Cellulitis

[HashRouge]

Please can I ask what your next steps would be? I'm waiting for a call back from the vet.
Cellulitis came on very quickly last week. One day we had a few minor mud rash scabs, the next morning her legs were like balloons and she was very lame. Vet came out and prescribed oral antibiotics. I'm kicking myself a bit for not insisting on IV antibiotics, but I've never dealt with cellulitis before! She also said 2x danilon per day. Several days later I asked to speak to the vet again as was not happy with horse's progress (or lack of progress!). Vet prescribed steroids. She has now been on steroids for 48 hours and the swelling has almost completely disappeared, but she is still lame and appears to be in agony if I touch her legs, even gently. The mud rash looks pretty bad to me, very red and angry. The vet didn't give me anything topical for it last week as she was worried about how reactive my mare is when you touch it, and didn't want me getting kicked. I'm managing to get her out in the field, as YO has given me the use of a different field just for my two, which isn't muddy, and I'm walking her as well, though usually just up and down the barn as I can't leave my other horse on his own.

Do I insist on IV antibiotics and/ or a course of different antibiotics? Or do I just ask for topical treatments to try and treat the mud rash from the outside? Or both? I've also just been looking at Silver Whinny socks - would these be worth a try instead of some sort of topical cream (but in conjunction with antibiotics/ steroids)?

 

[Pearlsacarolsinger]

Having lost a horse to cellulitis I would insist on throwing the kitchen sink at yours. Mine was a 16.3hh 11 yr old ID x and I think the emergency vet who came out on a Sunday underprescribed the intra muscular injection dose, a week later she was pts

 

[Carrottom]

If you can't apply cream I would ask the vet to come and sedate the horse to allow the first application. Mine was prescribed a steroid cream, sorry I can't remember what it was called.

 

[HashRouge]

Having lost a horse to cellulitis I would insist on throwing the kitchen sink at yours. Mine was a 16.3hh 11 yr old ID x and I think the emergency vet who came out on a Sunday underprescribed the intra muscular injection dose, a week later she was pts

This is what worries me, as I know it can be fatal. I've just spoken to the vet and she still seems confident oral antibiotics are the way to go, but is going to come out and swab the wounds to check we are using the right antibiotic. I feel like I'm getting this wrong - I've spoken to two vets at the practice now and they both said the same thing. Should I make more of a fuss when the vet is here? We are going to try some topical cream for the mud rash as well, I said I'll deal with the risk of getting kicked!

 

[DabDab]

I'd feel the same as you, although on the few occasions I've had cellulitis to deal with I've never had a vet reluctant to go with IV antibiotics when I've asked. When the vet comes out maybe just ask why they are avoiding the IV antibiotics?

 

[Ossy2]

Having a horse go through this, one week on I’d be wanting to throw everything at it the longer it goes on for the more damage it could be causing. Mine’s last bout of it was 10 years ago but she still suffers swelling and stiffness in that leg at times

 

[HashRouge]

I'd feel the same as you, although on the few occasions I've had cellulitis to deal with I've never had a vet reluctant to go with IV antibiotics when I've asked. When the vet comes out maybe just ask why they are avoiding the IV antibiotics?

Thanks, yes I'm going to push back on this! I'm feeling so down about this all, I feel like a terrible horse owner because I can't make her feel better. I was supposed to be flying to Argentina this coming Saturday and now thanking the heavens that I bought a flexible ticket, because there isn't a hope in hell I'll be able to leave her.

 

[vetsbestfriend]

My TB had a really nasty case of it just over a year ago, even the head vet at the practice had never seen a case so bad. As well as the serum oozing through the skin he also had huge weals come up that then burst pulling the skin and hair off too. I had the vet out daily for 4 days to give IV antibiotics and steroids, then he had oral antibiotics and steroids but after a week the healing was not as good as it should have been. So they took a swab from one of the weals and it turned out that the bacteria causing it was resistant to the general antibiotics so he had to have specialised antibiotics ordered in for him (with associated price tag!). Took over 4 weeks to get to a good state of recovery and even longer for the last of the swelling to go down. He grew a really thick winter coat on the leg and even now 16 months later I have to be careful about the amount of protein he has in his feeds even though he needs it for weight gain else his leg can swell a bit too. Vets gave me an antibiotic cream designed for mud fever to put on too but I actually found that using silver cream on the leg itself helped more. Good luck with the recovery.

 

[Pearlsacarolsinger]

Different horse but we've just got over a very nasty dermatitis which affected cob's hinders. That (eventually) proved to be caused by eating a small amount of linseed. She was very difficult to deal with because her legs were very sore. I found that I could get a spray onto her most safely and effectively, although I have used silver cream on her legs before.

 

[HashRouge]

My TB had a really nasty case of it just over a year ago, even the head vet at the practice had never seen a case so bad. As well as the serum oozing through the skin he also had huge weals come up that then burst pulling the skin and hair off too. I had the vet out daily for 4 days to give IV antibiotics and steroids, then he had oral antibiotics and steroids but after a week the healing was not as good as it should have been. So they took a swab from one of the weals and it turned out that the bacteria causing it was resistant to the general antibiotics so he had to have specialised antibiotics ordered in for him (with associated price tag!). Took over 4 weeks to get to a good state of recovery and even longer for the last of the swelling to go down. He grew a really thick winter coat on the leg and even now 16 months later I have to be careful about the amount of protein he has in his feeds even though he needs it for weight gain else his leg can swell a bit too. Vets gave me an antibiotic cream designed for mud fever to put on too but I actually found that using silver cream on the leg itself helped more. Good luck with the recovery.

Yes I'm glad that we're going for swabs as I want to make sure we're giving her the right stuff to get on top of the infection. I'm glad your horse got better.

 

[Hackback]

You probably don't want to hear this but a couple of years ago my horse had a nasty bout of mud fever, AKA pastern dermatitis. He developed cellulitis in one leg and was literally hopping but that did resolve with oral antibiotics. The mud fever didn't though. He had swabs and 2 types of bacteria were identified, one was penicillin resistant and the other was resistant to another antibiotic - TMPs? He therefore had three different types of antibiotics - apparently the problem with horses is that they don't have a huge variety of different antibiotics - 5 courses in total, some oral and some injected - steroids, both topical and oral, and goodness knows how many different creams. Every now and then the condition would seem to be getting better but then it would flare up again and he was so sore he was lame. It lasted about 8 months until in desperation I was googling (for the umpteenth time) ways to boost his immune system and I found out about Vitamin E. I gave him the water soluble kind as it said it was absorbed more easily and lo and behold his heels healed. It was literally a miracle. There were other benefits too so he remains on vitamin E to this day.

He does have Cushings though, so his immune system is already compromised.

At times I really thought I was going to lose him, I couldn't believe mud fever could be so devastating (or expensive!)

Good luck with your horse, I hope you have a speedier resolution than I did.

 

[HashRouge]

You probably don't want to hear this but a couple of years ago my horse had a nasty bout of mud fever, AKA pastern dermatitis. He developed cellulitis in one leg and was literally hopping but that did resolve with oral antibiotics. The mud fever didn't though. He had swabs and 2 types of bacteria were identified, one was penicillin resistant and the other was resistant to another antibiotic - TMPs? He therefore had three different types of antibiotics - apparently the problem with horses is that they don't have a huge variety of different antibiotics - 5 courses in total, some oral and some injected - steroids, both topical and oral, and goodness knows how many different creams. Every now and then the condition would seem to be getting better but then it would flare up again and he was so sore he was lame. It lasted about 8 months until in desperation I was googling (for the umpteenth time) ways to boost his immune system and I found out about Vitamin E. I gave him the water soluble kind as it said it was absorbed more easily and lo and behold his heels healed. It was literally a miracle. There were other benefits too so he remains on vitamin E to this day.

He does have Cushings though, so his immune system is already compromised.

At times I really thought I was going to lose him, I couldn't believe mud fever could be so devastating (or expensive!)

Good luck with your horse, I hope you have a speedier resolution than I did.

Please could you tell me where you got the Vitamin E and how you knew how much to feed? Mine has cushings too so I'm conscious her immune system is not great.

 

[Hackback]

It's Nano E - not the cheapest but it works for us. I get it from Equi-box

 

[HashRouge]

It's Nano E - not the cheapest but it works for us. I get it from Equi-box

Thank you, I'm going to give it a shot because frankly it can't hurt to give her immune system a boost!

 

[TPO]

I lost a horse to cellulitis in 2021. This was my horrible experience



https://forums.horseandhound.co.uk/threads/anyone-seen-swelling-like-this.800280/#post-14522231


Once my usual vet got involved (had a different partner out for the initial emerency call) he threw everything at it. I can't remember exact details without going through the thread buy we had IV antibiotics, bute, IV steroids, oral steroids and a steroid cream.



I bought some of the immune supplements mentioned in the thread - Trinity and something from the continent. Neither were a miraculous cure or made any notable difference.



I also bought Silver Whinneys. Kim was extremely helpful and sent all my pictures to America but sadly it was too late. The socks can't be used until all the swelling is gone (shouldn't apply any pressure to cellulitis iirc) so they ended up not being used.

My vet said that often occurrences are called cellulitis when they aren't. Apparently Vinnies was "proper" cellulitis and the worst case he'd seen. My vet liased with another expert who dealt with a lot of it (mainly a vet to racehorses). Their rough rule of thumb is that if its not improved/hasn't responded in 3 days/72hrs its pretty much too far gone. We tried with Vinnie for 5wks because there were signs of improvement and the vet felt it was worth continuing. That your horse has already improved so much is heartening so I'd push on and get the kitchen sink thrown at it ASAP. Time really is critical.

I'm really surprised that your vet didn't take that approach but having said that I had a vet try to extract a tooth (without permission or speaking to us) while Vinnie was being examined to see if his tendon sheath was infected so absolutely nothing surprises me now ??

Wishing you the absolute best for a full recovery

 

[Hobo2]

Just be careful about boosting the immune system. My mare had the same thing a year ago and the vet said it was the immune system going wild that stopped it healing and not to feed her anything that boosts the immune system. What started as a swollen leg in October to the skin hanging off her leg last January took 5 months of oral steroids to finally clear up. The good news fingers crossed touch wood it has not returned. She also has cushings.

 

[PurBee]

Thank you, I'm going to give it a shot because frankly it can't hurt to give her immune system a boost!

I know your horse is currently in the throes of infection from mud fever, so you are having to deal with that with medications etc, but i experienced the same as hackback when i introduced an ‘immune boosting’ balancer to my horses diet. Specifically copper/zinc/magnesium/vit E/selenium -these nutrients are in most standard powdered balancers from forageplus and prog. Earth.

Im on acidic very wet climate boggy-prone all-year-round soil, and since adding these minerals which lack in grass and hay, ‘bog burn’, ‘mud fever’ and all mud associated rashes/infections have not been an issue. I was surprised how effective it was just adding inexpensive balancer nutrients.
I was hosing them down of mud when brought in and on bed of shavings to dry-off, but in hindsight i think the hosing the mud off daily was detrimental, exposing sore skin to other potential bacteria, when i think the mud acted like a protective ‘mudpack’ to a degree, but hosing does depend on how bad the skin has got, mine were red, and hair loss, it didnt develop to severe scabs. I got them on a balancer quite quickly after these initial signs.
They now come in muddy fetlocks, they dry-off with shavings bed, mud falls off, clean legs. Good leg skin all weathers, with all year exposure to mud, despite my adventurous boy paddling in mud up to his knees some days!

It confirms for me that the nutrient baseline in the diet of these immune boosting ones specifically help, when we get posts on here from peoples horses who get ‘mud fever’ when declared fields arent even muddy.
(Dry mud has bacteria aswell as wet mud - the difference is the body’s immune system being equipped with the right nutrients to deal with the bacteria ingressing the skin layers)

When i first experienced mud fever symptoms and read more that horses need to be kept away from mud as much as possible so they dont develop it , i thought dammit, we’re doomed - they have to go away from this muddy hill! But wild horses arent commonly affected, and they roam all sorts of ‘dodgy’ terrain, especially the ones from northern climes - but they have exposure to eat an array of nutrients their domesticated brethren dont.

Bacteria is always in all soils, and the condition of the immune system to deal with bacteria on skin, depends on nutrients being available for the immune system to work fully.
Skin/hair health being dependent specifically on zinc/copper/vit E. - but best to throw the array of immune boosting nutrients into a horse with overt immune weakness.

If topical treatment is hard and you risk being kicked, have you tried a sponge tied to the end of a stick? Dip sponge in ointment and dab lightly onto leg from a safe distance?
I’ve used aloe vera for all sore skin issues with great results -its nicely cooling and relieving if inflammation is bad. It heals deeper layers on dermis than many topical oily skin creams as its water based and soaks right into the layers of the skin.
It allows skin to breathe and ooze serum, not blocking the healing process.

Obviously youre at emergency stages and it sounds like oral/IV antiB’s are required to quickly kill infection. Fingers crossed for you she recovers from this bout. As others have said, i’d throw everything at it at this point.
Consider having her on probiotics while the gut is being compromised with oral antib’s. A simple probiotic like protexin will support gut function while going through the anti-b course.

 

[Pearlsacarolsinger]

I stopped feeding FP balancer because it seemed that linseed was at the root of our latest problem and have gone back to Aloe Vera juice, which seems to suit her.
I had been feeding the ID glucosamine immediately before her cellulitis, so I would be very wary of introducing any new supplements just now, OP

 

[Goldenstar]

It’s a serious condition it’s always an emergency .
If you are not happy get the vet back out .
I would apply something topically I have used flammazine , and also my vets makes a paste on a udder cream base with antibiotic steroid and an anti fungal in it .
sadly once they have had it they are prone to get it again .

ETA a good soothing cream is mother bees care and protect .

 

[HashRouge]

Hello all, thank you so much for your advice! Swabs taken so will find out if we are using the correct antibiotics and then go from there. Vet does seem open to IV antibiotics, but said let's get the swab results first.

On a positive note - there is now no swelling, or negligible amounts. This has been consistent since Sunday morning, even after standing in at night (her first dose of steroids was Saturday PM). There is no pus and there also seems to be much less heat around her mud rash. Eating well, bright in herself, accepted her antibiotics by syringe very well this evening.

On the less positive side - the mud rash still seems very painful, although she tolerated a gentle warm water wash (with very dilute hibiscrub) and towel dry very well on one hind leg this evening. Less well on the other, but this is the leg where the mud rash is worse. Still very lame when she first starts walking, but improves after four or five steps. Part of the lameness I think comes from the fact her mud rash is over her fetlock joints, so flexing the joint must be very uncomfortable.

 

[HashRouge]

I stopped feeding FP balancer because it seemed that linseed was at the root of our latest problem and have gone back to Aloe Vera juice, which seems to suit her.
I had been feeding the ID glucosamine immediately before her cellulitis, so I would be very wary of introducing any new supplements just now, OP

Yes, on reflexion I think you are probably right!

 

[HashRouge]

I lost a horse to cellulitis in 2021. This was my horrible experience



https://forums.horseandhound.co.uk/threads/anyone-seen-swelling-like-this.800280/#post-14522231


Once my usual vet got involved (had a different partner out for the initial emerency call) he threw everything at it. I can't remember exact details without going through the thread buy we had IV antibiotics, bute, IV steroids, oral steroids and a steroid cream.



I bought some of the immune supplements mentioned in the thread - Trinity and something from the continent. Neither were a miraculous cure or made any notable difference.



I also bought Silver Whinneys. Kim was extremely helpful and sent all my pictures to America but sadly it was too late. The socks can't be used until all the swelling is gone (shouldn't apply any pressure to cellulitis iirc) so they ended up not being used.

My vet said that often occurrences are called cellulitis when they aren't. Apparently Vinnies was "proper" cellulitis and the worst case he'd seen. My vet liased with another expert who dealt with a lot of it (mainly a vet to racehorses). Their rough rule of thumb is that if its not improved/hasn't responded in 3 days/72hrs its pretty much too far gone. We tried with Vinnie for 5wks because there were signs of improvement and the vet felt it was worth continuing. That your horse has already improved so much is heartening so I'd push on and get the kitchen sink thrown at it ASAP. Time really is critical.

I'm really surprised that your vet didn't take that approach but having said that I had a vet try to extract a tooth (without permission or speaking to us) while Vinnie was being examined to see if his tendon sheath was infected so absolutely nothing surprises me now ??

Wishing you the absolute best for a full recovery

I'm so sorry your case had such a sad outcome. I read your thread a few days ago (and ended up on the phone to the emergency vet, but that's another story!).
That is good to know re the Silver Whinnys. My mare's swelling seems to have gone since starting the steroids so I wonder if the socks might be worth a go for us, but I will just have a double check tomorrow that there definitely isn't any residual swelling. Although I'm not sure I could get one on her left hind at the moment anyway (!!).

 

[PurBee]

Hello all, thank you so much for your advice! Swabs taken so will find out if we are using the correct antibiotics and then go from there. Vet does seem open to IV antibiotics, but said let's get the swab results first.

On a positive note - there is now no swelling, or negligible amounts. This has been consistent since Sunday morning, even after standing in at night (her first dose of steroids was Saturday PM). There is no pus and there also seems to be much less heat around her mud rash. Eating well, bright in herself, accepted her antibiotics by syringe very well this evening.

On the less positive side - the mud rash still seems very painful, although she tolerated a gentle warm water wash (with very dilute hibiscrub) and towel dry very well on one hind leg this evening. Less well on the other, but this is the leg where the mud rash is worse. Still very lame when she first starts walking, but improves after four or five steps. Part of the lameness I think comes from the fact her mud rash is over her fetlock joints, so flexing the joint must be very uncomfortable.

Thats great to hear the swelling has significantly reduced and she’s perkier in herself ?

 

[Goldenstar]

Sounds like you are winning

 

[Hackback]

Still very lame when she first starts walking, but improves after four or five steps. Part of the lameness I think comes from the fact her mud rash is over her fetlock joints, so flexing the joint must be very uncomfortable.

I had this with mine too - the movement opened up the cracks and scabs, it must have been so sore. The vet wanted me to give him gentle exercise though because it helped drain the lymphatic system and encouraged blood circulation.

Glad to hear your mare is improving.

 

[SussexbytheXmasTree]

When I last had a horse with this I insisted on IV antibiotics. I think Doxycycline is the antibiotic mainly used but it’s very harsh on the stomach. Previously I had tried oral doxycycline but it was impossible to get him to take it. Mine started with being on a yard where it was heavy clay and every horse got mud-fever. When I moved yards for the first couple of years he had a few bouts but then never had it again. My vet practice does their own steroid cream mix which I used topically.

 

[oldie48]

I'm glad your horse is improving but I'm adding this in case it's read by anyone else having to deal with cellulitis. My old boy went down (literally) with a very bad case, just one back leg affected but he was in so much pain I wanted the vet to PTS. It took three of us to get him off the floor and into the field. He came in from the field the night before and I thought he was brewing an abscess, by the next morning he was really very poorly and we never found the source of the infection. The vet threw everything she could at him including IV antibiotics and loads of pain killers so I could keep him moving. I got up every hour through the night to walk him a few steps in the pouring rain. Her view was that if he didn't show an improvement in 24 hours she would try a different antibiotic. She came back the next morning, gave him more IV antibiotic and slowly I could see him improving. He survived it and he was saved by the vet.

 

[hobo]

Hackback my vet encouraged me to still exercise my mare for the same reason. She was not lame on hers but it looked terrible and if I passed anyone I always had to say yes I know and the vet is treating her and wants her exercised.

OP sounds like you are turning a corner with your horse so fingers crossed it carries on improving.

 

[HashRouge]

Little update.

We don't have the swab results yet as there has been some sort of delay with the lab. Looks like it will be tomorrow now. However, the vet and I are both cautiously optimistic that we have beaten the cellulitis. The swelling has stayed down and there is reduced heat in her legs, plus no pus/ oozing.

She's still lame, although improves a lot once she gets going. However, I *think* she is starting to find it slightly less painful. Yesterday was a real low point, if I'm honest. The vet wants me to bathe her scabs in salt water, towel dry and apply cream (Flammazine). Yesterday afternoon this was a huge struggle. I managed, but it took ages and I honestly just wanted to cry for most of the evening afterwards. This morning I skipped the bathing part as it takes a long time to dry her legs and just applied cream. But this evening I did the whole routine in full and it was much, much easier. Her better leg I managed to do everything with almost no reaction, and her worse leg was much less of a drama than yesterday. Previously, if I touched the scabs on this leg, even with the slightest touch, she would fling her leg as high into the air as she could (like some kind of mad horse yoga movement), so dramatically that she would almost throw herself over onto her other side. But this evening we managed with just some more normal pulling away and mild kicking out behind (never thought I'd be pleased with a horse for kicking out!).

I'm thinking now that she probably is on the right antibiotics, but her healing is just slow because of her age/ cushings. Still, we will wait for the swab results.

However, even if we have kicked the cellulitis on the head, I am still dealing with a really nasty case of mud rash.

With that in mind, could I ask if anyone has used Silver Whinnys to help combat mud rash? I'm wondering if these might complement everything else we're doing and be a good longer term investment given her propensity to mud rash and other weird things like infected tick bites. I know that TPO said they can't be used where there is swelling due to cellulitis, but hopefully we're now past that stage.

I was also wondering what creams people have found to be effective. I've obviously got Flammazine from the vet, but it doesn't seem to go very far so I was wondering if I could use that on the worst areas and perhaps something else on patches that are healing well (has anyone used medical grade manuka honey on something like this?). I'll check with the vet obviously, but I know there is a lot of experience on here so always keen to get recommendations.

 

[Hobo2]

Glad she is more comfortable and you can treat it . If I can get pictures to post I will show you how bad my poor mare was but the good news is it has not come back.