Changes

==Diagnosis==

==Diagnosis==

'''Cytological''' analysis of '''FNA's''' may provide a diagnosis. Smears should show a '''chronic, active, sterile eosinophilic [[Chronic Inflammation - Introduction|inflammation]]'''. Eosinophils, neutrophils, macrophages and mast cells may all be present. This is common for a non-specific inflammatory response.   

'''Cytological''' analysis of '''FNA's''' may provide a diagnosis. Smears should show a '''chronic, active, sterile eosinophilic [[Chronic Inflammation - Introduction|inflammation]]'''. [[Eosinophils]], [[neutrophils]], [[macrophages]] and [[Mast Cells|mast cells]] may all be present. This is common for a non-specific inflammatory response.   

Diagnosis can be confirmed by '''biopsy'''. '''Histopathological''' examination should show a '''granulomatous eosinophilic inflammation surrounding multifocal areas of collagen degeneration'''.  

Diagnosis can be confirmed by '''biopsy'''. '''Histopathological''' examination should show a '''granulomatous eosinophilic inflammation surrounding multifocal areas of collagen degeneration'''.  

==Differentials==

==Differentials==

Any nodular disease may be considered a differential diagnosis. [[Hypoderma spp.|Hypoderma]] should be considered, but in these cases a breathing pore is normally present.  

Any nodular disease may be considered a differential diagnosis. [[Hypoderma spp.|''Hypoderma'']] should be considered, but in these cases a breathing pore is normally present.  

==Therapy==

==Therapy==

* '''Surgery''' — complete surgical excision. Normally only appropriate for single lesions. This is the only effective treatment for mineralised lesions.  

'''Surgery'''

:Complete surgical excision is normally only appropriate for single lesions. But this is the only effective treatment for mineralised lesions.  

* [[Steroids|'''Glucacorticoids''']] — administered systemically or intralesional.

[[Steroids|'''Glucacorticoids''']] — administered systemically or intralesionally.

:'''[[Steroids|Glucacorticoid]] administration intralesionally/perilesionally/sublesionally''' may be effective. Treatment is normally with either triamcinolone acetonide or methylprednisolone acetate. A total dose should be calculated prior to administration to prevent the development of [[Laminitis - Horse|'''laminitis''']] from exogenous steroids.

If the granulomas are recurrent it may be worth investigating underlying causes such as insect [[:Category:Hypersensitivity|hypersenstivity]]. This can be achieved by intradermal allergy testing, and management of this using insect control measures and hyposensitisation may be enough to prevent recurrence in the future.

 

 

If the granulomas are recurrent it may be worth investigating underlying causes such as insect hypersenstivity. This can be achieved by intradermal allergy testing, and management of this using insect control measures and hyposensitisation may be enough to prevent recurrence in the future.

{{Learning

{{Learning

 

[[Category: To Do - Siobhan Brade]]

[[Category:Dermatological Diseases - Horse]]

[[Category:To Do - Manson review]]

[[Category:Expert Review - Horse]]