Sarcoids: Treatment or Management?

Over the past 8 months I have gone from not really having a clue as to what a sarcoid was to becoming a self proclaimed expert. (ish) What I did know was what most people seemed to know, that they are a little warty growth what makes a horse worth less money. However, since Scottie developed one just over a month after passing his vetting -_- I have become slightly obsessed with researching them.

The most depressing thing I learnt about sarcoids is that they are a pain in the ass to treat and often treatment fails and generally makes them worse. After finding this out and talking to an animal vet at my yard, I decided to leave it be unless it changed. However, I didn’t leave it there.

I knew flies are attracted to sarcoids and have been known to make them worse. So I did what most horse owners do these days, and took to social media to ask for the best way to manage sarcoids. I was bombarded by all sorts of conventional and herbal treatments and their experiences with different ones. I thought this was interesting and kept this in mind as I continued to watch Scottie’s sarcoids.

In January I was set an assignment to design a factsheet for a condition from a long list of 30. Skimming down the list Sarcoids jumped out on me and I thought that would be perfect. I started doing more and more research into them and I decided that if Scottie’s sarcoids did get any worse I wouldn’t want to be treating during the summer months. This is about the time I decided  to try the herbal route. My opinion being, it might not do anything to help, but it can’t make them worse like other treatments.

My first line of thinking was to try Sarc Ex by Global Herbs. A few people had mentioned it to me and Supa Hoof by Global Herbs had done wonders for Scottie feet, so I thought I would give it a try. However, a couple of weeks in I found another sarcoid which had developed in his armpit. It was at this point I went back to Facebook for some more opinions. One or two people said stick with Sarc Ex, however the majority of people highly recommended turmeric again, several people saying they saw no improvement after 6 months of Sarc Ex but huge improvements within months of using turmeric. they also pointed out that turmeric was a fraction of the price of sarc ex. I know that you shouldn’t switch after less than a month, however I was sold.

51ryjangk8l

(£29 ish)

I did the good thing and finished the rest of the Sarc Ex while waiting for the turmeric to arrive. Scottie has now been on turmeric for nearly a week and although not seen any changes yet but I am going to take photos every 3 weeks to keep a record of any changes. My hope is that it will either prevent them growing any more or help get rid of them, but we will see.

turmeric

(£11 ish)

If you are considering using turmeric for treating sarcoids I would advise joining the Turmeric user group on Facebook. Full of great advise as well what you need to feed alongside it for it to be into the horses system. Or feel free to ask any questions below, but I would recommend the group.

I’m going to add my Factsheet below in case any of you are interested in some further reading! It also has my bibliography at the end.

Factsheet:

What are they?

Sarcoids are skin tumours believed to be caused by the Bovine Papilloma Virus. They can be on or below the surface of the skin, but only ever affect the skin. Therefore they will not spread to other organs like other forms of cancer. They affect horses all over the world and affect 6-7% of the UK Equine population and usually first occur in horses between 2 and 10 years of age. They can occur anywhere on the body, but are most commonly found on the face, groin and girth areas. It is believed they first form where the skin is thin, normally areas where flies feed from.

There is no evidence for sarcoids being heritable. However, there are several different studies to show that horses can be genetically predisposed to sarcoids. Jandova et al found that sarcoid development is linked to chromosomal regions ECA 20, ECA 23 and ECA 25. These regions include genes for virus replication and host immune response and therefore could affect how the horse deals with the Bovine Papilloma Virus. Their research also suggested that the heritability of this predisposition to sarcoids is around 8-21%.

What do the look like?

The appearance of a sarcoid is determined by the type of sarcoid. Many appear as bald, wart like growths. However some grow under the skin and appear as a small lump under the surface of the skin.

There are 6 different types of sarcoid which vary in appearance and activity:

Occult

Normally appear as small round bald patch or area of poor/different quality coat. They are often mistake for other things such as ringworm or rub marks and most commonly appear on face, groin and armpits. Any interference (even accidental) often results in transforming into a more serious form of sarcoid.

occult

Verrucous

Normally have a warty appearance, being grey and scaly. There is usually hair loss in the area, but might just be decrease in quality of the coat. They are most common on the face, groin, arm pit and sheath. As with the Occult sarcoid, they are often mistaken for other skin conditions including ringworm and often deteriorate into a more serious form of tumour if interfered with.

Verrucous

Nodular

Nodular sarcoids form under the skin and are often mistake for cysts and insect bites. They are most commonly found on the eyelid, groin, inner thigh and armpit. If there are multiple they can often form together to look like a bunch of grapes. These tumours are very problematic in the eyelid as they often have extensive roots.
There are two main types based on the skin involvement:
– Type A have no skin involvement, meaning you can manipulated them separately to the skin. They tend to be found in the girth areas where the skin is thicker and they have been unable to get through the skin. The skin may lose hair in the area.
– Type B does have skin involvement, meaning you can either see them or feel them when manipulating the skin. The skin above is often hairless resembling a verrucous lesion and if it becomes damaged can quickly develop into a fibroblastic tumour.

nod

Fibroblastic

This type of sarcoid often develops from less serious types after damage. They can occur anywhere on the body, including on the site of an injury. Fibroblastic tumours are also commonly bleed easily and have a wet/scabby surface.
There are two main types of fibroblastic tumour:
– Pedunculated have a thin stalk with a large growth on the end and may or may not have a root.
– Sessile have a broad, wide base.

fib

Mixed

Mixed sarcoid is the diagnosis given to an area which has two or more types of sarcoid present without a single type being dominant. They are most commonly found on the head, groin and armpit.

 mix

Malignant

Malignant sarcoids are rare, but most commonly found on the face, armpit and groin. Malignant sarcoids have only recently been classified as extensive local or wide spread lesions through the skin and subcutaneous tissue. Large lesions are often misdiagnosed as malignant, but it is not the size but the extension.

This is a very aggressive type of tumour and unlike other forms it will not cure itself. There is currently no treatment, only management and improvement. It is believed that it can be caused by incomplete treatment of other/earlier lesions.

Mal

Problems they cause?

Sarcoids rarely directly affect the health of the horse. However, depending on size, location and the number they can become sore, irritated and have been known to bleed. Larger tumours are likely to get caught or put pressure on the surrounding tissue. This can cause problems on areas around the eyes or on the sheath. Flies are also drawn to sarcoids which can cause more irritation and infection. However, the worst thing about sarcoids is how difficult they are to treat. Each horse and sarcoid reacts differently to treatment and once one treatment has failed, prognosis for any future treatment drops to around 40%.

How to choose treatment?

  • Tumour type and behaviour
  • Location
  • Tumour size
  • Time between tumour forming and treatment
  • Owner and horse compliance
  • Facilities and expertise
  • Cost

Available treatments:

There are over 40 known treatments for sarcoids, proving that there is no one easy way to treat them. These are some of the most used:

  • Surgical Removal
    Surgery is often chosen for small sarcoids however it has a high failure rate; success rate is higher after using other treatments first. There are procedures which can be taken to reduce risk of return. Nodular lesions on the thigh and groin region respond best to surgery.
  • Ligation
    This method consists of banding the sarcoids so the blood supply is cut of and they fall off. It should only be use on sarcoids which do not have a root formation and can be dangerous if they do have a root. This method is often used by owners and causes more problems.
  • Cryosurgery
    Otherwise known as freezing. This method only works for small, shallow lesions. It is very time consuming as each sarcoid needs to be frozen and thawed at least 3 times. There is also a high rate of reoccurrence.
  • Immune Methods
    This method works well for nodular and fibroblastic lesions around the eyes. It involves injecting the human BCG injection directly into the sarcoid with a pressure syringe. Should not be used on the limbs as usually makes them much worse. There is a risk that the horse will react badly to the protein in the injection.
  • Chemotherapy
    Chemotherapy usually consists of injecting cytotoxins or 5-Fluoro-urcail directly into the sarcoid. It is often considered one of the best methods of treatment; however it is only suitable for a small number or sarcoids and the chemicals used are potentially harmful to the vet.
  • Topical Cytotoxic Therapy
    Only available to vets for individual horses. It is very penetrative and sarcoids often get worse before getting better, causing the horse swelling and possible pain. Pain killers are often needed after treatment.
  • 5-Fluoro-uracil cream
    Effective on superficial occult sarcoids or as pre-treatment to surgery. It is only available by prescription.
  • Topical Adjunctive Agents
    Adjunctive treatments are treatments to use alongside other methods. There are 3 types that are said to work but still being researched and tested. These are:
    – Exterra cream, a mixture of plant extras and chemicals available in the US, prescription only.
    – Imiquimod, available for topical use on humans. Seems to be effective on some types of superficial sarcoids.
    – Retinoid drugs, currently being tested by Liverpool University. Works well for occult but rarely works as the only treatment.
  • Photodynamic Therapy
    So far only tested on a small number of horses but seems effective on small isolated lesions. This method involves the cells absorbing a photodynamic chemical and then using specific light intensity and wavelength to activate the chemical and damaging the cells. It has limited use.
  • Electrochemotherapy
  • Laser Surgery
    The chance of reoccurrence in horses with
  • Homeopathic
    These treatments are considered useless by the scientific side of the industry, with there being absolutely no evidence for them working. However, many horse owners swear by herbal treatments for sarcoids, often turning to them after conventional treatment failed. One homeopathic treatment many owners swear by, is feeding turmeric powder. Although there is no evidence or research into whether it actually works, many sarcoids have shrunk or disappeared completely while being fed turmeric. In fact some owners turned to turmeric after conventional medicine failed and saw improvements. However, some sarcoids go by themselves and herbal treatments might just be a coincidence.

Reoccurrence:

The biggest issue with sarcoids is that even with successful treatment, there is a high return rate, often with the sarcoids coming back larger and more aggressive than before. Therefore, the cost of the treatment often isn’t worth the risk of failure. It is this reason that many owners and vets decide not to treat small or unproblematic sarcoids.

Conclusion:

When my horse first developed a sarcoid I spoke to several different vets who all gave me different opinions on what I should do. Since it hadn’t grown since I had noticed it and it was out of the way, I decided to leave it alone and just watch it. More recently I have noticed a few patches of skin I think may develop into new sarcoids; again they are in out of the way and not worth treating as they are. I have therefore decided to go down the herbal route. I have started feeding turmeric as it was heavily recommended and I take the view of it is cheap and won’t make them any worse, whereas conventional medicine is expensive and there is a high risk of future problems.

As there is no universal treatment for sarcoids, there is still continuing research into new or improving treatment. Knotten at the University of Liverpool is currently one of the top scientists working on sarcoids and sarcoid treatment. One of the current best treatments for sarcoids is Liverpool cream, a cytotoxic cream developed by the University of Liverpool. Since there are so many owners swearing by herbal treatments and the fact that one of the tried and tested adjunctive treatments is based on herbal extracts, this could be a route for further research.

Bibliography:

Christen, G. Gerber, V. Dolf, G. Burger, D. Koch, C. (2014) Inheritance of equine sarcoid disease in Franches-Montagnes horses. The Veterinary Journal 199 68-71

Compston, P. Turner, T. Payne, R. (2013) Laser Surgery as A Sole Treatment of Histologically Confirmed Equine Sarcoids: Outcome and Risk Factors for Recurrence. Equine Veterinary Journal 45 2

Dick Vet Equine Practice. (2015) Sarcoid Fact Sheet. [www.doc]

Heath, S. (2013) Top vets warn against treating sarcoids with toothpaste. Horse and Hound. [www.doc]

Horse and Hound (2011) Mistle toe extract found to treat sarcoids in horses. [www.doc]

Horse and Hound (2010) Scientists believe they have found a cure for sarcoids. [www.doc]

Horse and Hound (2003) To buy or not to buy. [www.doc]

Horse Talk (2013) Non-surgical managements of sarcoids in the horse. [www.doc] http://horsetalk.co.nz/2013/09/30/non-surgical-management-sarcoids-horse/#axzz3XN1i5QZ5 (accessed 15/04/2015)

Jandova, V. Klukowska-Rötzler, J. Dolf, G. Janda, J. Roosje, P. Marti, E. Koch, C. Gerber, V. Swinburne, J. (2012) Whole genome scan identifies several chromosomal regions linked to equine sarcoids. Schweizer Archiv für Tierheilkunde 154 19-25

Knotten, D. (2015) Sarcoids: facts you need to know. University of Liverpool. [PDF.doc] http://www.liv.ac.uk/sarcoids

Lane, J. (1997) The treatment of equine sarcoids by cryosurgery. Equine Veterinary Journal 9 127-133.

Stadler, S. Kainzbauer,  C. Haralambus, R. Brehm, W. Hainisch, E. Brandt, S. (2011) Successful treatment of equine sarcoids by topical aciclovir application. Veterinary Record.

Tamzali, Y. Borde, L. Rols, M. Golzio, M. Lyazrhi, F. Teissie, J. (2012) Successful treatment of equine sarcoids with cisplatin electrochemotherapy: A retrospective study of 48 cases. Equine Veterinary Journal 44 214-220.

The Turmeric User Group (2015) Facebook. [www.doc] https://www.facebook.com/groups/415313751866609/ (accessed 30/03/2015)

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