Equine health encompasses the study and management of diseases, disorders, and overall well-being of horses. It involves understanding various physiological systems, preventive care, and treatment strategies to maintain optimal health in equine populations. Common areas of focus include nutrition, infectious diseases, orthopedic conditions, and reproductive health. Research in equine health aims to advance knowledge on diagnostic methods, therapeutic interventions, and management practices that improve horse welfare and performance. This page collects peer-reviewed research studies and scholarly articles that explore the diverse aspects of equine health, offering insights into current findings and advancements in the field.
Brown MP, Gronwall RR, Houston AE.Six healthy adult mares were each given an oral loading dose of ormetoprim(OMP)-sulfadimethoxine (SDM) at a dosage of 9.2 mg of OMP/kg and 45.8 mg of SDM/kg, followed by four maintenance doses of 4.6 mg of OMP/kg and 22.9 mg of SDM/kg, at 24 h intervals. Ormetoprim and SDM concentrations were measured in serum, synovial fluid, peritoneal fluid, cerebrospinal fluid, urine and endometrium. The highest mean serum OMP concentration was 0.92 micrograms/mL 0.5 h after the first dose; the highest mean SDM concentration was 80.9 micrograms/mL 8 h after the first dose. The highest mean synovial fluid c...
Rugh KS, Garner HE, Miramonti JR, Hatfield DG.Myocardial and haemodynamic responses to strenuous treadmill exercise were monitored with chronically implanted instrumentation in seven physically untrained ponies. In two other ponies, haemodynamics were monitored using a conventional catheter technique. During exercise (mean +/- sem heart rate = 203 +/- 3 beats/min), left ventricular peak systolic ahd end-diastolic blood pressure significantly increased from 125 +/- 2 to 208 +/- 6 mmHg and from 29 +/- 1 to 58 +/- 3 mmHg, respectively (P less than 0.05). Peak positive first derivative of left ventricular pressure (dP/dt) was also increased s...
Dudan F, Hirni H.Since 1980 techniques specifically designed to treat human neonatal diseases have also started to be applied to ill or premature equine newborns. These techniques will be described and their application to the most common equine neonatal disorders will be discussed. Such techniques include: post-natal cardiopulmonary resuscitation, exogenous thermal support, administration of broad spectrum antibiotics after diagnostic studies, supplemental oxygen therapy and mechanical ventilation, intravenous fluid and electrolyte therapy, blood component transfusion and total parenteral nutrition.
Andersson-Eklund L, Andersson L, Sandberg K.A study was carried out to attempt to explain the basis of the association between the Es locus and starting proportion in Swedish Trotters which had been observed previously. The effect of Es genotype on starting proportion has diminished among horses born in the late 1970s. There are indications that the incidence of leg lesions varies between Es genotypes. If this is true, it is possible that the decreasing effect of the Es locus on starting proportion is due to the environmental changes which have been made at race tracks in the early 1980s to reduce the strain on the legs of the trotters....
Bollwein A, Hänichen T.The cervical vertebral column of 103 horses of different age (42 weeks old fetus to 23 years) were examined with respect to age-related changes of the intervertebral disks. On gross examination the cervical intervertebral disks in the horse miss a pulpy nucleus but consist of a fibrocartilaginous tissue only, which is in contrast to literature. Age-related degenerative lesions as disintegration of connective tissue fibers leading to partial or complete loss of connection between the disks were found. In the more severe cases a yellow discoloration of the separated disks could be seen. Incidenc...
van Dijk S, Wensing T.1. The serum lipoprotein pattern was studied in four horses, four ponies and in three high producing lactating and three non-lactating cows. The lipoprotein pattern was estimated with a combination of the preparative ultracentrifugation and the heparin-manganese precipitation technique. 2. The lipid composition of the lipoproteins of horse, pony, lactating cow and non-lactating cow was determined. 3. In all three species more than 50% of serum total lipids was found in the HDL fraction. 4. The mean chylomicron fraction in horse and pony was 3.1%. In the cow it varied from 1.5 to 2.5%. 5. Betwe...
Valpotić I, Kastelan M, Rudolf M, Gerencer M, Jukić B, Basić I.The percentage of T and B lymphocytes in the peripheral blood of horses chronically infected with equine infectious anaemia (EIA) virus was determined and the results were compared with the percentage of these cells in healthy uninfected horses. Cells with membrane receptors for sheep erythrocytes (T and active T lymphocytes) were determined by E and A rosette techniques, while cells with receptors for the C3b component of complement and those with receptors for mouse erythrocytes (B lymphocytes), were determined by the EAC rosette method. The percentage of Fe positive cells was assayed by the...
Reef VB, Lalezari K, De Boo J, van der Belt AJ, Spencer PA, Dik KJ.Pulsed-wave Doppler echocardiography was performed on 30 clinically normal 1- to 6-year-old racing Standardbreds. There were 13 females, 13 geldings, and 4 stallions. Cardiac disease was not detected with M-mode, 2-dimensional real-time or pulsed-wave Doppler echocardiography. Normal flow velocities for right and left atrial outflow, right and left ventricular outflow, the aorta, and pulmonary artery were determined. Peak flow velocities for right and left atrial outflow occurred during the rapid filling phase and were higher toward the mitral valve (mean, 0.70 +/- 0.24 m/s) than toward the tr...
Essén-Gustavsson B, McMiken D, Karlström K, Lindholm A, Persson S, Thornton J.Five horses were studied during a five-week regime of controlled intensive daily training on a high-speed treadmill followed by five weeks of detraining. Muscle biopsies were taken weekly from both the right and left gluteus muscle and from the sternocephalicus muscle before, and at the end of, the training and detraining periods. Histochemical and biochemical analyses of the sternocephalicus muscle showed no metabolic adaptation with either training or detraining. No significant differences were observed in any of the analysed parameters in the gluteus muscle between contralateral sites. Glyc...
Furuoka H, Shirakawa T, Taniyama H, Ohishi H, Satoh H, Itakura C.Pancreatic tissue from 20 horses was examined using immunocytochemical techniques. In aged horses, neogenesis of endocrine cells, neoformation, and hyperplasia of islets occurred closely associated with the pancreatic duct; these changes were regarded as nesidioblastosis. In addition, pancreatic fibrosis accompanied by ductal proliferation and endocrine neogenesis was considered a regenerative change. Thus, the origin of neoformation in the endocrine pancreas was in the ductal system, and it is suggested that the pancreatic endocrine cells were of endodermal origin.
Pycock JF, Allen WE.The uteri of normal pony mares in oestrus were infected experimentally with Streptococcus zooepidemicus. Uterine contents were collected 30, 60, 120 or 240 minutes later and were tested for their chemotactic effect on equine-neutrophils both with a morphological assay based on neutrophil shape changes and with a modified Boyden chamber technique. By 30 minutes after infection the uterine contents were markedly chemotactic for isolated peripheral neutrophils and remained so at the 240-minute collection. Uterine contents from uninfected mares had minimal chemotactic properties. These results cou...
Burrows GE, MacAllister CG, Tripp P, Black J.The potential for interactions between chloramphenicol, phenylbutazone, acepromazine and thiamylal and chloramphenicol, rifampin, and phenylbutazone were evaluated in two groups of experiments. In the first, five horses were given thiamylal intravenously (iv) (6.6 mg/kg) after pretreatment with acepromazine, and the time of recumbency was determined. Administration of chloramphenicol iv (25 mg/kg) 1 h prior to anaesthesia significantly lengthened the recumbency time from 21.8 +/- 4.8 mins to 36.0 +/- 8.3 mins. There was an apparent but not statistically significant decrease in recumbency time ...
Shankarappa B, Dutta SK, Sanusi J, Mattingly BL.Competitive enzyme-linked immunosorbent assay (CELISA), mediated by a monoclonal antibody designated HybI, was developed for the diagnosis of equine monocytic ehrlichiosis. Inhibition of binding of HybI by the horse antibodies to Ehrlichia risticii was optimum at dilutions of 1:20 for serum and 1:10,000 for HybI. Mean optical densities (ODs) of positive and negative sera were 0.158 and 0.855, respectively. A comparison of ODs obtained by CELISA and indirect enzyme-linked immunosorbent assay (ELISA) indicated a marked tendency of positive and negative samples to cluster separately with respect ...
Juneja RK, Sandberg K, Kuryl J, Gahne B.Two-dimensional agarose gel (pH 8.6)-horizontal polyacrylamide gel (pH 9.0) electrophoresis of horse serum samples, followed by general protein staining, revealed genetic polymorphism of an unidentified protein tentatively designated serum protein 3 (SP3). The SP3 fractions appeared distinctly when a 14% concentration of acrylamide was used in the separation gels. The 2-D mobilities of SP3 fractions were quite similar to that of albumin. Family data were consistent with the hypothesis that the observed SP3 phenotypes were controlled by four co-dominant, autosomal alleles (D, F, I, S). Evidence...
Hoffer MA, Leach DH, Doige CE.The navicular bone, navicular bursa and their associated structures were collected from 20 horses ranging in age from 80 days gestation to 2 years post-gestation. The right front foot of every horse was sampled for light microscopy. The development of the navicular bursa and associated structures were studied. Study of the developmental anatomy of the equine navicular bursa established that the bursa is a distinct entity in both the fetus and the adult horse. Development of the bursal cavity in the fetus was found to be complete by 120 days of gestation. Synovial membrane of the navicular burs...
Schlater LR.Thirteen strains of a gram-negative, fermentative bacterium that produced gas from glucose were isolated from horses with a variety of clinical conditions. The morphological and biochemical characteristics of this bacterium are similar to those described for the family Pasteurellaceae. These strains appear to constitute a new taxon within the genus Pasteurella; however, the final taxonomic position of this group depends upon more detailed genetic studies. Case histories indicate that this bacterium may be a primary respiratory pathogen and may play a secondary role in various other disease con...
Cornick JL, Brumbaugh GW.An eight-year-old Thoroughbred gelding with dermatographic urticaria is presented. Forelimb edema and generalized urticaria were the presenting clinical signs. All hematologic and serum biochemical values were normal. Immunologic and histologic evaluation failed to reveal specific abnormalities. During hospitalization, an urticarial response to mechanical pressure (dermatographism) was identified. Clinical responses to corticosteroid and antihistaminic (H1) therapy were equivocal. The condition resolved in five weeks and an etiology was not discovered. A discussion of the pathogenesis, diagnos...
Auer DE.The role of oxygen-derived free radicals is considered critical to the etio-pathogenesis of equine inflammatory joint disease. In vivo, the superoxide radical in the joint may be derived either from activated polymorphonuclear leukocytes or from an ischemia/reperfusion cycle. In the presence of ferrous iron, it may generate the highly reactive hydroxyl radical (OH *). Predisposing factors may include synovitis, exercise-induced ischemia and minor traumatic injury to the joints. Unlike other inflammatory mediators, oxygen-derived free radicals may damage tissue directly and these reactive speci...
Mfitilodze MW, Hutchinson GW.A quantitative post-mortem study of 57 horses from northern Queensland was done to determine the prevalence and intensity of non-strongyle intestinal parasites. The following species (% prevalence) were found: Draschia megastoma (39%); Habronema muscae (43%); Gasterophilus intestinalis (34%), G. nasalis (30%); Parascaris equorum (15%); Strongyloides westeri (6%); Probstmayria vivipara (2%); Oxyuris equi (26%); Anoplocephala magna (2%); A. perfoliata (32%). Mean parasite numbers of individual species ranged from 10 to 1310. Prevalence and intensity data were compared to recent studies in Wester...
Cymbaluk NF, Christison GI.The effects of diet and climate were assessed in 42 light horse weanlings over 30 wk. Horses were fed diets varying in energy and phosphorus content. Diets were predominantly forage (73 to 77.5%) or concentrate (62 to 62.25%) and had 2.65 or 3.09 Mcal DE/kg DM, respectively. Horses were weighed every 14 d. Group feed intakes and climatic variables were recorded daily. Dietary phosphorus content did not affect intake or gain. Horses fed forage diets ate 18% more (P less than .001) DM than horses fed concentrate, but DE intakes did not differ. Average DE intakes, 21.5 Mcal daily, were 33% more t...
Tomić S, Sesartić L, Tomasić J.1. 14C-labelled methyl 2,6-di-O-pivaloyl-alpha-D-glucopyranoside (1) was used as a substrate for esterases from rabbit, guinea pig, mouse, donkey, pig, horse, sheep and human sera. 2. Stepwise de-esterification of the diester substrate 1 occurred with rabbit, guinea pig and mouse serum. Data on time-course experiments and kinetic data are reported. 3. The use of donkey, pig, horse, sheep and human serum led to the migration of the 2-O-pivaloyl group in substrate 1 to the position 4- in the sugar molecule, followed by stepwise de-esterifications of both 1 and the newly formed methyl 4,6-di-O-pi...
Orsini JA, Donawick WJ.Two female Standardbred foals 2 and 3 months of age were presented with signs of gastroduodenal obstruction that was confirmed with contrast radiography and exploratory surgery. Ventral midline celiotomy was performed, showing stenosis of the duodenum proximal and distal to the hepatopancreatic ampulla. The common hepatic duct, the pancreatic duct, and the sigmoid section of the duodenum proximal to the stenosis were greatly dilated. To bypass the intestinal obstruction, a side-to-side duodenojejunostomy was performed. Obstruction of the common hepatic duct was relieved by side-to-side hepatic...
Crawley GR, Grant BD, Krpan MK, Major MD.Thirteen cases of partial limb amputation in horses were reviewed. Nine horses (69%) survived 18 to 111 months (mean, 41 months). Four unsuccessfully treated horses were euthanatized within 21 days of surgery. The horses' ages at amputation were 4 to 13 years (mean, 7.3 years). There was no predilection for the left or right limb nor for fore or hind limb involvement. Osteomyelitis in six horses (46%) was the most common cause for amputation. Severe, open, comminuted fractures of the third metacarpal bone that were impossible to stabilize by any currently available technique in four horses (31...
Coruzzi G, Poli E, Montanari C, Bertaccini G.1. Uterine motility was studied in vitro in the myometrial tissue obtained from pregnant and non-pregnant mares. 2. The spontaneous contractions of the preparations were not modified by tetrodotoxin, by anticholinergics, antiadrenergics, histamine H1 and H2 blockers, antiserotoninergic and opioid antagonists; but disappeared in Ca2+ and Na+ free medium. 3. beta 2-adrenergic stimulants like salbutamol and hexoprenaline and the calcium channel blockers nifedipine and verapamil were effective inhibitors of the amplitude of phasic contractions (ID50S for salbutamol and nifedipine were 7.7 nM and 1...
Haluska GJ.Electromyographic (EMG) recordings were made during the last two weeks of pregnancy from two mares. Four bipolar EMG electrodes were implanted in the uteri of the mares; near the tubo-uterine junction and bifurcation of the pregnant horn, in the body of the uterus and near the cervix. Plasma samples were collected every 4 hours during the same period and more intensely during parturition. Estradiol 17 beta, progesterone, PGF2 alpha metabolite and oxytocin were measured by radioimmunoassay. During the last week preceding delivery, EMG activity was elevated and was greatest at night. EMG activit...
Melrose PA, Knigge KM.The present study describes the topography of immunoreactive (ir) oxytocin (OXY) and vasopressin (AVP) neurons in the forebrain of Equus caballus and the coexistence of ir proopiomelanocortin (POMC)-derived peptides in the same cells. These data are compared to those for other mammalian species and the possible significance of species variations is considered. As expected, magnocellular neurons of the equine hypothalamus, which contain ir OXY or AVP, have prominent discernible projections to the neurohypophysis. Further, as in other mammalian species, the field of ir OXY perikarya generally ex...
Mätz K, Gerhards H, Heider HJ, Drommer W.Bilateral blindness was diagnosed in a 5-year-old Hanoverian gelding presented for evaluation of a corneal opacity in one eye. About 12 months prior to the examination, the gelding had fallen head over, hitting his head and the cornea. Clinical and electroretinographic findings as well as pathohistologic and ultrastructural lesions of both eyes including the optic nerves are presented. Ophthalmoscopically visible pigment disruption of the non-tapetal fundus adjacent to the optic discs correlated morphologically with foci of degeneration and atrophy of the retina, whereas ophthalmoscopically vi...
Blikslager AT, Tate LP, Jones SL.An 8-year-old Hanoverian gelding was examined because of urine dribbling and urethral obstruction. Mild proprioceptive deficits of the left hind limb were evident during neurologic examination. Ultrasonography per rectum revealed dilatation of the pelvic portion of the urethra. Endoscopy of the urethra revealed 2 webs of tissue: 1 was located 10 cm proximal to the external urethral opening; the other was located 65 cm proximal to the external urethral opening and prevented passage of the endoscope into the urinary bladder. The mass was ablated with a neodymium:yttrium-aluminum-garnet laser, us...
Wester PW, Franken P, Häni HJ.Summary Both clinical and pathological features of seven horses suffering from a squamous cell carcinoma of the stomach are presented. The main complaints in the horses, aged six years or more, were loss both of weight and of condition. Metastases had often developed. The diagnostic difficulties and possibilities are discussed.
Malark JA, Peyton LC, Galvin MJ.Peritoneal fluid and blood was collected from 8 healthy adult horses. Four 1-ml aliquots of peritoneal fluid from each horse were then contaminated with 0 ml (normal), 0.05 ml (1 drop), 0.10 ml (2 drops), and 0.20 ml (4 drops) of blood from the same horse. Samples were analyzed for RBC count, nucleated blood cell count, total protein concentration, and nucleated cell differential count. Statistical analysis revealed no significant changes in nucleated cell number, nucleated cell differential, or total protein concentration in peritoneal samples contaminated with blood. The RBC count significan...
Psalla D, Rüfenacht S, Stoffel MH, Chiers K, Gaschen V, Doherr MG, Gerber V, Welle MM.Equine pastern vasculitis is clinically challenging and the underlying aetiopathogenesis is unclear. The aims of this retrospective study were to establish histopathological criteria for pastern vasculitis, to look for an underlying cause, to investigate whether the histopathological lesions are associated with a distinct clinical picture, to assess if and how the clinical picture varies, and to determine the treatment response. Skin biopsies and clinical data from 20 horses with a diagnosis of vasculitis of the distal extremities were investigated and histology was compared to biopsies from h...
Grabner A.Mycosis of the guttural pouches is a sporadic disease characterized by diphtheroid-necrotizing inflammation, and is caused by different fungal species, mainly by Aspergillus spp., Penicillium spp. and Candida spp. Highest incidence is during summer in stable horses. Proper diagnosis often requires--besides detection by mycological techniques--histological examination of tissue obtained by bioptic endoscopy. Prognosis is hopeless in late stages of the infection because of the erosion of the carotid artery or accompanied by the fatal complications of a not reparable cranial nerve damage also in ...
Meijer AE, van den Hoven R, Wensing T, Breukink HJ.In this communication, the results of an enzyme histochemical study on m. gluteus medius of horses, sensitive to exertional myopathy, during attacks of rhabdomyolysis are presented. The activity and location of about 25 enzymes were examined. In the present report, the early metabolic changes are discussed. Within 6 min after an attack, some large rounded fibres (approximately 2%) were seen, which showed an intense red staining in the haematoxylin and eosin sections. These hypercontracted fibres showed an increase in activity of mitochondrial adenosine triphosphatase, indicating the presence o...
Sandbaumhüter FA, Vimercati S, Thormann W, Mevissen M.The anesthetic ketamine is often combined with analgesics and benzodiazepines in equine medicine. Therefore, drug-drug interactions are possible. Enzyme kinetics for ketamine N-demethylation were determined using equine CYP3A94, CYP3A95 and CYP3A97, and the effect of medetomidine, diazepam and methadone on the ketamine metabolism was studied in vitro. Ketamine was incubated with the CYPs or equine liver microsomes (ELM) alone or in presence of medetomidine, diazepam and/or methadone for different times. Norketamine levels were determined using enantioselective capillary electrophoresis (CE) wi...
Ellero N, Lanci A, Baldassarro VA, Alastra G, Mariella J, Cescatti M, Castagnetti C, Giardino L.Neonatal Encephalopathy (NE) may be caused by hypoxic ischemic insults or inflammatory insults and modified by innate protective or excitatory mechanisms. Understanding the underlying pathophysiology is important in formulating a rational approach to diagnosis. The preliminary aim was to clinically characterize a population of foals spontaneously affected by NE. The study aimed to: (i) evaluate nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) levels in plasma samples obtained in the affected population at parturition from the mare’s jugular vein, umbilical cord vein an...
van de Velde LF.The present author's practice was offered the opportunity of testing a so-called buffy-coat analyser of the firm of Becton & Dickinson for its use in the field. He does not deny readers the report of his preliminary experience. In addition, the interpretation of the results and the limitations of the apparatus are briefly discussed.
Lawrence LM, Williams J, Soderholm LV, Roberts AM, Hintz HF.Four mature Standardbred horses were used in a 2-period cross-over design experiment to evaluate the effect of feeding state (fed or fasted) on metabolic response to 2 repeated bouts of exercise. Horses were either fasted 15 to 16 h before exercise or fasted for 12 h and then fed 2 kg of whole corn 2.5 to 3 h before exercise. In the first period, 2 horses in each feeding state were exercised. In the second period, the treatments were switched. The exercise test consisted of 2 exercise bouts separated by a 90 min recovery period. Each exercise bout included a warm-up phase and a high intensity ...
Marteniuk JV, Carleton CL, Lloyd JW, Shea ME.To determine whether sex of fetus, sire, month of conception, or year of foaling was associated with duration of gestation in mares. Methods: Epidemiologic retrospective cohort study. Methods: 500 foalings for 296 Standardbred mares. Methods: Data for reproductive events from 1986 to 1992 were analyzed. Analyses were conducted to determine whether duration of gestation was associated with sex of fetus, sire, month of conception, or year of foaling. Results: Mean duration of gestation was 343.3 days and was significantly greater for colt fetuses (344.4 days) than for filly fetuses (342.2 days)....
Marshall JF, Bhatnagar AS, Bowman SG, Morris NN, Skorich DA, Redding CD, Blikslager AT.Flunixin meglumine is used for treatment of equine colic despite evidence of inhibited recovery of mucosal barrier function following small intestinal ischaemic injury. This study aimed to characterise an alternative treatment (AHI-805) for abdominal pain in the horse. Objective: To determine the effect of AHI-805, an aza-thia-benzoazulene derivative, on the cyclooxygenase enzymes and the recovery of mucosal barrier function following ischaemic injury. Methods: Effect of AHI-805 on in vitro COX-1 and COX-2 activity was determined by measuring coagulation-induced thromboxane B(2) (TXB(2)) and l...
Rawlings CA, Bisgard GE.Renal clearance and excretion of endogenous substances were studied in 13 small adult ponies (152 plus or minus 93 (standard deviation (SD)) kg). Normal data of serum and urinary concentrations, clearance, and excretion of creatinine, osmolality, free water, sodium, potassium, and chloride during a 12-hour period are presented. Significant linear regressions on body weight (BW) were obtained for creatinine clearance (Ccr (ml/hr) = 127.2 times BW (kg) - 1553), osmolar clearance (Cosm(ml/hr) = 1.81 times BW (kg) m0.3), and free water (CH2O(ml/hr) = - 1.43 BW (kg) - 25.0). Compared with renal exc...
Subhahar MB, Singh J, Albert PH, Kadry AM.Etoricoxib, a selective inhibitor of cyclooxygenase-2, is used in the treatment of many inflammatory diseases and dental pain in humans. The aim of this study was to determine the pharmacokinetics and metabolism of etoricoxib in horses. Six horses weighing an average of 475 ± 25 kg were administered a single oral dose of etoricoxib at 1 mg/kg body weight. The results show that the drug reached a maximum concentration of 505.2 ± 67.8 ng/mL in 48 minutes after administration. The elimination half-life was calculated to be 10.20 ± 1.30 hours. Mass spectrometric analysis confirmed that eto...
Williamson AJ, McKinnon AO.Cystic urolithiasis is the most common form of urolithiasis reported in horses. In contrast to the gelding or stallion, clinical disease is less common in the mare and manual removal techniques are possible because of their shorter, wider urethral anatomy. However, these manual removal techniques can be traumatic and are limited by the size of the urolith. This report describes the use of a commercial laparoscopic specimen pouch to remove a cystic urolith in a mare. Conclusions: This approach may allow the extraction of larger uroliths per urethra in the mare, while affording some protection t...
Vaughan JT, Montes LF, Bembibre A, Blaquier PC.A 5-year-old Thoroughbred chestnut mare was presented because of multiple lesions noticed for approximately one year over the vulva and ther perianal areas. Clinically, there were moist warts that stood out because of their whitish color which contrasted strikingly with the surrounding, normally pigmented, uninvolved skin (Fig. 1). Repeated topical applications of 20% podophyllin in 95% ethyl alcohol produced rapid involution. Histopathologically, marked acanthosis, numerous mitoses, prominently vacuolated epidermal cells and a chronic dermal inflammatory infiltrate were seen (Figs. 2, 3, and ...