Horse Problems DatabaseHead and Neck – Sarcoids

Sarcoids are the most common occurring equine skin tumor worldwide.

Although common, sarcoids vary greatly in their size and appearance, the nature in which they grow and potentially spread and the way they respond to treatment. This variability makes sarcoids a challenge for both owners and vets.


Important facts about sarcoids:

  • All equid species are susceptible,­ even donkeys and zebras.
  • “Once a sarcoid horse, always a sarcoid horse!” A horse with one sarcoid is likely to develop more. BUT this can be stopped with “non-mainstream” treatments.
  • Sarcoids can develop anywhere on the horse’s skin, but more common sites include the chest, groin, sheath and face (especially around the eyes and mouth).
  • Sarcoids are likely to recur, regardless of treatment. EXCEPT if you use “non-mainstream” treatments.
  • Trauma of any nature to a sarcoid is likely to aggravate it.
  • No two sarcoids are the same; each sarcoid needs to be assessed on an individual basis. This ONLY happens with “non-mainstream” treatments.
  • Sarcoids can be unpredictable in all aspects of their development and treatment.
  • There is no ‘magic cure’ for sarcoids.

I’ll explain what I mean by “non-mainstream” treatments in a moment. First, just a quick explanation of sarcoid classifications.

Sarcoid classifications

There are 6 classifications for equine sarcoids; occult, verrucous (warty), nodular, fibroblastic, mixed and malevolent. Again no two sarcoids are the same and so many individual tumors may contain characteristics of several different types.

Occult

Occult sarcoids on shoulder and neck
www.horseandhound.co.uk

Verrucous (Warty)

Verrucous sarcoid around eye
www.liv.ac.uk

Nodular

Nodular sarcoid in groin area
www.horseandhound.co.uk

Fibroblastic

Fibroblastic sarcoid near eye
www.horseandhound.co.uk

Mixed

Mixed sarcoids on neck of horse
www.vetnext.com

 

So what’s the real scoop on sarcoids?

Here’s the most important fact about sarcoids that nobody talks about:

Sarcoids are not the problem.

Sarcoids are only a symptom of a diminished and/or malfunctioning immune system.

Here’s a gross example to illustrate this (skip if you’re squeamish):

Once I visited a client who had been treating a pus pocket on a horse’s shoulder. John had been treating this oozing, hot, pus pocket for two weeks. He was actually doing a nice job of treating it. He opened it up, got it draining, hot-packed it to increase circulation, and applying topical salve.

This treatment wasn’t working because, primarily, John thought the pus pocket was the problem. The real problem was the three inch nail that I dug out of that pus pocket.

Maybe this example seems obvious to you. But the sarcoid problem should be obvious to veterinarians, and it’s not. The problem is the immune system (the hidden, unseen nail), while the sarcoid symptom is external and obvious (just like the pus pocket).

This is why there are over 40 different treatments worldwide for Sarcoids. Because, depending on the horse’s particular underlying problem, different treatments work for different horses.

If you would just like to treat the symptom (i.e. get rid of the sarcoid) for now, here are your options:

1)  Traditional Veterinary treatments

Ann Rashmir-­Raven, DVM, MS, Dipl. ACVS, associate professor of Large Animal Clinical Sciences at Michigan State University’s College of Veterinary Medicine talks about different treatments:

Surgical Removal­­—While this is a relatively easy procedure to carry out in most cases, Rashmir­Raven noted it has a recurrence rate of 15 to 82%, with the majority of tumors growing back more aggressively and within six months. “Surgical excision is better used to reduce tumor volume and improve killing efficiency of other treatment modalities,” she suggested. She gave practitioners in attendance some tips on removing sarcoids, but stressed using adjunctive treatment options.

Laser Removal­­—The concept of laser removal isn’t too different from surgical removal; however, it might offer some benefits over the latter option, Rashmir­Raven noted: “Because laser energy is absorbed by surrounding tissues, tumor cells are killed up to 0.2 mm beyond the wound margins.” The downside? This method of excision has the potential to aerosolize infectious particles and agents from the sarcoid being removed, and Rashmir­Raven said it’s unclear what impact this could have on the horse and/or surgeons performing the procedure. Like surgical removal, she suggested veterinarians use laser removal in conjunction with another treatment option.

Cryotherapy­­—Although cryotherapy is a cost­effective sarcoid treatment option, Rashmir­Raven noted, “recurrence rates vary widely for this procedure with some authors reporting little success (1%) and others reporting 100%.” In this procedure veterinarians use liquid nitrogen to literally freeze the tumor off the horse’s body. Rashmir­Raven noted that cryotherapy typically results in scarring and hair depigmentation at the site of removal, so this isn’t the most cosmetic removal option. Additionally, she said, “due to the significant tissue destruction associated with cryotherapy, it might not be appropriate for tumors near the eye, nostrils, or similarly significant structures.”

Intratumoral Hyperthermia­­—Intratumoral hyperthermia, in which the sarcoid is heated, has reportedly been successful in treating equine sarcoids, she said. “More recently hyperthermia treatments have also included concomitant (when multiple drugs are given at or almost at the same time) chemotherapy,” Rashmir­Raven added. Unfortunately, hypertherapy units are not readily available in private practice.

Cisplatin Injections and Beads—­­One of Rashmir-­Raven’s choice treatments is the chemotherapeutic drug cisplatin, which is used in both injectable form and beads. She reported that cisplatin “consistently provides long­term control of equine sarcoids with a 96.4% resolution rate (3.7% recurrence rate) after four years in 409 cases.”

When using a cisplatin injection, she explained that tumors are generally injected three to five times, every two to three weeks. Large sarcoids, she said, should be debulked prior to cisplatin treatment. When using cisplatin beads ­­which release the drug slowly over the course of 30 days ­­the practitioner inserts the beads in the tumor and the surrounding areas, she explained. Rashmir-­Raven said she prefers the beads to the injection for most sarcoids due to the ease of placement. “Long­term results with cisplatin … have provided the best tumor resolution rate of all the published sarcoid treatment modalities,” Rashmir­-Raven said.

She briefly discussed the use of cisplatin electrochemotherapy in treating sarcoids, noting that one clinical trial that yielded a 99.5% success rate. Horses require general anesthesia for electrochemotherapy, so treatment cost is typically high, she noted.

Topical Acyclovir­­—Rashmir­-Raven explained the topical application of the antiviral drug acyclovir is considered a safe and cost ­effective treatment and surgical excision. In one study she discussed, acyclovir reduced the size of all 47 treated sarcoids and completely resolved 68% of those tumors. “Acyclovir is proposed to be routinely used for the treatment of flat and mild ­type sarcoids or potentially as a relatively economical way to shrink tumors prior to the use of cisplatin,” she said. She added that the cream or ointment should be applied daily for two to six months.

Topical Immiquimod­­—Known by the trade name Aldara, Rashmir­-Raven said that in studies immiquimod has reduced nondebulked tumor size by as much as 75%, and she added that her personal results with the drug have been even more effective when used on tumors that have been debulked. The drug is applied every other day for 32 weeks or until the tumor is resolved, she said. Potential side effects from immiquimod use include inflammation, oozing, hair depigmentation, and hair loss.

Topical Bloodroot Extract—­­Rashmir­-Raven discussed the use of a bloodroot extract salve used to treat a variety of skin conditions, including sarcoids. She relayed that the salve, marketed under the trade name Xxterra, is an economical option for some small sarcoids and larger sarcoids for which more expensive treatment isn’t an option. Sarcoids typically begin sloughing in seven to 10 days, and treatment is often required more than once.

Bacillus Calmette­Guerin (BCG) Injection­­—Rashmir­-Raven explained that BCG injections ­­one type of sarcoid “immuno-stimulant”­­ are known to have good success rates in treating sarcoids around the eyes (83­-100% efficacy). However, the success rates drop to less than 50% when treating sarcoids located elsewhere on the body. Additionally, she said, severe inflammatory and allergic reactions and anaphylaxis (a rapidly developing and sometimes life­-threatening allergic reaction) have been known to occur when using BCG.

Autogenous Vaccines and Sarcoid Implantation­­Essentially autogenous vaccines are created using tissue from the patient’s own body to prompt an immune response, Rashmir-­Raven explained. “Similarly, the removal, freezing, and re-implantation of a sarcoid into the same horse has demonstrated success in a limited number of cases,” she added. Also, while tumor implantation using sarcoids from a different horse has decreased the size of some sarcoids, it has also been known to stimulate the growth of new tumors,

she reminded. “Because other less­ invasive treatments frequently work well and tumor transplantation from a donor horse bears risks ­­such as tumor production and transmission of other diseases­­ this procedure should be reserved for refractory cases,” Rashmir­-Raven stressed.

2)  Other “weird” treatments that may work for your horse

Electric Zapping

A somewhat unconventional treatment, electric zapping is another effective option. An electric zapper, invented by Hulda Clark, electrifies the blood and kills any parasites, bacteria or other infection ­causing organism. As sarcoidosis is often caused by fungus, this treatment is typically effective for eliminating the condition.

Crest Toothpaste

Leta’s Herbs and Animals tried an experiment with Crest Toothpaste. Hearing that the fluoride in the toothpaste would help dry up the sarcoid. In about two weeks it was starting to dry up the sarcoid just like she had read. Despite there being no medical evidence for the treatment, some people claim that it does work. Accord to Horse and Hound Magazine Professor Derek Knottenbelt — an equine dermatology expert at Liverpool University says,” that this is completely ludicrous” while there are many that disagree with him.

Fluoride mouthwash

Richard with Horsekeeping LLC had heard from dozens of horse owners who have treated their horses’ sarcoids with fluoride mouthwash. Some had the same good results just like he had, the sarcoid dried up and went away. Others saw the sarcoid diminish in size but not go away, while others saw no effect whatsoever

Hydrogen Peroxide

Hydrogen peroxide is a safe antibacterial agent comprised of oxygen and water. As such, hydrogen peroxide effectively kills the infection associated with sarcoidosis via oxidation, or a process much like burning. The product is an effective cleanser, which functions to eliminate infection and, in turn, reduce inflammation.

2) Alternative treatments

If you would like to fix your horse’s immune system so that the sarcoids go away and do not come back, here are your options:

1) Balanced Eco Solutions

Ron Stalman at Balanced Eco Solutions has created a sarcoid salve and an immune system supplement to work alongside it. He works personally with you and your horse to find the solution for your particular sarcoid problem. Ron will literally spend hours with you (only if needed) on the phone to figure out your horse’s particular needs.

You can reach Ron at: Balanced Eco solutions

2) Vibrational medicine

Vibrational medicine works in a manner similar to homeopathy. You send in a saliva sample for analyis to find the underlying immune system problem(s). Then remedies individually designed for your horse are given.

You can find a practitioner at www.healerswhoshare.com.

More information is available at www.purplechanges.com

3) Homeopathic medicine

Homeopathic practitioners use homeopathic analysis and treatments to remedy the underlying immune system issues, and thereby eliminate sarcoids.

You will need to find a homeopathic practitioner in your area. You may find one using the American Homeopathic Veterinarian website: avhma.com

All three of these options take time to see the results, sometimes months. However, if you do not take care of your horse’s immune system, you will eventually have other immune system issues to deal with.

Other symptoms of immune system dysfunction include: mud fever, sweet-itch, scratches, allergies, hives, runny eyes, and sarcoidosis (internal sarcoids that eventually cause death).

The best option is to heal the immune system first, and then all the little symptoms—such as sarcoids—will disappear.

Best of luck with your horse!