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Discussion on Pemphigus possible
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Member:
sachet
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Posted on Monday, Dec 31, 2012 - 11:55 am:
My original post here was under the Bumps and Nodules section. From there I moved over to the Dermatophytosis (Ringworm) section. Now, based on process of elimination, I am moving to the Pemphigus section.
Dermatophilis and Dermatophytosis have been ruled out in my horse. Initially the in-house DTM showed red and we thought he had Ringworm, even though he did not present at all with the typical symptoms. A subsequent Fungal Culture came back negative for Ringworm.
The symptoms on this horse were intense itching and crusts (scabs), mostly adhered, all over the body except for upper neck and head. There was some hair loss, but mostly caused from scratching himself or picking off a scab for testing. There is no oozing, no sores, no erosions, no wheals, and no hives. Horse appears great otherwise.
After the initial positive DTM and while awaiting the Fungal Culture, we treated for Ringworm with oral fungal meds and Cetirizine for itch. A lime/sulfur dip was recommended by due to the cold weather, wasn't feasible.
To date, it has been almost two months since the start of symptoms. The Cetirizine has definitely controlled the itching, although the lesions on the body still itch.
Now finally, I come to my question this post is about. I have read the article here on Cetirizine. It states that test studies on horses showed that Cetirizine does inhibit wheal formation. However, I understand that it does nothing to address the cause of the wheals.
I am seeing ever so slight improvement in my horse's lesions (which as I've said are not wheals/hives). My question is....IF he has PF, do you think Cetirizine would control the breakout of lesions? OR, would Cetirizine only control symptoms of an allergy problem? My vet dermatologist gave me the impression that Cetirizine would only help with the itching, and not do anything for the lesions.
Unfortunately, I won't see the veterinary dermatologist again until Jan. 11. She is going to want to do biopsies at that time, and I do not want to do them. What besides PF would the biopsy show?
This has been an extremely stressful past two months with the worrying about the possibility of Pemphigus. I have of course read all the articles here and many on the web. This crazy disease has variable symptoms depending on the horse. Also, it is not as rare as some seem to think. On my horsey chatboards, I've come across several with horses that have it confirmed.
I have been taking photos regularly that I'd like to present here. However, sizing them small enough to be accepted won't show the lesions in enough detail.
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Member:
cathy33
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Posted on Tuesday, Jan 1, 2013 - 3:50 am:
Hi,
I am sorry your horse is giving you such cause for concern. My horse, Harley, has confirmed PF so I can understand your worries.
It would be really good if you could post some photos. I was recommended some software called pix resizer which is free to download I think.
Harley had no itching at all. His symptoms included scabs
that looked a bit like rain scald with raised hairs but they were generally dry but very painful, oedema on his belly and
sheath and back legs, weight loss and high temperature. By the time he was diagnosed and treated with steroids, he was very poorly indeed. Fortunately he responded well to
DExamethasone which he was on for 18 months but is now symptom free without steroids for over 3 months. I believe
Harley's symptoms are worse in the summer due to insects so it'll be interesting to see if the PF comes back in the Spring/summer.
Your case doesn't sound typical and if it is PF, then it is promising that he feels well in himself. It'll be interesting to see if Dex helps at all. Biopsies are the only thing that will confirm or eliminate a diagnosis of PF. The good thing about a firm diagnosis, is that you will know your options for treatment. You would not want to put your horse on high doses of steroids if it wasn't PF, that's for sure.
It's a horrible disease but I think the literature is overly pessimistic. Many people have had success in controlling the symptoms and their horse's lead a near normal life.
Keep us posted with updates
Cathy
As you say, the symptoms for PF vary enormously. Have you found the yahoo group for owners of PF horse's? It gives case studies that my help you.
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Moderator:
DrO
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Posted on Friday, Jan 4, 2013 - 8:57 pm:
Hello Sachet,
In general antihistamines are not effective against PF. It is not a histamine based reaction. However there may be some secondary histamine based symptoms that would be mildly responsive to antihistamines but no one reports such effects.
DrO
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Member:
sachet
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Posted on Friday, Jan 4, 2013 - 9:14 pm:
Thank you Dr. O.
There are cases documented where PF results in itchy skin. Would not the itch be caused from released histamine?
I guess what you are saying is that the anti-histamine could control the itch from PF, but not the lesions. I hope that is true, and that would answer my question.
I'm now into two months of symptoms, and thankfully not getting worse, as I would except to happen with typical PF cases left untreated. Of course, there are always those untypical cases, which my horse just may well be.
Cathy Williams, I just joined over at the yahoo PF group. I think you even responded to my first post there.
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Member:
sachet
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Posted on Friday, Jan 4, 2013 - 9:47 pm:
Finally resized the photo to fit here. In its' larger size, it is very clear. These lesions on the leg are not itchy nor sore, no inflamed. They are not 'pickable' and the have pretty much remained unchanged for the last two months. The leg is cold, no swelling. This is a sound horse and in regular work.
I have a lot of photos of the body lesions as well, but to my eye, all 'bumps and nodules on the body photos look the same. You just can't see enough detail.
I think these little things on my horse's legs are kind of unique looking. I told the dermatologist that I thought the lesions on the leg looked different than those on the body, but she said they are the same. Perhaps those on the body look different due to the extra flesh there and also because maybe they have merged together to form one larger crust.
Also, my photos of the horse's body are misleading because he has some hair loss from scratching himself and also some matted fur from blanket rubs, etc. His coat was never very nice, but now it is horrible. Very dry and skin thickened.
leg
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Member:
cathy33
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Posted on Sunday, Jan 6, 2013 - 12:12 pm:
Hi, Harley had something strange looking legions on his legs about a year ago. They were small legions, non itchy but did eventually come away from the skin but not painfully. The skin was fine underneath and the hair grew back. It looked very different to his the PF bumps he had when he was diagnosed but I kind of assumed it was all related to his compromised immune status. I also recall there were black specks of ?something associated with the stuff on his legs. Anyway it all cleared up on it's own in the end!
I am not sure whether Harley's legions were similar to your horse's or not. The main difference is that your horse's are fixed legions whereas harley's came away to leave some hairloss
Hope this helps a bit,
Cathy
Cathy
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Member:
cathy33
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Posted on Sunday, Jan 6, 2013 - 12:14 pm:
Hi, Harley had something strange looking legions on his legs about a year ago. They were small legions, non itchy but did eventually come away from the skin but not painfully. The skin was fine underneath and the hair grew back. It looked very different to his the PF bumps he had when he was diagnosed but I kind of assumed it was all related to his compromised immune status. I also recall there were black specks of ?something associated with the stuff on his legs. Anyway it all cleared up on it's own in the end!
I am not sure whether Harley's legions were similar to your horse's or not. The main difference is that your horse's are fixed legions whereas harley's came away to leave some hairloss
Hope this helps a bit,
Cathy
Cathy
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Moderator:
DrO
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Posted on Monday, Jan 7, 2013 - 8:10 am:
Pruritis (itchiness) is a complicated sensation where histamine plays a role. PF is not mediated by a histamine response. I have never heard of a case of confirmed PF that was controlled by antihistamines and as to whether it might help with control of the disease I do not know. I have not seen that recommendation.
DrO
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