, I'm not super keen on going whole hog with the vet. Skin biopsy, for example. But it sure would be nice to get them gone.

    Thoughts?


  • #2
    The way you describe the scabs does sound kind of scratches-like. We get the super hard to heal "scratches" at some of the farms here. Animax ointment is what seems to heal them (plus protecting from flies while they heal). The steroid in it seems to be the magical extra thing.

    Comment


    • #3
      OK this is far out in left field but just listen up.
      I had a scabby looking patch on my hand that kept getting bumped and everytime it did, it bled, scabbed over, til it happened again. Over and over. Bad spot for bumping.

      Suddenly one day it scabbed and scabbed to the point it had a pointy large horn growing out of it (made of scabs).
      So I go to Dr. Google and see there is actually a condition called Cutaneous Horn.
      I didn't like the choices of treatment so I decided to experiment on my own.

      I used "Nystatin Triamcinolone Acetonide Cream" a prescribed ointment I had on hand for bad skin fungus and it was
      terrific to clear it up on the patient in my family. So I applied it twice daily and put bandaid on. Did this 3-4 days and
      VOILA. totally gone w/ no scar and no sign there was anything there.
      So maybe your horse's problem is a fungal infection that you just haven't been able to knock out.
      "There is no fundamental difference between man and animals in their ability to feel pleasure and pain, happiness, and misery." - Charles Darwin

      Comment


      • #4
        I’d say you need to get a scraping cultured, not a biopsy. Until you know what you’re dealing with it’s hard to know how to treat it. Spitballing treatments hasn’t worked, so buck up and do the thing. Let us know what you find!!

        Comment


        • #5
          Well, nothing much has changed with the gelding I posted about on the linked thread. His chronic lesions do seem to be quite itchy on the hot days this summer, and he presents his hind legs to me for rubbing/scratching.

          The veterinary dermatologist I saw a half dozen years back said that in the chronic cases, the skin in the affected area becomes overreactive - hence the continuous scabbing with build-up. In my horse's case, most of the time when the scabs come off, there is no bleeding - just pink skin underneath.

          The one thing I have never tried that I would like to try if my horse's management situation would allow would be to keep the lower hind legs covered with something (sox, wraps) ALL the time. No topicals underneath, just covered/wrapped to test out the theory that something in the environment is the trigger that causes the skin to react such that having a barrier in place might break the cycle.

          Comment

          • Original Poster

            #6
            These are full thickness wounds. They are not scratches.

            Try the sox Groom&Taxi! Report back! Would love to know Have considered it here but what a pita and I just have seen NO healing if the scabs are left in place. But you have pink skin underneath, so your case is a little different!

            That is SUPER interesting (and bizarre ) about the cutaneous horn Marla 100. I'm using triamcinolone on her now, so we'll see how that goes.

            ​​​​​​​Thanks for the ideas, guys! Keep em coming

            Comment


            • #7
              I have seen similar to these on a couple of occasions, and both times on the pastern area. They were both the result of injuries where treatment/bandaging was stopped before they fully healed. Both times the owners just left them alone as the scabs didn't cause any problems. I always suspected that they were some type of proud flesh. The bottom one on your horse certainly looks like proud flesh.

              Comment


              • #8
                Is there any chance Cushing's is driving this? I have a horse boarded here who has similar chronic non-healing wounds on his hind pasterns and fetlocks. In his case, Cushing's is driving the immunocompromise that keeps him from healing. His owner has tried many things (he used to regularly blow up with associated lymphangitis or cellulitis) but has landed on benign neglect + Prascend. Since she stopped trying to remove the scabs, the cellulitis flares also stopped.

                Comment

                • Original Poster

                  #9
                  Originally posted by Postandrails View Post
                  I have seen similar to these on a couple of occasions, and both times on the pastern area. They were both the result of injuries where treatment/bandaging was stopped before they fully healed. Both times the owners just left them alone as the scabs didn't cause any problems. I always suspected that they were some type of proud flesh. The bottom one on your horse certainly looks like proud flesh.
                  It's curious you say that. I've considered treating this like proud flesh, but there's really zero evidence of it--when the scabs are off, the wound bed looks like healthy granulating tissue, and it certainly has never extended past the level of the skin margins. But is there something about these skin margins that isn't allowing healing, and would benefit from some light debridement? I don't know. Seems like a risky gamble...but it's crossed my mind.

                  findthedistance this mare was five when I bought her, with these things well established, which I think rules out Cushing's on age? I've thought about that too though! No Cushing's warning signs.

                  Comment


                  • #10
                    Originally posted by Simkie View Post

                    findthedistance this mare was five when I bought her, with these things well established, which I think rules out Cushing's on age? I've thought about that too though! No Cushing's warning signs.
                    Yes, Cushing's on a five year old would be pretty crazy. Sorry I'm no help. A dermatology consult may be in order.

                    Comment


                    • #11
                      Originally posted by Simkie View Post

                      It's curious you say that. I've considered treating this like proud flesh, but there's really zero evidence of it--when the scabs are off, the wound bed looks like healthy granulating tissue, and it certainly has never extended past the level of the skin margins. But is there something about these skin margins that isn't allowing healing, and would benefit from some light debridement? I don't know. Seems like a risky gamble...but it's crossed my mind.
                      .
                      My thinking was that the margins are possibly more normal scar tissue, so no hair growth. The area inside the margins is what I suspect is proud flesh, which as you know doesn't usually heal without taking it back to healthy flesh. That bottom wound looks like the middle area has a bubble of raised flesh. Just from the photo it looks like it has the appearance/consistency? of proud flesh.

                      Given they are such small wounds, if it were me I would just try treating the smallest of them as proud flesh.

                      Comment


                      • #12
                        I will second or third getting a culture. My gelding got kicked in the hind cannon bone several years ago and ended up with a cut that would. not. heal. Eventually he developed scratches despite being a solid bay. We treated for a few weeks with the normal scratches cream from the vet with no improvement. Eventually, the vet took a scraping, and it turned out to be some weird, rare strain of scratches, and he had to go on oral antibiotics to get rid of it. Although it hasn't recurred, it's been probably 7 years and he still has a spot there that is always scurfy and funky with thickened skin. When he was still in work, I would try to get rid of the scurf and make it pretty, but it never healed over to healthy skin. Now he's retired and I only go see him 1-2 times a month, and don't touch the leg. It never has turned back into an open sore under this benign neglect regimen, so I just leave it be, or knock the worst of the scurf off the top. Looks funky, but doesn't seem to bother him.

                        Comment


                        • #13
                          Originally posted by Simkie View Post
                          These are full thickness wounds. They are not scratches.

                          Try the sox Groom&Taxi! Report back! Would love to know Have considered it here but what a pita and I just have seen NO healing if the scabs are left in place. But you have pink skin underneath, so your case is a little different!

                          That is SUPER interesting (and bizarre ) about the cutaneous horn Marla 100. I'm using triamcinolone on her now, so we'll see how that goes.

                          Thanks for the ideas, guys! Keep em coming
                          I have tried the sox. The results were encouraging, and the horse actually seemed to like wearing them. However, he has trouble holding up his hind legs, and the pull-ons were too hard to get on and (especially) off over his hooves. Since the results were encouraging, I (god help me) had some sox custom made that close with velcro. Tried them a few days this summer, but his boarding situation right now does not allow me to check on him more than once a day, and he managed to mangle one of them between daily checks. I think the sox are best suited for use where someone can check them multiple times a day and adjust as needed.

                          Comment


                          • #14
                            At first glance I was thinking photosensitivity, especially since they eventually healed after a long period of wrapping.
                            I'm not so sure after reading subsequent updates. But it's obvious horse benefits from some type of physical barrier, which could mean several things.

                            If your current vet cannot diagnose these, it's time for a new vet, skin scraping and culture & sensitivity . There's plenty of competent yet mediocre vets in our area with a huge following --and I hope you haven't accidentally stumbled upon one WRT this case that's dragged on 8 yrs already.

                            I WOULD highly recommend -- Specifically-- Baus, Bradley, Cook, Gaeta, Mitchell, Neff, or Weinberg. I WOULD involve any of these at this point. And yes, you will pay dearly to have them handle this, especially as a new client. They have partners at each practice that are also very good, but for tough cases like yours, I like to go with the wrinkles & grey hair (or lack thereof) to receive the benefit of their experience. Be sure you insist upon a skin scraping. And test for Cushing's anyway. I don't care how young she was when it first presented.

                            Best of luck.
                            Last edited by Sansena; Aug. 23, 2019, 09:19 AM.

                            Comment


                            • #15
                              My old trainer had a horse with mud fever that developed horny scabs. She did the horse up in panalog for a week and left him in the stall, and it went away. That is my one and only experience with anything similar.

                              Comment


                              • #16
                                I still have no answers for my guy that I've posted about on all of these threads over the years. He's 18yo and still showing in the big jumper stuff. Still overall sound and happy and healthy. Nothing has changed about his scabby things. Nothing. Well, other than the fact that any time he injures himself a new one seems to crop up (and then sometimes randomly doesn't). So he's up to 5 or 6 on his RH and maybe 1 on his LH. The worst one is where an abscess burst out of his coronet band on his heel bulb. Every few months my farrier goes, "oh shoot! what's this?" and I have to remind him that it's been there for the last decade, lol! I was going to try using the sarcoid treatment stuff (basically Xterra, though under a different name), but I chickened out. It caused such big open wounds on the sarcoids I used it on, and I didn't want that happening on his lower leg while he's actively competing. But that's still something I'm curious about. He's been on some pretty serious rounds of antibiotics over the last couple of years and none have made even the slightest difference on the scabbies.
                                __________________________________
                                Flying F Sport Horses
                                Horses in the NW

                                Comment


                                • #17
                                  One of my horses who passed recently had hind leg scabs for over 10 years. When I had them tested earlier this year after switching to a new vet he was diagnosed with leukocytoclastic vasculitis. It is light sensitive so I found using Cashel fly wraps to be helpful but not 100% effective. His legs were so big that many options would not fit.
                                  The vet recommended a course of steroids to heal the scabs (with no guarantee they wouldn't come back at some point). The scabs were healing amazingly when he became sick with something else so I ultimately don't know what would have happened but early results were positive.
                                  I agree that testing is the best way, I wish I had done it sooner.
                                  http://www.stampyandthebrain.com

                                  Comment


                                  • #18
                                    If the triamcinolone does't do it, (BTW I kept my wound covered tightly w/ bandaid for best contact),
                                    this is an 'old time' concoction used around Fl. for summer sores and hard to heal wounds. I bought it for a suspected
                                    summer sore and it DID knock it out. I alternated w/ ivermectrim wormer spread on the wound. But it got rid of it.
                                    these wounds take daily or twice daily attention. This stuff is so popular here they sell it in feed stores.
                                    Underwoods -https://www.underwoodhorsemedicine.com/
                                    "There is no fundamental difference between man and animals in their ability to feel pleasure and pain, happiness, and misery." - Charles Darwin

                                    Comment


                                    • #19
                                      Another vote to culture. If there is some sort of organism causing it, then your vet can pinpoint it and better tailor a treatment.

                                      My horse Dexter has very similar type "spots". His did indeed start as bad nasty scratches but all summer he's has two spots on each side of his back left foot (the one that is white) kind of like your. I pick off the scab once a week and it actually seems to help.
                                      It is not enough to know how to ride; one must know how to fall.

                                      Comment

                                      • Original Poster

                                        #20
                                        I have zero appetite for pursuing scrapings or biopsies at this point. This horse has been stable and unbothered by this stuff for nearly a decade. It is more of a problem for me than her, and I see no reason to spend a considerable sum of $$ and time upsetting that apple cart. Especially when there's a very good chance the answer is "we don't really know" and "here, use this steroid ointment."

                                        The good news is that in just a few days of triamcinolone, chlorhexidine and emollient cream, there is more healing here than I've ever seen in such a short period of time! While I've used topical steroids before on her before, it's always been mixed with something else, and just your standard OTC cortisone 10. I am enthused by the very quick progress here! This horse has thin skin--a very, very fine coat in the summer, develops skin tags from fly bites that dry up and fall off over the winter (for the most part) and if anyone is going to get hives or sores from bugs, it's her. I was curious if using something to tamp down that inflammatory response would work, and yay, it does look like it is. The previous pictures were taken on the 21st. These are from this morning.





                                        PNWjumper this is pretty easy, if you'd like to try it, and no risk of a huge wound like with those debriding pastes. I covered the scabs with chlorhexidine ointment and then something very emollient--like bag balm, or corona--until they were ready to wipe off without peeling or picking. Took a day or two with twice daily application. Then washed with betadine. Clipped leg as needed. Then dried, sprayed triamcinolone on the wounds, filled the holes and wound edges with chlorhexidine ointment and covered again with bag balm. Twice daily, wipe off remaining goo, spray with triamcinolone, reapply chlorhexidine and emollient. Horse is unbothered, no need to wrap, takes just a few minutes. I've been futzing with this on and off for years and this is by far the fastest I've *ever* seen improvement. Only down side is the leg is gooey.

                                        @Groom&Taxi what a bummer about the sox! Do you think fly boots might work?

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