CHRONIC PROGRESSIVELYMPHEDEMA IN DRAFT

HORSESProf. Dr. H. De Cock

University of Antwerp

CPL IN DRAFT HORSES

1.Lymphatics of the skin2.What is lymphedema?3.Causes of lymhedema4.CPL in draft horses

o Clinical signs - histologyo Diagnosis o Treatment

1.The lymphatic system of the skin

2. What is lymphedema?

Lymph vessels are abnormal in structure (congenital malformation or secondary to trauma) → accumulation of fluids in tissue → tissue swelling → hypoxia of tissue → skin fibrosis (hardening), hyperkeratosis and secondary bacterial infections (not proper functioning of immune system)

3. Causes

• Primary lymphedema: congenital malformation or malfunctioning of lymphatics (CPL most likely)

• Secondary lymphedema: after trauma or infection skin

4. CPL in draft horses

Clinical signs: Starts with mild enlargement distal limbs → skin folds in pastern region → hyperkeratosis and ulceration skin → swelling becomes hard and nodular → secondary skin infections → lymphangitis

CPL mild lesions Scratches or pastern dermatitis lookssimilar in initial stages

Lymphedema ≠ Scratches

Cause is poor function of lymph vessels

Many possible causes

Slowly progressive Usually does not progress

No or minimal improvement with regular treatment

Cure with good treatment

All 4 limbs affected 1 or 4 limbs affected

Lymphangiography

Histology

Extremely dilated and degenerated lymphatics, proliferation of blood vessels (hypoxia), edema, inflammation and degenerated elastin surrounding the lymphatics in CPL

Normal lymphatic

In CPL

Normal lymphatic

In CPL

Elastin difference between normal (left) and CPL (right)

Diagnosis

• Most importantant are clinical signs• Lymphoscintigraphy possible but not

routinely performed• Anti-elastin antibodies rise in serum

(ELISA test performed at University of Antwerp)

Treatment in humans

1.Good skin care2.Elastic bandages3.Exercise4.Manual lymph drainage

Treatment in horses

1.Good skin care → prevention trauma and irritation oChorioptes mites preventionoWound careoDry skin

Reason: irritation and inflammation increases lymph stasis in legs

treatment

2. Supportive elastic bandages, life long and as much as possible

Reason: pushes accumulated fluid out of the skin

treatment

3. Lots of exercise

Reason: muscle movement pushes fluid out of the tissues

treatment

1.Manual lymph drainage • Few people know how to do this in the

horse ≠ regular massage

Reason: pushes accumulated fluid out of the skin

Results of treatment: lesions before and after treatment

Met dank aan iedereen die meewerkte aan het project:Eigenaars

DierenartsenLeen Van Brantegem (UA)

Verena Affolter & Greg Ferraro (UCDavis) Prof. Ducatelle (UGent)

Technisch personeel UA, UGent & UCDavis