Chronic Progessive Lymphedema By Brian S. Burks, DVM, Dipl. ABVP- Board Certified in Equine Practice Chronic Progressive Lymphedema (CPL) is a disorder of the lower limbs where the skin becomes thickened, nodular, flaky, and has surface ulceration. The distal limbs are swollen, initially with edema, or tissue fluid, but over time the limbs scar. CPL typically occurs in draft horses such as Shires and Clydesdales, but can affect any breed of draft, including Cobbs and Gypsy Vanners. Its onset is usually in young horses, and it progresses throughout life. Both front and hind limbs can be affected, with most lesions being on the back of the pasterns, though they can spread up to the hock and carpus. The swelling is mild initially, with only small, superficial ulcerations. When the disease becomes more chronic, the limbs will be permanently swollen and firm. The ulcerations become more prominent and coalesce. Firm nodules develop that can reach several centimeters in size. Hooves tend to have poor hoof quality, with flaky hoof walls that chip, split and can have large cracks. Foot canker and recurrent thrush may develop. The skin may begin to ooze fluid. Eventually severe bacterial and/or fungal lymphangitis occurs, which can necessitate euthanasia. The etiology is unknown. For some reason, lymph stasis occurs, which induces fibrosis and dermal ischemia. The skin becomes infected due to mites, poor skin hygiene, and microtrauma. Diagnosis is by clinical signs and signalment. There is distinct breed predilection. Nuclear scintigraphy has been useful to show lymphatic stasis. Treatment is palliative at best. There is no cure. Early diagnosis is essential for good clinical management. The skin should be kept clean of debris and urine; the feathers will need to be removed. Stalls need to be kept especially clean. Secondary skin infections and mite infestations need to be managed with systemic and topical antibiotics; mites may be killed with fipronil (Frontline) spray, though this is off-label in the horse and also with permethrins, as found in dairy premise sprays. Either may be removed using a good antiseptic shampoo with chlorhexidine gluconate. Additional treatment modalities include intermittent positive pressure compression and compression stockings, as are used in people. Systems similar to Game Ready can be tried, to massage the limbs, helping to remove the fluid. Other systems will begin pressure at the bottom of the limb, and work upward to move fluid. Stockings can be purchased commercially, and should be of ‘short-stretch’ material; they need to be tight to keep fluid from settling in the limb. Fox Run Equine Center foxrunequine
Posted on: Sat, 26 Jul 2014 11:00:00 +0000
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