Cushings horse losing her hair


I have a cushings 17 year old Arabian cross who is losing patches of hair.  As i brushed her it was just falling out and leaving bare skin.  Could this be from her prascend?  She was on 1 mg but she had no personality at all so we cut her back to a half that dose.  She is also on one scoop of thyroid meds.  

we couldn’t get her to eat or take her meds on the full dose either.  I just can’t figure out why her hair is shedding like this.  I thought she was supposed to no shed with cushings!  
Vikki Meeks
keller, TX

Sherry Morse

Hi Vikki,

You'll be getting a full welcome message shortly but losing hair in patches is not unusual in PPID horses.  Have you had your mare tested to be sure that the .5mg dose is enough to keep her ACTH numbers in the upper teens or 20s?


Hello Vikki,
Vikki you have me stumped about what would cause the hair loss. Has she been outside during wet weather? Rain rot comes to my mind. Also, many of us have found it easiest to syringe medications (mixed with apples sauce, yogurt, baby food, ect) directly into the horses mouth via a dosing syringe or empty dewormer syringe. 

I can tell you that you will get responses from members and moderators after they have a chance to put their thinking caps on. First thing you will be asked to provide medical history, diet information, test results, etc.  Since you are a new member you will find attached below our informational document. A good place to start reading is the ECIR website. It covers a lot of basics about PPID (Cushings), Insulin Resistance, Tests, Diet, etc. The sections below will lead you to more detailed information. Our experienced members and moderators need you to provide your horse's history (case history document) so they can give you safe advice. Meanwhile I urge you to use the Search buttons that you will find on every page you open. You can search our files and the messages here. If you need help with how to use the structure of this site go to our  WIKI which is in the column to the left. It will guide you thru creating and managing files and folder, signatures, etc. Use NEW TOPIC when you have a question or topic you want help with. 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 


Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased


hi I’ve just read your post & thought I’d share my Trichology experience with people not Equines. Moderators will need to comment & advise you.  When people are hyper or hypo thyroid they can loose hair to a greater or lesser degree. To ensure there is not an issue with the thyroid llevels they need to get their levels checked.  Your moderators will be able to comment on this & discount this for Equine, or support you with it if need be Carrie x
March 2021

Nancy C

Hi Vikki

Because we do not have detailed info on your horse, we are shooting in the dark, however, I wanted to point out that if the amount of thyroid meds is high enough to cause hyperthyroidism, this might  cause the hair loss.

Thyroid meds are often prescribed for weight loss, jump started by an over active thyroid (hyperthyroidism). More info in the links below.

Under active thyroid (hypothyroidism) is not usually seen in the horse except as a result of other uncontrolled disease, like PPID. Many member here have found that can be corrected via correcting the diet and controlling the PPID, if that is of issue.

Need more info....Hope you can fill out a Case History.
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


Just adding my experience with one of my animals.  My dog has been diagnosed with hypothyroid and one of her visible symptoms was a patchy loss of hair.  Even with her being on meds for over a year, the hair has never grown back.  
Ronelle and Yoyo
2015 Bend, Or, US

Sarah Orlofske

Hello All, 

I don't have any experience with the thyroid aspects, but my little mini mare Kate is a white blanket appaloosa and last year before she was confirmed as PPID she shed out terribly. It was very odd but all the white hair on her rump shed out first in big bare patches and the black hair that was left she aggressively rubbed off. This year she is on 0.5 prascend and is shedding out much better. We will be doing blood work in hopefully a couple weeks to see if she is at the right dose (it has been too cold for insulin here and we can't afford to do separate tests so trying to get them all done at that same time) but I am hopeful that with the shedding improving with the prascend that it is a good sign. 

We also had a horrible time getting Kate to take the meds. We actually tried twice in summer of 2019 and gave up because she went off her feed both times. Based on the recommendations here from this group I have now been syringing her meds. I started practicing for 2 weeks with applesauce before starting her on the meds and then she was happy about the syringe so when we started adding them meds she didn't object. This is a horse that would not touch any food at all that had the pills in it. There was no treat she ever liked enough for us to convince her to take the meds on her own. We also started her on the APF supplement I learned about here and it kept her eating pretty well through the acclimation process. She is still really picky and we struggle some times getting her to eat her supplements, but so much better than the first two attempts. I hope that helps, 

Sarah O. 
Rudolph, WI

Lesley Fraser

Omar had all sorts of ongoing hair problems until his PPID was diagnosed and controlled, I got his diet in line with ECIR recommendations, his hay was tested and then mineral supplements were balanced against the hay results (with ECIR help). He looked, and felt, like a new man after that.

Best wishes

Lesley & over the bridge Omar (not PPID/IR related),
2012. UK

Lesley and over the bridge Omar,
11-2012, Cambridge, UK

Omar - Case History

Lorna Cane

Thanks for taking the time to report in, Lesley.
Well done.


Lorna  in Eastern  Ontario
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