# Nasty sarcoid explosion- how would you protect?! **Treatment Updates**



## egrogan (Jun 1, 2011)

My mare has had a slow developing sarcoid for months, but it ulcerated and basically exploded overnight. Vet had been planning to treat this winter, to avoid flies on raw skin. Well, wih this development we're basically there now regardless.

This was the size of a pea last night. Today it looks like this.

This is in her "armpit" area and I'm trying to figure out if it's better to bandage (how?!) or just keep it clean and swatted up? She's never been sensitive about touching it but is understandably tender right now. Any help on bandaging ideas?

Trying to upload pix via mobile, might take me a minute
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## egrogan (Jun 1, 2011)

OK, couldn't get the picture off my phone, had to wait until I got home to the computer. It's below.

For months, it just looked like the flat dry-skin patch you see in most of the picture. About a month ago, it sprouted a pea-size nodule in the front. Vet wanted to watch and wait to treat after flies were gone later this fall. Then literally in 24 hours, the pea exploded into this huge, nasty sore. It was dripping blood when I got there tonight and obviously very raw.

Vet coming tomorrow morning to assess our next steps. I still would love any suggestions on how to bandage, if necessary, in this particular location. I think probably we're going to need to move forward with treatment (he's leaning towards the topical Aldara option), but I'm not sure given the flies. Thanks for any thoughts on your experience with this or more general advice on keeping the "armpit" protected and clean.


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## Roperchick (Feb 1, 2010)

we had that problem with our old arabian. since it was his armpit it was impossible to keep it wrapped up. we basically just put SWAT on it alot.

not alot really worked with him.


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## Cherie (Dec 16, 2010)

With that much loose skin, I would probably remove the entire section of skin in an elliptical shape (like a football) and suture the clean edges back together.

We did that many years ago and it never returned. If there is enough skin to do it, it would be my method of choice to get rid of any of them.

If there is not enough skin to just remove the whole thing, then I like to use a liquid Nitrogen application to freeze it and kill the base so that it does not come back.

I have used Blood Root (I believe it is in the active ingredient in X-terra) and Fluoride Tooth Paste and still have not had anything work as good as complete removal or freezing.


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## Super Nova (Apr 27, 2010)

That's a pretty small sarcoid as far as sarcoids go ........my gelding had a sarcoid that grew to about 2" in diameter and then one winter just disappeared. 

Super Nova.


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## egrogan (Jun 1, 2011)

Super Nova- thanks for putting things in perspective. I've been researching sarcoids for months, and you're right, comparatively this isn't that graphic. Particularly compared to some pictures I've seen of sarcoids around the eye. I guess it was just the sudden change and the raw, bloodiness of it that got me.

Meeting the vet in about an hour. Hopefully he shares your opinion


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## Super Nova (Apr 27, 2010)

egrogan said:


> Super Nova- thanks for putting things in perspective. I've been researching sarcoids for months, and you're right, comparatively this isn't that graphic. Particularly compared to some pictures I've seen of sarcoids around the eye. I guess it was just the sudden change and the raw, bloodiness of it that got me.
> 
> Meeting the vet in about an hour. Hopefully he shares your opinion


Where it is and what type it is will determine what you do about it.

My guy also has a moderate case of PSSM and has some heart issues so we didn't bother to treat as he is just a pasture pet. Treatment is expensive and not always successful. If it had been my daughter's show horse I would have treated as soon as I saw it.

The body is supposed to eventually recognize the foreign body and get rid of it on its on which is what happened to my guy.....but he does now have another one in a completely different location......but my guy's immune system is likely not a hundred percent.

Super Nova


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## kitten_Val (Apr 25, 2007)

I don't think you can protect it down there unfortunately. I agree with Cherie on possible approach. (I did look into sarcoids as well quite a bit, looks like many horses got them  ). Please, let us know what vet says!


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## Super Nova (Apr 27, 2010)

Well I am not sure that I would protect it.....the "angrier" it gets the more likely the body will recognize it as a foreign body and start attacking it. 

I would just try to keep the flies out of it.

Super Nova


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## kitten_Val (Apr 25, 2007)

Super Nova said:


> Well I am not sure that I would protect it.....


By "protection" I meant flies, SN.  Flies seem to LOVE those spots and they get eaten up (and bloody) in no time in my experience.


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## egrogan (Jun 1, 2011)

We did move forward with treatment yesterday. I got to the barn before the vet, and there was quite a lot of edema in the area. He took that as a somewhat positive sign, in that the body was starting it's own immune reaction to the growth. He does not like the surgical option, as in his experience, it's very difficult to get all underlying tissue, particularly since most of her tumor is "occult" or "plaque" type- i.e., the flat portion of it.

Step 1 started yesterday. He injected the tumor in several places, but focused on and under the large nodule, using cisplatin, essentially a chemotherapy drug. She will be given about 2 weeks to see if this causes an immune reaction which triggers sloughing of the skin. Vet said this will increase the edema significantly- he wouldn't be surprised if she's swollen to the size of a softball under there in the next couple of days. From there, if the tumor does begin to die, it will get worse before it gets better, producing a really large, open wound (getting "angry," as Super Nova described). Part of the reason for not debulking with surgery is to provide an injection site if we continue this approach.

If the injection doesn't seem to have any affect, then we will move to option 2, which will be topical treatment with Aldara cream. From what I've read, this does seem to have good results, but again will be accompanied with a really nasty open wound before healing eventually begins in 2-4 months.

The flies are definitely concerning me in either of these treatment options, as from looking at extensive pictures of other horses in treatment, I know what's coming, and this is absolutely the worst time of year for it. I've only really ever dealt with scratches and scrapes, so all I really know to do for flies is clean thoroughly with Betadine scrub wash and then cover liberally with SWAT. What else would you be doing with a much more significant wound that really can't be covered?

I think what's most frustrating about all of this is that I know this likely won't be the last sarcoid we deal with. Everything I've read indicates that once you begin treating, you're almost guaranteed to have another one pop up somewhere else in the future. I guess I can only hope that they never show up around her eyes, as those seem the worst.

Here are a couple of pictures from right after the injections yesterday. The pictures really hide the swelling, but it was pretty significant. The pictures also don't do a great job of showing how the texture of the nodule had already started changing. In person, it reminded me of the texture of a seed after you soak it in water- turning a little wrinkly and opaque. And just for comparison, the last picture is what it looked like back on June 30th- you can see how quickly the change has happened. 

I'll plan to update this throughout the process in case it will be helpful for others making treatment decisions in the future. I will say I got some great advice regarding when to treat from one of the Minnesota vets involved in the Aldara study- she said a useful rule of thumb was that when the sarcoids are pea size, they're probably fine to leave, but when they become grape size, it might be time to start thinking of treatment. Obviously a judgement call for vet and owner.


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## egrogan (Jun 1, 2011)

Oh, one other thing- Isabel was light sedated yesterday for the injections, which ended up being a good thing. The nodule was REALLY hard, and the vet had to use a lot of force to penetrate it with the needle. Since neither of us had ever seen her sedated, he started with a low dose (she's an ~900 lb Morgan), and it was a good thing, because she was absolutely wasted from the shot almost instantly. I was actually a little worried she was going to go down, she was so unsteady. So, just a public service announcement to know your horse when it comes to sedation- I know now that she needs really light sedation. Bonus was that he only charged me for a "low dose"


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## egrogan (Jun 1, 2011)

*Two days post-injection*

Still lots of edema, but Isabel is in good spirits and was happy to graze while I cold-hosed the leg to try to bring down the swelling. A bit fidgety while I was cleaning it out though. 

Starting to see some evidence of sloughing- you can see on the underside of the nodule that the skin is rupturing. No evidence of sloughing on the occult portion of the sarcoid though, just lots of swelling.

We may get a break with the weather- the humidity has broken, temperatures are back in the low 80s, and the flies were better today.


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## egrogan (Jun 1, 2011)

*Treatment update- first slough*

I'm posting a treatment update in case this is helpful for anyone else dealing with sarcoids in the future.

We are know about a week and half post-Nomagen injection, and we had our first slough. The hard black "shell" came off this morning while cleaning, though I'm a little disappointed that it left a raw "stump" behind. This isn't totally unexpected, but I wish it had taken the whole nodule with it. We still have a lot of work to do.

Vet is on vacation until next week, but I've been updating him on progress via email with pictures (what a great vet to respond to emails like that while on vacation!! ), and when he gets back, we're going to sit down to come up with a plan for the next several weeks. He indicated he's actually surprised there's been this much of a reaction to the injections. I personally didn't feel like we were making much progress, but he clearly has more experience than me. I think we will probably go to the Aldara cream next, but it's possible there will be one more round of injections.

I'm a little concerned about keeping the raw stump clean and infection free (picture below), but he continues to say that I should just rinse it out once a day and not cover it. I have been putting a little Neosporin ointment on it, but am interested in other opinions about that. Vetiricyn seems popular- thoughts for this circumstance? Would it be too harsh?


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## kitten_Val (Apr 25, 2007)

Bumping up for OP...


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## SilverShadowStable (Dec 31, 2011)

We are currently working with our Curly who is almost completely healed from his sarcoid. We actually did the "crest" treatment in spring and then left it because all it seemed to do was leave a bunch of matted fur for us to clean 12 hours later. Much to our surprise about a month later a dripping hole with a pulpy mass around the edges showed up a month later so we took him to the vet to eradicate the rest of the mass left behind. The vet had not seen the sarcoid so had not been the one that originally diagnosed it years earlier. (It was a small plaque for years the first vet said not to disturb it until it grows.)she cut the mass off that was left behind and sent it in to biopsy since she would not believe it was originally a sarcoid. She prescribed unpasturized honey to protect it. I know that works well in winter but I used what UC Davis director Dr. Ferrara prescribed to keep flies off and promote healing which is Sulphur mixed in mineral oil. Vaseline works really well too as better antibacterial properties. It's cheap, effective and excellent to promote skin regrowth and flies hate it. The sulphur is a known component that helps skin and the only flies aggressive enough to get past the sulphur pat were those small- med biting type that would lad on the dripping part that shed the salve off when dripping. Anyhow, the healing scar is now the size if pencil eraser head, down from a mess the size of a 1/2 cup measure that had grown agressively from a loonie sized plaque. The biopsy showed proud flesh and sarcoid cells. The vet wants to now inject the horse to prevent reaccurance of any sarcoids. I am not sure it's needed but he's booked for re-exam here in a month. 
Sorry long winded, but I thought I would explain everything. All sarcoids are not the same and the debulking worked with the leftover proudflesh, which we think was caused by the trainer currying the sarcoid under the curly's tummy, causing it to bleed and grow the proudflesh aggressively. 
The salve: Pure sulphur from pharmacy (real cheap!) mixed heavily into EITHER Vaseline until very sunshine yellow, or Mineral oil (I used heavy type not light) until very thick. You can actually stick light gauze to this salve to further deter flies until horse rubs the gauze off. I have seen this work excellent on a large shoe boil for a mare that was not a candidate for surgery to have it removed. 
Raye Anne

but
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## egrogan (Jun 1, 2011)

I can't believe it's been so long since updating. After the vet's injections did lead to much progress, we pressed pause on sarcoid treatment over the summer to let the bugs die down. Today was the big day- we had our first hard frost over the weekend, so we started the Aldara sarcoid treatment. I did a double take when I saw the price for 12 barely full little pouches of topical ointment, but $345 later, we're on our way. Just fair warning to anyone else considering going this route- the Univ. of Minnesota website estimates treatment to cost about $100/month, but that was not my experience. Granted, I chose to buy at a regular CVS pharmacy, as I didn't really trust the online pharmacies- but my vet really thought it would have been cheaper that way. Fingers crossed it's all going to be worth it.

Question- the instructions said to wear gloves when applying. I used a regular latex glove, but I couldn't tell if that was allowing as much ointment as possible to get on my mare- it seemed like I was wiping it off more than putting it on. Anyone have any experience with how much wasting of ointment might happen when wearing a glove to apply? Given how pricey this stuff is, I want every single drop making contact with our nasty little friends.

Isabel didn't flinch at all when I put it on- for some reason, I had built this up in my head as a dramatic, acid-like reaction the second the cream touched the skin. But, nothing happened, she just stood there longingly looking back in her stall for her dinner.

From here, I'm supposed to apply Mon-Wed-Fri for the next 4 weeks, and then reassess. I'm prepared for a gaping, open wound that needs to be cleaned before reapplication. Supposedly this will be painful enough that the protocol suggests bute if she seems really uncomfortable. I obviously don't want her to be in pain, but I want these nasty things gone!


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