Diagnosis is usually straight forward however with up to 40 reported treatment options, care is requires in selecting the best option for each individual case.
There are six recognised different types of sarcoids distinguishable by their appearance, occult, verrucose, nodular, fibroblastic, mixed and malignant. Transformation from one of the less aggressive types, occult or verrucae, to the more aggressive fibroblastic or less commonly malignant form can occur at any time but particularly following trauma (including fly worry) or application of a wide range of skin healing products.
This also highlights the importance of choosing the best treatment right from the start as the first treatment has the best chance of success.
Where subsequent treatments are required the chance of success is reduced by 40%
Failure can also lead to transformation of the sarcoids or an increase in their numbers. Choice of treatment is dependent on many factors including type, location, temperament as well as financial consideration. Unfortunately no treatment is 100% successful and the potential for recurrence is always present even occasionally after many years of remission.
Young horses with lesions small in size and numbers carry a more favourable prognosis.
MORE COVERED COMMON TREATMENT MODALITIES:
Treatment with AW4-Ludes cream is a common approach particularly for horses with multiple lesions in many locations. Protocols are tailored to the individual via a referral service at the University of Liverpool which can be applied by your own vet at home.
The cream contains several highly toxic components and so can only be applied by a vet. Commonly 3-5 applications are required, normally with an interval of 24-72 hours in between. Some horses become quite swollen and sore during treatment however the majority of cases respond well to a short course of oral anti inflammatories.
Follow up evaluation is required 6 weeks later to assess the need for any further treatment. Sometimes ligation of a pendulous or nodular sarcoid is done prior to application of the cream and occasionally ligation used on its own.
Laser surgery has increased in popularity due to rapid healing of the skin following removal and much lower recurrence rate then it seems with conventional surgical removal. Many cases can be treated under sedation although some due to sarcoid location or temperament may require a full general anaesthetic.
Sarcoids located round the eye region can be problematic due to the sensitivity of this location.
Injecting discrete lesions with BCG vaccine has been associated with good success rates but only when in this location.
Radiation therapy (often a small wire implant) remains the treatment with the highest success rate for unresponsive lesions especially those in very sensitive locations such as around the eye or over joints. This requires referrals to a specialist centre and is very expensive.
Benign neglect and leaving well alone is a risky option due to the unpredictability of the equine sarcoid. Even small lesions quiescent for many years can suddenly enlarge or increase in number.
If you think your horse may have a sarcoid please arrange for an examination from your vet!
Thanks to, Samantha Scott BVM&S MRCVS. Scardales vets