Equine pastern dermatitis: a narrative review on clinical presentation, diagnosis, risk factors, prevention, and therapeutic approaches.

Equine pastern dermatitis (EPD) is a nonspecific cutaneous reaction pattern on the distal extremities, typically in the palmar/plantar area of the pastern. Although EPD is commonly seen in equine practice and can be a debilitating condition, peer-reviewed original studies on many aspects of this multifactorial syndrome are still scarce. This narrative review aims to give an overview of the clinical presentation (forms of EPD and clinical scores and differential diagnoses), risk factors, and therapeutic approaches. The emphasis is on intrinsic and extrinsic risk factors as most of the original work has been published on these aspects. The available data supports the effects of age, breed, and breed-related phenotypical traits (draft breeds with feathers and large cannon circumference) on the frequency and severity of EPD manifestations. Hind legs and unpigmented limbs are also more frequently affected. Genetic effects in draft breeds appear to be complex, and no commercial genetic tests currently exist. Evidence for meteorological effects like rainfall and humidity is inconclusive. Associations with Chorioptes infestation and bacterial microbiota imbalances but not with fungal infections have been consistently shown. Causality has not been demonstrated for specific infectious agents. Original studies have investigated the effects of antibacterial agents (Kunzea oil, phytosphingosines, and triclosan), fatty acids, aromatic oils, and humectants as well as therapeutic approaches to Chorioptes infestation in EPD-affected equids. While therapy remains largely empirical, knowledge of investigated risk factors for this multifactorial syndrome can inform diagnostic and therapeutic approaches. Raising owner awareness of EPD could be key to improving the welfare of affected horses.