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Post by kathrynp on Dec 8, 2010 20:02:50 GMT 1
It is not possible to tell if skin is infected just by looking at it, swabs need to be taken and cultured to check for fungus and bacteria. I would be suspicious of an immune mediated disease for example a type of pemphigus but all other causes need to be ruled out. Malazzesia infection can also present like this. It is not difficult to diagnose even the most persistent skin disease but all tests must be done including swabs, scrapes, hair plucks and a biopsy. These should really have been done before any treatment was started because that will effect the results. I think it is really important your horse has a skin biopsy done ASAP as this is most likely to give you a diagnosis. If the steroid injection worked why can't he have steroid tablets? That is what I would have him on and oral prednisolone is very low risk for laminitis. If he has no history of lami and isn't over weight I wouldn't think twice a bout it. Tying him up to stop him itching may be dangerous if he gets really stressed. Can you try and distract with more hay or something? Exactly how much dectomax has he had? and were mites diagnosed before this was used? if not why is your vet using an unliscenced product without a proper diagnosis? I think you have a few problems here!
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Post by donnalex on Dec 8, 2010 22:23:04 GMT 1
Are you a vet?
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Post by kathrynp on Dec 8, 2010 22:28:28 GMT 1
yes
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Post by jill on Dec 8, 2010 22:34:49 GMT 1
Woohoo - a vet on the forum!!!!
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Post by donnalex on Dec 8, 2010 22:36:53 GMT 1
Come back, dont go offline now!
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Post by kathrynp on Dec 8, 2010 22:41:38 GMT 1
Are you going to answere Q's? just seen your vets been again and still no biopsy??
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Post by donnalex on Dec 8, 2010 23:12:42 GMT 1
Dont know why a biospy has not been suggested. If it was fungal would the Malaseb shampoo not have helped at all? He was washed with that on Monday with no improvement, in fact they looked a bit worse. Would a biopsy show anything up when he is on daily injections of Pen + Strep? The treatment was started as it was thought it was something simple that would clear up with antibiotics and bute and a one off jab of steroid (Colvosone). He has nw had two. I am very reluctant to go down the steroid route as he is a Highland pony and so possibly a higher risk of laminitis. I believe most of the ponies that end up on sterids end up being put down with lammi at some point?
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Post by arabmania on Dec 8, 2010 23:23:27 GMT 1
have you tried pig oil? pure aloe vera? just a couple of suggestions. i have no idea what it could be as it seems most thoughts have been exhausted
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Post by donnalex on Dec 8, 2010 23:38:31 GMT 1
Not tried any of those at the moment as I dont want to interfere with what the vet is giving him. He had a nasty over reach out hunting about five weeks ago and had a course of antibiotics to clear it up and I am wondering if this has set him up for it in any way? It seemed to start about three weeks ago so perhaps a week after the meds finished. Up until then he has never had any problems at all, he never reacts to fly bites or anything.
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Post by kathrynp on Dec 8, 2010 23:53:33 GMT 1
Going back to your original question - broadly speaking there are a five catergories of possible causes; bacterial infection, fungal infection, parasites, allergy and autoimmune. It seems to me your vet has taken the approach of treat for various things and see what the response is. My thoughts from what you have said are; The most common cause of very itchy legs is mites - it would appear you have treated with dectomax injections to elliminate this is a possibility. I would say mites are unlikely anyway if there are truly no lesions below the fetlocks and also I would expect to see all four legs and body affected. I have treated mite cases however that have required a total of four dectomax injections at 14 day intervals with only a significant reduction in mites after the 3rd jab (6 weeks). On the whole though as only back legs parasites are less likely. On the antibiotic injections he is obviously covered for bacterial infection although we must remember antibiotic resistance does exist. As you say probably the most important role of the antibiotics is to prevent infection. If fungal or yeast infection is involved it is unlikely to respond to one shampoo alone (even the malaseb - which would be my first choice) and I would suggest at least 4 washes with 48hrs between each one before drawing a conclusion as to whether or not the treatment has worked. However most shampoos are not suitable to be using on open wounds so depending on the degree of skin damage I mite not use one at all. Allergic and autoimmune diseases are hard to diagnose and often persistent although should respond to steroids. The only way to diagnose them is by skin biopsy which will also look for infectious agents. You statement about steroids is rather concerning. I would not at this stage be considering steroids for anything other than short term use - at the most 4 weeks. I have used oral prednisolone many times for itchy skin and respiratory alllergy and never had a pony get laminitis let alone be PTS. If he has had two injections and been ok these are much higher risk than tablets. You really have to way up the risk (in my opinion very small) with how much your horse is suffering and the degree of improvement the steroids make - a personal decision to make with your vet. I would say however that sometimes the itch cycle has to be broken because sometimes you have treated the original cause but continued self trauma prevents healing and steroids can be vital to allow a window of healing to begin. A good example of this is a couple of times I have given ponies with sever lice that were very itchy and self traumatising a short course of steroid tablets (1 week) to break the cycle and allow them to heal along side treating the mites.
My personal approach is to try and get a diagnosis before starting to treat but I do appreciate that sometimes it is sensible and cheaper to try a treatment if you are confident of what something is likely to be. The trouble with skin is the quality of diagnostic samples is really damaged once treatment has begun. In a horse that has been suffering for three weeks and is still getting worse I would want to be doing the gold standard diagnostic techniques for skin disease which is number 1 biopsy. Skin scrapes should also be done as should culture from a swab. Taking a biopsy is a very simple procedure done under sedation and yes it would still give useful info despite antibiotics, still better done than not done and definatley more use than a blood test!
I hope this helps make things a bit clearer. When I personally had very itchy skin I used a cream called eurax which was the only thing that gave me any relief, I see some one else reccomended E45, both may be worth a try but not on open wounds.
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Post by jen1 on Dec 9, 2010 1:31:08 GMT 1
i used eurax on one of my chaps who has sweet itch type syptoms , it was the only thing that worked for him and my son who has skin problems
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Post by donnalex on Dec 9, 2010 9:07:16 GMT 1
Will discuss with vet later on today when I see her. Thank you.
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Post by donnalex on Jan 5, 2011 9:39:39 GMT 1
So have had full lab results back. Nothing. He has had biopsy, skin scrape, tutfts taken, scab samples and brushed flakes onto paper. None of them show anything except 'inflammation in the skin layers'. He is getting better but is still on steroids. Starting to wean him off them now, tried once but he started up again. Have been washing him in Imaverol and am hoping that has done the trick. Malaseb improved it I think but not totally cleared it. Dare not put anything greasy on to get rid of the stubbrn scabs as dont want to make it worse or complicate things. Poor lad is not allowed any bedding yet but is on Fieldguard rubber mats and turned out in the day. He is not happy and is not lying down. He has had a rusbbish Christmas
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Post by starbuck on Jan 5, 2011 10:01:02 GMT 1
Poor Alex, hope he keeps on improving x
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Post by jen1 on Jan 5, 2011 13:37:44 GMT 1
how is the wee man now donna, was he wormed around the time of the flare up, or anything else new/
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