Posts Tagged ‘veterinary dermatologist’

Lick granulomas: An annoying little problem that is difficult to solve

September 26, 2011

If you’ve no idea what a lick granuloma is, count your blessings! What a nuisance they can be.  The official name for this disease is acral lick dermatitis.  “Acral” refers to an extremity (leg) and “dermatitis” means inflammation of the skin. The “lick” is thrown in because incessant licking behavior is what causes the problem.

Acral lick granulomas are skin sores that typically occur in large breed dogs (Doberman Pinchers and Labradors are notorious) and more males than females.  For reasons we truly don’t understand, affected dogs pick a spot towards the foot on one or more of their legs and begin licking…… and licking, and licking and licking.  The effect on the skin is no different than if you picked a spot on your arm and scratched at it round the clock.  The chronic self-inflicted irritation can result in thickening of the skin, increased pigmentation (skin appears darker than normal), an ulcerated surface with bleeding, and infection complete with pus, redness, and tenderness.  The average lick granuloma varies from dime-sized up to the size of a silver dollar.

Acral lick granulomas may be initiated by something that traumatizes or irritates the skin such as infection, allergy, or an embedded foreign body such as a thorn or splinter.  The dog overreacts lingually (no tongue in cheek here) and, over time, a lick granuloma appears.  It’s theorized that incessant licking may represent a self-soothing behavior (like thumb-sucking) associated with release of endorphins.  This theory is supported by the fact that, if one is savvy enough to interrupt the licking cycle at one site, many clever dogs redirect their attention to a new site on a different leg. Another possibility is that arthritis is present in the joint underlying the affected skin surface.  Licking is tantamount to a person massaging a sore joint.  Yet another theory is that boredom is the culprit. Truth be told, there are likely many different causes for lick granulomas.

The diagnosis of acral lick dermatitis is officially made via skin biopsy.  Your veterinarian may also recommend a skin scraping (material is scraped from the skin surface for evaluation under the microscope to rule out mange mites) and collection of samples for bacterial and fungal cultures.  Some veterinarians feel comfortable making the call based purely on history and visual inspection of the affected skin site.

Making the diagnosis is the easy part.  Stopping the licking is notoriously difficult.  In fact it can be a nightmare because many affected dogs simply will not be deterred from this obsessive behavior.  And even when one thinks the problem is licked (pun intended), a year or two down the road, the self-trauma cycle may begin all over again.

The ideal therapy for lick granulomas is identification and treatment of the underlying cause (foreign body, allergy, infection). If the cause cannot be determined (true for most dogs with lick granulomas) and eliminated, here are some therapeutic options.  Keep in mind, what works well for one dog may not work for another.

– Keep the site covered with a bandage.  You can use standard bandaging material or one of your own socks might be suitable.  Simply cut off the foot part and pull the tube section up over the affected area.  Secure in place with some tape.  If the lick granuloma is low enough on the leg, you can slip the dog’s foot into the toe of the sock.  A product called DogLeggs  may be worth a try as well.  If you are really, really, really lucky, your dog who is obsessed with applying his mouth parts to the spot you’ve covered will leave the bandage in place.  Warning!  It is extremely easy to put a bandage on that is too tight (a recipe for disaster).  Practice bandaging with a member of your veterinary team watching before trying it yourself at home.  Second warning!  Your dog may go one step beyond removing the bandage- he or she may eat the darned thing.  Close supervision is a must for the first day or two after accessorizing your dog with a bandage.  The last thing anyone wants is for a lick granuloma issue to morph into a gastrointestinal foreign body issue.

– Taste deterrents work for some dogs and there are a variety of products on the market (Bitter Apple is the classic).  If this is to stand a chance of breaking the cycle, application must be frequent and consistent.  Most dogs are so determined to lick that they will persevere in spite of the adverse taste reaction, and in all honesty, the looks on their faces after licking the nasty stuff time after time suggests that this “solution” may be less than humane.

– Elizabethan collars work well for some dogs.  Don’t forget to rearrange your house in advance so that nothing valuable is damaged as your dog learns to navigate his surroundings with a satellite dish around his neck.  (No, your television reception will not be enhanced.)

– Medications can be applied to the site that are antinflammatory in nature and/or help rebuild healthy tissue.  These typically must be accompanied by a method for keeping tongue away from skin so the medication has a fighting chance.

– Acupuncture and/or chiropractic treatments are thought to work for some dogs.

– Laser therapy at the site is successful with some lick granulomas.

– See if keeping your dog super-busy for a week or two breaks the cycle.  The hope is to alleviate boredom and/or create a dog that is too tired to lick.  Try increased play/exercise, a large Kong toy filled with peanut butter, doggie day care while you are away from home, or adoption of a playmate (careful here- sometimes the stress of a new animal in the household amplifies licking behavior).

– Behavior modification medications work for some incessant lickers, but should be tried when other efforts have failed.  Categories of medications that can be tried include tricyclic antidepressants, serotonin-inhibiting drugs, and endorphin blockers.

It’s a given that the more treatment options there are for a particular disease, the less we know about how best to treat it!  Lick granulomas are a classic example.  If your dog is afflicted, I strongly encourage you to enlist help from your veterinarian.  If, together you try two or three things without success, please consider consultation with a board certified dermatologist.  To find one in your neighborhood visit the American College of Veterinary Dermatology website.

Although a lick granuloma looks like a small problem, it can be downright difficult to cure.  If your dog’s lick granuloma remains small and clear of infection, and if the sound of licking is not keeping you awake at night, simply living with the problem is a reasonable choice to consider.

Has your dog had a lick granuloma?  If so, please tell us what you tried, what worked well, and what didn’t.

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
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