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Managing Pruritus
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‘The Itchy Horse’ - When you hear hooves think HORSES but remember that Zebras exist!
Pruritus is one of the commonest dermatological clinical presentations; it is a sign rather than a disease. Pruritus represents the final common pathway for a wide range of disorders some of which are common and easy to diagnose while others are more difficult! The most fundamental question may be simply to ask whether the signs are genuine pruritus or reflect pain, worry or even a neurosis. Psychogenic ‘pruritus’ is recognised in the self- multilation syndrome but is probably not genuine pruritus. Unless the underlying cause can be identified treatment will inevitably be symptomatic. Clinical investigation of the pruritic horse is often complicated by owners’ attempts at treatment; this is frequently ill-advised and often even harmful. A grading scale for pruritus has been suggested (ranging from 0 = no pruritic signs to 10 = extreme pruritic signs) but it has not gained any credibility in horses at least since there is no ‘typical’ degree or type of pruritus for any specific condition. (Scott and Miller 2003).
A really thorough (and honest) history helps significantly to narrow and refine the differential diagnoses. Refining a diagnosis is the key to successful treatment since once the cause is established the therapy (or lack of it!) is more logical. The temptation to embark on expensive diagnostic tests such as allergy and blood tests should be resisted since a high proportion of the cases encountered in practice will have a simple basis. Insect bite hypersensitivity (IBH) (most frequently due to Culicoidesspp. hypersensitivity) is probably the commonest single seasonal pruritic disorder. However, although the specific case may seem to be clear-cut, no differentials should be eliminated completely until all the clinical information has been gathered. [...]
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