Please keep in mind that none of these treatments listed below will “heal” chronic progressive lymphedema (CPL). However, a rigorous management following our suggestions below will assist you to slow down the process and even make some of the nodular lesions disappear. Your horse will need this management the rest of its life.
Clipping of the feathers
Long and dense feathering makes management of lymphedema more difficult. We highly recommend clipping the feathers and keep them short, if horses are not presented at shows. If you have a show horse, we still recommend to clip the feathers to initiate a rigorous treatment. As the skin condition improves and the edema is reducing - you may have a better chance to keep the horse's legs in better condition by. careful repetitive treatment, while the feathering is growing back. The feathers are usually back to their original length in about 10-12 months.
Treatment of skin infections
Progression of lymphedema is also associated with deposition of fibrous tissue and formation of fibrotic nodules.. As a result, these horses have a poor blood circulation and immune response in the skin of their legs. They tend to built up a thick keratin layer. The long feathering further occludes the skin surface, which then remains humid. These factors provide the perfect culture environment for infectious pathogens. This explains why horses with CPL constantly battle recurrent infections with mites (Chorioptic mange) and bacterial infections (Staphylococcus, Dermatophilus).
Horses with CPL should consistently be treated against reinfestation of mites and bacteria:
Careful washing, cleaning and drying of the legs on a routine basis is essential. Horses with long feathering may require blow-drying of their legs. We recommend using a product manufactured by HydroSurge Inc. ( www.hydrosurge.com ) called Apricot Sulfur Skin Treatment Shampoo.
Frontline spray to treat chorioptic mange (do not use Frontline on pregnant and nursing mares)
The best and most economical topical treatment is to find a source of wettable sulfur powder (“flowers of sulfur”). This can usually be found through a vineyard supply or at your local nursery (certain “rose dust” preparations). Mix this powder with mineral oil in to form a creamy paste. You can mix a moderate amount in a plastic lidded container or glass jar so that you have enough to last 2-4 weeks at a time. Apply this mixture to the ulcerated and/or affected areas of skin daily. This preparation is the best and most economical topical treatment we have found. You can use it indefinitely. Sulfur is safe to use in pregnant mares.
Systemic antiparasitic treatment: Frequent ivermectine treatment will also assist to keep the mites away.
Regular exercise is crucial. It will increase the circulation and the lymph drainage.
Manual lymph-drainage is regularly used in humans with lymphedema as long as there is no inflammation present within the tissue. MLD has been successfully used in horses with more acute lymphedema, but has not been established yet in horses with progressed CPL. A massaging coldwater stream may assist a massage. It is important to dry the skin before applying anything else after massage and rinsing. If the feathers were not clipped this may take a long time and you may have to use a hair dryer. Your horse may become more compliant to this treatment as swelling reduces over time
Bandaging and stockings
We have some limited experience with using special bandages developed for people with lymphedema. For horses, which always move around, “short-stretch” bandages should be used (example: Rosidal ®). Short stretch bandages have been successfully used in three horses with clipped feathering; but bandaging was not as successful on horses with long feathers. Of course it is crucial to have very good padding and keeping the bandages fairly tight. If tolerated, the best results will be achieved by keeping the bandages on 24/7. Of course they need to be redone at least every other day - better every day to control the legs. At first, there will be oozing from the lymphedema through the skin - so the bandages will get wet and have to be changed every day. With the reduction of the edema - this will stop. If the horse is only walked quietly the bandages can be left on for the exercise; very likely the legs have to be rewrapped after the exercise as the swelling will somewhat reduce. For more exercise it may be better to take the bandages off, use working bandages and then switch back to the short–stretch bandages after work. Again make sure the skin is dry when you rewrap.
After the edema has been reduced by using bandages - stockings are used for people to maintain avoid recurrence of lympedema. The use of such stockings in horses are currently under investigation.
It should be noted that horses suffering from CPL often are susceptible to reapeated bouts of “Thrush”. Consequently, thorough and routine foot trimming care is an essential part of the health care management for these horses.