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  Discussion on Hair loss from withers to hoof-its ugly!!
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Posted on Tuesday, Jun 27, 2000 - 12:49 pm:

Boy, I would really like to be able to clear this mess up!!! Let me know what you think.

My horse is a 8yr. old Dutch Warmblood. Last summer he rubbed his mane and tail completely out. The person who owned him before me said he was the most itchy horse she has every seen! He always rubbed his tail. I asked my vet to test him for allergies. They test came back showing that he has 36 out of 80 allergies they tested him for. Okay, so I am giving him allergy shots now. That has helped his itchy skin but he has developed another skin problem. Small scabby bumps appeared on his withers in Jan. follwowd by patchy hair loss. It then spread in a line down his leg to his hoof. My Vet treated it initally as a fungus infection. We got no results. Then he treated it a a bacterial infection again no results. Then he put him on antibotics-that did get resuts actually we thought we had it under controll and discontinued the treatment. In 3 weeks it had not on reapperaed but in a wider area but still in that line form his withers to his hoof. My Vet is stumped and can't find an equine dermatoligist for me. I thought someone might have dealt with this and could give me some advice. He is kept in nice conditions and groomed at least 3-4 times a week. It seems to me that it is allergy related.

It doesn't itch and doesn't seem to bother him until I start medicating with cortosone ointment, then he dances around.

It is not Rain Rot, he has never been in the conditions that could cause that. Although it does look like something dripped down his side.

It started as a small patch of dry skin, then that got scabby and then it spread down in a line.

This is what we have done to date:

ani-fungal, anti-bacterial shampoo. Bathed him in an anti fungal shampoo, as often as possible-at least once a week (no results)

Fulvicin-10 days I'm not sure the dosage, one
package daily (no results)

30 800mg Sulfamethoxazole and Trimethoprim Tablets, USP-douible strength, daily for 4 weeks
and cortisone cream. The combination of this improved the areas.

Discontinued the antibiotics for 3 weeks- the areas look worse that before although there are very few scabby areas. It looks like skin very little
hair growth.

Currently repeating 30 800mg Sulfamethoxazole and Trimethoprim Tablets, USP-double strength, daily and cortisone cream. Areas don’t seem
to be as responsive as the first time.
The width of the areas have increased in 3 weeks. I don't know if this will be permanent hair loss or not. I really hope not!

I have photos of the progression that I would be happy to email. I tried to figure out the HTML thing but it would be easier for me to email to anyone who is interested. HELP!!

Posted on Wednesday, Jun 28, 2000 - 7:50 am:

I think your mistake might be assuming it takes special conditions for rain rot to develop. The diagnosis explains a lot of your post. Start with the article on Equine Diseases: Skin Diseases: Overview of Hair Loss & Irritated Skin and see if it leads youto a sensible diagnosis.
DrO

Posted on Wednesday, Jun 28, 2000 - 6:27 pm:

I read the articles you suggested. I also sent you photos of the problem areas. Initally my Vet thought it was ringworm although he had never seen it grow in a linear pattern. He treated him with Fulvacin - as recommended in the article. We had no response to it. After reading the articles it sounds like it could be a combination of ringworm and Onchorerca. Could that be a possibility? The reasoning for that is because he has tested positive with allergies to several varities of flys. He skin has become depigmented (as seen in photos). The article about Onchorerca mentioned worming with Ivermectin. Now that I think about it I wormed him several days before I called my Vet again and it did get more irritated. It is calming down now. He has been on the antibotics for 8 days plus, he has recently been wormed. Am I on to something with this? Have you ever treated this condition and can I expect the hair t grow back? Thank you so much for your help.

Posted on Thursday, Jun 29, 2000 - 8:54 am:

Hello Adonna,
No, I believe you have rain rot. It is called this not so much because it happens in the rain but because the appearence has the look of a track of water. Reread the articles concentrating on the one on dermatophillus.
DrO

Posted on Thursday, Jun 29, 2000 - 9:39 am:

Hi Adonna, I'll try to remember to check in my vet handbook tonight for you but I'm sure I remember something called linear keratitis which looks like someone dripped white paint down the horse's shoulder in the photo. I'm sorry that my memory can't manage anything else at the moment, so I can't say what causes it but I'll try to remedy that when I get home this evening.

Posted on Thursday, Jun 29, 2000 - 10:51 am:

Hi DrO,
I read the article on rainrot. The skin has always been dry and flakey since this started. The photos that I sent may have looked like it was moist but that was the ointment that I applied. The hair didn't come out in scabby clumps. We have tried the treatment suggested. The chlorhexidine shampoo at least 3 times a week - less when we started (Feb/March) because of the cold weather. Also, chlorhexidine spray daily. There was no improvement. The only thing that has helped has been the antiboitics or the combination of both. I am stll bathing him 2 times a week with the shampoo. It seems to be improving daily but like I said we tried this before and wen we thought we had it under control we stopped the antibotics and it returned worse that it was before. It looked different the second time in that the skin was peeling rather than scabby. Also, the skin is black and depigmented. If this is rain rot it must be in a very advanced stage.
I would like to include the photos for everyone but I can't figure out the HTML thing. I will email them if you are interested.

Posted on Thursday, Jun 29, 2000 - 5:10 pm:

If you are sure you are not losing the hair on the margins of the affected areas embedded in small scabs then you are probably right. However I think I can see such scabs in the close up photo you sent and certainly those open lesions are moist. The history, clinical description you give, and photos, though not perfect are all very consistant with dermatophillus possibly with a secondary staph of the ope wounds.

If you are seeing resolution great but if you hit the wall again I strongly recommend you clean all the medication off of the skin and stop all medication and treatment for 72 hours, then come in and culture and biopsy a fresh lesion at the margin, including some healthy tissue. I would love to hear what is found.

Helen, the disease is linear hyperKERATOSIS and is not a erosive disease as seen in the photos. It does cause hairloss with ridges of raised hyperkeratotic (thickened skin) areas. It is a rare disease typically seen in QH's 1 to 5 years of age and thought to be genetic. The pattern is somewhat similar to Adonna's pictures.
DrO

Posted on Thursday, Jun 29, 2000 - 5:43 pm:

DrO,
At present there are no scabs or peeling skin. I will pass along your information. My Vet wants to do a biopsy next week. I will keep you updated. Thank you for your input.

Posted on Sunday, Aug 13, 2000 - 12:12 am:

DrO, Is there a preventive to rain rot? And how come rain rot was never heard of many years ago (like 15 years or more)

Posted on Sunday, Aug 13, 2000 - 9:54 am:

Good management, fly control, and early aggressive treatment are the best prevenitives I know.

The earliest description I can find is in a 1800's agriculture book on horse care. I know it was routinely written about in the modern literature in the 50s and 60's where it was described as a fungus, though now it is classed as a bacteria.
DrO

Posted on Tuesday, Aug 15, 2000 - 1:08 pm:

I would like to know if one can put fly spray on a colt that is being treated for rain rot at the same time? We put bedine on the colts so dont know if that will affect what we are trying to do while doing this treatment.I am talking about the ones that we have in the barn.

Posted on Wednesday, Aug 16, 2000 - 6:46 am:

Just don't put it on open sores.
DrO

Posted on Wednesday, Nov 22, 2000 - 11:17 am:

Hello Dr.O,
I have gone full circle with this skin problem. My vet saw no reason to do a biopsy. He said there wasn't enough to biopsy. I have been scubbing it once a week with 4% Chlorahexiderm shampoo. It looks better for a day or two but then the scabs grow back. It is very dry and scabby. When I scrub the scabs off there is moisture but no oozing. The scabs are still isolated to the original area. I am desperate at this point. He has had this since Jan. Do you have any suggestions for the next step?

Posted on Thursday, Nov 23, 2000 - 8:53 am:

Hello Adonna,
I am not sure what you mean by gone full circle. Above you indicate that you had got past the scabbing problems. I have long thought you had two different problems: the chronic itchy, scabby problem along the dorsal midline due to allergies, probably due to midge bites and then the acute dermatophillus that was evident in the photos. Which problem are you still having?
DrO

Posted on Friday, Nov 24, 2000 - 4:19 pm:

Hi Dr.O
You are right there were two problems. I have him on allergy shots and I kept him in at night through the summer. That was successful for the itchy skin problem.

I am still having problems with the acute dermatophillus. What I mean by going full circle is that it has been through several stages from a small crusty line of scabs to a wide band of hair loss skin depigmentation and no scabs back to a slightly wider line of thick crusty scabs resembling the original problem. His coat has grown back but when I wash the scabs off the hair comes out. The scabs do look like the photos in your Rain Rot article. Is there a more aggressive treatment I can try?

Posted on Monday, Dec 4, 2000 - 10:24 am:

Let's see, first before everyone goes out for the expensive allergy shots: currently there are no commercially available products that have shown any efficacy. I suspect managing exposure was the trick.

It is important to remove the scabs and the chlorhexidine treatment has never failed us in treating dermatophillus. Lack of response after a dedicated treatment period suggest you should review the diagnosis. I do not know of anything stronger.
DrO

Posted on Thursday, Dec 7, 2000 - 9:03 am:

DrO,I agree about the allergy shots. I was very diligent about keeping Eddie in at night and bathing him at least once a week. My vet gave me a good deal on the shots because he wanted to see how it would work. One or both has really helped the itchy skin problem.

Do you have any suggestions for a next step for the dermatophillus problem? Is there anything else it could be?

Posted on Friday, Dec 8, 2000 - 6:52 am:

It certainly could be something else. It is the limitation to this type exchange: I cannot see the lesions and even if I could it may require further testing.

Start with the skin articles with the most general descriptions that apply and work your way down through the specific diseases. After understanding them you can have your vet out to exam the horse and you should be able to ask approriate questions and help him with the diagnosis. He may feel different abiout the biopsy after a month of response to treatment.
DrO

Posted on Saturday, Dec 9, 2000 - 4:12 am:

Adonna and DrO,
First, please let me say one thing. This discussion is way over my head. But one time something happened to me that I will never forget. I won't get into the story, but wouldn't a second opinion from a different vet in her area be a reasonable action? Sometimes a second opinion from a fresh mind can be priceless.

Good luck Adonna, Kristi and I would have lost a horse if we had not gotten a second opinion. We feel for you, knowing what its like being at your wits end.

Jim

P.S. If you would please e-mail us your pics. Our address is in our profile.

Posted on Saturday, Dec 9, 2000 - 8:18 am:

Hello All,
So that everyone can see what is being talked about here are the pictures sent by Adonna. However these are from last June (6 months ago)
Adonna's Skin Problem
DrO

Posted on Saturday, Dec 9, 2000 - 8:24 am:

Adonnis skin disease

Posted on Saturday, Dec 9, 2000 - 8:21 am:

Adonnis skin disease

The upper pictures look like a pretty clasic example of bacterial skin disease, most likely dermatophillus. The lower problem looks a lot more like staph unless the lesions were created by hair embedded scabs as are in evidence in the upper photo.
DrO

Posted on Thursday, Dec 28, 2000 - 5:28 pm:

Dr.O,
My vet took a biopsy of the problem areas. I have the results but as far as I can tell there is still no diagnosis. I would like to get your opnion.

Specimen:1 Marked multifocal and extensive epidermal nerosis with superficial pustule formation and subacute interface dermatitis; dermis and elbow, equine

Interpretive Comments: Three separate sections of dermis were evaluated in total with serial sections. Several sections demonstrate a prominent inflammatory reaction accompanies bymutlifocal areas of epidermal necrosis. The midly hyperplastic epidermis exhibits multifocal areas of apoptosis and keratinocyte necrosis promarily within theintermediated and granular layers. Areas of nercrosis are infltrated by numerous clustrs of mildly degenerative neutrophils mixed with eosinophillc serocelluar matrix. At several sites the epidermal necrosis extends into bacillar layers and inflammatory cells also encompass a few hair folicles. The overlying stratum cornum is stil intact with foci of keratinacyte necrosis also accompanied by civatte body formation. No infectius agents are identified. The described alteriations are consistant with probable nevrotizing dermatitis with secondary pustule and crust formation. The leasions can be seen secondary to drug reactions and also with hepatocutaneous synDrOme. Erythems multiforme also frequently presrnts with areas of single cell apoptosis and eventual crust accumulations. All of these synDrOmes have a similar etiopathpgenesis in common characterized by initial epithelial cell necrosis with more diffuse necrotizing dermatitis and eventual pustule formation. The possibility of an immune component s considered, however, elimination of a drug hypersensitivity and hepatocutaneous synDrOme is strongly suggested. Submission of serum for a complete chemistry panel and bile acid determinations is suggested along with detailed evaluation of the clinical history (start at begining of this page) for possible exposure to an underlying antibiotic or potential hepatotoxin inducing necrotizing dermatitis.

Specimen 2: The clinical description suspected possible linear keratosis, however, the severity of the inflammatory lesions along pustule formation are not common with this synDrOme and extensive hyperkeratosis is not a prominent feature.

I'm sure this makes more sense to than it does to me. Can this be put into common terms?

Posted on Friday, Dec 29, 2000 - 6:51 am:

Hello Adonna,
Yes I think I can, this is a very informatinve response as it strongly suggests that infection is not the primary problem, at least not any more. They are saying that the primary event is death of the cells of the epidermis and that this is followed with a secondary skin inflammation.

The cause of the cell death is not apparent on th biopsy but suggest the following causes as most likely for the skin death:
1) drug reaction
2) skin disease secondary to liver disease
3) autoimmune disorders
I would add to the list local exposure to something caustic may have had such as affect.

You need to check the possiblity of liver dysfunction as they recommend, review what may have been put on the horse or fed to the horse that may have resulted in a reaction, and if all this turns negative discuss with your vet the possiblity of using steroidal cremes on the affected areas for the autoimmune components. The problem is very superficial so I think local treatment may be enough. If not oral dex or prednisolone may be indicated. Keep us informed this is a great case for us though I know a bugger for you.
DrO

Posted on Friday, Dec 29, 2000 - 2:42 pm:

This was a test

Posted on Friday, Dec 29, 2000 - 3:06 pm:

Dr.O,
I will have my vet do a blood test for liver disease. He also recommended the treatment that you suggested. The only thing he was fed prior to the outbreak was a complete feed, grass hay and pasture grass. His did test positive for several ingredients in the feed as well as several grasses.I don't have the results with me but I will provide them for you if you are interested. You have the information of everything he has been given since Feb. Do you think consulting with an equine dermatologist - after the blood test- would be of benefit? I took more photos today to show everyone how it has progressed. I've had to keep a blanket on him due to the sub 0 temp. in this area so the dead skin has been rubbed off.

The images are posted below. It took several tries to figure it out!

Thank you for your advice.
Adonna

Posted on Friday, Dec 29, 2000 - 3:23 pm:

side

Posted on Friday, Dec 29, 2000 - 3:28 pm:

fullview

witherside

pastern

Posted on Friday, Dec 29, 2000 - 7:01 pm:

Dr. O. Do horses get anything like shingles?

Posted on Sunday, Dec 31, 2000 - 10:53 am:

Adonna, I think that would be excellent idea. He may only need the history (medical records if good), pictures, and biopsy result, let us know what he says. Considering belows conversation you may want a human dermatologist to review also.

Elizabeth, for those who don't know Shingles is the common term for a chronic infection of humans that is caused by a particular herpesvirus, varicella-zoster virus. It is characterized by an eruption of groups of vesicles on one side of the body following the course of a nerve due to inflammation of ganglia and dorsal nerve roots resulting from activation of the virus which in many instances has remained latent for years; the condition is self-limited but may be accompanied by or followed by severe postherpetic pain.

It sure looks like it. doesn't it Elizabeth but I find have no report of such in horses and I believe (though not sure) herpes infected cells would show in the biopsy. Adonna, this is an interesting possibility, as to a as yet unknown disease is the horse. I do not think the biopsy results rule this possibility out and it could account for the distribution. I tried to find more on the histopath and turned up these:

Herpes incognito

Resnik KS, DiLeonardo M
Institute for Dermatopathology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

Can a microscopist suspect that telltale histopathologic changes of infection by herpesvirus (varicella, zoster, or simplex) are nearby even when no diagnostic epithelial changes are present in the sections being studied? Punch-biopsy specimens from three patients are presented; in two of those cases herpesvirus infection was not even a clinical consideration. The initial histopathologic sections from these patients did not show changes of herpesvirus infection, but step sections revealed focal diagnostic changes. Atypical lymphocytes were present in each of these cases. When atypical lymphocytes are found in concert with a pattern of an inflammatory-cell infiltrate that does not conform precisely to any well-defined entity, a microscopist should consider that the findings may represent changes near infection by herpesvirus. In addition, we reviewed every case we diagnosed as herpesvirus infection over an 18-month period and found that in just over two thirds of those specimens (32 out of 45 cases), atypical lymphocytes accompanied the characteristic epithelial changes induced by herpesvirus.

Scanning and transmission electron microscopic studies of lesional epidermis in herpes zoster.

J Dermatol 1994 Aug;21(8):560-70
Tanaka K, Tsuda S, Sasai Y
Department of Dermatology, Kurume University School of Medicine, Japan.

The epidermal skin lesions of herpes zoster were studied by scanning (SEM) and transmission electron microscopy (TEM). When erythematous lesions were observed by TEM, many of the infected keratinocytes showed evidence of cell degeneration, being characterized by swollen nuclei, disappearance of desmosomes, and widening of intercellular spaces. Macrophages and/or lymphocytes migrated through the intercellular spaces between degenerated keratinocytes. In the vesicular lesions, SEM and TEM showed some infiltrating neutrophils, directly adhering to the virus-infected keratinocytes, with swollen nuclei and irregularly clumped chromatin. In some specimens, balloon-degenerated keratinocytes were observed in the cavity. In the pustular stage, ruptured keratinocytes and numerous neutrophils were observed in the reticular-degenerated epidermal tissue. These results suggest that, in herpes zoster, the epidermal damage may be due, at least in part, to cell-mediated host immunity as well as to the cytopathic effect of varicella-zoster virus.

Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency synDrOme (AIDS). Histologic and molecular biologic findings.

Am J Dermatopathol 1992 Feb;14(1):1-7

LeBoit PE, Limova M, Yen TS, Palefsky JM, White CR Jr, Berger TG
Department of Pathology, School of Medicine, University of California, San Francisco 94143-0506.

Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental.

Keep us informed!
DrO

Posted on Tuesday, Jan 2, 2001 - 11:40 am:

To me it looks like something caustic is/has been dripping on the horse and running down his shoulder, finally dripping onto his lower cannon bone. Just an observation. I hope you figure out the cause!

Posted on Tuesday, Mar 20, 2001 - 12:48 pm:

Hi Dr.O,
I consulted with a veterinarian who is a friend of a friend. I sent him the information that is on this posting. The following is the results he recieved....

I finally heard back from the NCSU Vet school about the photos and
information. Seems the information went to every department in the school.
After the usual disclaimers about making a diagnosis from photographs,
the dermatologists determined that the lesions would be most consistent with
what is know as Linear Keratosis. This is a condition that has no known
underlying etiology and is usually self limiting as seems to be the case
here. Apparently it is more common in quarter horses but it is an uncommon
disorder in any case. From what I could discern, it results from a primary
focal keratinization disorder ( a focal area in the skin that does not
produce and rid itself of the superficial layers of the skin, thus resulting
in the crustiness you are seeing). The dermatologists suggest using a
keratolytic shampoo (to help lift the flaking). Several examples of this
would be Sebolux, T-lux, or even Selsun Blue. Your veterinarian can assist
you with a product. Of course it behooves you to make sure you control any
secondary infection if it should occur but apparently that is not a common
sequellae. More information may (or may not) be found in Scott's Large Animal
Dermatology textbook as I was told there is an article on it in this book.
Without having seen this case in person, I would think this is the
diagnosis as (in hindsight) it fits the clinical presentation nearly
perfectly and mirrors other cases I have researched (including cases in which
they treated in the same manner you did and got the same results)
Best of luck and I hope this helps put your mind at ease. –H

Thank You so much for you help. My Vet had made the same diagnosis (He did read
Scott's Large Animal Dermatology book) before we did the biopsy but felt like
there was more to it than that. Sorry, I don't know all the Vet terms he threw
out. As long as I keep the panalog ointment on it there is no flaking. I had been using
a shampoo that would lift the flaking but they came back within a day. Am I
understanding that as far as they can tell there is nothing I can do and that it
should go away itself? This is nasty stuff he has had it 14 months now.–A

You're partially correct in that there is little that you can do. Using
seborrheic medications is the preferred method of control but even with that
it may not completely resolve as the problem is a primary keratinazation
defect, or defect in the skin "metabolism/function". In respect to other
underlying problems, the dermatologists feel that any abnormality in the
liver tests previously run have no bearing on the skin problem.
In a "by the way" comment, dogs with conditions similar to this have been
occasionally treated with some effectiveness with retinoids or Vit A. I don't
know if there is any information on this in large animals but it may be worth
looking into if the lesions persist or worsen.–H

Posted on Thursday, Mar 22, 2001 - 7:01 am:

Hello Adonna,
Nobody likes being the interesting case. When you stand back and look at the whole picture, trying to find a cause really only two things give that pattern:
1) Some infection or caustic agent has "run down" the leg.
2) Some forms of linear hyperkeratosis seems to follow what we call "dermatomes".
The biopsy suggest both are present. Is it possible that in an attempt to treat "linear hyperkeratosis" that the skin reacted to one of the treatments? This might happen with nitrofurazone, iodine, betadine, chlorhexidine, any antibiotic, and thousands of other topicals.

Vitamin A, Vitamin E, topical corticosteroids, and protection from the sun, all seem rational treatment. Addona, I would not expect to be ble to treat the noninflammed hairless areas, instead look to treating the inflammed (reddened, hot, errosive) areas like in the first picture. With the thought that infection is not clearly the problem and the approval of your vet I would use antiinflammaatory and pro-metabolite creams I mention at the top.
DrO

Posted on Thursday, Mar 29, 2001 - 4:58 pm:

test

Posted on Thursday, Mar 29, 2001 - 5:21 pm:

Dr.O,
Trust me I don't enjoy being the interesting case but I thought you would find the following especially interesting. The only treatment I have done since 12-28-00 is application of Panalog Ointment every 2-3 days. There are no scabs and the hair is groing back slooooooowly. There is a circular area the appeared last week. It started as about a 4" swollen area and has localized as a hard crust circle about 1". Who knows what will develop next. Just for everyones curiosity, I have done several experiments with water to see what path it would take on his side. I have never had it come close to this path especially since it wraps around the back of his leg then back to the front.
side
curious circle this area is lower on the wither/side area
closeup
Close up, higher on wither area, this area can be seen at the upper prtion of previous image
pastern

Posted on Friday, Mar 30, 2001 - 6:53 am:

Wow, great job with the photos and it looks like real progress! Panalog has one of the most potent steroids (triamcinolone) available, but is an expensive formulation. With such good luck I am reluctant to recommend changing but you might consider some generic steroidal creme particularly in you can find one with the same steroid at the same concentration. If it does not do the job you could always switch back.
DrO

Posted on Friday, Mar 30, 2001 - 11:34 pm:

Adonna: Double wow! Just wanted to let you know that others have been following this faithfully. It's been a great learning experience and your case history is so wonderfully thorough. Thank you for taking the time.

Posted on Monday, Nov 5, 2001 - 3:58 pm:

Dear DrO and Friends,

May through June Eddie’s condition was looking slightly better but it never completely healed and his coat was growing in very sparsely. I had tried everything possible traditionally and consulted with enough Veterinarians who felt this condition is Linear Keratosis and could be kept under control but never cured. The suggestions for treatment were unsuccessful.

I have researched keratisition and most articles mention an immune system disorder associated with hypersesitivity. Eddie’s condition began as chronic itch which could have started out as a reaction to insect bites. After the original irritant was gone the damaged skin became infected with parasitic agents that could have been both fungal and bacterial which perpetuated the problem. He was treated with antibiotics which could have stressed the immune system.

The condition developed into a skin condition which is one of the natural reactions of the body’s immune system to deal with all the toxins in the blood left behind due to constant reactivity changes.

Because of his hypersensitivity he had a allergy test and tested positive to several allergens. Allergy desensitization injections were prescribed which could have further stressed the immune system or it could have been a reaction to the antibiotics.

The skin condition did not improve and he was treated with more antibiotics which could have stressed the immune system further.

I discontinued all medication in January except the topical use of A& d ointment. In June since the A&D ointment was only keeping the problem at bay I tried Tea Tree oil ( a natural antiseptic used to treat minor cuts, fungus, etc. ) applied topically once a day. Without it being diluted it was to harsh and only made the condition worse so I went back to the A&D ointment.

In July I decided to boost his immune system by using vitamin supplements. The information l I read said the problem could be caused by vitamin difficencies primarily A,E,D &C. I talked to several companies and Holistic consultants (that is a story in itself...) about products and found a product I wanted to try. It has selenium and vitamin E. It is a powder that I gave daily in his feed. After only 2 weeks there was a dramatic change in the appearance and his coat had begun to grow in places where there hadn’t been hair in over 1 1/2 years. When the 5lb. container was empty I waited about three weeks to see if it was the supplement or if the condition had just run its course. It began to regress again but not to the degree seen in any of the photos. I started him back on the supplement. I have also added a Ester C and garlic mixture for horses-- I figure Vit. C is good for anyone and garlic will help keeps flys off of him (he does have bad breath). I have also found and ointment with A,D,E and Tea Tree oil that works well. This is the best combination that I have found. His coat has almost completely grown back in. I have seen steady improvement over the past months and I am so excited about it that I wanted to share this with everyone who has been following this post.

compairison

wither close up

pastern comp

elbow compairison

Adonna

Posted on Monday, Nov 5, 2001 - 4:30 pm:

Wow Adonna, just followed these posts out of curiousity and also because of your photo documentations. Beautiful job! Curious what the supplement is that you found per your post:

"about products and found a product I wanted to try. It has selenium and vitamin E. "

I'd love to know!

Excellent photos and documentation, what a long haul! Dawn:)

Posted on Monday, Nov 5, 2001 - 9:57 pm:

"The condition developed into a skin condition which is one of the natural reactions of the body’s immune system to deal with all the toxins in the blood left behind due to constant reactivity changes. "

Adonna I had to ask more about this statement. I had personally gone through an episode such as this where no one could find the exact cause of my little skin ailment. It comes and goes. As does the stress of life. I find that if I allow things to stress out, it comes back. I wonder if the elements of stress in your horse were all worked out during all of this?

My other question is what is the "whole other story about holistic" medicines. I tried an acupuncturist for my little dilemma, too. Had you done so for your horse?

I am not trying to parallel human and horse endocrine (?) type disorders but was wondering about this, maybe you can shed some light on my arm....

jo

ps. congratulations on your success. Hard work I see from above.

Posted on Tuesday, Nov 6, 2001 - 6:41 am:

That is tremendous Adonna.
Along with the ingredients the concentration and dosage of the vitamin E / selenium supplement would be useful.

As I reread your history I do have two questions that did not occur to me before:
1) where did you give the allergy shots?
2) early in the course did you use any topical treatments not mentioned above?

I went and checked your address against the map in the article Care: Nutrition: Selenium and found it interesting to note that you live in a very deficient area. However this alone is not typical for selenium deficiency. If we assume that this supplement is the cause of the improvement, how can we put this all together?

I find your pathogenesis above interesting but unsatisfying in that it does not account for the very focal nature of your problem. Now my story is also conjectural, but I would like to account for the pattern. Vitamin E and selenium are important antioxidants, they remove caustic substances (free radicals) from our cells and tissues. I purpose that there is/was an insult of some type to this area.

I do not know what type but the pattern suggests some topical caustic substance, though immune hypersensitivity can unexplainably cause such a pattern, as can some genetic-associated diseases. I could also conjecture a infection that was cured but left behind damage that self-perpetuated due to either autoimmune reactions or toxins. I could get really wild, what if this is a induced genetic defect that occured in the cell line that formed this dermatome in the embryo that resulted in a increased need for vitamin E. Owwww,Somebody stop me...

Whatever the cause, the skin could just not get past the insult/defect and the inflammation became self-perpetuating. This is where the vitamin E / Se stepped in. It was able to cool down the inflammation and stabilize the cells, through it's antioxidant properties, so that the disease process could turn the corner.

We must be very careful. Your wonderful persistence Adonna creates a problem: what if this process was always self-limiting and it was going to get better eventually no matter what. If this were true would not the last thing used before improvement appear to be the magic cure? Or what if earlier treatments set in motion the ability to heal and it just took some time. It appears from a careful review of the photos that much healing began in early 2001. Don't get me wrong, I think the history and temporal relationships you give are a powerful argument supporting the idea that this was the cure, particularly when you stopped and the problem began to worsen. Hopefully we will not get further problems to experimetn with.

This certainly has been one of the most interesting cases we have had this year, please continue to keep us updated.
DrO

Posted on Tuesday, Nov 6, 2001 - 11:54 am:

Adonna: So many thanks for your wonderful case history. It was so neat to come here and find your update.

Dr. O, Are you saying that there was a bit of "The treatment being worse than the cure?" involved here? Years ago I had an Anglo-Arab that I was POSITIVE had ringworm. In my treatment zeal, I caused a huge area of dermatitis and a major mess. The vets couldn't properly diagnose from my "muddying of the water". When I finally left it alone, it began to heal - back to the original spot. Which, after a biopsy, turned out to be an old, round scar.

Posted on Tuesday, Nov 6, 2001 - 12:31 pm:

Adonna,
Please let us know what ointment it is that you use that has the A,D, E and tea tree oil in it.
Thanks! What an amazing story.

Denise

Posted on Tuesday, Nov 6, 2001 - 4:20 pm:

DrO,

You crack me up! I appreciate the conjucture. My vet. had the same question about the linear pattern. I will gather my information for everyone. Can I mention product names and manufacturers?

Adonna

Posted on Tuesday, Nov 6, 2001 - 10:01 pm:

Adonna , you mentioned that you feed garlic - I thought I read in a local article (but can't find it) that garlic is now a no-no to feed horses? Maybe Dr. O can clear this up - thanks

Posted on Wednesday, Nov 7, 2001 - 6:17 am:

Let's see where to start,
Elizabeth, I think it is possible and sometimes this occurs with approved medications and unusual of allergic reactions. I also wonder if some of the allergin in the allergy shots got into an artery and deposited in the skin distal to the injection resulting in a chronic inflammation. The pattern is not quite right for this (I would have expected branching) but possible.

Janet, yes garlic has this potential but due to a missprint in a recent article in a popular magazine (they have corrected it in the following issue) the risk is greatly over blown. We had a discussion about this last month lets form more information see, Equine Diseases: Cardiovascular, Blood, and Immune System: Forums: Garlic supplements toxic to horses?.

Adonna, absolutely.
DrO

Posted on Wednesday, Nov 7, 2001 - 8:03 am:

JoJo,

My dermatologist has started prescribing a new ointment which is made from the medication given to transplant patients so they don't reject their new organs. It is in the process of getting approved to be used for dermatology but they can still prescribe it just insurance won't cover. This stuff (Tacrolimus .1%)is a miracle! Before I was ready to amputate my hand due to the discomfort(itchy-allergic red pussy bumps and swollen tissue to the point that I couldn't bend my fingers well and the skin would split)I had tried everything else for years but all would mostly just manage it some of the time.

Sorry Dr. O for posting this here, but JoJo didn't have an e-mail for me to write directly.Although it maybe relevant since this drug is used to keep the immune system from attacking it's own body. My dermatologist also stated that people with this condition have the same DNA structure as people with allergies, but pinpoint and allergy that causes this reaction is difficult. Also interesting is this didn't state for me until after the birth of my first child.Kim

Posted on Friday, Nov 9, 2001 - 5:22 pm:

DrO,

In response to your questions:

1) The allergy shots were given about mid neck in the skin and on alternating sides.
2) There were no other topical treatments other than those mentioned above.

I don’t know if the problem was self limiting but I do know that it was just holding its own as long as I used the A&D ointment every other day. If it went more than 2 days without the ointment it would regress to being dry and scabby and the hair would begin to come out. The Tea Tree oil, as seen in the 6-01 photos caused complete hair loss and skin peeling ( similar to sun burned skin, but I realize it was to harsh) in the areas.

When I began feeding him Imupro with selenium (Pro-Formula Labs purchased from Horse Health USA). there was rapid improvement and hair growth. After dealing with this problem for well over a year I don’t believe it would have gotten better on its own. Topically I am using Animal Legens Tea Tree ADE ointment purchased from State Line Tack and I only apply it once a week. In between applications there is no drying or scabs. I can hardly see the area that needs application now. If I had not been looking at it every day it would be difficult to find the areas.

Other observations if he was turned out the sun aggravated the area (maybe due to lack of hair). Flys also aggravated the area. He was kept in most of the summer. I changed locations and feed in May from a complete feed (Purina Omelean 100) to whole oats topped with Grow N’ Win. The allergy test showed he was allergic to many of the ingredients in the complete feed.

This is the list of allergens that tested positive:
Grasses: Fescue, Timothy, Johnson
Weeds: Pigweed, Mach Elder, Kochia Firebush, English Plantain
Trees: Cottonwood, Box Elder Maple, Elm, Walnut, Hazelnut
Fungi (these are very difficult to read please excuse the typos): Cu---leria, Hormodendrum, Helminthosporium, Stemphyllum, Cnadida Albicans, Rhizopurs, Chaetomium, Rhodo--ruta, Fusarium, Pullulania, Penicillium
Barn dust
Foods: Corn, Cottonseed, Sorghum, Oats, Pasture mix, Wheat
Indoor: Pine shavings, Cotton
Insects: Mosquito, Deer fly, Horse fly
Grains: Corn pollen, Oat pollen, Wheat pollen, Barley pollen

I found this site to be very informative particularly the artical on Vitamin E and Horses and Selenium, and Normal, Deficiency and Toxicity in Horses. I also found an artical by Robert McDowell published in Horse talk Magazine (www.horsetalk.co.nz/health/herbs-detox.shtml) that I found very interesting and started my research in Homeopathic treatment. Homeopathy and Holistic Health Care can get WAYYYYYY out there but a lot of the treatments make good sense.

I have Eddie’s complete history from the time he was imported including medical records from his previous owner. The pervious owner had been treating Eddie with a variety of medications for what she thought was a stifle problem but after several tests and xrays it was decided he has Central Nervous System damage. She feels very strongly that this is what could have started this problem. CNS damaged could have been caused by an injury that occurred before she purchased him and did not present itself until she had been working him on a daily basis. While she owned him he did not have a skin problem or any evident linear line. She suggested that the CNS damage could have manifested in that area. How is that for conjecture? That explanation is beyond me, but maybe the problem is much deeper than what it appears to be. As far as his movement or any abnormalities, I haven’t noticed anything out of the ordinary since I have owned him. I wouldn’t even say he had a stifle problem. But, I use him lightly.

I hope everyone finds this information helpful. I will keep you up dated if there are any changes in his condition.

Posted on Friday, Nov 9, 2001 - 9:55 pm:

Much appreciated Adonna. Be looking forward to updates.

Posted on Monday, Nov 12, 2001 - 8:28 am:

Hello All,
Concerning the allergin test, whether done by blood or intraderaml testing, these have not been shown to be of benefit in indentifying allergins in horses and high in both false positives and false negatives. On the other the location of the allergy injections seems to let it out as a direct cause of the skin disease.

I feel the need to say there is nothing homeopathic about these treatments. All of the treatments that are associated with improvement have well understood mechanisms (primarily antimicrobial and/or antiinflammatory) of action. I think this is important to understand as homeopathy has a very, very improbable methodology.

"Holistic" always requires definition as it has two different meaning in medicine according to my dictionary. To the degree that it means treating the whole body and not just individual parts holism is a great philosophy. To the degree that it means treatments, out of the mainstream, with little or no proof of efficacy or at least a good known mechanism of action, I have problems with it. I prefer the term alternative medicine for this second definition. However, there is no evidence of this type treatment in the treatment regimen, though some have questioned the antimicrobial claim of tea oil (Tea tree oil: the science behind the antimicrobial hype.
Lancet. 2001 Oct 13;358(9289):1245).

The actual reason, or combination of reasons, for the improvement contines to grow more difficult to assess as you add important facts like moving the horse and protection from sunlight and insects.
DrO
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