Equine Pastern Dermatitis (EPD) is not a single disease, but a cutaneous reaction pattern of the horse. EPD should be considered a syndrome, rather than a diagnosis. Uncovering the underlying etiology prior to treatment is key to minimizing treatment failures and frustration. To achieve a positive therapeutic outcome, treating the predisposing and perpetuating factors is just as important as addressing the primary cause of EPD. This article reviews clinical signs, differential diagnoses, diagnosis, and treatment of EPD.