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Acral lick dermatitis, or “lick granuloma”, is a skin condition occasionally seen in dogs. The name for this condition stems from its location (acral – meaning on the extremities) and from its cause (licking). Affected dogs usually lick at one “chosen” spot on one leg. They may spend hours engaged in this activity every day. An infected, non-healing wound eventually arises at the site.
There are many factors that may contribute to the development of a lick granuloma. Almost always, the condition is self-perpetuating. Once the dog creates the wound, it is a continual source of irritation and stimulates further licking. The licking can become enough of a habit that it continues even when the “underlying” cause is resolved. Some of the factors that may contribute to lick granulomas include:
Itching: an itchy skin condition, such as an allergy, may initiate the lick granuloma.
Pain: the dog may lick the skin over a painful joint or bone.
Boredom: energetic dogs that are left alone for much of the day may focus their attention on excessively licking a limb.
Stress: the continual licking may help nervous dog relieve their anxiety.
Obsessive-compulsive disorder: the behavior that creates a lick granuloma shares some features with human obsessive-compulsive disorders.
We make the diagnosis by examining the skin, and by finding out how much licking behavior is noted at home. We sometimes recommend a skin biopsy or other procedures to make sure that we are not dealing with a similarly-appearing skin condition that would be treated quite differently. A specimen may be sent to a laboratory so we can find out what kind of bacteria is present in the granuloma.
While making the diagnosis is rarely difficult, finding out what has caused the granuloma can be a challenge, especially when it has been going on for a long time. Our investigation includes an assessment of the dog’s temperament, personality, daily activities, and concurrent skin conditions.
Many different treatments are used for lick granulomas. Unfortunately, any treatment that is extremely effective for one patient may fail on the next; there is no “miracle cure” available. Sometimes a dog may receive several different treatments before one works very effectively. Some of the treatments that are used for lick granulomas include:
Antibiotics: both antibiotic pills and ointments are used to treat lick granulomas. There is usually an infection within the granuloma that contributes to the continued irritation. Antibiotics do not address the underlying cause for the granuloma’s development, but in some cases no other therapy is needed.
Anti-inflammatory medications: we may use either oral, topical, or injectable anti-inflammatory medications to reduce the irritation from the granuloma.
Other topical therapies: we may prescribe a bitter spray to deter licking, or a cream to “numb” the skin.
Electronic “bandages” that produce a very tingling sensation when licked.
Physical barriers: bandages and plastic “Elizabethan collars” may effectively prevent the dog’s access to the granuloma, but are not usually suitable for long-term use.
Behavioral modification in dogs whose lick granulomas seem to result from the psychological factors listed above, we may recommend:
— Spending more time actively playing and walking with your dog
— Avoiding confinement in kennels or crates
— Obtaining a companion for your dog behavioral training
— Psychological drug therapy, either short-term or lifelong medications to reduce anxiety, stress, and obsessive-compulsive tendencies
— Consulting a behavior specialist
Surgery: laser or radiosurgery to remove the infected tissue and seal off nerve endings may speed the resolution of the lick granuloma
Because each dog is unique, different combinations of therapy may be recommended for your pet. With some time and effort, lick granulomas can be controlled in most dogs.