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By Gemma Carman BVetMedSci (Hons) BVM BVS MRCVS of Spring Paddocks Equine Vets. With thanks to Jeremy Kemp-Symonds MRCVS for selected photos.

Theskinisthe body’s largest organ and fulfilsamultitude of roles including temperaturecontrol, vitaminDsynthesis and protecting the body against challenges from the outsideworld.Theskincan only respond to injuryinacertain number ofways,somanydifferent dermatological diseases can have a similar appearance.This article will focus on sarcoids,warts and other commongrowths.

Sarcoids Asarcoid is the most common cutaneous (skin) tumour of the horse. Sarcoids can also affectdonkeys, mules and other equids such as zebra. It is thoughtthatapproximately 50%of the equine population is genetically susceptible to the disease although thereisnocolour,sex or age predilection.Thin skin is most commonly affectedbysarcoids, especially the face, girthareaand between the hindlimbs.Sarcoids can also develop atwound sites and other areas prone to injury. Although the disease itself is seldom life- threatening,somehorses aresobadly affectedthatitcannot only decrease their value but also affecttheirwelfare to suchadegreethateuthanasia is required on humane grounds. Theexactcause of sarcoids remains

disputed but it is likely to be linked with the Bovine Papilloma Virus (BPV). Flies have been implicatedasthe main carrier of this virus; not only fromhorse to horse but also fromone location on an individual to another siteonthe same horse.Onceasarcoid has developed,most persist,with the majorityworsening over time.Only a very small number will spontaneously

Mixed sarcoids

Fibroblastic sarcoid

resolve. Diagnosis of sarcoids remains

difficult because of theirmany differentformswhich can often have asimilar appearancetoother diseases.For example,somesarcoids can look like ringwormwhile certain types have the same appearanceas granulation tissue.Itiscommonfor vets to photograph sarcoids which get senttoaspecialistwhocan make atentativediagnosis by drawing on personal experienceofthe disease. Most sarcoids will require

treatmentatsomestage and there areawide varietyofoptions.Each case will requireaslightly different approach, so yourVetwill advise youonthe most appropriate line of treatmentfor your horse.

1)Topical treatments (creams) Themost commonly used cream forsarcoid treatmentisAW4- LUDES. Although an effective treatment, this option should not be

undertaken lightly as the affected siteoften becomes very soreand swollen by the cream. As the cream can only be handled and applied by your Vet, the repeatedapplications can become expensive. In certain sarcoids which areindelicate areas forexample near the eye, other treatmentchoices areavailable eg Effudix cream can be preferable to AW4-LUDES cream or BCG injections.Anemerging treatment is Acyclovir cream which can help to treatsome small sarcoids and is becoming increasingly useful afterlaser surgerytoincrease the chances of success.

Verrucous sarcoid

2) Surgical removal In order thatany sarcoid treatment is successful,every tumour cell must be destroyed or removed. It is thereforevital thatifasarcoid is to be surgically removed, thatall the tumour tissue is eliminatedwhich can be challenging as the edge between normal and abnormal tissue is oftendifficult to determine. Laser surgerycarries abetter outcomethan simply excising the tumour because the laser seals the edges of the site, making spread of the cancerous cells less likely.

3) Ligation Sometimes singular small and nodular sarcoids can be ligated with atightband.This must be done with caution as applying the band to the wrong partofthe sarcoid can worsen the condition dramatically.Some cases can be targeted using acombination of ligation and topical creams.

10 MAY2013

4)Benign neglect In certain cases,factors such as size, siteand type dictate thatasarcoid is best leftuntreated.These areusually cases wherethe rate of growth of the sarcoid is likely to be slowand it is not affecting the horse in anyway. This can also be the routetaken if any interferencewith the tumour is likely toworsen the condition.These cases requireconstantmonitoring in order thatany issues areidentified before they becomeaproblem. Aboveare the most commonly

used treatments although others areavailable butmaynot be used as frequently due to increased side effects,lower likelihood of success or cost.Any treatmentthathas not been recommendedbyaVet and is not specifically designed forthe treatmentofequine sarcoids carry arisk of exacerbating the tumour leaving them untreatable by any other method. Thereisnoway of preventing a

horse fromdeveloping sarcoids and asafeand effectivevaccine has been yettobecreated.The bestways to reducethe likelihood of sarcoids arising onahorse is to ensureitis healthyand to maintain strictfly controlduring the summermonths.

Warts Papillomatosis is the most common cause ofwartsinhorses.These nodules aretriggered by the Equine PapillomaVirus (EPV).Despite papillomatosis and sarcoids being caused by similar viruses,the two remain separatediseases with differenttime-courses,treatments and prognoses.EPV can be spread

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