Scratches
“Scratches” are a term used in equine medicine to describe a common Dermatitis and its location. “Derm” meaning skin,”itis” meaning inflammation of. Scratches therefore is a local dermatitis of the pastern region usually located on the “back” of the pastern. Of course everybody will want to know what causes scratches, the treatment, and how to prevent it. I will get to these questions later but first let me go on and say this particular practice tip will be talking about the severe case of scratches to which has blown up the leg severely. The leg is hot, swollen, “thick and doughy”, painful to touch, the pastern area is really red, inflamed, crusty, oozing serum, and possibly smells bad, too. The horse involved may have had this problem before and is therefore a reoccurring problem or “chronic.”
These particular cases of scratches are similar to the classic dog dermatitis problem or “hot spots.” Many of the dogs get these so called hot spots frequently and it becomes a nagging problem. Therefore, I attack these cases a little differently and more aggressively than other cases of scratches.
Commonly you are told to wash the area with some medicated soap and water and clean it by scrubbing daily, spray some antiseptic liquid or rub some cream on it and it will get better. Sound familiar? In my experience, this treatment avenue will only make matters worse by irritating the skin even more. The skin will ooze more serum and serum will scald the pastern area (causing a bigger problem).
Let me say now that nothing in equine vet medicine is really black and white, or easy. No two cases of anything are the same, no two laminitis cases are the same, or colics, lameness etc.
But I really do start off treating these difficult cases of scratches very similarly. I believe there is an autoimmune / allergic aspect to this kind of case. Not only is there a local infection but the horse also is having an allergic reaction to the infected area. The leg will severely swell or blow up and cause a secondary diagnosis of allergic infectious or non- infectious lymphangitis. I start off by taking blood for a “blood panel”. I want to know if there is a systemic or total body problem. If the white cell count is normal and the fibrinogen is low, I do not use antibiotics at this time. I give the horse pain killers to relieve pain and sedate the horse. This makes it easier to handle the horse because, in these cases, the leg is very swollen and painful, and the horse will not let you touch the leg, let alone touch the pastern area. (Note: I use “D.A.R.T.”, an acronym for Domosedan, Ace, Rompun, and Torbugesic mix 10cc of each into a 50 ml bottle, give 1 ½ cc IV, this sedation combo has been fabulous in my practice. Nobody kicks ever!) I do not wash the infected area. I use a special formula of “scratches cream” called J.A.G. BP which will soon be available through Farmvet. I formulated it myself - it has three different base creams to soften the area. One is an anti-fungal, another is an antibacterial, and a steroid to help quiet and sooth the inflamed area down. After sedating the horse I give a combination of Bute, Banamine, Ketophen. (The 3 together work better than one shot alone.) I also give a diuretic to help liberate the fluid retention and reduce swelling. The key here is to give 20mg of Vetalog and 400mg methylprednisolone or depo-medrol. I’m without these two steroids you will not get “a hold” of this case and “buck” the allergic aspect to this kind of scratches. I apply the JAG BP cream liberally to the un-cleaned, infected pastern area, surround the whole foot, pastern and fetlock and up to the midcannon region with plastic saran® wrap along with cotton wrapping material, either sheet cotton or, what I use is the padded cast rolls of synthetic cotton around the foot, pastern, and fetlock. Then cover this with co-flex or vetrap / elasticon and then duct tape. Then apply a standard support leg-wrap bandage to the leg. This bandage may look like over kill but I assure you it is not! Apply the bandage with pressure to help reduce the swelling. The horse needs exercise daily. Up to 1 hour a day, maybe even more. Keep on 4 grams of Bute daily for a couple of days, and don’t remove the bandage for 2 to 3 days, Now, if the bloodwork I took and sent off “STAT” comes back with the signs of infection, then I add the appropriate antibiotics. Note: part of the treatment and prevention of these chronic cases is to use of any one of the 3 kinds of immune-stimulation drugs on the market. These are Equistem, Equi-immune, or Zylexis. This will bolster the horses immunity and help heal the scratches.
When you remove the bandages in 2 to 3 days you won’t believe the results, it is fantastic! Then re-evaluate the area and decide to leave open and dry out for 4 days to one week. (Either spray Blue-Kote on in or the yellow dry furax spray for 5 days longer. The causes? If you have an imagination you can think of many reasons. Anything that breaks down the normal skin barrier in the region is the culprit! Mud, sand, too much soap, water, and scrubbing, bell boots, overzealous clipping that causes micro cuts, and horses put away wet are a few. You can name a hundred causes as to why the area gets irritated - getting wet, urine spray then dirt, shavings contaminating the area. Serum oozes out, bacteria, fungi grow = immune reaction and infection.
Prevention is aimed at any measure to prevent disrupting the normal skin in that area.
Since I mentioned immune building, like Equistem, etc. giving a course of these products over several weeks can decrease the possibility of another “Scratches” outbreak on the horse as long as your are not initially, continually irritating the pastern region.
I hope this article was found helpful for the difficult, reoccurring cases of “Scratches”. Keep watching for more practice tips from “Dr. Jimmy.”
P.S. In the future, I will be publishing some great funny stories about things that have happened to me in 25 years that I have been in this business! But the next practice-tip is “myth busting.” Antibiotic use and the abscess found in a hoof. “Is your vet using them & why?”
Dr. James A. Giacopuzzi D.V.M., FERRIER, has been shoeing and practicing veterinary medicine for over 25 years. His résumé includes 10 years working at Humphrey & Giacopuzzi & Associates Equine Veterinary Hospital in Somis, California. A polo practice in La Quinta, California for 7 years, and now resides in Rolling Hills Estates, California where his practice includes Hunter/Jumpers, all kinds of performance horses, and corrective horse shoeing. He lives there with his wife Alden and his two children Gianna and Julian.
*The statements above are the views and opinions of Dr. Giacopuzzi and not of FarmVet.com. If you have any problems with your horse, please always contact your vet.
