Pastern dermatitis in horses: which causes are established and which are not

Pastern dermatitis is a reaction pattern of the skin, not a diagnosis

Pastern dermatitis denotes an inflammation of the skin at the pastern, typically on its rear surface: palmar on the forelimbs, plantar on the hindlimbs. A 2023 review from Bern states expressly that this picture is a non-specific reaction pattern of the skin of the distal limbs, and not a diagnosis. A 2013 clinical review says the same: it should be regarded as a syndrome, not a disease. Anyone looking for the cause is therefore not looking for a single agent, but for the combination of predisposition, skin barrier, colonisation and environment that has come together in that horse.

This explains why the same condition looks so different from case to case. A scaling form, a moist crusting form and a chronic proliferative form with thick ridges are described. Among German draught horses the crusting and the hyperkeratotic-hyperplastic forms were the most common. Diseases in their own right also circulate under the same everyday name: inflammation of the blood vessels of the pastern, and chronic progressive lymphoedema of the draught breeds.

Why does this distinction change anything in daily practice?

Because it reverses the order of steps. Read as a disease in its own right, pastern dermatitis is treated straight away. Read as a reaction pattern, it first requires the question of what the skin is reacting to. The 2013 review names precisely this omitted step as the reason for treatment failures, an expert opinion that has never been tested in a trial.

Mites: the finding that turns up most consistently

Chorioptes bovis is a mange mite living on the skin surface of the distal limbs. The Bern review counts this infestation among the few links that are found consistently. Its possible scale emerges from a Belgian study of 156 draught horses and 142 warmblood horses from the same country: 144 of the draught horses, that is 92.31 per cent, carried mites, and not one warmblood did. In foals, mites were detectable from the sixth day of life.

That Belgian work, however, concerned chronic progressive lymphoedema, a related but separate disease of the draught breeds. What carries over is mainly the contrast between the breeds, not the conclusion about ordinary pastern dermatitis. A small American study of 15 affected horses puts the picture in place: four of them were mite-positive, and all four had feathering. Chorioptic mange is regarded there as an important differential diagnosis in feathered horses.

Is every case of pastern dermatitis a mite mange?

No. In a field study of 37 severely affected draught horses with a warty form there was no link between severity and mite infestation. Mites are common in feathered horses and are evidently not the driving finding in advanced proliferative forms. They can only be demonstrated by skin scrapings or adhesive tape, never by the appearance of the lesion alone.

The skin flora: altered, but not convicted

The second consistently found link concerns the bacterial community of the skin. A Swiss case-control study examined 80 horses, each with one affected and one healthy pastern. On the affected side bacterial diversity was clearly lower, and the composition deviated more strongly the more severe the lesions were, most clearly in the staphylococcal family. The work concludes expressly that the role of these bacteria in the development of the condition remains to be clarified.

A second study from Bern compared 105 affected with 95 healthy horses. Staphylococcus aureus was detectable on 59.0 per cent of the affected pasterns and on 6.3 per cent of the healthy ones; in the nose the figures were 59.0 against 8.4 per cent, and the organisms from nose and limb were often closely related. Eight isolates were methicillin-resistant. The authors remain cautious: the finding suggests a contribution to the development of the condition without proving it, since both studies measure at a single point in time and cannot say whether colonisation preceded the lesion or followed it.

What is not found regularly: fungi and Dermatophilus

Two agents stand almost always at the top of advice texts, and neither holds up well to scrutiny. Dermatophilus congolensis passes for the classic pastern dermatitis organism. In an American study of 15 affected and 8 healthy horses, a molecular detection method found it in a single horse without feathering and in no feathered horse. Under the microscope, bacteria were visible in all affected horses, but never forms that would have matched this agent.

For skin fungi the picture was similar: dermatophyte culture remained negative in all 23 horses of that study. The Bern review reaches the same result independently. Unlike mite infestation and an altered skin flora, a link with fungal infections is not found consistently in the literature.

Who is affected: breed, feathering, age, white limbs

The best supported risk factors do not concern the environment but the horse itself. The Bern review names age, breed and breed-typical bodily features, above all heavy feathering and a large cannon bone circumference, as supported by data, for frequency as well as for severity. Hindlimbs and unpigmented limbs are affected more often. The genetic effects are regarded as complex in the draught breeds, and no commercial genetic test exists.

For Swiss conditions there is a study of 974 three-year-old Franches-Montagnes horses. 15.2 per cent showed clinical signs. The decisive factor was not coat colour, which had no link at all with the skin findings, but the unpigmented skin of the individual limb: limbs with white markings were affected 2.6 times more often than pigmented ones. The proportion of white markings in this population has more than doubled within thirty years. Why unpigmented skin is more susceptible, whether through sunlight, a different barrier function or co-inherited traits, is open.

Wet, mud and summer: what the weather data yield

Hardly any explanation is as widespread as the sodden paddock, and hardly any is as poorly supported. The Bern review expressly rates the data on rain and moisture as inconclusive. That contradicts the common assumption that prolonged exposure to wet is a preparing or even a triggering factor.

The only time series available follows six Franches-Montagnes stallions, four of them affected, under identical husbandry conditions, over twelve consecutive months with monthly examination and sampling. The lesions tended to worsen in autumn and in early spring. No clear link appeared, by contrast, between severity and rainfall: high scores were just as often preceded by low as by heavy rainfall. The authors themselves call their observations preliminary and the group too small for a firm conclusion. Notably, the weather affected the bacterial community of affected pasterns more strongly than that of healthy ones.

Why does my horse have pastern dermatitis in summer?

The study evidence gives no robust answer to that. It says only that the equation wet equals pastern dermatitis did not hold in the one longitudinal observation available. Mite infestation and unpigmented skin act all year round, and in that same observation the lesions also worsened in spring. A dry summer is therefore no protection.

Stable outbreaks: the trail that is rarely followed

Pastern dermatitis passes for a problem of the individual horse. Two Finnish studies show that it can also occur as an outbreak. In 2021 and 2022 Finland saw a nationwide rise in a pustular and vesicular pastern dermatitis; in the affected stables about one third of the horses fell ill, sometimes severely. An equine parapoxvirus, known only since 2013, was determined as the probable trigger. The most important risk factor found was the keeping of racehorses, and affected stables often reported race participation before the disease appeared.

A follow-up study examined the stable environment. Of 138 environmental samples analysed, 24 were positive for viral genetic material, and five of the six affected stables had at least one positive sample: on grooming equipment, on box fittings, in the bedding and on the hands of the carers. Detection of genetic material is not, however, proof of a virus able to multiply, and it was not shown that any particular object actually transmitted the disease.

Bacteria can spread in the same way. In one Finnish stable in 2021, Corynebacterium diphtheriae and Corynebacterium ulcerans were detected in five horses with pastern dermatitis, two isolates of them toxin-producing. The source remained unknown despite tracing, all human contacts tested were negative, and all the horses recovered. Such outbreaks are documented possibilities, not frequent causes: no figures exist for Switzerland, and a routine test is not available outside Finland.

Why it comes back: what the work-up regularly lacks

A Swiss survey of the owners of 123 horses draws a clear picture. 92 per cent of the horses were affected at the time of the interview and, of 115 usable answers, 62 per cent concerned horses that had already had pastern dermatitis at least four times. 69 per cent of all treatment decisions were taken without veterinary advice. Of 150 wound and care creams used, 14 were prescribed. In nearly one third, a practice was called in only when pain or lameness appeared.

This is exactly where the circle closes. According to the same work, self-treatment makes it harder to determine the underlying cause and often makes treatment longer and more expensive. It also alters what a later work-up can still find: in the cross-sectional study of 16 horses the bacteriological result depended on earlier treatment.

That treating a cause once found does not automatically heal the skin is shown by the few trials. In a randomised double-blind trial in 32 Spanish-Breton horses the mite count fell clearly under the combination, but the skin changes improved only to a limited degree, and nothing changed in the most severely affected horses; the authors attribute this to the short study duration of seventy days. In a placebo-controlled trial in 19 draught horses, itching and mange lesions had clearly receded after successful mite treatment, but the skin fold score, a measure of tissue change already established, had not.

Sometimes even the most thorough work-up finds nothing. In a series of 20 horses with inflammation of the blood vessels of the pastern no underlying cause could be determined despite tissue examination, the response to treatment was poor and the prognosis guarded.

Feeding: much asserted, little tested

In forums and in advertising, feeding is a standing topic: too much protein, too little zinc, an acidification. For none of these explanations did this research find a study in the horse that had tested it. That is not proof to the contrary but a gap: these claims have not been refuted, they have never been examined.

What does exist are two observations without intervention. In a study of 493 Rhenish German draught horses with chronic progressive lymphoedema, haylage and concentrate feed in winter went together with higher scores, grazing and clean bedding with lower ones. The heaviest weight there, however, lay with breeding region, sex and age: stallions reached values 1.92 times higher than geldings and 5.02 times higher than mares. In the field study of 37 draught horses with a warty form, the amounts of maize and oats fed had some influence on severity.

Both observations concern draught breeds and chronic forms, neither is adjusted for other influences, and in neither was anything changed and then measured. Anyone deriving a feeding recommendation from this confuses an observation with a trial.

Cause map for pastern dermatitis: what has actually been tested for each named cause

Original analysis

Limitations and uncertainty

• No systematic review of this condition exists so far. The two most cited overviews, from 2013 and 2023, are narrative reviews without a systematic search, without formal appraisal of study quality and without quantitative synthesis; the 2023 authors themselves note that peer-reviewed original work is scarce on many aspects of this many-layered syndrome.
• The editorial requirement to base at least half of the sources on the level of systematic review, meta-analysis or randomised trial cannot be met in this field: only three of the works used here reach that level, everything else being case-control, cross-sectional and longitudinal studies as well as case series.
• Almost all available studies measure at a single point in time. Whether mites, staphylococci or an altered skin flora precede the lesion or settle only on skin already altered cannot, in principle, be decided with this design.
• A large part of the solid figures comes from draught breeds and concerns chronic progressive lymphoedema, a related but separate disease. These results transfer only to a limited degree to ordinary pastern dermatitis in a riding horse, and the comparison between breeds mixes mite infestation, feathering, conformation and genetics.
• The available treatment trials comprise 19 to 37 horses, mostly of a single breed and often from a single holding, with follow-up from seventy days to six months. For a chronically recurring skin disease that is short, and in one trial 16 of the 37 horses enrolled dropped out early.
• Frequently named feeding causes such as a protein excess were not tested in any intervention study in the horse during this research. They are therefore neither established nor refuted, and the feeding data that do exist are pure observations, unadjusted for farm management.

Open questions

• Does the shift in skin flora precede the lesion, or is it its consequence? This could only be answered by longitudinal studies in horses that are healthy at the outset.
• Why is unpigmented skin more susceptible: through sunlight, through a different barrier function, or through traits inherited along with depigmentation?
• Does determining the underlying cause before treatment really improve the outcome? This expert opinion, repeated for years, has never been tested in a trial.
• How common are outbreaks caused by the equine parapoxvirus outside Finland, and how many would be found if they were looked for systematically?

Frequently asked questions

Why does pastern dermatitis keep coming back in my horse?

Because pastern dermatitis is not a single disease that is cleared once and for all, but a reaction pattern resting on a mostly permanent basis. Breed, feathering, cannon bone circumference, age and unpigmented skin are among the best supported risk factors, and none of them can be changed. In a Swiss owner survey, 62 per cent of the horses had already had at least four episodes in their lives. The same work shows a second reason: 69 per cent of all treatment decisions were taken without veterinary advice, which makes it harder to determine the underlying cause and often makes treatment longer and more expensive.

Is this pastern dermatitis, or is it mites?

That is not an either-or. Pastern dermatitis describes how the skin looks; Chorioptes mites are one possible cause behind it, and the one that accompanies the picture most consistently in the literature. In a Belgian study, 92.31 per cent of the draught horses carried mites and not one of the 142 warmblood horses from the same country did. In feathered horses, chorioptic mange is therefore regarded as an important differential diagnosis. It cannot be recognised from the appearance of the lesion, only through skin scrapings or adhesive tape, that is through a veterinary examination.

My horse has pastern dermatitis in summer although everything is dry. How can that be?

The equation wet equals pastern dermatitis does not stand up to the data. The Bern review expressly rates the evidence on rain and moisture as inconclusive. In the only longitudinal observation available, six Franches-Montagnes stallions over twelve months, the lesions worsened in autumn and in early spring, and high severity scores were just as often preceded by low as by heavy rainfall. Mite infestation, unpigmented skin and the horse's own predisposition act all year round. A dry summer is therefore no protection, and pastern dermatitis in July is nothing contradictory.

Are white limbs really more susceptible?

Yes, this is one of the clearer findings. In a study of 974 three-year-old Franches-Montagnes horses, 15.2 per cent showed clinical signs of pastern dermatitis, and limbs with white markings were affected 2.6 times more often than pigmented ones. The counter-check is remarkable: the horse's coat colour had no link at all with the skin findings. So it is about the unpigmented skin of the individual limb, not about greys or chestnuts. Why this is so, whether through sunlight, a different barrier function or co-inherited traits, this study does not settle.

Can my horse catch it from others at the yard?

For individual agents this is documented; for ordinary pastern dermatitis it is not. In Finland a nationwide rise in a pustular pastern dermatitis occurred in 2021 and 2022, with about one third of the horses in each affected stable falling ill; an equine parapoxvirus is regarded as the probable trigger. A follow-up study found viral genetic material on grooming equipment, box fittings, bedding and the hands of the carers. Detection of genetic material is not, however, proof of a virus able to multiply. Nothing has been recorded on this in Switzerland, and a routine test is not available outside Finland.

Is it the feed, too much protein?

There is no test of this, neither for nor against. This research found no study in the horse that had examined a protein excess, a zinc deficiency or an acidification as a cause of pastern dermatitis. Only observations are available: in 493 Rhenish German draught horses with chronic progressive lymphoedema, haylage and concentrate feed in winter went together with higher scores, grazing and clean bedding with lower ones. Nothing was adjusted, nothing was changed, and the heaviest weight lay in any case with breeding region, sex and age. No feeding recommendation follows from this.

Can I catch something myself while tending my horse?

Reported in isolated cases, rare overall. In the Finnish outbreak, skin changes were occasionally described in people, which points to a possible transmission. In one Finnish stable, Corynebacterium diphtheriae and Corynebacterium ulcerans were detected in five horses with pastern dermatitis, two isolates of them toxin-producing; all human contacts tested remained negative, and the source was never found despite tracing. The investigators nevertheless recommended gloves and hand hygiene when tending skin lesions. These are isolated, documented events, not an everyday risk and no cause for alarm.

Sources

1. Gerber V, Kaiser-Thom S, Oesch S. Equine pastern dermatitis: a narrative review on clinical presentation, diagnosis, risk factors, prevention, and therapeutic approaches. Journal of the American Veterinary Medical Association, 2023 (Other | Horse)DOI 10.2460/javma.22.12.0569
   Narrative review: pastern dermatitis is a non-specific reaction pattern of the skin of the distal limbs and not a diagnosis; the link with Chorioptes infestation and with a disturbed skin flora is found consistently, that with fungal infections is not, and causation is established for no agent.
2. Yu AA. Equine Pastern Dermatitis. Veterinary Clinics of North America: Equine Practice, 2013 (Other | Horse)DOI 10.1016/j.cveq.2013.09.003
   Clinical review by a single author: pastern dermatitis should be handled as a syndrome and not as a diagnosis, and determining the underlying cause before treatment is said to be the key to fewer treatment failures, an expert opinion that has never been tested in a trial.
3. Kaiser-Thom S, Hilty M, Axiak S, Gerber V. The skin microbiota in equine pastern dermatitis: a case-control study of horses in Switzerland. Veterinary Dermatology, 2021 (Case-control study | Horse)DOI 10.1111/vde.12955
   In 80 horses each with one affected and one healthy pastern, bacterial diversity was lower on the affected side and the composition was shifted more strongly the more severe the lesions were, while the authors expressly describe the role of the bacteria in the development of the condition as unresolved.
4. Kaiser-Thom S, Hilty M, Ramseyer A, Epper P. The relationship between equine pastern dermatitis, meteorological factors, and the skin microbiota. Veterinary Dermatology, 2022 (Cohort study | Horse)DOI 10.1111/vde.13045
   In six Franches-Montagnes stallions under identical conditions over twelve months the lesions tended to worsen in autumn and in early spring, but no clear link with rainfall appeared, since high scores were just as often preceded by low as by heavy rainfall; the observations count as preliminary.
5. Kaiser-Thom S, Gerber V, Collaud A, Hurni J. Prevalence and WGS-based characteristics of Staphylococcus aureus in the nasal mucosa and pastern of horses with equine pastern dermatitis. BMC Veterinary Research, 2022 (Case-control study | Horse)DOI 10.1186/s12917-021-03053-y
   In 105 affected and 95 healthy horses, Staphylococcus aureus was detectable on 59.0 per cent of the affected pasterns against 6.3 per cent of the healthy ones, eight isolates were methicillin-resistant, and the authors phrase a contribution to the development of the condition expressly only as a supposition.
6. Sangiorgio DB, Hilty M, Kaiser-Thom S, Epper PG. The influence of clinical severity and topical antimicrobial treatment on bacteriological culture and the microbiota of equine pastern dermatitis. Veterinary Dermatology, 2021 (Cross-sectional study | Horse)DOI 10.1111/vde.12912
   In 16 affected horses with 32 limbs examined, the bacteriological results depended both on severity and on antimicrobial treatment already given, and beta-haemolytic streptococci as well as Trueperella pyogenes were found only on untreated limbs of severely affected horses.
7. Oesch S, Kaiser-Thom S, Vidondo B, Gerber V. Owner reported clinical signs and -treatment decisions in equine pastern dermatitis. Schweizer Archiv für Tierheilkunde, 2022 (Cross-sectional study | Horse)DOI 10.17236/sat00356
   Among 123 horses, 69 per cent of all treatment decisions were taken without veterinary advice, 62 per cent of the horses had had at least four episodes in their lives, and in nearly one third a practice was called in only when pain or lameness appeared, which according to the authors makes determining the cause harder.
8. Brys M, Claerebout E, Saey V, Chiers K. High prevalence of Chorioptes bovis: an important factor in chronic progressive lymphedema in Belgian draft horses. Veterinary Research Communications, 2025 (Cross-sectional study | Horse)DOI 10.1007/s11259-025-10695-y
   144 of 156 Belgian draught horses, that is 92.31 per cent, were infested with Chorioptes bovis, while in 142 warmblood horses of the same country neither mite nor lymphoedema was found; the authors describe the mite as a possible contributing cause, not as the cause.
9. Carbonell JD, Fernandez N, Escobar MJ, Alvarez MT. Comparative Efficacy of Topical Pyrethroids and Benzoyl Peroxide for Treating Chorioptic Mange in Spanish-Breton Horses. Journal of Parasitology Research, 2025 (Randomised trial | Horse)DOI 10.1155/japr/8948099
   In a double-blind randomised trial in 32 Breton horses over seventy days the mite count fell markedly further under the combination, but the skin changes improved only to a limited degree and not at all in the most severely affected horses, which the authors attribute to the short study duration.
10. Brys M, Claerebout E, Chiers K. Alleviating lesions of chronic progressive lymphedema in Belgian draft horses by successfully treating Chorioptes bovis infestation with moxidectin 0.5% pour-on. Veterinary Parasitology, 2023 (Randomised trial | Horse)DOI 10.1016/j.vetpar.2023.110074
    In a placebo-controlled trial in 19 draught horses, itching and mange lesions had clearly receded after mite treatment, but the skin fold score as a measure of established tissue change had not, and in three of the ten treated horses mites reappeared after 24 weeks.
11. Rufenacht S, Roosje PJ, Sager H, Doherr MG. Combined moxidectin and environmental therapy do not eliminate Chorioptes bovis infestation in heavily feathered horses. Veterinary Dermatology, 2011 (Controlled trial | Horse)DOI 10.1111/j.1365-3164.2010.00892.x
    In a double-blind placebo-controlled trial in 19 heavily feathered horses over 180 days, oral mite treatment together with treatment of the environment had no effect on mite counts or clinical signs; only crusts were more frequent in the placebo group.
12. Thomas J, Narkowicz C, Peterson GM, Jacobson GA. Randomised controlled trial of the treatment of pastern dermatitis with a formulation containing kunzea oil. Veterinary Record, 2009 (Randomised trial | Horse)DOI 10.1136/vr.164.20.619
    Of 37 randomised horses only 21 completed the study; the preparation containing kunzea oil clearly reduced the lesion area after seven days, which the comparison antifungal did not, while neither fungal diagnostics nor a placebo group nor follow-up for relapse was provided for.
13. Aufox EE, Frank LA, May ER, Kania SA. The prevalence of Dermatophilus congolensis in horses with pastern dermatitis using PCR to diagnose infection in a population of horses in southern USA. Veterinary Dermatology, 2018 (Cross-sectional study | Horse)DOI 10.1111/vde.12659
    In 15 affected and 8 healthy horses, Dermatophilus congolensis was detected only in a single unfeathered horse and in no feathered horse, dermatophyte culture remained negative in all of them, while chorioptic mange frequently accompanied the picture in feathered horses.
14. Virtanen J, Hautala K, Utriainen M, Dutra L. Equine dermatitis outbreak associated with parapoxvirus. Journal of General Virology, 2023 (Cross-sectional study | Horse)DOI 10.1099/jgv.0.001940
    In a nationwide Finnish rise from 2021 to 2022, about one third of the horses in each affected stable developed a pustular and vesicular pastern dermatitis; an equine parapoxvirus was determined as the probable trigger and the most important risk factor was the keeping of racehorses.
15. Tervo S, Aaltonen K, Hautala K, Utriainen M. Detection of equine parapoxvirus in the stable environment during pastern dermatitis outbreak in Finland. Acta Veterinaria Scandinavica, 2026 (Cross-sectional study | Horse)DOI 10.1186/s13028-026-00870-9
    Of 138 environmental samples analysed from Finnish stables, 24 were positive for viral genetic material, and five of the six affected stables had at least one positive sample on grooming equipment, box fittings, bedding or the hands of the carers, while detection of genetic material does not evidence a virus able to multiply.
16. Gronthal TSC, Lehto AK, Aarnio SS, Eskola EK. Pastern dermatitis outbreak associated with toxigenic and non-toxigenic Corynebacterium diphtheriae and non-toxigenic Corynebacterium ulcerans at a horse stable in Finland, 2021. Zoonoses and Public Health, 2023 (Case series | Horse)DOI 10.1111/zph.13090
    Five horses at a Finnish stable were positive for Corynebacterium diphtheriae or Corynebacterium ulcerans, two isolates produced toxin; the source of infection was never found despite tracing, all human contacts tested remained negative and all the horses recovered.
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    In 917 German draught horses the proportion of affected animals lay between 47.5 and 96.1 per cent depending on breed, all four limbs or both hindlimbs were most often affected, and breed, age, sex and limb position clearly influenced occurrence.
18. Geburek F, Deegen E, Hewicker-Trautwein M, Ohnesorge B. Zur Entstehung von Warzenmauke bei Kaltblutpferden. Teil II: Klinische Untersuchungen. Deutsche Tierärztliche Wochenschrift, 2005 (Cross-sectional study | Horse)PMID 16124697
    In 37 draught horses with a warty form there was no link between severity and sex, breed, work performed, coat care or Chorioptes infestation, but there was with age, hoof care status, cannon bone circumference, stable hygiene and the amounts of maize and oats fed.
19. Federici M, Gerber V, Doherr MG, Klopfenstein S. Association of skin problems with coat colour and white markings in three-year-old horses of the Franches-Montagnes breed. Schweizer Archiv für Tierheilkunde, 2015 (Cross-sectional study | Horse)DOI 10.17236/sat00026
    Among 974 three-year-old Franches-Montagnes horses, 15.2 per cent showed clinical signs of pastern dermatitis, limbs with white markings were affected 2.6 times more often than pigmented ones, while coat colour was unrelated to the skin conditions.
20. Psalla D, Rufenacht S, Stoffel MH, Chiers K. Equine pastern vasculitis: a clinical and histopathological study. The Veterinary Journal, 2013 (Case series | Horse)DOI 10.1016/j.tvjl.2013.09.001
    In 20 horses with inflammation of the blood vessels of the pastern no underlying cause could be determined and no histological feature could be assigned to a particular clinical picture; the response to treatment was poor and the prognosis guarded.
21. Sievers J, Distl O. Prevalence of Chronic Progressive Lymphedema in the Rhenish German Draught Horse. Animals, 2023 (Cross-sectional study | Horse)DOI 10.3390/ani13060999
    In 493 Rhenish German draught horses, breeding region, sex and the interplay of age and sex weighed most heavily, while haylage and concentrate feed in winter went together with higher scores, grazing and clean bedding with lower ones, all as pure observation without intervention.