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Pastern Leukocytoclastic Vasculitis (very bad scratches)

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  • Pastern Leukocytoclastic Vasculitis (very bad scratches)


    I have been treating two horses for three months for scratches and one is now said to have Pastern Leukocytoclastic Vasculitis. My vet is doing a biopsy on Monday to confirm this diagnosis. I do not know how my mares contracted this problem, I have no mud on my farm and both horses have lived there for most of their lives. I had a friends horse join my heard earlier in the year and he did come in with fungus and also was recovering from strangles. Since shortly after his arrival, my mares have developed this quickly spreading skin infection that exists on the whites of their lower legs.

    We have been using a topical mixture for the last 5 weeks of furazone/dexameth/utterbalm which appeared to work for the first week but since appears to be failing and the skin lesions are spreading. Last week we tried giving Trichlormeth/Dexameth orally and gave 200MG for the first dose and an 100MG for an additional 4 doses.

    The two mares with this problem are related. One is the 15yo dam of the other 4yo. The 4yo is far more chronic with the disease and her lower left hind leg swells 2X3 times its normal size if left unwrapped. She is getting impossible to treat because the scabs and area are very painful for her. She has also started to throw her head now and appears to have some drainage from her sinuses. I do not know if this is related but do wonder. My vet thought she has alergies that brings this on and it is most prevalent when she is out eating grass.

    My vet bills for this skin infection exceed $1000 and yet we have found no relief for my horses. If anyone had any idea how to treat this afesome skin condition, please let me know. I have photos of the legs if anyone would like to see. My email is vpstevens@yahoo.com if you would like to discuss further.

    Any help would be greatly appreciated. I love my mares and am seriously concerned about their health from this issue.
    Last edited by vpstevens; Sep. 22, 2007, 08:45 PM. Reason: Didn't proof before hitting the post button.

  • #2
    Try the butt cream mixture. Equal parts triple antibiotic, zinc oxide and atheltes foot cream. Got rid of my horse's scratches very quickly.
    I\'m not crazy. I\'m just a little unwell.


    • Original Poster

      I have tried a 40% zinc oxide/neosportin triple antiobiotic/1% hydrocortizone mixture. We treated one leg with this mixture and another leg with the nitrofurizone/dexameth/utterbalm which was provided by my vet. The mixture provided by my vet started working where the zinc/antibiotic/cortizone did not. I do not know what the ingredient is in the foot powder but will check it out tomorrow.

      We did culture both the mares and their cultures came back negative for any fungus or parasite.


      • #4
        I would definintely not be putting anything else on your mares other than what the vet prescribes.

        I've seen and heard of a lot of scratches cases being made worse by topical treatments, and your mares clearly have what's beyond just 'regular' scratches.

        There are several posters on this board who have dealt with/are currently dealing with skin problems that are beyond scratches like you who have had success with pulsing systemic anti-fungals... I don't remember the names of the two posters I'm specifically thinking of, but I know Apassianato (from this board) has had a lot of issues with her horse's hind leg (thought it was scratches and it ended up being much more complicated) so you may want to contact her... she also will probably know the other two posters who have been dealing with this kind of thing that could share their experiences with you.

        Sorry I can't be of more help, please keep us updated on your progress. Jingles for your mares.
        Originally posted by Martha Drum
        ...But I don't want to sit helmetless on my horse while he lies on the ground kicking a ball around without a bridle while Leatherface does an interpretive dance with his chainsaw around us.


        • #5
          Hey there, I just saw your PM a little while ago. Just wanted to say please stop all the tropicals, and stop scrubbing or washing the area. First thing is to keep the legs dry and wrapped and out of the sun/dirt/mud.

          My horse was the poster child for this disease at UC Davis, literally! He quickly turned around with a combination of a bland diet, oral antibiotics, prednisolone, and Pentoxyfiline, and topical Genesis spray with the legs wrapped 24/7 until the redness/inflammation went down completely, then wrapped during the day until the hair began growing back.

          This is an autoimmune response, any scrubbing and topicals is going to make the inflammation worse, and disturbing the skin will only invite a staph infection which could lead to severe cellulitis or worse. The legs need to be CLEAN and DRY while you treat the issue from the inside out. The genesis spray I used was an alcohol based steroid spray that decreased the skins inflammation while drying quickly.

          I worked extensively with Dr White and the UC Davis veterinary dermatology school. He's awesome, your vet might want to get in touch with them for dosage information. I seem to have lost my vet records.
          On the Internet, nobody knows you're a dog


          • #6
            Ok, I saw your post on my other thread and figured I'd respond here. Basically, t2 weeks ago my horse broke out with a terrible rash all over his face (allergy thing, 2ndry bacterial infection but not really the problem...) What has worked is banamine for 5 days, dexameth for 6 days (large dose), Animax (rx triple antiobiotic ointment), and an oatmeal wash. Hypersensitivity is the main issue with my guy, and this really seemed to work for him. But I will echo others by saying that less in more, and scrubbing and harsh tx's can make things worse (esp in my guy who is hypersensitive).
            Last edited by goodmorning; Sep. 23, 2007, 05:46 PM. Reason: I must have been sleeping when I wrote that!


            • #7
              There's been several folks who have had some serious "funk" issues with their horse. My guy ended up having Pemphigus which is a different autoimmune disorder than Perfect Pony's and R D Light's: http://www.hoofcare.com/article_pdf/...sKnot7D4CD.pdf

              Here's a pic of my horse's leg from March of '07:

              As far as the advice to STOP putting topicals on it, I agree! Scrubbing can be just as damaging as Perfect Pony mentioned. Frankly the best thing you could do at this point is to get a biopsy of a whole piece of skin including healthy vs. "infected." Get smears of scabs on slides too.

              Tiki and Utah were two I knew to fight a really bad case of scratches, and I'll be darned as to what the outcome was (one of them was using Fulvacin I think). Easystreet had a horse to have a persistent wound of sorts...never got the outcome of that either. Not that they haven't posted it at all, just that I have missed or forgotten. And I'm REALLY prone to forgetting things these days...

              Jingles for you and your horses!!! And keep us updated!
              RIP Bo, the real Appassionato


              • Original Poster

                Thanks for your response. The photo of your horse's leg does not resemble the problem on my mares leg. The article discussing Pastern Leukocytoclastic Vasculitis (http://www.vetmed.ucdavis.edu/ceh/pu...-1-bkm-sec.pdf) on page 7 shows almost an exact photo of my mare's leg.

                The biopsy is being done on Monday and so we have stopped treating her today so there will be nothing on her skin for 48 hours. Already today the skin has started to darken to a dark scabbing black from lack of treatment. I believe they plan to send the biopsy to Arizona to a lab that specializes in equine dermatology. I will be providing my vet all the information provide by "Perfect Pony" because her case seems most similiar to mine.

                Thanks for your response.


                • #9
                  Originally posted by vpstevens View Post
                  Thanks for your response. The photo of your horse's leg does not resemble the problem on my mares leg. The article discussing Pastern Leukocytoclastic Vasculitis (www.vetmed.ucdavis.edu/ceh/pubs-HR24-1-bkm-sec.pdf) on page 7 shows almost an exact photo of my mare's leg.

                  The biopsy is being done on Monday and so we have stopped treating her today so there will be nothing on her skin for 48 hours. Already today the skin has started to darken to a dark scabbing black from lack of treatment. I believe they plan to send the biopsy to Arizona to a lab that specializes in equine dermatology. I will be providing my vet all the information provide by "Perfect Pony" because her case seems most similiar to mine.

                  Thanks for your response.
                  Great that a biopsy is being done, that's going to help you guys! I can only speak from my standpoint/experience with my horse's condition, so maybe Perfect Pony and R D Lite will know of some other tests to run on the horse. Certainly a run-down of what's gone on and what's been given systemically as well as topically will be asked for.

                  Again, keep us updated!
                  RIP Bo, the real Appassionato


                  • Original Poster

                    Thank you for your guidance. I will stop treating both my horses immediately. I had only stopped treating one leg on my filly since that was what they needed for the biopsy. I will stop treating the other two infected legs as well as all 4 legs on my older mare. I will also ask my vet to contact Dr. White and consider sending him the samples for biopsy instead of the place in Arizona.

                    I cannot begin to tell you the level of fustration that I have had with trying to treat and keep this infection from spreading. What is odd is that I have three horses on my farm and the only horse that is not infected is a paint gelding that has all white legs.

                    My hay has not changed, my pastures have not changed nor has anything in my horses normal schedule. My older mare is heavily shown by a 4H youth and has had just as many lame days as good in the past two months.

                    I will let you know what my vet says on Monday.

                    Thanks again for all your advice.


                    • #11
                      Well, glad you are stopping the goop. If it is not a "typical" case of scratches, all that crap is just going to make it worse. (Ask me how I know- and I was Following the advice of the first vets I went through) I had two horses here who shared a condition, the likes of which I had never encountered. It arrived last August in the midst of drought and took over my life and made both my horses run away when they saw me coming, because I was treating it like "scratches". A horrible, horrible winter. Got a new vet in January.
                      The stuff my guys had never cultured out to anything, and I know for Tiki, hers was done a long time ago, and it didn't grow anything either. We can only ass-ume it to be some kind of fungus, because the only thing it responded to was the griseofulvin pulsing. The med made it weak enough where I could then apply ichthammol X24 hours, wash, dry, and a lot of the crap would come off, I would dust with Desenex or Tinactin or monistat cream (go ahead, know the fun of buying 5 or 6 bottles of athletes foot powder along with 5 or 6 tubes of the seven day yeast infection cream). Depending on the "condition" of the stuff, I would either really dry it out with the powder then go to town with the icht. for a few days in a row, or alternate, or...horribly, I just developed a feel for it.
                      Interestingly, even though it spread to every available area of white sock, it did not return to an area where it had already been. One of the guys is just getting over the last area (yes, really- seven months of treatment even with the stuff that is working- but it never did again look like it did prior to anti-fungal treatment).
                      The above linked threads will take you through more of the saga, and there are probably more of them. Send questions if you have some or you just want to express some frustration (I actually ended up on a therapists couch as a result of this)...hang in there.


                      • #12
                        Originally posted by vpstevens View Post
                        Thanks for your response. The photo of your horse's leg does not resemble the problem on my mares leg. The article discussing Pastern Leukocytoclastic Vasculitis (www.vetmed.ucdavis.edu/ceh/pubs-HR24-1-bkm-sec.pdf) on page 7 shows almost an exact photo of my mare's leg.
                        For some reason I cannot get the pdf to load, but if that is the dermatology issue from a couple years ago that picture is of my old horse. He was at UC Davis for over a week. They truly were lifesavers.
                        On the Internet, nobody knows you're a dog


                        • Original Poster

                          Your right. The article will not currently come up. Good thing I saved a copy locally on my PC. The article if from CEH Horse Report and is dated January 2006. Only the two white socks in the hind are photographed for the horse with this disease and it is a chestnut colored horse. The photos resemble to the tee what my mare's white socks look like.

                          Today, after just 24 hours of no treatment of my mare, the inside area looks to be oozing and slightly bloody. I am keeping her wrapped but sadly, today looks even worse.

                          I really hope the biopsy scheduled for tomorrow will get us going on the right track.


                          • Original Poster

                            Here is a link which shows photos from yesterday of my mares left hind leg. These photos were taken after I had just cleaned all the medication off in efforts for Monday's biopsy.

                            I will be updating this album today to show just how much worse it could get in one day.



                            • #15
                              Yep, that is it for sure. I would clip the area and if you want to start working on the inflammation you can use a cortisone cream with some sort of neosporin type antibiotic. My vet started with a cortisone cream but we switched to the genesis because it didn't turn to goop.

                              It WILL look worse before it gets better. But trust me, the worst thing you can do is scrub and/or wet the area, it just makes it look a little better but opens up the area to infection.

                              When we started treated my gelding I literally did not touch his legs for weeks, just let the medication and condition run it's course. The legs will get a bit scabby but eventually the scabs will fall off. Your horse's legs look so much better than mine did. I am sure with the right treatment it will be fine and clear up.
                              On the Internet, nobody knows you're a dog


                              • Original Poster

                                Thanks for your reply Perfect Pony. I have just posted more photos from today and it is sad to watch the issue get worse. My mare is completely lame today on both her left front and left hind.

                                I have her wrapped and again untreated.

                                I was there when this mare was born and have loved her ever moment of her life yet now she hates to see me coming for fear that I will touch her legs:-(

                                Hopefully tomorrow will be the beginning of a turn-a-round.

                                New photos posted at: http://good-times.webshots.com/album/560809755pEHoct


                                • #17
                                  Originally posted by vpstevens View Post

                                  I was there when this mare was born and have loved her ever moment of her life yet now she hates to see me coming for fear that I will touch her legs:-(

                                  New photos posted at: http://good-times.webshots.com/album/560809755pEHoct
                                  Well, "we" don't have the same thing, but I do get how you feel. The one horse I had had since he was a baby, the other only for a year and a half. My "baby", Utah, was always one to whinny at me when I got home from work. When he started walking away from me it was heartbreaking. I thought for sure we would never regain our relationship, that I would have to sell him and all I saw were the dreams I had disappearing. More than one night crying on a hay bale. When I switched vets, I just begged her to help as I thought I was going over some edge...at least she "got" how stressed I was (had to break out her bedside manners!)
                                  The good news...he has forgiven me and we are back to happiness...I bet your girl will forgive you too.
                                  Hey, I am in WI too...gorgeous day today!


                                  • #18
                                    Here's another recipe to add to the pot. It came from my vet, who is an equine specialist.

                                    Wash with 4-percent chlorhexidine shampoo (DVM chlorhexidine shampoo, available through vet offices, or the more expensive Hibiclens, found at Walgreens)) letting the shampoo stand on the area for ten minutes. Work fingers under the shampoo, easing the scabs off. Rinse, dry thoroughly, then apply vaginal yeast infection cream over the area. Repeat daily. The vaginal yeast cream is an anti-fungal which is also negative for gram A and gram B bacteria, and contains a light moisturizer so the skin won't crack, letting bacteria into it. For faster results, I also cover the vaginal yeast infection cream in a diaper rash product such as Desitin. Stall horses inside at night so they are not out on the wet grass, particularly on clear nights when radiational cooling allows the non-evaporated moisture to fall onto the grass to form dew, and wash the towel used on the horse for drying each day so you are only using a fresh, clean towel on this.

                                    A few years back, we had some wet weather in the spring that blanketed the area from about Michigan to the northeast. By summer, everyone who had never seen it before was screaming about it. I also know of farms who have ended up with this when a leech field running under a pasture fails, or manure spread on the fields outstrips the ground's ability to absorb it before the horse's are reintroduced to the pasture. Once it rains, the staph gets into their opened pores, and you are behind the eight ball. It can also occdur with the above conditions if you have washed the horse and let it out to run over the ground before it was dry--the open pores again.

                                    Uckele has some good immune system boosters (HerbalMune Plus, BioQuench, Phytoquench) that can be used (with your vet's approval) to help get your horse's immune system up to speed. Once that horse gets scratches and such, he/she is susceptible to it for life, so I would suggest a good, longterm overall vitamin supplement for them in addition to what is already in their feed, and keeping a jar of diaper rash cream or ointment on hand to cover the areas periodically once this subsides. I dealt with this for years on a gelding, with additional supplements and all. It is a royal PITA, and you have my empathy. Once you cure it, keep the legs dry and stay ahead of it. Good luck with your horse.
                                    "The difference between genius and stupidity is that genius has its limits." Albert Einstein



                                    • #19
                                      Hi, just saw this thread.

                                      Good for you for having the biopsy taken, because you will not know for certain that you are dealing with leukocytoclastic vasculitis until the results are back. As my vet said, "Equine skin has a limited repertoire for expressing its displeasure,"--which is to say, lots of skin issues, including LV, look alike. I'm also a little bit surprised to hear that you are dealing with more than one horse with the condition. It's not terribly common, and it's not contagious, but there is plenty that isn't known about it, so I suppose it's certainly possible.

                                      That said, if you are dealing with LV, "scratches" remedies won't do you any good. They're designed to treat a bacterial or fungal infection, while LV is an immune-mediated response. The scabs are the result of serum and/or whole blood from affected blood vessels in the skin leaking through the skin.

                                      My horse's legs looked much, much worse than the photos you posted, but I do know how frustrating it is to deal with. My horse was hospitalized for two weeks at his first diagnosis and treated with intravenous and topical corticosteroids. He was on 25 mg of dexamethasone daily for months, with an additional 25 mg IV or IM when he was in a lot of pain. I would NEVER suggest giving a horse that much dex unless there was truly no other option, and for Reuben, there was no other option. He also had triamcinolone cream applied to his affected legs. For several months, I did this under sweat wraps, as this was the only way to keep the swelling under control. I changed his wraps daily and lightly washed his legs with Hibiclens chlorhexidine solution, to combat secondary infection.

                                      Reuben's LV still wasn't under control, so after talking to Perfect Pony, I suggested that my vet speak to Dr. White at Davis, and we started Reuben on pentoxifylline. He got 5200 mg three times daily, which seemed to help keep everything under control. Be warned, though: that dosage amounts to 39 pills daily, and there are only 100 in a bottle. Most places charge between 40 and 60 dollars a bottle, and Reuben was on the pentox for three months, give or take. To do the math for you: about 600 dollars a month for pentoxifylline alone. I took on a second job while I was in school full time to pay for Reuben's vet bills, and I had some significant discounts from my vet.

                                      There are some other things that help, and are, in my experience, necessary. One is NO SUNLIGHT. Not "less sunlight." Not "a little sunlight." No sunlight. Reuben was on stall rest for ligament injuries related to his collagen disorder during most of this time, but when he did get to be turned out, it was at night with polo wraps from his knees to his coronary bands. My vet also felt strongly that alfalfa and green grass were contributing to the problem, so Reuben wasn't allowed to have either. Sure enough, when he did get alfalfa accidentally, he had a terrible flare-up of his condition. All of this wasn't easy. It meant I started paying double for stall board with private turnout where Reuben couldn't get to other horses' hay or grass. It meant I hauled grass hay in the backseat of my car. It meant I paid for extra bedding so he wouldn't scrape up his legs. Because no one at my barn could wrap legs, it meant I drove over 100 miles a day so I could go to the barn twice daily and care for him.

                                      The good news is that most horses with LV will make full recoveries. Reuben's was so impossible to manage because it was a part of a much more serious autoimmune collagen disorder. Unfortunately, I had to have him put down after a year of struggling with his condition.

                                      If your horses do have LV, you will probably see a lot of progress when you and your vet can begin targeting the condition specifically rather than trying to treat everything that might be causing scratches. Be consistent in your treatment, make the lifestyle changes your horses might need, be vigilant in watching out for secondary infection if your horses go on immunosuppressive drugs, and hang in there.

                                      Good luck!
                                      R D Lite "Reuben" (Put Em Up x Scheme for a Dream-Drouilly) 1997-2006


                                      • #20
                                        To counteract all the Debbie downer posts, I DO want to say there is a light at the end of the tunnel if this is what you are dealing with. My gelding made a full recovery, and after a few months of irritation and hairless legs, the hair grew back. He was given to a new home because it was also discovered he had a large knee chip, but I saw him nearly a year later. His legs looked normal with no special treatment during that time. Whatever set him off didn't come back.

                                        I have to say, I can't believe people continue to post on this thread with their "home remedies". Do they post blindly without actually reading the thread??
                                        On the Internet, nobody knows you're a dog