Chronic Progressive Lymphedema in Belgian Draft Horses: Understanding and Managing a Challenging Disease.
Abstract: Chronic progressive lymphedema (CPL) in draft horses is characterized by increased dermal thickness and fibrosis, with the development of skinfolds and nodules, hyperkeratosis, and ulcerations on the distal limbs of affected horses. Secondary bacterial, fungal, or parasitic infections frequently complicate and aggravate the lesions, as well as the progression of this disease. CPL has a particularly high prevalence of up to 85.86% in the Belgian draft horse breed. Due to the disease's progressive and incurable nature, affected horses are often euthanized prematurely. The treatment options are solely symptomatic, aimed at improving the horse's quality of life. Despite the severity of this condition, many uncertainties about its etiology and pathogenesis still remain to date. The established scientific research on CPL is rather limited, although there is an urgent need for strategies to tackle this disease. This review summarizes the available knowledge, serving as a guideline for practitioners, and provides perspectives for future research programs.
Publication Date: 2023-05-12 PubMed ID: 37235431PubMed Central: PMC10222719DOI: 10.3390/vetsci10050347Google Scholar: Lookup
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Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The study is about the chronic progressive lymphedema (CPL), a painful and incurable disease afflicting Belgian draft horses, which is characterized by increased skin thickness and fibrosis, amongst others. The research seeks to shed light on the disease’s characteristics, the available treatment options, and outlines potential paths for future study.
Chronic Progressive Lymphedema in Belgian Draft Horses
- The research centers on Chronic Progressive Lymphedema (CPL), a disease that predominantly affects Belgian draft horses. The disease is known for causing an increase in dermal thickness and fibrosis which leads to the development of skinfolds and nodules, hyperkeratosis (an increase in the skin’s keratin layer), and ulcerations on the lower limbs of the horses.
- The disease can become more complicated and severe due to secondary infections from bacteria, fungi, or parasites which aggravate the lesions and speed up the progression of the disease.
- Interestingly, the breed that seems to be most affected by this disease is the Belgian draft horse, with a prevalence rate of up to 85.86%, which is alarmingly high.
Treatment and Management of CPL
- Due to the progressive and incurable nature of CPL, horses affected by it are often euthanized prematurely. This is done mostly because the condition negatively impacts the quality of life of these horses.
- Current treatment options are focusing on managing the symptoms of the disease, mainly to improve the quality of life for the horse. The study does not provide specifics on these treatment options but suggests they are limited and purely symptomatic.
Research on CPL and Future Perspectives
- The research piece clearly identifies that despite the severity and high prevalence of the disease, there is still much to learn. Numerous uncertainties remain around the causes (etiology) and the development (pathogenesis) of the disease.
- Scientific research on CPL is limited, but as the research article suggests, there is an urgent need for it due to the damaging impact of the disease.
- The researchers aim to provide a thorough review of the available knowledge on CPL, serving as a guideline for those treating it and raising points of interest for future research programs. The hope is that these research programs will ultimately lead to a breakthrough in preventing or curing CPL.
Cite This Article
APA
Brys M, Claerebout E, Chiers K.
(2023).
Chronic Progressive Lymphedema in Belgian Draft Horses: Understanding and Managing a Challenging Disease.
Vet Sci, 10(5).
https://doi.org/10.3390/vetsci10050347 Publication
Researcher Affiliations
- Laboratory of Veterinary Pathology, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
- Laboratory of Veterinary Pathology, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
Conflict of Interest Statement
The authors declare no conflict of interest.
References
This article includes 96 references
- Schutzer E. Ein Beitrag zur Kenntnis der Dermatitis Chronica Verrucosa (Sogenannter Straubfuss). 1909.
- Gustine G. Die Sogenannte Warzenmauke des Pferdes “Dermatitis Chronica Verrucosa”.. 1910.
- Wussow W, Hartwig W. Die Zuchtverwendungsdauer der Beschäler des Landgestüt Kreuz und ihre Abgangsursachen. Tierzucht 1954;10:336–342.
- Ferraro G.L. Chronic progressive lymphedema in draft horses. J. Equine Vet. Sci. 2003;23:189–190.
- Affolter V.K. Chronic Progressive Lymphedema in Draft Horses. Vet. Clin. N. Am. Equine Pract. 2013;29:589–605.
- De Cock H.E., Affolter V.K, Wisner E.R., Ferraro G.L., MacLachlan N.J. Progressive Swelling, Hyperkeratosis, and Fibrosis of Distal Limbs in Clydesdales, Shires, and Belgian Draft Horses, Suggestive of Primary Lymphedema. Lymphat. Res. Biol. 2003;1:191–199.
- De Cock H.E., Affolter V.K., Wisner E.R., Larson R.F., Ferraro G.L. Lymphoscintigraphy of draft horses with chronic progressive lymphedema. Equine Vet. J. 2006;38:148–151.
- De Keyser K. Clinical Assessment, Genetic Parameters and the Role of Elastin in Chronic Progressive Lymphedema in the Belgian Draft Horse. 2014.
- De Keyser K, Janssens S, Peeters L.M., Gasthuys F, Oosterlinck M, Buys N. Chronic progressive lymphedema in the Belgian draft horse in Belgium: Clinical phenotyping, prevalence and risk factor analysis. Vlaams Diergeneeskd. Tijdschr. 2014;83:119–124.
- François L. Conservation Genomics of Living Heritage Breeds. 2018.
- Mittmann E.H., Mömke S., Distl O. Whole-genome scan identifies quantitative trait loci for chronic pastern dermatitis in German draft horses. Mamm Genome 2010;21:95–103.
- De Keyser K, Janssens S, Peeters L.M., Foqué N, Gasthuys F, Oosterlinck M, Buys N. Genetic parameters for chronic progressive lymphedema in Belgian Draft Horses. J. Anim. Breed. Genet. 2014;131:522–528.
- Ferraro G.L. Pastern dermatitis in Shires and Clydesdales. J. Equine Vet. Sci. 2001;21:524–527.
- Powell H, Affolter V.K. Combined decongestive therapy including equine manual lymph drainage to assist management of chronic progressive lymphedema in draft horses. Equine Vet. Educ. 2012;24:81–89.
- Affolter V.K., Dalley B., Kass P.H., Brown E.A., Sonder C., Bannasch D.L. Chronic progressive lymphedema in Friesian horses: Suggestive phenotype of affected horses and genome-wide association study. Vet. Dermatol. 2020;31:234-e51.
- Wallraf A., Hamann H., Deegen E., Ohnesorge B., Distl O. Analysis of the prevalence of pastern dermatitis in German Coldblood horse breeds. Berl. Munch. Tierarztl. Wochenschr. 2004;117:148–152.
- De Cock H.E., Affolter V.K., Farver T.B., Van Brantegem L., Scheuch B., Ferraro G.L. Measurement of skin desmosine as an indicator of altered cutaneous elastin in draft horses with chronic progressive lymphedema. Lymphat. Res. Biol. 2006;4:67–72.
- Wallraf A. Populationsgenetische Untersuchung zum Aftreten von Mauke bei den deutschen Kaltblutpferderassen. 2003.
- Bonnissent C.R. Étiologie du Syndrome “Pattes à Jus” Chez le Baudet de Oitou et le Trait Mulassier Poitevin. 2012.
- Boerma S., Back W., Sloet van Oldruitenborgh-Oosterbaan M.M. The Friesian horse breed: A clinical challenge to the equine veterinarian?. Equine Vet. Educ. 2012;24:66–71.
- Lynch L.L., Mendez U., Waller A.B., Gillette A.A., Guillory R.J., Goldman J. Fibrosis worsens chronic lymphedema in rodent tissues. Am. J. Physiol.-Heart Circ. Physiol. 2015;308:H1229–H1236.
- De Cock H.E., Van Brantegem L., Affolter V.K., Oosterlinck M., Ferraro G.L., Ducatelle R. Quantitative and qualitative evaluation of dermal elastin of draft horses with chronic progressive lymphedema. J. Comp. Pathol. 2009;140:132–139.
- Van Brantegem L., de Cock H.E.V., Affolter V.K., Duchateau L., Hoogewijs M.K., Govaere J., Ferraro G.L., Ducatelle R. Antibodies to elastin peptides in sera of Belgian Draft horses with chronic progressive lymphedema. Equine Vet. J. 2007;39:418–421.
- Meyer W., Neurand K., Schwarz R., Bartels T., Althoff H. Arrangement of elastic fibres in the integument of domesticated mammals. Scanning Microsc. 1994;8:375–390.
- Rockson S.G. The Lymphatics and the Inflammatory Response: Lessons Learned from Human Lymphedema. Lymphat. Res. Biol. 2013;11:117–120.
- Pereira de Godoy J.M., Guerreiro Godoy M.F., Pereira de Godoy H.J., De Santi Neto D. Stimulation of Synthesis and Lysis of Extracellular Matrix Proteins in Fibrosis Associated with Lymphedema. Dermatopathology 2021;9:1–10.
- Grada A.A., Phillips T.J. Lymphedema: Pathophysiology and clinical manifestations. J. Am. Acad. Dermatol. 2017;77:1009–1020.
- Young A.E., Bower L.P., Affolter V.K., De Cock H.E., Ferraro G.L., Bannasch D.L. Evaluation of FOXC2 as a candidate gene for chronic progressive lymphedema in draft horses. Vet. J. 2007;174:397–399.
- Geburek F., Deegen E., Hewicker-Trautwein M., Ohnesorge B. Verrucous pastern dermatitis syndrome in heavy draft horses. Part II: Clinical findings. Dtsch. Tierärztl. Wochenschr. 2005;112:243–251.
- Mömke S., Distl O. Molecular genetic analysis of the ATP2A2 gene as candidate for chronic pastern dermatitis in German draft horses. J. Hered. 2007;98:267–271.
- Mittmann E.H. Application of Horse Genomics to Identify Quantitative Trait Loci (QTL) for Chronic Pastern Dermatitis in German Draft Horses. 2009.
- Liao S., Von der Weid P.Y. Inflammation-induced lymphangiogenesis and lymphatic dysfunction. Angiogenesis 2014;17:325–334.
- Geburek F., Ohnesorge B., Deegen E., Doeleke R., Hewicker-Trautwein M. Alterations of epidermal proliferation and cytokeratin expression in skin biopsies from heavy draft horses with chronic pastern dermatitis. Vet. Dermatol. 2005;16:373–384.
- Lindgren G., Naboulsi R., Frey R., Solé M. Genetics of Skin Disease in Horses. Vet. Clin. North Am. Equine Pract. 2020;36:323–339.
- Nobles T., Miller R.A. Intertrigo. StatPearls [Internet] 2021.
- De Keyser K., Janssens S., Buys N. Chronic progressive lymphedema in draft horses. Equine Vet. J. 2014;47:260–266.
- Moncrieff G., Cork M., Lawton S., Kokiet S., Daly C., Clark C. Use of emollients in dry-skin conditions: Consensus statement. Clin. Exp. Dermatol. 2013;38:231–238.
- Johnsen H. Hyperkeratosis Chronic Progressive Lymphedema. 2021.
- Poore L.A.B., Else R.W., Licka T.L. The clinical presentation and surgical treatment of verrucous dermatitis lesions in a draft horse. Vet. Dermatol. 2012;23:71–75.
- Yu A.A. Equine Pastern Dermatitis. Vet. Clin. North Am.-Equine Pract. 2013;29:577–588.
- Johnsen H. Chronic Proliferative Pastern Dermatitis Chronic Progressive Lymphedema. 2021.
- Menzies-Gow N.J., Bond R., Patterson-Kane J.C., McGowan C.M. Coronary band dystrophy in two horses. Vet. Rec. 2002;150:665–668.
- Twitchell E.L., Hartman R.A., Waxman S.J., Lescun T.B., Miller M.A. Pathology in practice. Coronary band dystrophy with proliferative pododermatitis. J. Am. Vet. Med. Assoc. 2014;245:385–387.
- Jubb K.V.F., Kennedy P.C., Palmer N. Pathology of Domestic Animals. 5th ed. Volume 1. Integumentary System. 2016;pp. 553–554.
- Stannard A.A. Disorders of cornification. Vet. Dermatol. 2000;11:187–189.
- Nagamine C.M., Castro F., Buchanan B., Schumacher J., Craig L.E. Proliferative Pododermatitis (Canker) with Intralesional Spirochetes in Three Horses. J. Vet. Diagn. Investig. 2005;17:269–271.
- Brandt S., Schoster A., Tober R., Kainzbauer C., Burgstaller J.P., Haralambus R., Steinborn R., Hinterhofer C., Stanek C. Consistent detection of bovine papillomavirus in lesions, intact skin and peripheral blood mononuclear cells of horses affected by hoof canker. Equine Vet. J. 2011;43:202–209.
- Redding W.R., O’Grady S.E. Nonseptic Diseases Associated with the Hoof Complex. Vet. Clin. North Am. Equine Pract. 2012;28:407–421.
- Fürst A.E., Lische C.J. Chapter 90-Foot. In: Equine Surgery. 4th ed.. 2012;pp. 1264–1299.
- Geburek F. Zur Entstehung des Warzenmauke-Syndroms der Kaltblutpferde, klinische und histomorphologische Untersuchungen. 2002.
- Agneray S. Les pododermatites du cheval: Connaissances actuelles et étude rétrospective de cas de la Clinéquine du campus vétérinaire de Lyon. 2014.
- Adam E.N., Southwood L.L. Primary and secondary limb cellulitis in horses: 44 cases (2000–2006). J. Am. Vet. Med. Assoc. 2007;231:1696–1703.
- Kano Y., Momose T. Acute lymphangitis. Clevel. Clin. J. Med. 2020;87:129–130.
- Oomen A.M., Moleman M., Van den Belt A.J.M., Brommer H. An atypical case of recurrent cellulitis/lymphangitis in a Dutch Warmblood horse treated by surgical intervention. Equine Vet. Educ. 2012;25:23–28.
- Wilson W.D. Rational selection for antimicrobial use in horses; Proceedings of the 47th AAEP Annual Convention. 2001;24–28 November; pp. 75–93.
- Braid H.R., Ireland J.L. A cross-sectional survey of the diagnosis and treatment of distal limb cellulitis in horses by veterinary surgeons in the United Kingdom. Equine Vet. Educ. 2021;34:e234–e244.
- Yuan Y., Arcucci V., Levy S.M., Achen M.G. Modulation of Immunity by Lymphatic Dysfunction in Lymphedema. Front. Immunol. 2019;10:76.
- Kaiser-Thom S., Hilty M., Axiak S., Gerber V. The skin microbiota in equine pastern dermatitis: A case-control study of horses in Switzerland. Vet. Dermatol. 2021;32:646.
- Sangiorgio D.B., Hilty M., Kaiser-Thom S., Epper P.G., Ramseyer A., Overesch G., Gerber V. The influence of clinical severity and topical antimicrobial treatment on bacteriological culture and the microbiota of equine pastern dermatitis. Vet. Dermatol. 2021;32:173-e41.
- Cafarchia C., Figueredo L.A., Otranto D. Fungal diseases of horses. Vet. Microbiol. 2013;167:215–234.
- De Keyser K., Peeters L.M., Buys N., Janssens S. Assessment of skinfold thickness as a factor related to chronic progressive lymphedema in Belgian draft horses. Commun. Agric. Appl. Biol. Sci. 2010;76:189–192.
- Sievers J., Distl O. Prevalence of Chronic Progressive Lymphedema in the Rhenish German Draft Horse. Animals 2023;13:999.
- Verschooten F., Deprez P., Nollet H., van Loon G., Van Zeveren A., Devriese L., Vand Schandevijl K., Vandenberghe F., Delesalle C., De Clercq D.. De hengstenkeuring van het Belgische trekpaard. Vlaams Diergeneeskd. Tijdschr. 2003;72:224–232.
- Knottenbelt D.C. Pascoe’s Principles and Practice of Equine Dermatology. 2nd ed.. 2009;p. 502.
- Cremers H.J. The incidence of Chorioptes bovis (Acarina: Psoroptidae) on the feet of horses, sheep and goats in the Netherlands. Vet. Q. 1985;7:283–289.
- Rüfenacht S., Roosje P.J., Sager H., Doherr M.G., Straub R., Goldinger-Muller P., Gerber V. Combined moxidectin and environmental therapy do not eliminate Chorioptes bovis infestation in heavily feathered horses. Vet. Dermatol. 2011;22:17–23.
- Paterson S., Coumbe K. An open study to evaluate topical treatment of equine chorioptic mange with shampooing and lime sulphur solution. Vet. Dermatol. 2009;20:623–629.
- Suagee J.K., Bennett-Wimbush K., Splan R.K. Feeding Grass Hay Before Concentrate Mitigates the Effect of Grain-Based Concentrates on Postprandial Plasma Interleukin-1β. J. Equine Vet. Sci. 2020;86:102899.
- Suagee J.K., Burk A., Quinn R.W., Hartsock T.G., Douglass L.W. Effects of diet and weight gain on circulating tumour necrosis factor-α concentrations in Thoroughbred geldings. J. Anim. Physiol. Anim. Nutr. 2011;95:161–170.
- Federici M., Gerber V., Doherr M.G., Klopfenstein S., Burger D. Association of skin problems with coat colour and white markings in three-year-old horses of the Franches-Montagnes breed. Schweiz Arch Tierheilkd. 2015;157:391–398.
- Colman J., De Keyser K. Het scoren van de beenkwaliteit bij het Belgisch trekpaard. Ledenblad K.M.B.T. 2010;84:40.
- Pugh D.G., Hu X.P., Bourke K.H. Control of chorioptic mange mites on horses, donkeys, and mules Alabama Cooperative Extension System, ANR-1444.2013.. 2013.
- Van Brantegem L., de Cock H.E.V., Affolter V.K., Duchateau L., Govaere J., Ferraro G.L., Ducatelle R. Antibodies to elastin peptides in sera of Warmblood horses at different ages. Equine Vet. J. 2007;39:414–416.
- De Keyser K., Berth M., Christensen N., Willaert S., Janssens S., Ducatelle R., Goddeeris B.M., De Cock H.E.V., Buys N. Assessment of plasma anti-elastin antibodies for use as a diagnostic aid for chronic progressive lymphedema in Belgian Draft Horses. Vet. Immunol. Immunopathol. 2015;163:16–22.
- Gloor M., Fluhr J., Wasik B., Gehring W.J. Clinical effect of salicylic acid and high dose urea applied according to the standardized New German Formulary. Die Pharm. 2001;56:810–814.
- Piquero-Casals J., Morgado-Carrasco D., Granger C., Trullas C., Jesús-Silva A., Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol. Ther. 2021;11:1905–1915.
- Yu A.A. Pastern dermatitis. Current Therapy in Equine Medicine 2003;5th ed.;pp. 201–203.
- White S.D., Yu A.A. Equine dermatology. AAEP Annu. Conv.-San Antonio 2006;52:457–500.
- Sauvé F. Staphylococcal cutaneous infection in horses: From the early 2000s to the present. Can. Vet. J. 2021;62:1001–1006.
- Tasleem S., Naqvi S.B., Khan S.A., Hashimi K. ‘Honey ointment’: A natural remedy of skin wound infections. J. Ayub Med. Coll. Abbottabad. 2011;23:26–31.
- Almasaudi S.B., Al-Nahari A.A., El-Ghany E.A., Barbour E.K., Muhayawi S.M.A., Al-Jaouni S., Azhar E.I., Qari M.H., Qari Y., Harakeh S. Antimicrobial effect of different types of honey on Staphylococcus aureus. Saudi J. Biol. Sci. 2017;24:1255–1261.
- Kondratjeva J., Combarros D., Pressanti C., Cadiergues M.C. What is the most effective treatment in horses with chorioptic mange?. Equine Vet. Educ. 2022;35.
- Osman S.A., Hanafy A., Amer S.E. Clinical and therapeutic studies on mange in horses. Vet. Parasitol. 2006;141:191–195.
- Kotb S., Abdel-Rady A. Epidemiological studies of equine mange with special reference to different therapeutic protocols for effective treatment of Chorioptic mange. Assiut Univ. Bull. Environ. Res. 2013;16:29–52.
- Littlewood J., Rose J., Paterson S. Oral ivermectin paste for the treatment of chorioptic mange in horses. Vet. Rec. 1995;137:661–663.
- Rendle D.I., Cottle H.J., Love S., Hughes K.J. Comparative study of doramectin and fipronil in the treatment of equine chorioptic mange. Vet. Rec. 2007;161:335–338.
- Curtis C.F. Pilot study to investigate the efficacy of a 1 per cent selenium sulphide shampoo in the treatment of equine chorioptic mange. Vet. Rec. 1999;144:674–675.
- Heile C., Schein E. Wichtige Parasitosen beim Pferd und deren strategische Bekämpfung-ein Überblick. Teil 2: Ektoparasitosen. Der Prakt. Tierarzt. 2005;86:248–253.
- Westermann C.M., Boerma S., van Nieuwstadt R.A. Amitraz-intoxicaties bij het paard; casuïstieken en achtergronden [Amitraz intoxications in the horse: Cases and backgrounds]. Tijdschr. Diergeneeskd. 2004;129:438–441.
- Auer D.E., Seawright A.A., Pollitt C.C., Williams G. Illness in horses following spraying with amitraz. Aust. Vet. J. 1984;61:257–259.
- Liebisch A., Oldbrich S., Deppe M. Untersuchungen zur Uberlebensdauer von Milben der Arten Psoroptes ovis, Psoroptes cuniculi and Chorioptes bovis abseits des belebten. Dtsch. Tierarztl. Wochenschr. 1985;92:181–185.
- Vlaminck L., De Cock H.E.V., Hoesten H., Gasthuys F. Epidermal shaving for hyperpapillomatosis secondary to chronic progressive lymphedema in Belgian draft horses. Vet. Dermatol. 2008;19:76.
- Callebert J. Beenscores van de dierenartsen. Ledenmagazine K.M.B.T. 2016;108:49–52.
- Janssens S. De genetica van CPL. Trekpaard Jeugd; Ranst, Belgium 2018;pp. 23–26.
- Janssens S., Chapard L., Buys N. Genetische variatie bij het Belgisch trekpaard (deel 2). Ledenblad V.F.B.T. 2021;2:14–15.
- Franklin I.R. Evolutionary change in small populations. Conservation Biology: An Evolutionary-Ecological Perspective 1980;pp. 135–149.
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