KRUUSE Manuka Dressings to treat Mud Fever Use of Manuka dressings in the management of pastern dermatitis “Mud Fever” in horses Aimi Duff – BVM&S MRCVS – Scott, Mitchell & Associates, Hexham Summary In this article I report five horses suffering from pastern dermatitis managed using manuka honey dressings. All the horses presented with dermatitis in multiple limbs of varying severities. In two cases there was secondary cellulitis/lymphangitis. The manuka dressings were used on one affected limb and the owners were asked to manage the other limbs as they would normally. The manuka dressings had a positive effect on the dermatitis, with a marked improvement in all cases. There are no reports to the author’s knowledge of manuka dressings being used to manage pastern dermatitis. Introduction Pastern dermatitis, also known as ‘mudfever’, is commonly seen in equine general practice, with multiple proposed aetiologies, (Colles et al, 2010; Pilsworth et al, 2006). Horse skin is normally resistant to bacterial infection but natural skin defences can be insulted by physical trauma, friction, injurious topical treatments, ectoparasite, and excessive wetting which make the skin more liable to trauma (Colaham met al, 1999; Colles et al, 2010; Knottenbelt et al, 1994; Pilsworth et al, 2006). Other factors associated with pastern dermatitis include chronic wetting of the distal limb skin, season and skin colour, with increased prevalence seen in the winter months and in equids with white skin (Knottenbelt et al, 1994; Pilsworth et al, 2006). The culmination of this insult to the skin’s natural defences and physical trauma to the skin permits invasion by opportunistic pathogens such as Dermatophilus congolensis, Staphylococcal spp, (Colles et al, 2010; Knottenbelt et al, 1994). The bacteria then multiply causing an infective inflammatory process within the skin which we know as pastern dermatitis (Knottenbelt et al, 1994). Clinical signs vary with severity but the condition manifests as a seborrheic dermatitis in the palmar/plantar heel and pastern, with some cases involving the cannon region, (Colaham et al, 1999). Pastern dermatitis is often bilaterally symmetrical, (Colaham et al. 1999). Mild pastern dermatitis is characterised by alopecia, erythema and mild serum exudation, (Colaham et al. 1999; Knottenbelt et al, 1994; Pilsworth et al, 2006). Hair may be lost in tufts with a scab at the roots, (Knottenbelt et al, 1994). With more moderate to severe disease there is more profuse serum exudation which dries to form a crust over the affected area. The skin may become oedematous or thickened and cracked, and lameness may develop (Colaham et al. 1999; Colles et al, 2010; Knottenbelt et al, 1994; Pilsworth et al, 2006). Serum exudation drives the condition; it provides ideal conditions for bacterial replication, (Knottenbelt et al, 1994). In some cases the condition progresses to an acute cellulitis/lymphangitis, or to a chronic suppurative condition known as ‘greasy heel’, (Colles et al, 2010; Pilsworth et al, 2006). Attempts at management might include application of ointments to unhealthy tissue which can impede rather than improve the situation; their occlusive nature permits secondary opportunistic bacterial infection (Pilsworth et al, 2006). Management of this condition involves three phases: debridement, treatment and prevention, (Pilsworth et al, 2006). The objective of the debridement phase is to remove any contaminated debris and necrotic tissue, (Pilsworth et al, 2006). Debridement might be achieved manually or using topical treatments such as Dermisol™ (Pfizer Animal Health), (Pilsworth et al, 2006) or honey (Mathews et al,2002; Molahan, 2001). Once the affected area has been successfully debrided the extent of ulceration can be assessed and a suitable antimicrobial treatment can be applied (Pilsworth et al, 2006). Honey has been used in wound management for its ability to optimise the wound healing environment and also its antimicrobial activity since 2000 BC, (Mathews et al, 2002). The antibacterial effect attributed to honey is associated with its high osmolarity, acidity and hydrogen peroxide content. The high osmolarity draws lymph from the wound which brings with it nutrients for tissue regeneration, and macrophages which assist in the debridement phase (Mathews et al, 2002; Molan, 2001). The consituents of honey; glucose, fructose, vitamins, minerals, enzymes, antioxidants and amino acids provide cellular energy and factors necessary for granulation, (Mathews et al, 2002). Additionally, honey acts as a barrier to wound invasion and has a hygroscopic effect which reduces inflammatory oedema. The generation of low levels of hydrogen peroxide within honey promotes angiogenesis and consequently healing, (Mathews et al, 2002). We were in the position of trying manuka honey dressings as a treatment for pastern dermatitis. This trial was performed using patients presented for pastern dermatitis in multiple limbs. Because the trial was practice based, investigations were limited to the basic clinical requirement; causative organisms were not identified. Controls were matched as far as possible using multiple affected legs on the same patient, although there was variation in severity in what was considered the ‘honey treatment’ and ‘control’ legs. Case studies In all cases the ‘honey-treatment’ leg was managed by clipping the hair around the affected site, removing any gross contamination, applying the ‘Kruuse Manuka ND’ dressing, securing this in place with a soft bandage and then a conforming bandage and leaving the area dressed for 3 days and maintaining the horse on box rest. Pastern dermatitis in the ‘control’ legs was managed as the owners would normally. www.kruuse.com
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