Your "Scratches" How-To
With all the wet weather we've had over the past couple of months, skin problems have been a big topic of conversation with our clients. The most popular? "Scratches."
What is Scratches? "Scratches" is a long-term skin irritation/infection located on the lower limb, especially the heel bulb and pastern, although it can extend up higher. It is more common in breeds with "feathers" on their legs - think drafts - but any horse can get this condition. What causes this? It is caused by an invasion of bacteria into the skin - so somehow the normal barrier of the skin has become compromised. Although horses standing in constant unsanitary conditions are very likely to have such issues, usually it's as simple as a period of prolonged rain making the pastures muddy, and in turn, the skin wet. Wet skin can't protect itself as well, and before you know it, you've got an infection! What are the signs? There is a wide range of severity, and in my experience, owners usually think their horse's scratches is more severe than it actually is. With that said - it still needs treatment, no matter the level of severity to stop it from progressing. Here is my personal scale based on the variety of cases I've seen:
Mild: Less than a dozen or so crusts. Crust size is small, perhaps less than the size of a pencil eraser.
Moderate: Significant number of crusts, although still on the smaller side. More inflammation and pain is present.
Severe: Large sections of skin ulcerated or crusted. Cellulitis may be present (deep infection of the tissue, requiring systemic antibiotics).
How do I treat it? I am always a fan of making treatment simple and cheap whenever possible, and this is a case when you can do that for most horses. I find that most owners have tried a kajillion different combinations of shampoos, leave-on ointments, sprays, etc., and even toxic chemicals (yes, really!) with little success before talking to me. It's not that the product they've used is necessarily ineffective, but there are specific guidelines that need to be followed to be successful. My preferred medication is iodine scrub/shampoo. I'll dispel a couple things first - I understand this is not the only thing that works. It's just what I know, and know extremely well, and I recommend it for good reasons (more later). Two - if you've used this without success, pease stick with me here!
I have found over the years that iodine scrub works extremely well on scratches and rain rot, and in mild and moderate cases, you can often use it alone - no other treatments needed. Isn't that simple? For more severe cases, additional medications might be needed. What I have realized, though, is that there are very specific rules that you have to follow when using it - if you don't follow these, no dice!
Why do I specifically like iodine? One, it's cheap. You usually don't need to drop a lot of money to fix your horse's scratches. Two, iodine kills both bacteria and fungus, so it gets things like ringworm, rain rot, staph infections - basically, you're covering most of your skin infection "bases." It's not going to reach deep infections, however. For that, you're going to need systemic antibiotics.
Here are "The Rules" to follow for success in treating scratches:
1. Use Iodine SCRUB, a.k.a. SHAMPOO, not solution. Solution will not work.
Also be aware that there are different concentrations of scrub available. Lower concentrations *may* not work as well for your horse, but it you already own it, use it.
For cost efficiency, buy gallons, especially if large areas of skin are affected.
2. Do not dilute it. It will not work. I can't tell you how many times I have seen this.
On this same topic, if you are in the medical field and possess surgical scrub sponges, put them down! I have seen many treatment failures with these.
3. The scabs need to come off. Sorry, this may not be fun for either of you.
Reasoning: Scabs cover the infection, so for the iodine to come in contact with the infection, you have to remove them.
This may require sedation depending how extensive the scabbing is and how painful your horse is. Talk you your vet about this.
After one good session of scab removal, you may still need to remove a few more, but the bulk should be removed on Day 1.
4. Each time you clean the leg, the iodine scrub needs to sit on the leg for AT LEAST 5 minutes. Studies have shown that you need at least 5 minutes of contact time to properly kill bacteria.
After this, be sure to wash all the scrub off thoroughly.
5. Frequency - Not just once is going to do it. :)
Mild cases: You can sometimes get away with every 2-3 day baths.
Moderate to severe cases: You need to do it every day.
Improvement time: You *should* be seeing noticeable improvement within 1-2 weeks. If there is hair loss, I will start visibly noticing new hairs at about 2 weeks.
On the horse pictured above, we clipped his legs to allow better access to the skin for scab removal and iodine penetration. As you can see in the third picture, his skin was very inflamed, so he was placed on anti-inflamatories for several days. Cellulitis was not suspected yet in this case. After two weeks of topical care, the owner reports this horse has improved significantly and inflammation is no longer present.
Follow "The Rules" and you WILL have success. Don't get discouraged. Scratches happen to just about everybody!