Sarcoids are very frustrating to treat as no two react the same and there is no magic cure. Treatment will depend on the position, size and number of sarcoids. There are though to be over 40 sarcoid treatments around the world. It is preferable to treat them early while the lesions are small. It is thought that treatment of horses under four years old has a better outcome.
It is important to consult your vet before treatment. Remember that treatment can cause sarcoids to change and become larger and more aggressive in nature.
Benign neglect and monitoring of small, recently developed sarcoids may be advised. Some sarcoids stay the same for years causing no problem to the horse.
The entire sarcoid needs removed otherwise it may return more aggressively. Sometimes removal can be done under sedation and local anesthetic but otherwise a general anesthetic will be required which carries risks and is expensive.
Liverpool cream is a topical chemotherapy created by Derek Knottenbelt from Liverpool University and is also known as AW4-LUDES. The active ingredient is 5-fluorouracil. and it contains a variety of heavy metals, cytotoxic chemicals and natural plant oils. It is prescription only and the vet will need to apply the product due to its cytoxic nature. The sarcoid will often swell and appear worse before improving and many horses resent the application of the cream. It typically involves two treatments one day apart then a third 2 days later followed by another 2 days later. This treatment may be painful for the horse so often anti-inflammatories are given too. As there are four vet visit involved to apply the treatment the cost can be quite high.
Cryosurgery uses liquid nitrogen to rapidly freeze then slowly thaw the sarcoid to kill the rapidly dividing tumour cells whilst sparing normal cells. It tends to be used on small superficial lesions. The recurrence rate is high.
Cisplatin is a chemotherapy drug that is injected directly into sarcoids. It is is mixed with oil to give it slow-release properties and injected 3-4 times at fortnightly intervals. Again the sarcoid may look worse before it improves.
Immune Response Modifier
Imiquimod (Aldara cream) is an immune response modifier with potent antiviral and antitumour activity. It has recently been used to treat equine sarcoids and is commonly used to treat human skin cancer and genital warts. A thin layer of cream is applied over the sarcoid initially 3x per week ad may take 2-4 months to improve. The surrounding area may also swell. This treatment costs around £60 and the owner can apply the cream wearing gloves.
Ligation involves applying a tight band around the sarcoid base.
Laser removal is a surgical laser is used to remove the sarcoid either with sedation and local anaesthetic or under general anaesthetic
BCG Injection is usually used for nodular and fibroblastic lesions around the eyes. It is much less effective elsewhere and should not be used for sarcoids on the limbs as these often become much worse. Injection of BCG (used for human TB vaccination) is once per week for 3 weeks. It is considered a risky treatment and supportive medication is required.
Turmeric has been used successfully to treat sarcoids by either adding the raw ingredients (turmeric, pepper and oil) to feed or making a golden paste. It can be applied topically when mixed with Sudocream, however it is thought to work better when ingested.
Whatever treatment option is chosen it is important to continue treatment until there is an effective response otherwise there is a high likelihood of recurrence often with a worse sarcoid than the original.
Research indicates that bovine papillomavirus may involved in the development of equine sarcoids which may result in vaccines becoming available in the future.