Nearly at wit's end - persistant skin infection

[soloequestrian]

At this rate I will be needing medication for it as well as the horse - for depression:

This has been going on for around 2 years. Initially I thought it was mud fever - small scabby areas at the backs of both his hind legs, above the heel bulbs. I treated with various mud fever preparations and each time we seemed to be winning for a bit and then he would take a reaction to whatever cream I was using and we'd be back to square one. After several months of this, the vet had a look. Horse was tested for liver function (normal) and also had cultures grown from the infected areas. Since then, he has had a course of systemic antibiotics, topical antibiotics, and antibiotic foot soak and most recently yet another course of topical antibiotics. With each (over the course of 18 months), we've had a bit of improvement but then get to a holding stage. There is no sore or broken skin, but there are scabs over the top of the infected bits and if I stop treatment, these start to get sore. At the moment, I wash his hind legs with hibiscrub twice per day and apply antibiotics, with an attack on the scabs every few days (he hates this - it is obviously sore to have the scabs removed, but I'm fairly sure the antibiotics do nothing when applied on top of the scabs). He was recently tested for Cushings and came back with a slightly high ACTH measurement, so is on Prascend. I was hoping to see improvement due to that, but there hasn't been any (he is in about week 6 of the Prascend). He isn't prone to injury, but overreached a few weeks ago in some unexpectedly soft ground. These cuts healed up very quickly - the infection never seems to move further than the top of his white sock (just above fetlock) on one foot, and never further than just above the coronary band on his coloured leg.
I really don't know what to do next. The vets keep saying to persevere with the antibiotics, but the bacterium (a rare staphylococcus apparantly) has already become resistant to one type and I can see that happening again.
Anyone have any thoughts?

 

[YasandCrystal]

This sounds like a nightmare for you. Have you considered trying something herbal or aromatherapy like tea tree oil and lavender? You could add these pure essential oils to either an oil carrier base or a plain cream. Personally I would get an Aloe Vera gel or suchlike and add 5 to 10 drops of lavender and half the number of tea tree oil and try a small area for a week with daily application.

Lavender is anti bacterial, analgaesic and promotes healing. They are both completely safe. The tea tree is anti bacterial. I would suggest that Hypocare spray, but that is wet and that could affect the skin through making it wet perhaps.

Hibiscrub is very very harsh and it would not surprise me if that was not inhibiting the healing.

 

[wench]

Is it necessary to use the hibiscrub twice a day?

 

[soloequestrian]

I was using an udder cream with tea tree (and aloe?) in it for about a year, but recently he reacted badly to it so I've had to stop. I did run out of Hibiscrub a while ago, and was using the Savlon that has the same active ingredient (cetrimide I think) - there was no change. I'd be happy to hear of alternatives to those? Just something like baby shampoo perhaps?

 

[callmelucky]

i know a woman whos horse has scabby bits around her pastern/fetlock/cannon bones of her white legs. i cant remember what its called but she uses aloe vera gell and keeps legs covered with turnout boot when out...seems to help alot.

 

[YasandCrystal]

I was using an udder cream with tea tree (and aloe?) in it for about a year, but recently he reacted badly to it so I've had to stop. I did run out of Hibiscrub a while ago, and was using the Savlon that has the same active ingredient (cetrimide I think) - there was no change. I'd be happy to hear of alternatives to those? Just something like baby shampoo perhaps?

I think the active ingredient in the hibiscrub/savlon is possibly the problem.

My mare had an operation on her hind tendon and she got an infection at the incision site and also little scabs around her heels which the vet referred to as mud fever like. I had to bathe the area with diluted iodine (warm water and iodine) daily and soften and remove the scabs. I then had to thoroughly dry the area and add a cream that the vet's had made up - bright yellow in colour. I found this did not clear the area of scabs so I then started using almond oil with the lavender and tea tree and alternatively some sudocreme with the oils too. It eventually vleared up but did take a while.

 

[MozartK]

I have pm'ed you

 

[GreedyGuts]

Sounds complicated and it might be worth seeking a second opinion or referral.

Has your vet tried using potassium iodide. This has antibacterial properties and can be given orally for prolonged periods to clear established infections. The other thing that might be worth discussing with your vet is whether steroids would help.

I agree with other posters that hibiscrub is to aggressive for such frequent cleansing of the skin, and will prevent normal skin bacteria from reestablishing.

 

[ozpoz]

I would also be hesitant to use hibiscrub on irritated skin. I would try neem oil applying daily - and I would not wash the area.

 

[9tails]

Have you tried Camrosa? It doesn't sound like the aggressive hibiscrub/scab picking is doing a whole lot of good so I'd be inclined to slather it with Camrosa or Manuka Honey and give it a chance to heal itself.

 

[chestnut cob]

My last horse had a strange skin infection (started off as midge bites which became infected and led to a sort of rain scald type infection, and at the same time he had an allergic reaction to alfalfa so was covered in hives too). I was given quite a lot of ABs by the vet but I felt they made him worse in the end so stopped using them. Vet also gave me Malaseb to wash him with which helped but didn't clear it up completely. I tried various things - Hibiscrub, Dermoline, tea tree oil, purple spray on each lump (seriously!), Sudocrem... it's a nightmare.

In the end someone suggested washing in baby shampoo... bingo. It cleared up straight away. He occasionally used to get a sweat rash after work under saddle area and baby shampoo cleared that up too.

I'd be wary of constant AB use and using harsh chemicals. Have you tried washing in something very mild and then just putting something like Sudocrem on top? I also really like Muddy Marvel for anything vaguely infected - it's for mud fever which the same horse used to get very badly, but I put it on all sorts of things now and it clears it up.

 

[Doris68]

I have PM'd you.

 

[soloequestrian]

Thanks for all the replies! I've been back in touch with the vet, and the horse is going to have biopsies taken next week. Until then, I'll use salt water or baby shampoo and see what happens!

 

[chestnut cob]

Also, have / can you clip all of the hair off the area? Mine was so much better once I'd clipped as I could get to the scabs and they dried out a lot.

 

[PolarSkye]

Been there . . . stop washing, get some injectable cobactan, keep your horse in on dry bedding until the scabs dry up . . .

Good luck.

P

 

[hollyandivy123]

stop using the hibiscrub, i use surgical iodine scrub which i use by soaking gamgee and wrapping round the scabs leave on 30min to 1hr and then I use a mixture of udder cream and i little bit of sulphur and the put this on in excess.
make sure he has a broad spectrum vitamin and brewers yeast in his feed.

this cleared up a persistent scab issue after trying everything else. i routinely pop on the cream every so often

 

[Maesfen]

Second Holly & Ivy completely; Hibiscrub used as often as you are doing is the work of the devil.
If you can't get sulphur try Protocon which contains it and always use a circular motion rather than from side to side which seems to rub them off far better and easier on the horse but never pick at the scabs; if they're not falling when you rub the cream on they're not ready to come off.

 

[Nothing Original]

I had major problems with mud fever type scabs healing on my old horse due to virtually no imune system and had similar troubles to the ones that you are having.

I agree with all the comments about not washing daily and would definitely say only use luke warm salt water on days you have to bathe then pat dry with kitchen towel.

I did find a cream that worked wonders called aromaheel from aromese. Friend of mine who is quite into using aromatherapy suggested it.

http://www.aromesse.com/skin-problem/Aromaheel_Mud_ointment.html

Was the only thing that worked in the end - along with keeping out of any mud or water so no turn out in rain etc. - I really did keep it dry and just use the cream but it worked in the end....

Good luck.

 

[Rebels]

Sounds similar to something our horse had and we tried everything. In the end he was booted all year round for a year as he had leukocytoclastic vasculitis. Once we got rid of the scabs he had to be UV free for a year to let his immune system recover, now 100% fine in the worst mud you can think of. Google that and see what you think, we had 6 years of drugs, creams, tests etc until I saw this by chance at a vet talk.

 

[soloequestrian]

Sounds similar to something our horse had and we tried everything. In the end he was booted all year round for a year as he had leukocytoclastic vasculitis. Once we got rid of the scabs he had to be UV free for a year to let his immune system recover, now 100% fine in the worst mud you can think of. Google that and see what you think, we had 6 years of drugs, creams, tests etc until I saw this by chance at a vet talk.

This is something that has been mentioned, and I do use UV boots in the summer which seem to help keep things in check. Do you mean that just the legs had to be UV free? Did that mean wearing boots 24/7? How did you get rid of the scabby bits initially?

 

[Rebels]

Just the legs, he has four white legs up to his knees. Basically had turnout chaps on in winter with Muddy Buddy powder in them to help keep the leg dry, had to stable 12 hours as there was a limit to how long they could be worn then as soon as it was dry he had equilibrium UV boots on 24/7. He also had a strange rash on his nose which was put down to a skin reaction but once the legs healed so did the nose, its immune system linked where constant mud fever makes the immune system very touchy and so we had to prevent any irritants including light reaching him. Initially he was kept in with sudocrem wraps, so legs washed with either Seleen shampoo or Malaseb, patted dry and then left until bone dry, then a super thick layer of sudocrem covered in cling film and a stable bandage over all of that. That left soft new pink skin under the scabs which slid off when the sudocrem was wiped off (very messy, never quite comes off the stable bandage either but always found it to get the scabs off, its the aftercare that is the problem). We had got to the point where you could knock a scab off and it would scab over immediately. The aromaheel worked well for the bigger stubborn scabs if we didn't boot but tbh it was keeping him UV free that made the difference. We did that for just over a year before we noticed the white hair was thicker, the skin looked stronger and much healthier. We had previously nearly lost him to lymphangitis and he had 6 months in a box with tree trunk legs on injectable steroids. As soon as he went out it returned, I saw this condition at a vet talk by Professor Knottenbelt (the guy that invented the Liverpool cream). I will try and find the link to his book for you.

 

[Rebels]

BTW it is often triggered by the sun reflecting from things like buttercups back onto their legs in summer and water/snow in winter hence why it is a whole year round condition. Ours was treated for : buttercup allergy, feed allergy, bedding allergy, arena surface allergy, mites, mite allergy, standard mud fever. He has had Norodine, injectable antibiotics, Predisnalone steroids by the buckets. Creams wise we had tried Flamazine, may work better than sudocrem if scabs are bad, Betnovate, Sulphur creams, aromaheel, muddy marvel, every udder cream formulated that can be bought anywhere, baby shampoo (tesco value worked best if we had to wash his legs). One thing that helpers was clipping the legs fairly close to let the skin breathe with all the cream on and also stop him getting sweaty under boots. He had two sets, washed every other wear, nightmare in winter but seemed to stay dry with the Muddy Buddy powder to help. Normal talc damaged the skin, too strong.

 

[soloequestrian]

Update: Horse had biopsies taken today and is now has shaven legs swathed in a silver/activated carbon dressing and is doped up so he can stay in.
Fingers crossed that the answer is on it's way.
Thanks again to everyone who replied - feeling a lot more hopeful!

 

[HappyHooves]

hope the news will be good. Glad you are also feeling less suicidal!

 

[Elsbells]

Treat from the inside too. Micronised linseed keeps the skin and coat healthy. It might be a waste of time although in my mind, it could only help?

Hope it all comes right, good luck.

 

[Tnavas]

At this rate I will be needing medication for it as well as the horse - for depression:

This has been going on for around 2 years. Initially I thought it was mud fever - small scabby areas at the backs of both his hind legs, above the heel bulbs. I treated with various mud fever preparations and each time we seemed to be winning for a bit and then he would take a reaction to whatever cream I was using and we'd be back to square one. After several months of this, the vet had a look. Horse was tested for liver function (normal) and also had cultures grown from the infected areas. Since then, he has had a course of systemic antibiotics, topical antibiotics, and antibiotic foot soak and most recently yet another course of topical antibiotics. With each (over the course of 18 months), we've had a bit of improvement but then get to a holding stage. There is no sore or broken skin, but there are scabs over the top of the infected bits and if I stop treatment, these start to get sore. At the moment, I wash his hind legs with hibiscrub twice per day and apply antibiotics, with an attack on the scabs every few days (he hates this - it is obviously sore to have the scabs removed, but I'm fairly sure the antibiotics do nothing when applied on top of the scabs). He was recently tested for Cushings and came back with a slightly high ACTH measurement, so is on Prascend. I was hoping to see improvement due to that, but there hasn't been any (he is in about week 6 of the Prascend). He isn't prone to injury, but overreached a few weeks ago in some unexpectedly soft ground. These cuts healed up very quickly - the infection never seems to move further than the top of his white sock (just above fetlock) on one foot, and never further than just above the coronary band on his coloured leg.
I really don't know what to do next. The vets keep saying to persevere with the antibiotics, but the bacterium (a rare staphylococcus apparantly) has already become resistant to one type and I can see that happening again.
Anyone have any thoughts?

Have you tried Nizoral? Dilute with hand hot water, wash and in your horses case rinse off after 10 mins. I would be inclined to stop using Hibiscrub - it's harsh and if you read the instructions should not be used on broken skin.

The other suggestion would be to poultice with Active Manuka Honey

Finally look at what you are feeding - take him off all processed feeds and starting with plain meadow chaff introduce each feed individually, eg chaff and oats.

Is there any possibility that the initial scabs are a result of mites rather than mudfever type condition. Is so then wipe with Neem oil. This is both antibacterial and an insectacide.

If you can havea multi mineral lick available 24/7 - it needs to be one with Copper & Zinc in it.

 

[Orangehorse]

Sounds a complete nightmare.

Have you contacted Global Herbs? They have various mixes that can help boost the immune system.

 

[posie_honey]

you;'ve had some great sugguestions - but to add another one - filtabac cream - seems to work wonders for mud fever - and is also a sun screen http://www.hyperdrug.co.uk/Aniwell-FiltaBac-Cream/productinfo/FILTABACC/
fingers crossed it gets sorted soon