Leukocytoclastic Vasculitis

[landf]

Has anyone whose horse has suffered from this got any advice....? I have been battling with it now for 9 months and I have almost reached the end of the line. My horse has been on 2 courses of high dose steroids as well as topical steroids and antibiotics. But we never manage to get rid of it all - there is always a tiny area which then erupts as soon as steroids stop. He's been on box rest for 2 months as he can't get legs wet, muddy or any direct sunlight on them and still it doesn't shift.

It's got to the point where I am questioning my horse's quality of life..... The skin lesions are extremely painful, he doesn't cope well with the steroids which have a sedative effect on him and he's not allowed any turnout and can only be walked in a barn to avoid UV exposure. I can't ride him either for all of the above reasons - can't cover legs with boots as they rub the lesions and when on the steroids he's too sedated to ride anyway!

Any advice?

I should point out that he has 4 white legs and all 4 are affected.

 

[Rebels]

Argh, just typed it out and stupid tablet deleted it!
Firstly, I've used germoline on lesions as it has a local anaesthetic in it, then I bandage as if over stitches so with a thick layer of cotton wool and then an elastic cotton bandage then a stable bandage. If they are super sore then thick cotton wool, then a soffban then stable bandage. It should give you nearly an inch of soft layers and shouldn't be too painful. If you can get covered then he can at least graze. Our lad was in for nearly 6 months on injections of Excenel and buckets of Predisnalone. He had no definition from his hock down on the hinds and knee down on the fronts plus his nose was cracked and sore so I was questioning life quality. Is your boy on bute? I would also try an immune boosting herbal powder, someone else will advise you better, we fed nettles and cleavers which has a blood cleansing effect. What lotions are you using on the lesions at the moment?

 

[landf]

Thanks for your reply. The ground is too wet/muddy to turn him out even in bandages - his worst lesion is just above the coronet band, so very close to ground.

I thought boosting the immune system was the wrong thing to do as it is immune mediated - the whole point in giving steroids is to reduce the activity of the immune system.........

He was on Fuciderm and Fucidin H but they stopped working so he has recently changed onto Cortavance. He's also been on Prednisolone then Dexamethasone.

 

[Rebels]

OK, maybe phrased it incorrectly , its a case of supporting the immune system. Nettles and cleavers seemed to help ours. With a very low lesion i would scrape and brush his foot out, then bandage down over the bulbs of the heels and then put a poutice type boot on which is taped to the bandage. Basically anything I could to give him 5 mins grazing in hand on the road side. I found bandaging like that even in the stable helped protect him from the UV plus helped keep the lesions clean. We tried a few different creams including sulphur paste which helped dry out some of the scabs/lesions. Occasionally I would dress a wound with a dressing or use animal lintex for its antiseptic properties. I was recommended manuka honey but never did try it. Flamazine sometimes helped, we had 2 or 3 on a cycle, one would stop and then the previous works for a bit.

 

[landf]

Does your horse still suffer from it or have you managed to finally get rid of it?

 

[Rebels]

After 5 years of low level 'what is it' and then 6 months of awful we had 2 years of fantastic, living out in mud, wet etc with no problems. All 4 legs grew super thick lovely white hair, not the thin patchy stuff he had previously. This was bootless, creamless all year round. Then with this snow he has had a few lesions come up overnight on both hinds which started to puff up. He has had a week of box rest staying clean and dry with a sudocrem wrap on initially to remove the scabs and its all nearly sorted, its just a case of letting it heal enough not to return. Same as mud fever in a standard horse I think, just that I know he has the possibility to escalate. This shouldn't need the vet.

 

[landf]

Glad you seem to have got on top of it. I find it physically and mentally draining! Can you pinpoint what seemed to get to the bottom of it? Or is it just a case of chipping away trying different things?

 

[Rebels]

No one thing seemed to crack it, we had an arsenal and had to swap creams regularly. the drugs took an age to help, he was needle phobic by the end, so patient bless him but it was a nightmare. Like you said, mentally and physically draining especially with the extra box rest work. We stripped back the diet to as plain as possible, gave ad lib hay, oil etc to try and get him in the best physical condition we could. He spent nearly a year afterwards with UV boots and then turnout boots with 12 hours in the dry. We just kept chipping. Have you spoken to Professor Knottenbelt? He is the world expert and very helpful so could possibly advise a different drug your vet may not have tried.

 

[landf]

Yes, my vet contacted him petty early on. My horse also spent 2 weeks in Liphook hospital undergoing specialist treatment which is when he was diagnosed. My vet and I are still in regular contact with the specialist who dealt with him there. I think they want to put him back on the Dexamethasone orally which I am really disappointed about - the dose he needs to be on completely wipes him out and he spend most of his time in a semi sedated state at the back of his box :-(

 

[Rebels]

How rubbish, I actually went to a talk by Knottenbelt, went home and told the vet what to Google! Sounds like your lad is bad, all I can say is that when its gone its gone, ours was so much happier and energetic, I didn't realise how much it must have taken out of him. In hindsight I may have added something like propell plus like I would with a normal infection. Fingers crossed for you.

 

[flower549]

Sorry, I don't have any pearls of wisdom to add, but this is very sad. I am sending a hug to both of you.

I hope this works out.

xx

 

[Paint Me Proud]

Have you considered trying sulphur powder on it?

My boy had a scabbed crusting nose for several weeks and i couldnt shift it. So i mixed some sulphur powder with aqueous cream and applied it. The result next morning got a literal 'OMG' from me, it had completely gone.

Worth considering.

 

[SaharaS]

oh no...have a horrible feeling I have one to add to the list..not confirmed yet but showing very similar, thankfully only one leg..I do hope both of yours come good..stick at it..I'm having dreadful troubles at the mo with one with something similarly horrific & physically draining is not the word so totally appreciate where you are coming from..hugs to all...

rosehips are a good tonic too & will boost the immune system - i second the nettles also and as controversial as this will sound, she mugged me for a whole garlic the other day & merrily chomped away on it & looked disgusted when the last clove had vanished..the next day was an easier day, so i tried it on the one who I suspect has LV & the same reprive the next morning..each of them seem to want garlic every other day, and turmeric powder rubbed into olive oil seems to be helping too-you could add seaweed to this and mix it in an aloe gel based paste & apply - speak to vet first if concerned but it seems to ease pain, swelling & sores in conjunction with the garlic.This bloody weather for the last year has been so hard on us all..hopefully spring will bring some hope.hang in there

 

[jennie1000]

Does anyone have any photos o this condition and the elisions that I could see?

 

[Billabongchick]

Ours has been diagnosed with this yesterday after weeks of me treating it as mudfever. On day 1 of steroids and cream today but had been on box rest bandaged for past week anyway with little improvement and had been using Flamazine before. It seems buttercups can be a culprit in starting it off.

 

[Rebels]

Billabongchick- ours was reacting to the light reflecting back from the buttercups if you can believe it. He was tested for buttercup allergy but he wasn't allergic. Snow has the same effect, reckon a few more horses may be diagnosed as the light is reflected back more. It starts with anything that causes a constant low level reaction then the immune system just goes mad. After that then its just so reactive it doesn't take much to cause problems.

 

[Billabongchick]

Thank you Rebels. Apparently there were buttercups in her field and when we bought her just one tiny patch on her foreleg had popped up. Friend we got her from wasn't sure if it was mudfever as so high up but it has got consistently worse over past month or two and now we know why. I am hoping that the steroids will help clear it so I can bandage.

What is the difference between UV and turn out boots? I was planning on polo bandages under t/o boots when we get to that point but am now worried reading this that the condition could turn into something far worse than initially imagined.

Unfortunately I was away and when leg swelled up Sunday (was looking ok sat apparently) I asked YO to take her to vet Monday so I haven't spoken to the vet yet. Apparently they said ok to ride her as long as legs washed and dried after but they look so sore to me. However because they sedated her to descab what was left after clingfilm/sudocrem I did last week (which got rid of a lot) the scabs are minor now. I mean they are angry red/pink but not proud of the skin so much so fleece polo bandages should not cause too much discomfort by rubbing?

 

[Rebels]

Ours started with one scab on a front leg and ended up with 4 tree trunk legs, its a funny condition, hard to predict. UV boots are very light weight summer boots for when the ground is dry and ours are like a mesh so they don't heat the legs. Turnout boots are variable but tend to be thicker and can be heating. Most are breathable but all are advised not to be worn more than 12 hours as they have a mildly supportive action on the leg. They are fitted like a second skin and usually end up vile after 2 seconds but ours were invaluable.
With regards to washing the legs we used malaseb then seleen shampoo, the lesions will be very sensitive to chlor hexidine so hibi scrub was out. We only washed when the creams were thick, we found it best to dry wipe off the clumps of cream then reapply instead of scrubbing. They have to be bone dry to have any cream back on, either hair dryed or left several hours. We would often put udder cream on to ride and he ended up bootless unless doing xc.

 

[Billabongchick]

Thanks, the T/O boots I have are neoprene hence I thought polo bandages might be good although I appreciate you wouldn't want to leave them on all day. She is happy stabled so even if she had limited turnout when dry that would be enough to keep her happy luckily. I am glad to hear that yours has been manageable mostly; hopefully the steroids will have a good effect and the other effects will be manageable and not too inhibiting for ours!

 

[landf]

Sorry, only just caught up with this again as I'm in the middle of a house move!

We took more scrapings this week and he now has a severe bacterial secondary infection again. Specialist has prescribed Baytril. It's an oral drug but I have to apply it directly to the lesions and hope for the best - the bacteria they found is pretty much resistant to everything apparently. Vet is hopeful though.

 

[Rebels]

Fingers crossed for you.

 

[sam72431]

Have you had liver tests run? What blood enzymes is he showing? My boy was diagnosed with this and showing high liver enzymes so I have worked on getting his liver healthy and his legs have now completely cleared up, following advice on this forum I got advice from the head nutritionist at Dodson and Horrell he is a different animal so full of energy and just happy in himself! Obviously different for different horses but he now has two and half scoops alfa a and three scoops of pasture mix with scoop of sugarbeet split into as many feeds as possible along with milk thiatle and naf blk the diet is very important!!

 

[Billabongchick]

Poor you Landf. I hope the oral stuff works for him. I'm back to the vet with ours on Monday for followup (it's looking better so far and she was full of life when i rode her yesterday as vet said ok with bandages on) and prob going to get liver test done for peace of mind. Also interested in supplements and diet to aid recovery. Is milk thistle the best to use?

Been worrying a lot since she was diagnosed but another lady on yard next door with a lovely coloured horse said he had it last year and is fine now even without boots on so that made me feel a bit better.

 

[landf]

Yes, he's had blood test etc, and all clear. Fingers crossed for the Baytril - the lesions are certainly less red tonight so hopefully it's doing something!

Mine is a coloured too Billabongchick - 4 completely white legs! Encouraging that you know someone who has had a positive outcome.

 

[landf]

Sadly it looks like its back to the drawing board for us again as the Baytril has done nothing :-(

 

[Billabongchick]

Oh no, not good news. Maybe you could suggest cycling round the various treatments as Rebels said? Has anything worked at all at any point?

 

[Rebels]

Hi, could you ask your vet about trying something like medical grade manuka honey on the lesions? It may not cure them but it may give you long enough for him to have a break from creams, it could be worth a go for a week then you can reassess. Have you tried back to basics eg sudocrem wrap? When we reached a wall we rewrapped the legs and got a lot of muck out, smelt awful but skin did improve.

 

[maginn]

My horse also suffers with Leukocytoclastic Vasculitis (PLV) & thankfully I have found a solution that worked for her. She suffered badly for 3 years as it wasn't diagnosed the first 2 winters she had it, the vets just thought it was mud fever, but she got it mid september every year and when that happened the 3rd year on the trot when in dry conditions I got a different vet out and finally a correct diagnosis.

This is a really hard condition to deal with as you know. So you might think I am a bit mad to say the best thing is not to treat it as such. I was told that it was an old horseman's saying that you shouldn't treat "early onset mud fever" just leave it be. Perhaps the truth of this is because it isn't actually mud fever if the horse has if it gets it in a bone dry field.

I spent 2 years having vets out and I tried everything on offer. My poor mare was so sore and fed up with me & nothing seemed to do any good, in fact she just got worse. But I suppose the one thing that did seem to help her in the first 2 years was the onset of spring which helped to dry it up. As it was "getting better" I left well alone & then hey presto it cleared up.

Come year 3 I still hadn't learnt from this & she got a scabs on both heels again during mid september, so I went all out with another treatment which I thought was worth a shot. Her legs just got steadily worse and more scabby & very pink ... She end up in a really bad way all four legs scabby as hell and worse than ever. It was at this point I got a second vet out & thankfully a correct diagnonsis.

With his agreement and as everything was making it worse we decided not to treat it for a few weeks and & see what happened. The scabs got really thick & nasty looking but my mare was comfortable, not lame or sore, & after 3 weeks one leg was totally clear. The others took longer and it did take about 3 months in all to be totally clear of it but I could see progress when before there had been none !

So this is what worked for me, no creams, lotions etc this will soften the scabs & they will come off, but they will soon be back. They need to be left to really dry up. I used turnout boots but they must be close fitting & not rub (the close contact boot by Equilibrum are the best IMO). I would turn out in these, which also protects against the winter sun, bring in overnight removing the boots. Although the legs can get quite warm in them this did not seem to be an issue. Mud & wet will not make the scabs worse (this is not like mud fever) but it will not help in attempts to keep the area dry and if it is very wet & sore initially you could also get secondary infections like mud fever in addition to the PLV.

If you are not going to turn out then you can skip this part just keep the areas as dry as possible, shavings bed would be better than straw.

It's really important to note that any rubbing or stimulation of the area & forced scab removal will encourage more scabbing so it is counter productive but if you leave them to dry up you will find that the scabs start to crack & reveal healthy skin underneath. When it gets to this really dried up stage you can really gently fick away at any scabs that are ready to come off - but do not rub & do not remove any scabs that are not ready to come off - IF YOU SEE ANY BLOOD STOP. It is very hard not to over fiddle I almost have to sit on my hands but it does work. I would only do this once a week tops, and be prepared that it will look a lot worse initially as the scabs may well get really thick. I reasoned that my horse was much more comfortable with non scab removal & although unsightly it was not causing a problem for her.

Something I tried this year may also help but is not totally necessary is Cortavance - this is a steriod spray (used for cats & dogs usually) but it does not enter the bloodstream so it's not dangerous like steriods that you inject, this a POM so you will need to get it from the vet but it was recommended to be by Derek Knottenbelt. Derek did advise scab removal under cling film wraps before treating in this way, but I did try this and it didn't work for my mare. Leaving the scabs to dry, removal of any dried up ones & then a spray really worked. It seems to help stop the scabs reforming as I guess it surpresses the immune overreaction. This year there was only one leg to deal with (now clear) and last year she was completely free of it.

Best of luck to you. Be brave & try it

 

[Billabongchick]

Have been to the vets with ours this afternoon and she was very pleased with progress to the point she said it looked much better than she expected it would. I intend to keep her in until all skin is entirely healthy and will then have to tackle the bandage or boot issue. As she has such sensitive skin she did suggest just using sun screen to avoid rubs. Just hope some dry weather comes soon. She has downed her dosage of steroids to wean her off too so then we will be down to just Flamazine to stay on top of it.

 

[Rebels]

I found maginn s method to work when he had low level scabs but when he was hit badly and was lying down groaning from the pain then we had no choice but to throw everything at it. Its so hard, it seems to vary so much horse to horse and become frustrating to the point of obsession.